Abraham B. Siegelaub

The Leukocyte Count as a Predictor of Myocardial Infarction

Abstract The multiphasic-examination findings of 464 persons in whom a first myocardial infarction later developed were compared with those of two control groups, one matched for age, sex and race (ordinary controls), and the other matched in addition for standard coronary risk factors (risk controls). The total leukocyte count, measured, on the average, 16.8 months before the myocardial infarction, was strikingly related to development of infarction. The mean leukocyte count in cases was significantly higher (p<0.001) than in either control group. Ascending from lowest to highest quartile in the cases and ordinary controls the increase in risk of myocardial infarction associated with the leukocyte count was similar to that found for cholesterol and blood pressure. Cigarette smoking, which was strongly related to the leukocyte count, may account for about two thirds of the relation of the count to infarction. The leukocyte count may prove valuable in the routine assessment of risk of myocardial infarction...

Pain Tolerance: Differences According to Age, Sex and Race

The nature and extent of group differences in pain tolerance according to age, sex and race were examined. The method of pain tolerance determination was mechanical pressure on the Achilles tendon, performed on 41 , 119 subjects as part of the Kaiser-Permanente Automated Multiphasic Screening examination. The results showed that, on the average, a) pain tolerance decreases with age; b) men tolerate more pain than women; and c) Whites tolerate more pain than Orientals, while Blacks occupy an intermediate position. When the results of this study are compared with earlier work, it appears that, with increasing age, tolerance to cutaneous pain increases and tolerance to deep pain decreases.

Alcohol and Mortality: A Ten-Year Kaiser-Permanente Experience

We studied 10-year mortality in relation to baseline alcohol use habits among four groups of 2015 persons, well matched for age, sex, race, and cigarette smoking. Persons reporting daily use of two drinks or fewer fared best; the heaviest drinkers (six or more drinks) had a doubled mortality rate, and users of three to five drinks had a mortality rate, and users of three to five drinks had a mortality rate approximately 50% higher. The nondrinkers had a mortality rate similar to that of users of three to five drinks per day. Cancer, cirrhosis, accidents, and nonmalignant respiratory conditions contributed significantly to the excess mortality of the heavier drinkers; coronary disease mortality was significantly higher among nondrinkers. Smoking intensity was a possible factor in the increased mortality of heavier drinkers, but the data were also compatible with the hypothesis that smoking and drinking are synergistic in the production of certain cancers and nonmalignant chronic respiratory illness. Other traits associated with alcohol use or abstinence are possible contributors to the excess mortality of both heavy drinkers and nondrinkers.

Cigarettes, alcohol, coffee and peptic ulcer.

Abstract The relation of cigarette smoking, alcohol and coffee consumption and educational attainment to a history of peptic ulcer was studied in 36,656 white male and female subjects of multiphasic examinations, 30 to 59 years of age. Among men, a 2.1-fold greater percentage of cigarette smokers than of nonsmokers reported a history of peptic ulcer; for women the prevalence was 1.6 times greater in cigarette smokers. Duration of smoking, quantity smoked and inhalation were each related to a history of peptic ulcer. Although alcohol and coffee consumption were correlated with cigarette smoking and the two beverages reportedly stimulate gastric acid secretion, they were not positively related to prevalence of peptic ulcer and did not explain the relation of cigarette smoking to peptic ulcer; nor did educational attainment or body build. (N Engl J Med 290:469–473, 1974)

Lung function and risk of myocardial infarction and sudden cardiac death.

In a serach for risk factors for myocardial infarction and sudden cardiac death, the mean total vital capacity as measured at multiphasic health checkups was lower in persons who later had a first myocardial infarction than in risk-factor-matched controls (3.17 vs. 3.29 liters, 395 pairs, P less than 0.05) and non-risk-factor-matched controls (3.16 vs. 3.41 liters, 401 pairs, P less than 0.001). Findings were little affected by age and height adjustment and were similar for sudden cardiac death. The first-second vital capacity was also inversely related to later development of these conditions, but the ratio of that measurement to total vital capacity was not. Heavy smoking, productive cough, exertional dyspnea and cardiac enlargement were associated with diminished total capacity. However, exclusion of subjects with these findings did not reduce the predictive value of total vital capacity. Diminished vital capacity deserves continued attention as a possible coronary risk factor. Its relation to subsequent coronary events is not well explained.

Smoking Habits and the Leukocyte Count

In 86,488 multiphasic examinations, mean leukocyte counts were highest in cigarette smokers, intermediate in ex-cigarette and cigar or pipe smokers, and lowest in nonsmokers. Among the races, whites had the highest, yellows next, and blacks the lowest leukocyte counts. The leukocyte count was related to quantity smoked, inhalation, and smoking duration. Most groups who changed smoking habits showed corresponding changes in leukocyte counts. Higher leukocyte counts in smokers appeared largely to be a direct effect of smoking, although a small part of the increase seemed attributable to chronic bronchitis. A contribution of genetic or constitutional differences between smokers and nonsmokers was not ruled out. “Normal” leukocyte count values should take into account age, sex, race, and smoking status.

3. Outpatient clinic utilization, hospitalization, and mortality experience after seven years☆

The Multiphasic Checkup Evaluation Study is a controlled clinical trial aimed at testing the efficacy of periodic Multiphasic Health Checkups in preventing or postponing illness, disability, and death. This paper reports on outpatient clinic utilization, hospitalization, and mortality experience of the study group subjects, who have been urged to undertake annual checkups, and of the control group subjects, who were not so urged, after the first seven years of the project effort. While there has been little difference in utilization of outpatient physician and laboratory services other than those directly connected with the Multiphasic Health Checkups, the study group subjects have had more diagnoses made. Among the men ages 45–54 at entry, hospital usage has been slightly lower in the study group, while the opposite has been the case among the women ages 45–54 at entry. The overall mortality rate has been slightly lower in the study group, while, for a group of causes of death defined as being potentially postponable or preventable, the study group mortality rate has been significantly lower (p < 0.05). There is no strong indication that chance fluctuation, underreporting, differentially selective loss to followup, or an initial study-control group health status disparity accounted for this last difference.

Changes after quitting cigarette smoking.

Changes in cardiorespiratory symptoms and coronary disease risk indicators over an average 11/2-year period were assessed in 9392 persistent cigarette smokers and 3825 persons who quit smoking between two multiphasic checkups. The prevalence of questionnaire-reported chronic cough fell markedly in subjects who quit a one-or-more-pack/day habit (e.g., from 11.2% to 1.8% in white men,p < 0.001). However, chest pain, shortness of breath and exertional leg pain showed no consistent improvement in quitters compared with persistent smokers. Weight gain was about 2–3 lbs greater in quitters, but changes in blood pressure were small and not consistent across race-sex groups, nor were there consistent differences between persistent smokers and quitters in trends in vital capacity, cholesterol or prevalence of ECG abnormality. Quitting was associated with increase in serum uric acid levels of about 0.2–0.5 mg/dl and relative falls in hemoglobin, leukocyte count and serum glucose levels, all consistent with smoker-nonsmoker differences previously found in cross-sectional studies. Except for the small increases in weight and uric acid levels, quitting smoking did not appear to increase risk of coronary heart disease by other mechanisms.

Dollar Cost per Positive Test for Automated Multiphasic Screening

Abstract The costs to identify a clinically important test by an automated multiphasic screening program provide useful information in planning for a specified target population. When 44,663 multip...

A Psychological Questionnaire Predictive of Myocardial Infarction: Results from the Kaiser-Permanente Epidemiologic Study of Myocardial Infarction

&NA; A 155‐item psychological questionnaire was given to 330 multiphasic examinees who subsequently developed a well‐documented first myocardial infarction (MI). Two age‐sex‐race‐matched control groups remaining free of MI were selected from multiphasic examinees; one group was additionally matched to the cases for standard coronary risk factors. Responses to several questionnaire items were associated with subsequent MI to a statistically significant degree, and a further test indicated that the questionnaire as a whole contained more associated items than would be expected by chance. Outside experts selected items to represent certain psychological traits that have been hypothesized as predicting MI. Items representing “emotional drain” and “somatization” proved to be associated with subsequent MI, but these relationships were no longer apparent when persons with coronary symptoms and diagnoses at the time of testing were removed from the study group. Sets of items representing certain other traits were not significantly predictive, except for those representing “anxietyneuroticism,” in the symptom‐free subgroup. In studying factors predicting MI, care should be taken that psychological traits are not confused with symptoms of coronary heart disease.