Oglesby Paul

DIETARY VITAMIN D AND CALCIUM AND RISK OF COLORECTAL CANCER: A 19-YEAR PROSPECTIVE STUDY IN MEN

Mortality rates from colon cancer in the USA are highest in populations exposed to the least amounts of natural sunlight; differences in endogenous vitamin D production and calcium absorption could be responsible. To investigate this possibility, the association of dietary vitamin D and calcium with 19-year risk of colorectal cancer was examined in 1954 men who had completed detailed, 28-day dietary histories in the period 1957-59. Risk of colorectal cancer was inversely correlated with dietary vitamin D and calcium. In the quartiles of a combined index of dietary vitamin D and calcium, from lowest to highest, observed risks of colorectal cancer were 38.9, 24.5, 22.5, and 14.3/1000 population. This association remained significant after adjustment for age, daily cigarette consumption, body mass index, ethanol consumption, and percentage of calories obtained from fat.

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.

Hostility, risk of coronary heart disease, and mortality

&NA; Level of hostility (Ho) was assessed by a 50‐item subscale of the Minnesota Multiphasic Personality Inventory at the initial examination of 1877 employed middle‐aged men who were free of coronary heart disease (CHD). Ten‐year incidence of major CHD events (myocardial infarction and CHD death) was lowest in the first quintile of the Ho scales distribution, highest in the middle quintile, and intermediate in the other three quintiles. After adjustment for age, blood pressure, serum cholesterol level, cigarette smoking, and intake of ethanol, the relative odds of a major CHD event was 0.68 for men with Ho scores less than or equal to 10 points in comparison to men with higher scores. The Ho scale was positively associated with crude 20‐year mortality from CHD, malignant neoplasms, and causes other than cardiovascular—renal diseases and malignant neoplasms. After adjustment for the risk factors listed above, the Ho scale had a statistically significant, positive, monotonic association with 20‐year risk of death from all causes combined. A difference of 23 points on the Ho scale, i.e., the difference between the means of the first and the fifth quintiles, was associated with a 42% increase in the risk of death. These results support the previous findings of Williams et al. with respect to the Ho scale and coronary atherosclerosis, and also suggest that the Ho scale may be associated with factors having broad effects on survival.

A Longitudinal Study of Coronary Heart Disease

Certain of the data accumulated over the course of more than 4 years in a prospective study of coronary heart disease being carried on in an industrial population have been presented.In a base population of 1,989 men, 88 cases of coronary heart disease have developed: angina pectoris, 47 men; myocardial infarction, 28 men; death from coronary, disease, 13 men. This approximates one case per 100 men per year.The development of clinical coronary heart disease has shown an association with early age of death of father, history of “noncardiac” chest discomfort, history of chronic cough, history of shortness of breath, history of peptic ulcer, presence of increased skinfold thickness, elevated blood pressure, AV nicking in the fundi, elevated blood cholesterol, ST and T abnormalities in the electrocardiogram, and use of cigarettes and coffee.No relation was encountered between body weight, mean blood sugar levels, lipoprotein lipase levels, or diet (other than coffee), and the development of coronary heart disease. Similarly, there was no association with job type and no certain relation to physical activity off the job.

DIETARY VITAMIN A AND RISK OF CANCER IN THE WESTERN ELECTRIC STUDY

Intake of dietary provitamin A (carotene) was inversely related to the 19-year incidence of lung cancer in a prospective epidemiological study of 1954 middle-aged men. The relative risks of lung cancer in the first (lowest) to fourth quartiles of the distribution of carotene intake were respectively, 7.0, 5.5, 3.0, and 1.0 for all men in the study, and 8.1, 5.6, 3.9, and 1.0 for men who had smoked cigarettes for 30 or more years. Intake of preformed vitamin A (retinol) and intake of other nutrients were not significantly related to the risk of lung cancer. Neither carotene nor retinol intake was significantly related to the risk of other carcinomas grouped together, although for men in whom epidermoid carcinomas of the head and neck subsequently developed, carotene intake tended to be below average. These results support the hypothesis that dietary beta-carotene decreased the risk of lung cancer. However, cigarette smoking also increases the risk of serious diseases other than lung cancer, and there is no evidence that dietary carotenoids affect these other risks in any way.

Psychological depression and 17-year risk of death from cancer.

&NA; Psychological depression, measured in 1957‐1958 by the Minnesota Multiphasic Personality Inventory at the baseline examination of 2,020 middle‐aged employed men, was associated (p less than 0.001) with a twofold increase in odds of death from cancer during 17 years of follow‐up. The association did not vary appreciably in magnitude among the early (1958‐1962), middle (1963‐1968), and later (1969‐1974) years of follow‐up, persisted after adjustment for age, cigarette smoking, use of alcohol, family history of cancer, and occupational status, and was apparently not specific to any particular site or type of cancer. This result, predicted in advance on the basis of findings by other investigators, is consistent with the hypothesis that psychological depression is related to impairment of mechanisms for preventing the establishment and spread of malignant cells.

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.

COLON CANCER AND BLOOD-CHOLESTEROL

Abstract Internationally there is a correlation between the mortality-rates for colon cancer and coronary heart-disease. Dietary fat is suspected as a common aetiological factor, perhaps operating in colon cancer through the transformation of bile-salts into carcinogens by certain intestinal bacteria. This evidence prompts a search for associations between the two diseases within individual populations, and the present report analyses the relation between blood-cholesterol level and the development of colon cancer. Data from six prospective studies of coronary heart-disease in men have been pooled, yielding 90 cases of colon cancer. The initial levels of blood-cholesterol in these men were found surprisingly to be lower than the expected values, the median deviation being -0·26 standard-deviation units (corresponding to a little more than 10 mg. er 100 ml.), p

A prospective study of the relationship between personality and coronary heart disease

As part of a prospective epidemiological study of coronary heart disease, the Minnesota Multiphasic Personality Inventory (MMPI) and the Sixteen Personality Factor Questionnaire (16PF) were used to obtain measures of personality from 1990 men who were 40–55 years of age and free of clinical coronary disease at the beginning of the study 412 years ago. With respect to the MMPI, data are presented for 48 men who have subsequently developed only the symptoms of angina pectoris, 37 men who have had myocardial infarctions, and 1771 men who have remained free of clinical coronary heart disease. For the 16PF, the number of cases in the angina, infarct, and non-coronary groups is 31, 18, and 1773, respectively. In all cases, the data on personality were obtained prior to the appearance of clinical coronary heart disease. Statistical analyses of these data indicate that the men who subsequently developed angina pectoris, in comparison to the subjects with myocardial infarction, scored significantly higher on the HsK and Hy scales of the MMPI and lower on Factor C of the 16PF. It was also found that the total coronary group (cases of angina plus cases of infarct) had significantly higher mean scores on Factors L and Q2 than the men in the non-coronary group. These findings suggest that the men in the angina group, as compared to the men with myocardial infarction, were characterized before the clinical appearance of coronary heart disease by the following attributes: (1) a tendency to complain about somatic symptoms of all sorts and to be worried about the state of their health even in the absence of objective findings; (2) greater lability in cardiovascular functioning; and (3) greater emotional lability and suggestibility. With respect to the observed psychometric differences between the total coronary and non-coronary groups, it is inferred that the men who later developed coronary heart disease, as compared to those who did not, tended to be: (1) more independent in their social relationships; (2) more suspicious about the motives of other people; and (3) to have greater feelings of inner tension. It is emphasized that these results should not be taken as descriptions of ‘coronaryprone’ or ‘angina-prone’ personalities because these data do not by themselves demonstrate the existence of an etiological relationship between personality and coronary heart disease. This evidence supports the general hypothesis that patterns of behavior are significant in the epidemiology of coronary heart disease in man.

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.