Showing papers by "Ralph B. D'Agostino published in 1996"
TL;DR: Ischemic stroke associated with AF was nearly twice as likely to be fatal as non-AF stroke, Recurrence was more frequent, and functional deficits were more likely to been severe among survivors.
Abstract: Background and Purpose Stroke occurring with atrial fibrillation (AF) is more likely to be fatal or more severe than non-AF stroke based on clinical series, but data from prospective epidemiological studies are sparse and inconsistent Methods Over 40-year follow-up of the original 5070 Framingham cohort, 501 initial ischemic strokes, including 103 with AF, were analyzed Stroke severity was rated as none, mild, moderate, severe, or fatal Since 1981, functional status indicated by the Barthel index has been evaluated acutely and at 3, 6, and 12 months Severity and functional status of AF strokes were compared with non-AF strokes using χ2 test and Student's t test Thirty-day mortality was assessed by logistic regression analyses Results AF was associated with increased stroke severity (P=048) Thirty-day mortality was greater in AF strokes than in non-AF strokes (25% versus 14%) The multivariate-adjusted odds ratio for 30-day mortality for AF subjects was 184 (95% confidence interval, 104 to 327)
1,261 citations
TL;DR: The association between SI and upper body adiposity (waist-to-hip ratio) was similar in each ethnic group, suggesting that greater insulin resistance may be in large part responsible for the higher prevalence of NIDDM in these minority groups.
Abstract: The etiology of NIDDM is still controversial, with both insulin resistance and decreased insulin secretion postulated as potential important factors. African-Americans and Hispanics have a two- to threefold excess risk of developing NIDDM compared with non-Hispanic whites. Yet little is known concerning the prevalence of insulin resistance and secretion defects in minorities, especially in African-Americans in population-based studies. Fasting and 2-h post-glucose load glucose and insulin levels, insulin-mediated glucose disposal (insulin sensitivity index) (S(I)), glucose effectiveness (S(G)), and first-phase insulin response (acute insulin response [AIR]) were determined in nondiabetic African-Americans (n= 288), Hispanics (n= 363), and non-Hispanic whites (n= 435) as part of the Insulin Resistance Atherosclerosis Study. Subjects received a standard 2-h oral glucose tolerance test on the first day and an insulin-modified frequently sampled intravenous glucose tolerance test on the second day. African-Americans and Hispanics were more obese than non-Hispanic whites. Both African-Americans and Hispanics had higher fasting and 2-h insulin concentrations and AIR but lower S(I) than non-Hispanic whites. No ethnic difference was observed in S(G). After further adjustments for obesity, body fat distribution, and behavioral factors, African-Americans continued to have higher fasting and 2-h insulin levels and AIR, but lower S(I) than non-Hispanic whites. In contrast, after adjustment for these covariates, no significant ethnic differences in S(I) or fasting insulin levels were observed between Hispanics and non-Hispanic whites. Hispanics continued to have higher 2-h insulin levels and AIRs than those in non-Hispanic whites. In this report, the association between S(I) and upper body adiposity (waist-to-hip, ratio) was similar in each ethnic group. Both nondiabetic African-Americans and Hispanics have increased insulin resistance and higher AIR than nondiabetic non-Hispanic whites, suggesting that greater insulin resistance may be in large part responsible for the higher prevalence of NIDDM in these minority groups. However, in Hispanics. the greater insulin resistance may be due to greater adiposity and other behavioral factors.
533 citations
TL;DR: In this paper, the authors determined the prevalence of AF from 1968 to 1989 in the Framingham Study cohort aged 65 to 84 years and evaluated the prevalence by sex and in the presence of VHD, prior MI, and CHF.
448 citations
TL;DR: Evidence for an association of apoE epsilon4 with other dementia, primarily multi-infarct dementia and stroke and the low positive predictive value of this marker suggest that use of ApoE genotyping as a screening test for AD is not supported.
Abstract: Apolipoprotein E type 4 allele (apoE epsilon4) is associated with Alzheimer's disease (AD) in the late-onset familial form and in sporadic cases, but the age-associated risk in a randomly sampled elderly population is not established. We examined the association of apoE epsilon4 with AD and other dementias (mainly multi-infarct or dementia following stroke) in 1,030 persons aged 71 to 100 years in the population-based Framingham Study cohort. Kaplan-Meier survival analysis revealed that 55% of the apoE epsilon4/epsilon4 homozygotes developed AD by age 80, whereas 27% of apoE epsilon3/epsilon4 heterozygotes developed AD by age 85, and 9% of those without a 4 allele developed AD by age 85 years. In comparison with persons without a 4 allele, the risk ration for AD was 3.7 (95% CI = 1.9 to 7.5) for apoE epsilon3/epsilon4 heterozygotes and 30.1 (95% CI = 10.7 to 84.4) for apoE epsilon4 homozygotes. ApoE epsilon2 (2/2, 2/3, or 2/4 genotypes) was associated with an absence of AD. One-half (n=21) of the 43 AD patients were either homozygous or heterozygous for apoE epsilon4. We found evidence for an association of apoE epsilon4 with other dementia, primarily multi-infarct dementia and stroke. The risk ratio was 2.3 (95% CI = 0.9 to 6.1) for non-AD dementias among persons with apoE epsilon3/epsilon4. Although the apoE epsilon4 allele is a potent risk factor for AD and may be associated with other forms of dementia, most apoE epsilon4 carriers do not develop dementia, and about one-half of AD is not apoE epsilon4 associated. The low positive predictive value of this marker (0.10) suggest that use of apoE genotyping as a screening test for AD is not supported.
329 citations
257 citations
TL;DR: This investigation of LTS hypertension, its treatment, and its sequelae in a free-living general population confirms the reduction in CVD mortality demonstrated in more short-term clinical trials of hypertension therapy in select patient groups.
Abstract: Background Cardiovascular morbidity and mortality result from the chronic processes involved in hypertension. However, long-term sustained (LTS) hypertension has received little attention. Methods and Results Trends in the prevalence of LTS hypertension and its treatment were assessed in 1950, 1960, and 1970 among three cohorts of men and women in the Framingham Heart Study (Mantel-Haenszel test). Cardiovascular disease (CVD) incidence and mortality were compared between patients with LTS hypertension with and without long-term treatment by use of the χ2 test. Cox proportional hazards regression analysis was used to estimate 10-year risk of death as a function of risk factor levels and treatment. Prevalence of LTS hypertension rose from 138 to 208 per 1000 between the 1950 and 1970 male cohorts (P<.01), while prevalence fell from 253 to 198 per 1000 between the female cohorts (P<.02). Long-term treatment increased 51% between the male cohorts and 45% between the female cohorts (both P<.001). While CVD inc...
205 citations
TL;DR: While some ethnic variability exists, a negative relationship between abdominal obesity and insulin sensitivity was confirmed for all three ethnic groups across the spectrum of glucose tolerance.
Abstract: Increased abdominal obesity has been related to lower insulin sensitivity (SI), independent of overall obesity, but it has been suggested that this relationship may be weaker in non-whites. In the Insulin Resistance and Atherosclerosis Study (IRAS), SI was estimated using a minimal model analysis of the frequently sampled intravenous glucose tolerance test in 1,625 men and women aged 40-69 years. Subjects included African-Americans, Hispanics, and non-Hispanic whites from Oakland and Los Angeles, CA, San Antonio, TX, and the San Luis Valley, CO. Minimum waist circumference was significantly (P = 0.0001) associated with SI after adjusting for age, sex, height, BMI, glucose tolerance status, ethnicity, and clinic. This relationship was significantly (P = 0.0001) stronger in subjects with normal glucose tolerance (NGT) (beta = -0.030, P = 0.0001) than in those with impaired glucose tolerance (IGT) (beta = -0.010, P = 0.02; NIDDM: beta = -0.013, P = 0.0001). There were no significant ethnic differences in effect size across the spectrum of glucose tolerance. Waist circumference was also positively related to fasting insulin, an indirect measure of insulin sensitivity, in NGT (P = 0.0001), IGT (P = 0.0003), and NIDDM (P = 0.0002). The waist-fasting insulin relationship was significantly weaker in African-Americans, relative to non-Hispanic whites, in NGT and IGT (tests of statistical interaction: P = 0.04 and P = 0.02, respectively). In general, these patterns were similar in models specifying waist-to-hip ratio (WHR), rather than waist circumference, as the independent variable. While some ethnic variability exists, a negative relationship between abdominal obesity and insulin sensitivity was confirmed for all three ethnic groups across the spectrum of glucose tolerance.
181 citations
TL;DR: Examination of 20-year trends in risk factors, incidence, and mortality among women and men in Framingham, Massachusetts, found that more than half of the 51% decline in coronary heart disease mortality observed in women between 1950 and 1989 and one third to onehalf of the 44% decline observed in men could be attributed to improvements inrisk factors in the 1970 cohorts.
Abstract: Variations in cardiovascular disease mortality between sexes, over time, and across regions point to population differences in the biologic, behavioral, and environmental factors influencing cardiovascular health. The authors examined 20-year trends in risk factors, incidence, and mortality among women and men in Framingham, Massachusetts, who were members of the Framingham Heart Study and aged 50-59 years in 1950, 1960, and 1970. The incidence declined 21% between the female cohorts (p < 0.01 for trend) with the greatest decline occurring between the 1950 and 1960 cohorts. The 20-year incidence declined only 6% between the male cohorts despite an 18% decline (p < 0.05 for trend) during the first 10 years of follow-up. Cardiovascular disease mortality declined 59% between the female cohorts and 53% between the male cohorts (both p < 0.001 for trend). The largest mortality declines occurred between the 1950 and 1960 female cohorts during the second 10 years of follow-up and between the 1960 and 1970 male cohorts during both follow-up periods. Obesity, hypercholesterolemia, and high blood pressure were significantly lower at baseline and 10 years later in the 1970 female cohort compared with the 1950 cohort (all p < 0.001). Smoking and high blood pressure were significantly lower at baseline and 10 years later in the 1970 male cohort compared with the 1950 cohort (both p < 0.001). More than half of the 51% decline in coronary heart disease mortality observed in women between 1950 and 1989 and one third to one half of the 44% decline observed in men could be attributed to improvements in risk factors in the 1970 cohorts.
166 citations
TL;DR: Central auditory dysfunction precedes senile dementia in a significant number of cases and may be an early marker for senile Alzheimer's disease.
Abstract: Objectives: To determine in older people the relation between auditory dysfunction and cognitive dysfunction, and if central auditory test abnormalities predict the onset of clinical dementia or cognitive decline. Design: Prospective population-based cohort study. Setting: Framingham Heart Study outpatient biennial examinations 18 and 21. Participants: Members of the Framingham Heart Study cohort with normal findings from cognitive screening tests at biennial examination 18. Measurements: Peripheral audiometric thresholds and word recognition in quiet; Synthetic Sentence Identification with Ipsilateral Competing Message (SSI-ICM); Mini-Mental State Examination; and detailed neuropsychological testing of subjects with abnormal findings from the Mini-Mental State Examination. Relative risk of dementia was determined using age-adjusted Cox proportional hazards regression models. Results: Hearing loss significantly lowered performance on the verbal parts of the Mini-Mental State Examination. The relative risk of subsequent clinical dementia or cognitive decline was 6 in subjects with very poor scores ( Conclusions: Central auditory dysfunction precedes senile dementia in a significant number of cases and may be an early marker for senile dementia. Hearing tests should be included in the evaluation of persons older than 60 years and in those suspected of having cognitive dysfunction. (Arch Otolaryngol Head Neck Surg. 1996;122:161-167)
161 citations
TL;DR: Although the causal nature of this association remains open to debate, prenatal care providers should routinely discuss the risks and benefits of epidural analgesia with women during their pregnancies so that they can make informed decisions about the use of pain relief during labor.
160 citations
TL;DR: It is concluded that ethnic differences exist in CCA but not in ICA IMT in nondiabetic subjects, and these differences in IMT are a non-invasive measure that is consistent with some of the data on clinical end points.
Abstract: Background and Purpose Ethnic differences in cardiovascular disease (CVD) morbidity and mortality have been observed in US adults. However, little data exist on differences in indices of preclinical atherosclerosis such as carotid wall intima-media thickness (IMT) for US non-Hispanic whites, Hispanics, and blacks. This study was undertaken to determine whether there were ethnic differences in carotid wall IMT. Methods Internal carotid artery (ICA) IMT and common carotid artery (CCA) IMT, indices of atherosclerosis, were assessed with the use of B-mode ultrasound in 1020 nondiabetic participants in the Insulin Resistance Atherosclerosis Study, a multicenter study designed to examine the association between insulin resistance and carotid atherosclerosis. The study included 281 blacks, 329 Hispanics, and 410 non-Hispanic whites aged 40 to 69 years. Results Blacks had significantly greater CCA IMT than non-Hispanic whites (865 versus 808 μm); this remained significant after adjustment for major CVD risk facto...
TL;DR: Plasma samples from the 20th biannual examination of the Framingham Heart Study cohort were analyzed to determine distribution of plasma homocysteine concentrations, with emphasis on relationships to vitamins that are involved in homocy steine metabolism and prevalence of carotid artery stenosis.
Abstract: Recent epidemiologic studies suggest that elevated homocysteine concentrations in plasma represent a risk factor for vascular disease and stroke. In the present study, we analyzed plasma samples from the 20th biannual examination of the Framingham Heart Study cohort to determine distribution of plasma homocysteine concentrations, with emphasis on relationships to vitamins that are involved in homocysteine metabolism and prevalence of carotid artery stenosis. Results showed that homocysteine was positively correlated with age. After controlling for age and sex, homocysteine exhibited strong inverse correlation with plasma folate, and weaker correlations with plasma vitamin B12 and pyridoxal-5′-phosphate. Homocysteine was also inversely correlated with intakes of folate and vitamin B6, but not vitamin B12. Prevalence of high homocysteine (>14 μmol/L) was 29.3% in this cohort, and inadequate plasma concentrations of one or more B vitamins appeared to contribute to 67% of the cases of high homocysteine. After adjustment for sex, age, HDL cholesterol, systolic blood pressure, and cigarette smoking, the prevalence of carotid-artery stenosis ≥25% was 43% in men and 34% in women with an odds ratio of 2.0 for individuals in the highest homocysteine quartile, compared with those in the lowest quartile (p < 0.001). Plasma concentrations of folate and pyridoxal-
TL;DR: Distinct dietary patterns in Framingham men and women vary in compliance with national nutrition and health policy objectives and provide insights for developing behavioral interventions to improve food and nutrient intake.
Abstract: Purpose. The goal of the study was to characterize the dietary patterns of adult men and women. Design. The study used a cross-sectional analysis of food consumption behaviors and nutrient intake measured from 1984 through 1988. Setting. The Framingham Offspring/Spouse Study, Framingham, Massachusetts. Subjects. The population-based sample comprised 1831 men and 1828 women between 20 and 70 years of age. Measures. Dietary patterns were defined by cluster analyses, which used the estimates of usual daily food intake from food frequency questionnaires, and the patterns were compared with Food Guide Pyramid recommendations. Nutrient intakes were independently estimated from 24-hour recalls and compared with Year 2000 nutrition recommendations. Results. Cluster analyses identified five groups of men and five groups of women with distinctive dietary patterns. Men differed on intakes of all food groups except vegetables and snacks plus sweetened beverages. Specific dietary behaviors, including low inta...
TL;DR: The robustness and power of two group analysis of covariance test applied to small samples distorted normality by floor effects when the regression slopes are homogeneous are investigated through computer simulations.
Abstract: We investigate through computer simulations the robustness and power of two group analysis of covariance test applied to small samples distorted normality by floor effects when the regression slopes are homogeneous. We consider four parametric analysis of covariance tests that vary according to the treatment of the homogeneity of regression slopes and two t-tests on unadjusted means and on difference scores. Under the null hypothesis of no difference in means, we estimated actual significance levels by comparing observed test statistics to appropriate values from the F and t distributions for nominal significance levels of 0.10, 0.05, 0.02 and 0.01. We estimated power by similar comparisons under various alternative hypothesis. The hierarchical approach (that adjusts for non-homogeneous slopes if found significant), the test that assumes homogeneous regression slopes, and the test that estimates separate regression slopes in each treatment were robust. In general, each test produced power at least equal to that expected from normal theory. The textbook approach, which does not test for mean differences when there is significant non-homogeneity, was conservative but also had good power. The t-tests were robust but had poorer power properties than the above procedures.
TL;DR: In this paper, the long-term relation of a single fibrinogen determination to initial and recurrent atherosclerotic cardiovascular events over 20 years of follow-up was examined.
Abstract: Examination of the long-term relation of a single fibrinogen determination to initial and recurrent atherosclerotic cardiovascular events over 20 years of follow-up revealed a powerful and comparably independent impact on initial events in both sexes but an influence on recurrent events only in men.
TL;DR: The simple FVC is an inexpensive and robust predictor of cardiac failure in persons predisposed by coronary disease or left ventricular hypertrophy and should help identify candidates for cardiac failure needing echocardiographic examination for ventricular dysfunction.
Abstract: Cardiac failure is a common lethal outcome of coronary heart disease and left ventricular hypertrophy. The efficacy of forced vital capacity (FVC), measured biennially, in predicting the onset of cardiac failure was explored in 818 Framingham Study subjects with these predisposing conditions, among whom 324 developed cardiac failure. Among the men and women who had coronary disease or left ventricular hypertrophy, those with FVCs in the lowest quartile were at substantially increased risk of developing cardiac failure. For men, comparing the lowest quartile with men whose FVCs were in the highest quartile ( 5.6 L), the risk ratio was 1.8; for women with FVCs
Journal Article•
TL;DR: Results showed that homocysteine exhibited strong inverse association with plasma folate and weaker associations with plasma vitamin B-12 and pyridoxal-5'-phosphate (PLP) and inversely associated with extracranial carotid stenosis after adjustment for age, sex and other risk factors.
Abstract: Recent studies demonstrated associations between occlusive vascular disease and hyperhomocysteinemia of both genetic and nutritional origin. In the present study we analyzed plasma samples from the 20th biannual examination of the Framingham Heart Study cohort to determine distribution of plasma homocysteine concentrations with emphasis on relationships to B vitamins and prevalence of carotid artery stenosis. Results showed that homocysteine exhibited strong inverse association with plasma folate and weaker associations with plasma vitamin B-12 and pyridoxal-5'-phosphate (PLP). Homocysteine was also inversely associated with intakes of folate and vitamin B-6, but not vitamin B-12. Prevalence of high homocysteine (>14 μmol/l) was 29.3% in this cohort, and inadequate plasma concentrations of one or more B vitamins appear to contribute to 67% of the cases of high homocysteine. Prevalence of stenosis ≥25% was 43% in men and 34% in women with an odds ratio of 2.0 for individuals in the highest homocysteine quartile (≥14.4 μmol/l) compared with those in the lowest quartile (≤9.1 μmol/l), after adjustment for sex, age, high density lipoprotein cholesterol, systolic blood pressure and cigarette smoking (P trend < 0.001). Plasma concentrations of folate and pyridoxal-5'-phosphate and folate intake were inversely associated with extracranial carotid stenosis after adjustment for age, sex and other risk factors.
TL;DR: Three-dimensional intraoparative mapping from 160 right and left vantri~lar intramural sites was padormed just prior to explanfatien in 6 patients with idiopathic dilated cardiomyopathy undergoing sen:lia to define the electrophyslo;ogio mechanism(s) of ventdcular tachycar~lia in nonisshemic oardiomyopathy.