Sharon L. Edelstein
George Washington University
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Journal of Bone and Mineral Research | 1997
Gail A. Greendale; Sharon L. Edelstein; Elizabeth Barrett-Connor
This study examines the associations between endogenous sex steroids and bone mineral density (BMD), using data from a geographically defined cohort in Rancho Bernardo, California. Participants were community‐dwelling women and men aged 50–89 years who took part in a study of endogenous sex steroid measurement between 1984–1987 and who had BMD measured in 1988–1991. Those taking corticosteroids or estrogen at the time of sex steroid determination were excluded. The main study outcomes were BMD of the ultradistal radius, midshaft radius, lumbar spine, and total hip by sex steroid level, adjusted for age, body mass index, cigarette smoking, alcohol consumption, leisure exercise, use of thiazides, thyroid hormones, and former estrogen use (women only). At the time of the hormone measurements, the mean age of the 457 women was 72.1 years and that of the 534 men was 68.6 years. A statistically significant positive relation was seen between bioavailable estradiol and BMD at all sites in women and men. Total estradiol was significantly associated with BMD at all sites in women and at all but the ultradistal radius in men. Estrone had a global effect on BMD in women and was not measured in men. Higher bioavailable (but not total) testosterone levels were associated with higher BMD of the ultradistal radius, spine, and hip in men and the ultradistal radius in women. Dehydroepiandrosterone was positively associated with BMD of the midradius, spine, and hip in women and was not associated with BMD at any site in men. Of the sex steroids tested, bioavailable estrogen was most strongly associated with BMD in both women and men. We conclude that endogenous sex steroid levels are significantly related to bone density in older women and men. Individual variation in age‐related bone loss may be partially accounted for by alterations in sex steroid levels with aging. Further study to elucidate safe environmental and medical methods to maintain optimal sex steroid levels in old age is needed.
Journal of the American Geriatrics Society | 1996
Elizabeth Barrett-Connor; Sharon L. Edelstein; Jody Corey-Bloom; Wigbert C. Wiederholt
OBJECTIVE: To determine whether the weight loss associated with Alzheimers disease precedes or follows the dementia.
Journal of Clinical Epidemiology | 1992
Hillary Klonoff-Cohen; Elizabeth Barrett-Connor; Sharon L. Edelstein
Serum albumin levels probably predict subsequent mortality in the elderly, but it is not clear whether this is independent of disease. A 3 year prospective study of 2342 healthy non-institutionalized men and women aged 50-89 years old, residing in Rancho Bernardo, California, confirmed the following findings. Serum albumin levels decreased with increasing age in both men and women, and this association was independent of health status. In addition, for every standard deviation decrease in albumin, the relative odds of dying was 1.24 (p = 0.04), after adjusting for age, sex and lifestyle factors such as smoking, exercise and alcohol consumption. Separating the study sample into those who did and did not report disease at baseline did not appreciably alter these findings. Most of the albumin levels of the older adults (70-89) fall within the normal and narrow range of the younger adults (50-69), nevertheless, albumin levels predict outcome independent of known disease. The albumin-early mortality association suggests that serum albumin levels are a predictor for subclinical disease in the healthy elderly.
Controlled Clinical Trials | 2002
Richard R. Rubin; Wilfred Y. Fujimoto; David G. Marrero; Tina Brenneman; Jeanne B. Charleston; Sharon L. Edelstein; Edwin B. Fisher; Ruth Jordan; William C. Knowler; Lynne C. Lichterman; Melvin Prince; Patricia M. Rowe
The Diabetes Prevention Program (DPP) is a multicenter randomized controlled trial designed to test whether diet and exercise or medication can prevent or delay the onset of type 2 diabetes in persons with impaired glucose tolerance, who are at increased risk of the disease. This paper describes DPP recruitment methods, strategies, performance, and costs. The DPP developed an organizational structure for comprehensive management and continuous monitoring of recruitment efforts. The DPP utilized a variety of recruitment strategies, alone or in combination, and a stepped informed consent procedure leading to randomization. Studywide and clinic-specific recruitment data were monitored, analyzed, and used to modify recruitment approaches. DPP recruitment was completed slightly ahead of schedule, meeting goals for the proportion of women enrolled and nearly meeting goals for the proportion of racial/ethnic minorities. Clinics varied widely in the recruitment strategies they used, and these strategies also varied by participant age, gender, and race/ethnicity. Staff time devoted to recruitment averaged 86.8 hours per week per clinic, with the majority of effort by staff specifically assigned to recruitment. The number of staff hours required to recruit a participant varied by recruitment strategy. Recruitment cost (excluding staff cost) was about 1075 US dollars per randomized participant. The DPP experience offers lessons for those planning similar efforts: (1) a method for ongoing assessment and revision of recruitment strategies is valuable; (2) a range of recruitment strategies may be useful; (3) the most effective methods for recruiting potential subjects may vary according to the gender, age, and race/ethnicity of those individuals; (4) recruitment strategies vary in the amount of staff time required to randomize a participant; and (5) a stepped screening may make it easier to identify and recruit volunteers who understand the requirements of the study.
Diabetes Care | 1996
Sue Park; Elizabeth Barrett-Connor; Deborah L. Wingard; Jun Shan; Sharon L. Edelstein
OBJECTIVE To examine the relation between GHb, fasting plasma glucose (FPG), postchallenge plasma glucose (PCPG), and mortality from cardiovascular disease (CVD) and ischemic heart disease (IHD) in older adults. RESEARCH DESIGN AND METHODS A community-based study of 1,239 nondiabetic older adults followed for an average of 8 years, from baseline (1984–1987) to 1993. RESULTS GHb, but not FPG or PCPG, was significantly related to CVD and IHD mortality in women but not men. The age-adjusted relative hazard for those in the highest quintile of GHb (≥ 6.7%) compared with women with lower levels was 2.37 for fatal CVD (95% CI = 1.30−4.31, P = 0.005) and 2.43 for IHD (95% CI = 1.12−5.25, P = 0.024). This association persisted after adjustment for all covariates (age, systolic blood pressure, BMI, LDL, HDL, triglycerides, cigarette smoking, antihypertensive medication use, and estrogen use). GHb was significantly associated with LDL and HDL levels in women, but the association between GHb and CVD or IHD persisted after adjustment for these lipoproteins. CONCLUSIONS We concluded that GHb is a better predictor of CVD and IHD mortality than FPG or PCPG in women without diabetes; no single measure of glycemia was predictive in men. The reason for the sex difference is unexplained.
Circulation | 1991
P D Reaven; Elizabeth Barrett-Connor; Sharon L. Edelstein
Although there is some evidence that physical activity may decrease blood pressure in young and middle-aged women, the physical activity-blood pressure association in older women has rarely been studied. As part of an ongoing community-based study of chronic disease, 641 Caucasian women between the ages of 50 and 89 years had blood pressure measured following the Hypertension Detection and Follow-up Program protocol. They also answered selected Health Interview Survey questions about their leisure-time activity and were classified into categories of light (58%), moderate (24%), heavy (6%), or no physical activity (12%) by the estimated metabolic rate required for each activity. Women who engaged in any physical activity were significantly younger and thinner than sedentary women and had lower fasting and 2-hour postchallenge insulin levels. They did not differ in alcohol consumption, cigarette use, or prevalence of coronary heart disease or diabetes. Rates of systolic and diastolic hypertension were significantly lower in women participating in light, moderate, or heavy physical activity compared with sedentary women. Blood pressure levels decreased with each increase in reported activity intensity (p less than 0.005 for trend), with systolic blood pressure approximately 20 mm Hg lower in the heaviest activity group compared with systolic blood pressure in sedentary women. Intergroup differences remained statistically significant after adjustment for age and body mass index. Although physical activity was associated with lower fasting and 2-hour postchallenge insulin levels (p less than 0.01 for trend), adjustment for insulin levels did not alter blood pressure differences among activity groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes | 2008
Kieren J. Mather; Tohru Funahashi; Yuji Matsuzawa; Sharon L. Edelstein; George A. Bray; Steven E. Kahn; Jill P. Crandall; Santica M. Marcovina; Barry J. Goldstein; Ronald N. Goldberg
OBJECTIVE— To determine whether baseline adiponectin levels or intervention-associated change in adiponectin levels were independently associated with progression to diabetes in the Diabetes Prevention Program (DPP). RESEARCH DESIGN AND METHODS— Cox proportional hazards analysis was used to evaluate the contribution of adiponectin and treatment-related change in adiponectin to risk of progression to diabetes. RESULTS— Baseline adiponectin was a strong independent predictor of incident diabetes in all treatment groups (hazard ratio per ∼3 μg/ml higher level; 0.61 in the lifestyle, 0.76 in the metformin, and the 0.79 in placebo groups; all P < 0.001, P = 0.13 comparing groups). Baseline differences in adiponectin between sexes and race/ethnicity groups were not reflected in differences in diabetes risk. DPP interventions increased adiponectin levels ([means ± SE] 0.83 ± 0.05 μg/ml in the lifestyle group, 0.23 ± 0.05 μg/ml in the metformin group, and 0.10 ± 0.05 μg/ml in the placebo group; P < 0.001 for increases versus baseline, P < 0.01 comparing groups). These increases were associated with reductions in diabetes incidence independent of baseline adiponectin levels in the lifestyle and placebo groups but not in the metformin subjects (hazard ratio 0.72 in the lifestyle group (P < 0.001), 0.92 in the metformin group (P = 0.18), and 0.89 in the placebo group; P = 0.02 per ∼1 μg/ml increase, P = 0.02 comparing groups). In the lifestyle group, adjusting for change in weight reduced, but did not remove, the effect of increased adiponectin. CONCLUSIONS— Adiponectin is a powerful marker of diabetes risk in subjects at high risk for diabetes, even after adjustment for weight. An increase in adiponectin in the lifestyle and placebo groups was associated with a reduction in diabetes risk. However, these changes in adiponectin were comparatively small and less strongly related to diabetes outcome than baseline adiponectin levels.
Journal of the American Geriatrics Society | 1994
Elizabeth Barrett-Connor; Sharon L. Edelstein
Objective: To determine whether low plasma dehydroepiandrosterone sulfate (DHEAS) levels predict poor cognitive function in the elderly.
Diabetes Care | 2012
George A. Bray; Sharon L. Edelstein; Jill P. Crandall; Vanita R. Aroda; Paul W. Franks; Wilfred Y. Fujimoto; Edward S. Horton; Susan Jeffries; Maria G. Montez; Sunder Mudaliar; F. Xavier Pi-Sunyer; Neil H. White; William C. Knowler
OBJECTIVE Metformin produced weight loss and delayed or prevented diabetes in the Diabetes Prevention Program (DPP). We examined its long-term safety and tolerability along with weight loss, and change in waist circumference during the DPP and its long-term follow-up. RESEARCH DESIGN AND METHODS The randomized double-blind clinical trial of metformin or placebo followed by a 7–8-year open-label extension and analysis of adverse events, tolerability, and the effect of adherence on change in weight and waist circumference. RESULTS No significant safety issues were identified. Gastrointestinal symptoms were more common in metformin than placebo participants and declined over time. During the DPP, average hemoglobin and hematocrit levels were slightly lower in the metformin group than in the placebo group. Decreases in hemoglobin and hematocrit in the metformin group occurred during the first year following randomization, with no further changes observed over time. During the DPP, metformin participants had reduced body weight and waist circumference compared with placebo (weight by 2.06 ± 5.65% vs. 0.02 ± 5.52%, P < 0.001, and waist circumference by 2.13 ± 7.06 cm vs. 0.79 ± 6.54 cm, P < 0.001 in metformin vs. placebo, respectively). The magnitude of weight loss during the 2-year double-blind period was directly related to adherence (P < 0.001). Throughout the unblinded follow-up, weight loss remained significantly greater in the metformin group than in the placebo group (2.0 vs. 0.2%, P < 0.001), and this was related to the degree of continuing metformin adherence (P < 0.001). CONCLUSIONS Metformin used for diabetes prevention is safe and well tolerated. Weight loss is related to adherence to metformin and is durable for at least 10 years of treatment.
Diabetes Care | 2006
Elizabeth A. Walker; Mark E. Molitch; M. Kaye Kramer; Steven E. Kahn; Yong Ma; Sharon L. Edelstein; Kellie Smith; Mariana K. Johnson; Abbas E. Kitabchi; Jill P. Crandall
OBJECTIVE—To evaluate barriers to and strategies for medication adherence and predictors of adherence and the primary outcome in the Diabetes Prevention Program (DPP). RESEARCH DESIGN AND METHODS—Within a randomized, controlled primary prevention study for type 2 diabetes, we collected data on study medication adherence, its predictors, and health outcomes in 27 clinical centers across mainland U.S. and Hawaii. Medication arm participants included 2,155 adults with impaired glucose tolerance randomly assigned to either metformin or matched placebo treatment arms. Structured interviews were used to promote medication adherence and to collect data regarding adherence. Adherence was measured by pill count. The primary DPP outcome of type 2 diabetes was assessed by fasting plasma glucose and oral glucose tolerance test. RESULTS—Older age-groups were more adherent than the youngest group (P = 0.01) in the metformin group. The most frequently reported barrier to adherence was “forgetting” (22%). Women reported more adverse effects of metformin (15 vs. 10%, P = 0.002) in the metformin group. Odds of nonadherence increased as participants reported more than one barrier (odds ratio 19.1, P < 0.001). Odds of adherence increased as participants reported multiple strategies to take medication (2.69, P < 0.0001). There was a 38.2% risk reduction for developing diabetes for those adherent to metformin compared with those adherent to placebo (P < 0.0003). CONCLUSIONS—DPP medication adherence results are unique in primary prevention for a chronic disease in a large multiethnic sample. Our finding that adherence was associated with risk reduction for diabetes supports the development of brief interventions in clinical settings where medication adherence is a challenge.
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University of Texas Health Science Center at San Antonio
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