Mark H. Lepper

Diet, Serum Cholesterol, and Death from Coronary Heart Disease: The Western Electric Study

Over twenty years ago, we evaluated diet, serum cholesterol, and other variables in 1900 middle-aged men and repeated the evaluation one year later. No therapeutic suggestions were made. Vital status was determined at the 20th anniversary of the initial examination. Scores summarizing each participants dietary intake of cholesterol, saturated fatty acids, and polyunsaturated fatty acids were calculated according to the formulas of Keys and Hegsted and their co-workers. The two scores were highly correlated, and results were similar for both: there was a positive association between diet score and serum cholesterol concentration at the initial examination, a positive association between change in diet score and change in serum cholesterol concentration from the initial to the second examination, and a positive association prospectively between mean base-line diet score and the 19-year risk of death from coronary heart disease. These associations persisted after adjustment for potentially confounding factors. The results support the conclusion that lipid composition of the diet affects serum cholesterol concentration and risk of coronary death in middle-aged American men.

Relationship of education to major risk factors and death from coronary heart disease, cardiovascular diseases and all causes, Findings of three Chicago epidemiologic studies.

The relationship of education to risk factors at baseline and to long‐term mortality from coronary heart disease (CHD), cardiovascular diseases (CVD), and all causes was analyzed for three cohorts of middle‐aged employed white men in Chicago: 8047 from the Chicago Heart Association Detection Project in Industry (CHA) (entry 1967‐1973), 1250 from the Peoples Gas Company Study (PG) (entry 1958-1959) and 1730 from the Western Electric Study (WE) (entry 1957-1958). Each man was classified into one of four groups: not a high school graduate, high school graduate, some college but not a graduate, or college graduate. For all three cohorts, a graded, inverse association was observed at baseline between education and blood pressure, which was statistically significant for CHA and WE men and independent of age and relative weight. For all three cohorts, a significant, graded, inverse association was also recorded between education and cigarette use at entry. For serum cholesterol, no clear pattern was observed for the education groups in any of the three cohorts. CHA men showed a graded, inverse relationship between education and relative weight. This cohort was the only one of three showing a significant, graded inverse association between education and prevalence of ECG abnormalities at entry. For this CHA cohort, 5-year follow-up data showed a statistically significant, graded, inverse relationship between education and ageadjusted mortality rates from CHD, CVD and all causes. With adjustment for entry age, diastolic pressure, cigarettes, serum cholesterol, relative weight and ECG abnormalities, this inverse relationship remainedreduced in degree, but still statistically significant for CVD mortality. Similarly, for the pooled PG-WE cohort of 2980 with 20-21 years of follow-up, education and the three mortality end points were inversely related but not graded, with statistical significance for all three end points in the univariate analyses. The results of these studies indicate inverse relationships between education and lifestyle-related risk factors at baseline and between education and long-term risk of CHD, CVD and all-causes mortality. The inverse relationship between education and mortality is accounted for in part by the established major biomedical risk factors.

Alcohol consumption and 17-year mortality in the Chicago Western Electric Company study

Abstract The association between baseline alcohol intake and mortality from all causes and specific causes based on 17 years of follow-up experience was analyzed for 1,832 white males originally age 40–55 from the Chicago Western Electric Company study. Alcohol consumption was expressed as number of drinks per day for all intake combined, including hard liquor, beer, and wine, based on the maximum intake reported on three questionnaires. With mortality rates adjusted only for age, total intake was associated with increased risk of death from all causes, the cardiovascular diseases, coronary heart disease, cancer, and other causes at the level of six or more drinks per day. There was no increase in mortality with increasing alcohol consumption below this level. Only the associations between alcohol intake and death from the cardiovascular diseases and coronary heart disease failed to persist after adjustment for other risk factors, such as smoking and blood pressure. When the deaths were divided into those occurring within the first 10 years of follow-up and those occurring more than 10 years after entry, the association between baseline alcohol intake and mortality was generally stronger for those deaths occurring more than 10 years after entry.

Serum cholesterol and risk of death from cancer and other causes in three Chicago epidemiological studies

Abstract Although hypercholesterolemia is established as a major risk factor for coronary heart disease, the finding in some epidemiological studies of no association between serum cholesterol and all causes mortality suggests that serum cholesterol may be inversely related to the risk of death from non-cardiovascular causes, e.g. cancer. This possibility led to the examination of this question in middle-aged white males from the Chicago Peoples Gas Company and Chicago Western Electric Company studies, and in middle-aged white males and females from the Chicago Heart Association Detection Project in Industry. In each of these studies, there was no significant association between initial serum cholesterol level and subsequent mortality from cancer, or from causes other than cancer and the cardiovascular diseases in men. There was, however, a significant inverse association with other causes of death in women. When the cancer deaths were examined by site, there was a significant inverse association between serum cholesterol and deaths from sarcoma, leukemia and Hodgkins disease in the Western Electric men and one that was nearly so in the Chicago Heart Association men. Serum cholesterol was not significantly related to lung cancer, colorectal cancer, oral cancer, pancreatic cancer, or to all other cancers combined in any of the three studies in men or in women. There was, however, the suggestion of a positive association for breast cancer in women. Thus, the results of these three studies do not generally support the hypothesis of an inverse association between serum cholesterol and cancer in urban middle-aged white American males and females.

Pulse pressure-III. Prognostic significance in four Chicago epidemiologic studies

This report, the third in a series on pulse pressure and pure systolic hypertension, examines the associations between blood pressure and the cardiovascular diseases and coronary heart disease, both cross-sectionally and prospectively, utilizing data from four Chicago epidemiologic studies, in an effort to determine whether or not a widened pulse pressure, or pure systolic hypertension, is an independent risk factor. In these analyses, blood pressure is divided into two components, one related to level and the other to pulse pressure, with pulse pressure redefined so that the association between pulse pressure and the prevalence of ECG abnormalities or mortality, indicates whether the endpoint is more strongly related to systolic or diastolic blood pressure. In these studies, blood pressure level is significantly related to both ECG abnormalities and mortality. In the cross-sectional analyses, pulse pressure is generally positively related to the prevalence of ECG abnormalities, indicating a stronger association for systolic blood pressure, and thus a possible association with pure systolic hypertension. However, in the prospective analyses, pulse pressure is generally not related to mortality, indicating an equal association with mortality for systolic and diastolic blood pressure in these studies. Thus, although the cross-sectional analyses generally support the hypothesis that a widened pulse pressure, or pure systolic hypertension, is an independent risk factor for the cardiovascular diseases and coronary heart disease, the prospective analyses do not.

The value of two or three versus a single reading of blood pressure at a first visit

Abstract Several indices of diastolic blood pressure (DBP), based on three DBP readings at a single examination were assessed to determine which was best for predicting blood pressure status over the next 8 years. Measures of both level and variability were evaluated, singly and in combination. The results show that two or three DBP readings at one sitting permit a more accurate classification of future blood pressure status than a single reading. The mean of three readings was the best measure for classifying individuals as hypertensive, borderline or normotensive. When used with the mean of three readings, variability of DBP at one examination did not consistently yield further information concerning risk of future hypertension.

Asymptomatic hyperglycemia and coronary heart disease in middle-aged men in two employed populations in Chicago

Abstract Studies of possible association between asymptomatic hyperglycemia and coronary disease were conducted among middle-aged employed men in Chicago. In one cohort, frequency of ECG abnormalities at baseline was examined among men at different glucose levels. In univariate analysis, those at the highest glucose levels had higher rates of ECG evidence of CHD, but this association did not remain when such factors as age, blood pressure, weight, cholesterol and cigarettes were taken into account in multivariate analysis. Among the studies, long-term follow-up to mortality (10, 13 and 15 yr) showed inconsistent findings on association of hyperglycemia and subsequent death. In one cohort (Gas Company men followed for 10 yr after a 1-hr post-load glucose determination) a positive glucose-mortality association was found in both univariate and multivariate analysis. But in the two remaining cohorts (Gas Company 13 yr after casual glucose determination and Western Electric 15 yr after 2-hr post-load determination), no such association was found. While differences in method and sample size as well as other limitations may have contributed to the differences observed, the inconsistency of the findings do not permit a conclusion that asymptomatic hyperglycemia is a positive coronary risk factor.

Pneumococcal meningitis: the problem of the unseen cerebrospinal fluid leak.

A study was done of all patients treated for pneumococcal meningitis at the Municipal Contagious Disease Hospital, Chicago, Illinois, between 1954 and 1968 to estimate the frequency and differential features of recurrent diseases. Seventeen of 155 patients (11 per cent) had more than one episode of bacterial meningitis. There were 26 deaths in the non-recurrent and none in the recurrent group. Neurological complications occurred in five of 17 patients (29.4 per cent) with recurrent disease and 18 of 138 patients (12.9 per cent) without recurrent meningitis. Recurrent meningitis was more frequent in younger persons and males. Patients with recurrent disease were more likely to have an upper respiratory infection, to be hospitalized early in their illness, and to have positive blood cultures. Although a history of severe head trauma was significantly more frequent in those with recurrent disease (35.3 per cent) than in those without recurrences (9.4 per cent), this history was often overlooked by the patient even in the presence of cerebrospinal fluid rhinorrhea. Most often the trauma occurred six months or more prior to the initial episode of meningitis. The data suggest that each patient presenting with pneumococcal meningitis should be evaluated for evidence of dural tears or other host defense defects. Controlled data concerning surgical or antibiotic prophylaxis are needed.

Relative weight and blood pressure in four Chicago epidemiologic studies

Because systolic blood pressure rises more sharply with age than diastolic blood pressure, leading to an increasing prevalence with advancing age of elevated systolic blood pressure without elevated diastolic pressure, i.e. so-called pure systolic hypertension, the question arises as to whether or not pure systolic hypertension has its own etiology and pathogenesis. Since pure systolic hypertension is characterized by a widened pulse pressure, the present report examined the association between relative weight and pulse pressure, both cross-sectionally and prospectively, in addition, to the association between relative weight and the level of blood pressure, in four Chicago epidemiologic studies. The positive association between relative weight and the level of blood pressure in these studies, in both cross-sectional and prospective analyses, reaffirms the finding in previous studies of a positive association between weight and blood pressure and the prevalence and incidence of hypertension. However, the results of these studies did not generally support the hypothesis that relative weight is related to pulse pressure, and thus possibly to pure systolic hypertension.

An Analysis of Ordering Patterns and Utilization of Bacteriological Culture Reports.

Excerpt A 2-week-period prevalence study was conducted to determine ordering patterns and utilization of bacteriological reports. All bacteriological reports (1381) were monitored, and ongoing char...