Jeremiah Stamler

Alcohol consumption, cardiovascular risk factors, and mortality in two Chicago epidemiologic studies.

Multivariate analysis of the association at baseline between problem drinking and cardiovascular risk factors among 1,233 white male employees of the Chicago Peoples Gas Company age 40-59 showed the 38 problem drinkers with significantly higher blood pressures and cigarette consumption and significantly lower relative weights than the others. Similar analyses among 1,899 white male employees of the Hawthorne Works of the Western Electric Company in Chicago age 40-55 showed the 117 men consuming 5 or more drinks per day with significantly higher blood pressures and cigarette use than the others. No significant differences were recorded between heavy drinkers and the others in serum cholesterol level. The gas company problem drinkers had significantly higher 15- year mortality rates from all causes, cardiovascular diseases, coronary heart disease, and sudden death. These differences could not be entirely explained by their blood pressure, smoking, and relative weight status. The Western Electric heavy drinkers had increased 10-year mortality rates both for all causes and noncardiovascular causes.

Echocardiographic correlates of left ventricular structure among 844 mildly hypertensive men and women in the Treatment of Mild Hypertension Study (TOMHS).

BackgroundEchocardiography provides a noninvasive means of assessing left ventricular (LV) structure and evidence of LV wall remodeling in hypertensive persons. The relation of demographic, biological, and other factors with LV structure can be assessed. Methods and ResultsLV structure was assessed by M-mode echocardiograms for 511 men and 333 women with mild hypertension (average blood pressure, 140/91 mm Hg). Measurements ofLV wall thicknesses and internal dimensions were made, and estimates of LV mass indexes and other derivations of structure were calculated. LV hypertrophy criteria were based on previously reported echocardiographic population studies of normal subjects. These measures were compared by age, sex, race, body mass index, systolic blood pressure, antihypertensive drug use, physical activity, alcohol intake, cigarette smoking, and urinary sodium excretion. Despite virtual absence of ECG-determined LV hypertrophy, 13% of men and 20%o ofwomen had echocardiographically determined LV hypertrophy indexed by body surface area (g/m2), and 24% of men and 45% of women had LV hypertrophy indexed by height (g/m). Black participants had slightly higher mean levels of wall thickness than nonblack participants but similar LV mass. Systolic blood pressure and urinary sodium excretion were significantly and independently associated with LV mass index and LV hypertrophy using both g/m2 and g/m. Body mass index was significantly related to LV mass index and LV hypertrophy using g/m. Smoking was significantly associated with LV mass index, i.e., using continuous measurement but not using the dichotomy for LV hypertrophy. ConclusionThis study of a large population of men and women with mild primary hypertension, largely without ECG evidence of LV hypertrophy, showed a substantial percentage of participants with echocardiographically determined LV hypertrophy. LV mass indexes correlated positively with systolic blood pressure, body mass index, urinary sodium excretion, and smoking.

Correlates of the JAS type A behavior pattern score

Abstract The Jenkins Activity Survey (JAS), a self-administered and machine-scored questionnaire designed to assess the Type A behavior pattern described by Rosenman and Friedman, was included in an industry-based CHD risk factor screening program in the Chicago area. Data on 4108 white persons age 25–64 yr, categorized into four sex age groups, have been analyzed to investigate the relationship of the JAS Type A score to sex, age, socio-economic status (SES), CHD risk factors, prevalence of myocardial infarction, and compliance with recommendation to obtain followup medical evaluation. The following results were obtained. 1. 1. The Type A score is positively correlated with SES in all four sex age groups. 2. 2. After controlling SES, men do not differ significantly in mean Type A score from women, but both men and women age 45–64 yr have lower mean Type A scores than men and women age 25–44 yr. 3. 3. The number of cigarettes smoked per day is positively correlated with Type A score in men and younger women, but the magnitude of the correlation is very small. 4. 4. Prevalence of high blood pressure, defined as having elevated pressure or being treated medically for high blood pressure, is unrelated to Type A score in men and younger women but positively related in middle-age women after controlling for age, relative weight, and SES. 5. 5. The Type A score is weakly related to prevalence of hypercholesterolemia only in the total group of men age 25–44 yr; it is unrelated in older men and in women. Among persons not under medical treatment for CHD risk factors and without evidence of myocardial infarction, the Type A score is unrelated to concentration of serum cholesterol. 6. 6. The Type A score is unrelated to level of serum uric acid, plasma glucose after challenge, or relative weight. 7. 7. Compliance with a recommendation to obtain medical evaluation of suspect screening test results is unrelated to Type A score. 8. 8. Prevalence of myocardial infarction, as evidenced by Q-waves on the ECG or by history of physician-diagnosed heart attack, is positively related in middle-age men to Type A score after taking age, diastolic blood pressure, serum cholesterol, and cigarette smoking into account.

Uric acid: a risk factor for coronary heart disease?

The association between serum uric acid the prevalence of ECG abnormalities was analyzed for 24,997 employed men women, white black, age 18–64 years, from the Chicago Heart Association (CHA) Detection Project in Industry. In addition, the relationships between uric acid 5-year mortality from all causes, from cardiovascular diseases (CVD), from coronary heart disease (CHD) were analyzed for 7804 white men women age 45-64 years from this study 967 white men age 44–63 years from the Chicago Peoples Gas Company Study. For men, the associations between uric acid the prevalence of ECG abnormalities with mortality appear to be secondary to associations between uric acid other risk factors. For women, however, the associations could not be explained by other risk factors.

The association between urinary sodium excretion and blood pressure in children.

SUMMARYThis study explored the association between sodium excretion and blood pressure (BP). A new method was used to minimize the measurement error introduced by the large intrinsic variability of 24-hour sodium excretion. The ratio of intra- to interindividual variation was used to estimate the number of measurements needed to characterize the individual. When seven consecutive 24-hour samples were collected from 73 children, ages 11-14 years, a significant correlation between mean individual sodium excretion and BP was demonstrated. The independent relationship persisted when controlling for height, weight, pulse, age, sex and race (p = 0.045), but was eliminated by simultaneously considering mean creatinine excretion. Although the cross-sectional association described is quantitatively weak, a linear relationship between BP and sodium over the range consumed in this society could be important for prevention.

Effects on serum lipids of adding instant oats to usual American diets.

This study was designed as a test of the serum lipid response and dietary adaptation to recommended daily inclusion of instant oats in an otherwise regular diet. Hypercholesterolemic adults were randomly assigned to a control or intervention group. Participants in the intervention group were given packages of instant oats and requested to eat two servings per day (approximately two ounces dry weight), substituting the oats for other carbohydrate foods in order to maintain baseline calorie intake and keep weight stable. Serum lipids were measured in blood collected by venipuncture at baseline, four weeks, and eight weeks. Baseline mean total cholesterol (TC) levels were 6.56 mmol/L and 6.39 mmol/L for intervention and control groups, respectively. After eight weeks, mean serum total cholesterol of the intervention group was lower by -0.40 mmol/L, and mean net difference in TC between the two groups was 0.32 mmol/L (95% CI: 0.09, 0.54). Low-density lipoprotein-cholesterol was similarly reduced with mean net difference of 0.25 mmol/L (95% CI: 0.02, 0.48) between the two groups. Mean soluble fiber intake increased along with slight self-imposed reductions in mean total fat, saturated fat, and dietary cholesterol intake in the intervention group. Neither group changed mean body weight. Daily inclusion of two ounces of oats appeared to facilitate reduction of serum total cholesterol and LDL-C in these hyperlipidemic individuals.

Sex differential in the relationship of electrocardiographic ST-T abnormalities to risk of coronary death: 11.5 year follow-up findings of the Chicago Heart Association Detection Project in Industry.

The independent contributions of ST segment depression and/or T wave abnormality (ST-T abnormalities) on the baseline resting electrocardiogram to risk of 11.5 year coronary heart disease (CHD) mortality were explored among 9203 white men and 7818 white women who were 40 to 64 years old and without definite CHD at entry in the Chicago Heart Association Detection Project in Industry. At baseline, prevalence rates of ST-T abnormalities were age related for both sexes, and at every age the rate was higher in women than men (age-adjusted prevalence rates 12.3% and 8.1%, respectively). Univariate analysis showed that ST-T abnormalities were associated with significantly increased risk of death from CHD for both men and women. However, men with ST-T abnormalities had much greater age-adjusted and multiple risk factor-adjusted absolute excess risk and relative risk than women with such electrocardiographic abnormalities. When baseline age, diastolic pressure, serum cholesterol, cigarettes/day, history of diabetes, and baseline use of antihypertensive medication were included in the multivariate analysis, ST-T abnormalities remained significantly related to death from CHD in men but not women. The interaction term between sex and ST-T abnormalities was at a borderline level of statistical significance by Cox regression analysis. In conclusion, ST-T abnormalities indicate an increased risk of subsequent death from CHD independent of major coronary risk factors for middle-aged U.S. men, but this is not clearly so for women.

The relationship of education to blood pressure: findings on 40,000 employed Chicagoans.

SUMMARY The relationship of education to both actual blood pressure and the prevalence of high blood pressure, based on a systolic pressure of 160 mm Hg or greater or a diastolic pressure of 95 mm Hg or greater, was analyzed among 27,033 men and women, white and black, age 25–44 and 45–64, from the Chicago Heart Association Detection Project in Industry. The educational status of each individual was categorized as not a high school graduate, high school graduate, some college, or college graduate. A statistically significant inverse association between education and high blood pressure was present in all groups of whites. This association could not be “accounted for” by differences in age, relative weight, and heart rate among the educational strata. Controlling for these variables did, however, lessen the association. Among black males a significant inverse association between education level and blood pressure was found for the younger group. For the older black males there was a clear inverse association although with the small numbers it did not achieve statistical significance. For black females there was no clear association.

Independent contribution of electrocardiographic abnormalities to risk of death from coronary heart disease, cardiovascular diseases and all causes. Findings of three Chicago epidemiologic studies.

The importance of major and minor ECG abnormalities at baseline for subsequent risk of death from coronary heart disease, cardiovascular diseases and all causes was analyzed for middle-aged white men from the Chicago Peoples Gas Company, Chicago Western Electric Company and Chicago Heart Association Detection Project in Industry studies. Univariate analysis showed that in all three studies, men with major ECG abnormalities had death rates considerably higher than those with normal ECGs. When baseline age, diastolic pressure, serum cholesterol, relative weight and number of cigarettes per day were taken into consideration in multivariate analysis, ECG abnormalities retained significant relationship to the three death end points. Findings from the Chicago Western Electric Company and Chicago Heart Association studies showed independent relationship between minor ECG abnormalities and the three death end points. In the Chicago Peoples Gas Company (20-year follow-up) and in the Chicago Western Electric Company (17-year follow-up), when the deaths were divided into those that occurred within the first 10 years of follow-up and those that occurred more than 10 years after entry, the association between ECG abnormalities and mortality held for both the first and second decades of follow-up. Overall, findings from this study demonstrate an independent relationship between ECG abnormalities and death from coronary heart disease, cardiovascular disease and all causes.

Effect of dietary sodium reduction on red blood cell sodium concentration and sodium-lithium countertransport.

A randomized, crossover trial was carried out on the effect of moderate sodium reduction on red-blood-cell sodium metabolism. The participants were healthy high school students (mean age = 16 years, n = 33). Changes in sodium-lithium countertransport and intracellular sodium concentration were evaluated 24 days after a decrease in dietary sodium from approximately 110 to 40 mEq per day. Dietary sodium restriction had no significant effect on either sodium-lithium countertransport or intracellular sodium concentration.