Julian E. Keil

Mortality Rates and Risk Factors for Coronary Disease in Black as Compared with White Men and Women

BACKGROUND Currently recognized risk factors for coronary artery disease have been identified primarily from investigations of white populations. In this investigation, we estimated mortality rates for coronary disease and for any cause and identified risk factors for death from coronary disease among whites and blacks. METHODS Data collected over a 30-year period in the Charleston Heart Study were used to estimate mortality rates and quantify associations with risk factors assessed at the base-line examination in 1960 and 1961 of 653 white men, 333 black men, 741 white women, and 454 black women. RESULTS There were no significant racial differences in the rate ratios for death from coronary disease; however, women had significantly lower death rates than men. Over the 30-year period, the mortality rates for coronary disease per 1000 person-years were 5.2 for white men (95 percent confidence interval, 4.1 to 6.3), 4.6 for black men (3.0 to 6.2), 2.1 for white women (1.6 to 2.6), and 3.2 for black women (2.3 to 4.0). Significant, or nearly significant, predictors of mortality due to coronary disease were systolic blood pressure in all four groups; serum cholesterol level among white men, white women, and black women; and smoking among white men, white women, and black men. Although the difference was not statistically significant, the risk of death from coronary disease was consistently increased among diabetics in all four groups. A higher level of education was predictive of lower rates of death due to coronary disease among white men and black women. For all causes of death taken together, the rates for blacks were higher than the rates for whites. The presence of hypertension, a history of smoking, and a history of diabetes were significant or nearly significant predictors of mortality from any cause in all four groups. CONCLUSIONS Although the rates of death from coronary disease were somewhat lower among black men than white men and higher among black women than white women, the black:white mortality rate ratios were not statistically significant, and the major risk factors for mortality from coronary disease were similar in blacks and whites in the 30-year follow-up of the Charleston Heart Study.

Prevalence of Raynaud phenomenon in the general population: A preliminary study by questionnaire

A short questionnaire inquiring about cold sensitivity of the fingers was administered to 1752 randomly selected subjects in a probability sample drawn from the adult population of the state of South Carolina. The overall prevalence of reported cold sensitivity was approximately 10% and showed no sex or race difference. A female preponderance was revealed only after subjects exposed to vibrating tools were excluded, and then only in the white group. Estimates of the prevalence of Raynaud phenomenon were obtained using the following criteria: cold sensitive subjects reporting white and/or blue color changes: 4.6%; cold sensitivity leading to medical consultation: 3.0%; combination of the two criteria above: 1.9%.

Predictors of physical disability in elderly blacks and whites of the Charleston heart study

During the 1984/85 recall of the Charleston Heart Study Cohort, physical function data were obtained for 247 white males, 376 white females, 123 black males, 247 black females and 71 high socioeconomic status (SES) black males over 60 years of age. Black females had the highest prevalence of physical disability (55.8%), followed by white females (43.2%), black males (39.0%) and white males (25.8%) and high SES black males (22.3%). Physical disability was 1.5-2.5 times as prevalent among individuals with a history of cardiovascular disease (CVD) than those without such a history. Among individuals without a current history of CVD univariate analyses showed the following as significant (lower 95% CI greater than 1.0) predictors of physical disability: elevated systolic blood pressure in white females, black males, and black females; elevated cholesterol in black females; obesity in black females; and low educational level in white females. Regression analyses indicated that obesity in 1960 accounted for 10.9 and 2.9% respectively of the variability in physical disability scores in 1985 for black females and white females.

Electrocardiographic abnormalities and 30-year mortality among white and black men of the Charleston Heart Study.

BackgroundThe long-term predictive significance of a single ECG tracing for mortality was explored among the white and black men of the Charleston Heart Study. Methods and ResultsThe 1960 baseline tracings of men ages 35 to 74 in the Charleston Heart Study cohort were coded according to the Minnesota classification. Tracings were categorized as being normal or having minor or major abnormalities. The 30-year vital status was ascertained for the cohort, and the association between ECG findings and coronary and all-cause mortality was evaluated. The proportion of black men with major abnormalities at the 1960 baseline examination was almost twice that ofwhite men. Rates of all-cause mortality increased with severity of abnormalities for white and black men. The absolute excess risk for black men with major abnormalities was 23.3 per 1000 person-years and 12.8 for white men. The excess risk for coronary mortality was 73 for white men and 6.5 for black men. ConclusionsMany of the findings in this study confirm earlier associations derived from studies ofwhite populations and extend the observations to black men. However, the magnitude of the relative risk for mortality was different for white and black men. After controlling for traditional coronary disease risk factors and minor abnormalities, white men with major abnormalities were 2.72 (95% confidence interval, 1.47, 5.04) times more likely to die of coronary disease compared with black men, who were 1.95 (95% confidence interval, 0.93, 4.11) times more likely to die of coronary disease.

Prolonged ingestion of commercial DDT and PCB; effects on progesterone levels and reproduction in the mature female rat

A report linking human polycystic ovary with increased exposure to environmental DDT (Heinrichset al. 1971) prompted the present study comparing effects of PCB and DDT or their combination on reproduction in female rats under more realistic conditions with respect to level (75 and 150 ppm), route of administration (dietary contaminant), and period of exposure (8 and 36 weeks). Evaluation of estrous cycle length, mating frequency, number and size of litters; as well as plasma levels of DDT, PCB, progesterone (P), and 17α=hydroxyprogesterone (17α=OH-P), permitted comparison of short and long term reproductive changes from ingestion of two levels of DDT and/or PCB.PCB reduced plasma progesterone (p<.01) while plasma 17α OH-P was unchanged by PCB or DDT. High DDT and PCB abolished reproduction. Histologically, distinct ovarian stromal changes accompanied 150 ppm of PCB, while increased numbers of more prominent follicular cysts were evident with 150 ppm of DDT. Although DDT and PCB generally reduced or abolished litter production, no treatment tested significantly altered litter size. Long term chronic ingestion of more realistic levels of technical DDT (85%p,p′, 15%o,p′-DDT) in these studies did not lead to polycystic ovaries in adult rats comparable to those reported following i.v. administration of pureo,p′-DDT to immature rats. Plasma DDT levels above 800 ppb are clearly detrimental to reproduction, while levels below 500 ppb had little effect. Finally, we present the first evidence reported to our knowledge demonstrating that prolonged ingestion of PCB (150 ppm) markedly reduces reproduction (p<.05) accompanied by significantly reduced progesterone in plasma (p<.01) as well as by histologically characteristic ovarian stromal changes not seen with DDT alone.

Incidence of coronary heart disease in blacks in Charleston, South Carolina

We studied a cohort of 2275 blacks and whites of both sexes in Charleston County, South Carolina, during the period of 1960-1961 to 1974-1975. There were 93 prevalent cases of coronary heart disease (CHD) at intake, and 317 new cases occurred by 1975 in persons originally free of CHD. White males had the highest incidence rates for all types of CHD and acute myocardial infarction (AMI). Black males and black females had the next highest rates. The incidence of angina pectoris in black females was double the rate in white females and five times the rate in white males. The rate of sudden death in black males was two and one-half times the rate in black females, three times the rate in white males, and four times the rate in white females. One hundred and one black males who had been selected on the basis of high socioeconomic status (SES) had AMI and CHD rates half that of other black males. None of the high SES black males experienced angina pectoris, AMI death, or sudden death during the observation period.

Prevalence of raynaud phenomenon in the adult population of South Carolina

A prevalence estimate for Raynaud phenomenon among adult residents of South Carolina was based on data obtained from respondents in a statewide health survey, followed by face-to-face interviews and clinical screening for Raynaud phenomenon, using a screening procedure developed by the authors. The survey obtained 5246 personal interviews from a probability sample of over 3000 households, and 494 survey subjects participated in the clinical screening. The prevalence estimates and their standard errors were computed using survey case weights, design-based estimation, and logistic modelling techniques. The prevalence of Raynaud phenomenon among adult residents of South Carolina was determined to be 3.5%, with a standard error of 0.6%. Prevalence was higher for females (4.3%, SE = 0.7%) than for males (2.7%, SE = 0.6%). These figures are much lower than most estimates in the existing literature on Raynaud phenomenon.

Polychlorinated biphenyl (Aroclor 1242): effects of uptake on growth, nucleic acids, and chlorophyll of a marine diatom.

ConclusionCylindrotheca closterium absorbed and concentrated the polychlorinated biphenyl (Aroclor 1242) 900 to 1000 times above the level in sea water. At.1 ppm concentration in sea water, PCBs inhibited growth and diminished levels of RNA and chlorophyll of this marine diatom.

Acute myocardial infarction: Period prevalence, case fatality, and comparison of black and white cases in urban and rural areas of South Carolina

Community surveillance revealed 1085 prevalent cases of acute myocardial infarction (AMI) during 1978 in urban metropolitan Columbia and rural Pee Dee areas of South Carolina. Six hundred fifty-eight hospitalized cases met our criteria and were classified as definite or probable. Death certificates identified 427 who died before admission to the hospital and who were classified as unvalidated. However, there is need to verify death certificate diagnosis in out-of-hospital deaths which account for approximately two thirds of total cases in blacks and about one third of white cases. Other findings were: White males had higher AMI rates in the rural Pee Dee area than in urban Columbia, while black males and black females had higher rates in Columbia than in the Pee Dee area and white females had similar rates in both areas. Rates for out-of-hospital AMI mortality were higher in blacks than in whites. Out-of-hospital AMI mortality rates in Columbia and the Pee Dee area were four times higher than in Minneapolis-St. Paul in 1978. For definite and all criteria AMI, white males had the highest rates, double the black male rate except for all criteria AMI in Columbia, where white male and black male rates were similar. Urban cases of both races experienced more anterior infarctions than rural cases.

Outcomes of Black and White Hypertensive Individuals After 30 Years of Follow-Up

Outcomes of a 30-year follow-up for the participants of the Charleston Heart Study were studied with elevated blood pressure assessed using various classifications. The traditional categories of > or = 140/90 mmHg, > or = 160/95 mmHg and isolated systolic hypertension, as well as high normal and the four stages of high blood pressure were utilized in analyses. Prevalence rates of hypertension were, in general, higher among blacks compared to whites. Blacks had higher prevalence rates of hypertension and greater prevalence of high blood pressure at younger ages. Risk ratios were higher for black and white hypertensives than their normotensive counterparts. Blacks were found to have substantially higher population attributable risk proportions, particularly at the higher blood pressure categories. The results suggest that the standard clinical classifications of hypertension as related to mortality are appropriate for blacks and white.