Richard B. Shekelle

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.

Relationship of Baseline Major Risk Factors to Coronary and All-Cause Mortality, and to Longevity: Findings from Long-Term Follow-Up of Chicago Cohorts

The focus here is on relationships between major risk factors and long-term mortality from coronary heart disease (CHD) and all causes, and on longevity, in Chicago cohorts: 25-year follow-up for Peoples Gas (PG) men aged 25-39 (n = 1,119), 30-year follow-up for PG men aged 40-59 (n = 1,235), 24-year follow-up for Western Electric (WE) men aged 40-55 (n = 1,882); also 15-year follow-up for five cohorts of the Chicago Heart Association (CHA) Study: men aged 25-39 (n = 7,873), 40-59 (n = 8,515), 60-74 (n = 1,490), and women aged 40-59 (n = 7,082) and 60-74 (n = 1,243); also 12-year findings for very low risk men (n = 11,098) and other men (n = 350,564) screened for the Multiple Risk Factor Intervention Trial (MRFIT). With a high degree of consistency, multivariate analyses showed independent positive relationships of baseline serum cholesterol, blood pressure and cigarette use to risk of death from CHD and all causes. For the WE cohort, with baseline nutrient data, dietary cholesterol was also independently related to these mortality risks. Combined risk factor impact was strong for both men and women of all baseline ages. Thus, for WE men, favorable compared to observed levels of serum cholesterol, blood pressure, cigarette use and dietary cholesterol were estimated to result in 24-year risk of CHD death 69% lower, all-cause death 42% lower and longevity 9 years greater. For CHA middle-aged and older women, favorable baseline levels of serum cholesterol, blood pressure and cigarette use were estimated to yield 15-year-CHD risk lower by about 60% and longevity greater by about 5 years. For MRFIT, very low risk men (serum cholesterol < 182 mg/dl, systolic/diastolic blood pressure < 120/<80), nonsmokers, nondiabetic, no previous heart attack), compared to all others, observed 12-year death rates were lower by 89% for CHD, 79% for stroke, 86% for all cardiovascular diseases, 30% for cancers, 21% for other causes, 53% for all causes, and longevity was estimated to be more than 9 years longer. These findings indicate great potentials for prevention of the CHD epidemic and for increased longevity with health for men and women, through improved life-styles and consequent lower risk factor levels.

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. n nWith 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. n nStatistical 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. n nThese 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. n nWith 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. n nIt 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. n nThis evidence supports the general hypothesis that patterns of behavior are significant in the epidemiology of coronary heart disease in man.

Serum uric acid and 11.5-year mortality of middle-aged women: Findings of the Chicago heart association detection project in industry

The relationships of serum uric acid to mortality from all causes, the cardiovascular diseases, and cancer were evaluated in 6797 white women age 35-64 years followed for an average of 11.5 years in the Chicago Heart Association Detection Project in Industry (CHA). Serum uric acid levels at baseline were strongly and significantly associated with all causes mortality in this cohort, with control for multiple risk factors and with exclusion of hypertensives on treatment. When the analysis was performed on age-specific groups 35-44, 45-54, and 55-64 years of age, the association was observed primarily in women in the oldest age group. All cardiovascular deaths, deaths due to coronary heart disease, and all cancer deaths were also associated with serum uric acid levels in the 55-64 year old group. The relationships persisted with control for multiple risk factors and with exclusion of treated hypertensives. A site-specific analysis of cancer deaths demonstrated elevations in mean serum uric acid levels for nearly all sites. Differences in mean serum uric acid levels between decedents and survivors tended to be largest in the first 5 years of follow-up for the cardiovascular deaths, but for cancer decedents they tended to be larger for subsequent years of follow-up. As an initial report on the association of serum uric acid and cancer in women in this age group, the results of this study require confirmation. Although hormonal influences may play a role, pathophysiologic mechanisms relating serum uric acid to mortality in white women aged 55-64 are currently unknown.

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.

Neuroticism and cynicism and risk of death in middle-aged men: The Western Electric study

&NA; MMPI measures of neuroticism (N) and of cynicism (C) were obtained at the initial examination of 1871 employed, middle‐aged men in Chicago. Neither N nor C was significantly associated cross‐sectionally with systolic blood pressure or serum cholesterol, but both were positively associated with cigarette smoking and alcohol consumption. N was not significantly associated with risk of death from coronary disease, other cardiovascular diseases, cancer, all other causes combined, or all causes combined after adjustment for C, age, cigarette smoking, alcohol consumption, systolic blood pressure, and serum cholesterol. C was significantly associated with coronary death and total mortality after adjustment for N and the other variables listed above, and relative risks of 1.4 to 1.6 were observed for all endpoints. These results support the idea that neuroticism is not associated with major causes of mortality, but that cynicism is associated with several causes. The associations between cynicism and mortality may be mediated by cigarette smoking and excessive alcohol consumption since adjustment for these factors may have been incomplete due to correlation between cynicism and errors in self‐reported data.

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.

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.

Dietary cholesterol and ischaemic heart disease.

In a cohort of 1824 middle-aged men followed for 25 years, intake of dietary cholesterol was associated with risk of death from ischaemic heart disease, from other cardiovascular diseases combined, from all cardiovascular diseases combined, and from all causes combined. The relative hazard of death from all cardiovascular diseases combined, associated with the difference between the mean of the first and fifth quintiles of cholesterol intake (a difference of 184 mg cholesterol/1000 kcal intake) was 1.46 (95% confidence interval 1.10-1.94) after adjustment for age, intake of other dietary lipids, and other coronary risk factors (including serum cholesterol). When stratified into three groups according to serum cholesterol (less than 220 mg/dl, 220-259 mg/dl, and 260 mg/dl or above), the corresponding relative hazards were 1.58, 1.50, and 1.41, respectively. These results are further evidence for the concepts that dietary cholesterol is atherogenic in man, and that the effect is partly independent of total serum cholesterol. They reinforce the recommendation that intake of dietary cholesterol should be low in people without overt hyperlipidaemia as well as those with raised serum cholesterol.

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.