Robert I. Sholtz

Multivariate prediction of coronary heart disease during 8.5 year follow-up in the western collaborative group study

The Western Collaborative Group Study is a prospective study of 3,154 employed men aged 39 to 59 years. Ischemic heart disease occurred in 257 subjects during 8.5 years of follow-up. Risk of coronary heart disease was studied with use of the multiple logistic risk model. The incidence of coronary heart disease had a highly significant association with serum cholesterol level, behavior pattern, cigarette smoking and systolic blood pressure in younger (39 to 49 years) and older (50 to 59 years) men and also with age and corneal arcus in the younger group. Type A behavior pattern was strongly related to the incidence of coronary disease in both age groups, independent of interrelations of behavior patterns with any other risk factor.

DDT and Breast Cancer in Young Women: New Data on the Significance of Age at Exposure

Background Previous studies of DDT and breast cancer assessed exposure later in life when the breast may not have been vulnerable, after most DDT had been eliminated, and after DDT had been banned. Objectives We investigated whether DDT exposure in young women during the period of peak DDT use predicts breast cancer. Methods We conducted a prospective, nested case–control study with a median time to diagnosis of 17 years using blood samples obtained from young women during 1959–1967. Subjects were members of the Child Health and Development Studies, Oakland, California, who provided blood samples 1–3 days after giving birth (mean age, 26 years). Cases (n = 129) developed breast cancer before the age of 50 years. Controls (n = 129) were matched to cases on birth year. Serum was assayed for p,p′-DDT, the active ingredient of DDT; o,p′-DDT, a low concentration contaminant; and p,p′-DDE, the most abundant p,p′-DDT metabolite. Results High levels of serum p,p′-DDT predicted a statistically significant 5-fold increased risk of breast cancer among women who were born after 1931. These women were under 14 years of age in 1945, when DDT came into widespread use, and mostly under 20 years as DDT use peaked. Women who were not exposed to p,p′-DDT before 14 years of age showed no association between p,p′-DDT and breast cancer (p = 0.02 for difference by age). Conclusions Exposure to p,p′-DDT early in life may increase breast cancer risk. Many U.S. women heavily exposed to DDT in childhood have not yet reached 50 years of age. The public health significance of DDT exposure in early life may be large.

EFFECT OF CIGARETTE SMOKING AND COFFEE DRINKING ON TIME TO CONCEPTION

To test the hypothesis that coffee consumption and cigarette smoking are associated with time to conception, we analyzed data collected from 1,341 primigravidas participating in the Child Health and Development Studies in the San Francisco Bay Area between 1959 and 1966. Women were interviewed in person about their reproductive and medical history, habits (smoking, coffee and alcohol consumption), and sociodemo-graphic characteristics. Logistic regression models showed that after adjusting for covariates, women who smoked cigarettes had about one-half the fertility [odds ratio (OR) = 0.5–0.6] of nonsmoker-noncoffee drinkers for times to conception of 6 and 12 months, regardless of whether they drank coffee. On the other hand, coffee consumers who did not smoke did not have decreased fertility compared with nondrinkers who did not smoke (adjusted OR = 1.0–1.2). Coffee drinking did not increase the risk of delayed conception among smokers over the risk posed by the smoking exposure by itself (adjusted OR = 0.6–0.8). We observed an effect of smoking even at low doses (1–9 cigarettes per day). The present study adds to the evidence of an association between cigarette smoking and reduced fertility.

Relation of Corneal Arcus to Cardiovascular Risk Factors and the Incidence of Coronary Disease

Abstract The relation of corneal arcus to the incidence of clinical coronary heart disease was prospectively studied in 3152 men, 39–59 years old at intake. During a mean 8 1/2-year follow-up period, coronary disease developed in 255 initially well men. At entry into the study, arcus prevalence was found to be significantly related to age, serum cholesterol and smoking habits, but was not related to hematocrit, blood pressure, weight or obesity, habitual physical activity or diet, parental history of coronary heart disease, serum triglycerides or lipoproteins or to alcohol use. Subjects under 50 years of age with corneal arcus had a significantly higher incidence of coronary heart disease even after adjustment for age, serum cholesterol and smoking habits. Corneal arcus at younger ages is an independent risk factor for coronary heart disease. (N Engl J Med 291:1322–1324, 1974)

Ocular components before and after acquired, nonaccommodative esotropia

Background Acquired nonaccommodative esotropia describes the sudden onset of a constant, comitant strabismus of idiopathic origin in children >6 months of age. Case Report We present a case of acquired nonaccommodative esotropia at 20 months of age in a subject participating in the Berkeley Infant Biometry Study, a longitudinal study of emmetropization and ocular component development in infants between 3 months and 3 years of age. Ocular components for this child were normal before the onset of strabismus (within 2 SD’s of the mean for orthotropic study participants) for refractive error, corneal power, lens radii, lens power, and ocular axial dimensions. Refractive error postsurgically was significantly more hyperopic and crystalline lens power lower than average at +2.38 D and 37.2 D, respectively. Conclusions The lack of abnormal ocular parameters is consistent with the idiopathic etiology of acute onset esotropia. This case suggests that ocular component values may not be useful for assessing the risk of acquired nonaccommodative esotropia.