Siegfried Heyden

Risk of stroke in asymptomatic persons with cervical arterial bruits: a population study in Evans County, Georgia.

A survey of the rural community in Evans County, Georgia, revealed cervical arterial bruits in 72 (4.4 per cent) of 1620 persons 45 years of age of older without previous stroke, transient ischemic attacks, or overt ischemic heart disease. The prevalence of such asymptomatic bruits increased with age and was greater in women and persons with hypertension. We estimated the risk of stroke associated with cervical bruits during a six-year follow-up period, taking age and blood pressure into account. The presence of asymptomatic bruits was associated with a significantly higher risk of stroke in men but not in women, with odds ratios of 7.5 and 1.6, respectively. Despite the high risk of stroke among men with bruits, the correlation between the location of the bruits and the type of subsequent stroke was poor. Moreover, cervical bruits in men were a risk factor for death from ischemic heart disease. We suggest that asymptomatic cervical bruits are an indication of systemic vascular disease and do not themselves justify invasive diagnostic procedures or surgical correction of underlying extracranial arterial lesions.

Influence of race, sex and weight on blood pressure behavior in young adults.

This study is concerned with blood pressure behavior in young adults (aged 15 to 29 years) in the biracial community of Evans County, Ga., on two occasions 7 years apart. On the basis of casual blood pressure recordings the prevalence of systolic pressure equal to or greater than 140 mm Hg or diastolic pressure equal to or greater than 90 mm Hg, or both, showed race/sex differences as follows: white males 19.0 percent, white females 12.7 percent. black males 34.0 percent, black females 31.6 percent. Similar differences were noted in the incidence during the 7 year interval. The problem presented by the variability of the casual blood pressure recording is apparent in this interval study. Of particular interest is the association of weight with blood pressure in this youthful group, particularly among white males and females and black females, in relation to both initial and subsequent pressure levels. The data suggest that in this population under 30 years, weight is a risk factor for hypertension, and that maintenance of ideal weight, instituted in youth, may be a preventive measure.

Sex differences in coronary mortality among diabetics in Evans County, Georgia

Abstract Long-term epidemiological studies of diabetes mellitus and its sequelae are very few in number. More specifically, to our knowledge, only three prospective epidemiological studies have addressed themselves to the sex difference in coronary mortality among diabetics. The present report, in agreement with the three other long-term studies, demonstrates, in a 4.5-yr follow-up, an excess risk of CHD mortality among diabetics, of greater magnitude in women than in men. A multivariable risk function analysis was applied which included age, race, fasting triglycerides, cholesterol, body mass, blood pressure, smoking history and laboratory determination of the presence or absence of definite or probable diabetes. The accumulation of cardiovascular risk factors in diabetic women, though markedly stronger than among diabetic men, does not fully explain the higher CHD mortality among diabetic women.

Black-white differences in serum lipids and lipoproteins in Evans County

Abstract The Evans County Cardiovascular Disease Survey has demonstrated a higher prevalence and incidence of coronary heart disease in white than in black men. Prior studies by us have disclosed similar associations of CHD with the risk factors of elevated blood pressure, serum cholesterol, and smoking in Evans County as have been reported elsewhere. The lower frequencies of CHD in black than in white males are present, controlling for the standard risk factors in univariate and in multivariate logistic risk function analyses. Black-white differences in total serum triglyceride and in cholesterol within lipoprotein fractions at identical total serum cholesterol levels are described in this report. Significantly higher LDL cholesterol and total triglycerides are present in whites, and higher HDL cholesterol was found in blacks in an age, sex, and total serum cholesterol matched comparison. The determinants of the black-white differences in lipid and lipoprotein fraction distributions are still to be elucidated, but in this sample, lipid differences are not explained by social characteristics, such as occupation and social class. The black-white lipoprotein fraction differences in Evans County are consistent with a negative, coronary risk factor role of elevated HDL cholesterol, which has been postulated based on other experimental and prevalence studies.

Frequency of church attendance and blood pressure elevation

Blood pressure levels were examined with regard to church attendance patterns in a group of white male heads of households who appeared in the 1967–1969 follow-up examination of the Evans County Cardiovascular Epidemiologic Study. A consistent pattern of lower systolic and diastolic blood pressures among frequent church attenders was found compared to that of infrequent attenders which was not due to the effects of age, obesity, cigarette smoking, or socioeconomic status.

Coffee and cholesterol in epidemiological and experimental studies

Twenty-two cross-sectional studies involving 130,000 persons from 8 different countries have reported their findings on the association between coffee consumption and cholesterol levels. Results of these reports display a variety of trends in the association between coffee intake and serum cholesterol concentrations: 8 (36%) studies demonstrated a significant positive association in both sexes, and 5 (23%) studies showed no association in men or women. In 3 other reports where both sexes were included, significant positive association was observed only in women. The remaining 6 investigations examined only men with 4 (18%) reporting a significant correlation between coffee and cholesterol. This unexplained incongruity of cross-sectional data points to a relationship between coffee and cholesterol in some populations, which needs to be further explored. In addition, HDL cholesterol levels appeared unrelated to coffee intake in the 11 studies in which it was measured. The 7 available human experiments showed the same low level of agreement in the results among small numbers of volunteers. Experiments involving different brewing methods suggest that a major part of the cholesterol-increasing effect can be explained by different brewing methods. A critical assessment of the published reports leads to the conclusion that the data are insufficient to warrant public health admonitions against coffee drinking, but that it may be of clinical importance in some hypercholesterolemic individuals.

Ischemic heart disease risk factors and twenty-year mortality in middle-age Evans County black males

Ischemic heart disease (IHD) risk factors and 20-year mortality rates were studied in middle-aged Evans County black males. We hypothesized, a priori, that blood pressure, cholesterol, and smoking would be predictive of mortality in black males; that black-white differences in mortality would be due to differences in risk factor levels and not risk functions per se; and that social status would be associated with risk factor levels and would be a predictor of mortality. Multivariate analyses of cumulative risk of dying and time to death suggest that the major IHD risk factors are predictors of all-cause and IHD mortality in black males. Black-white differences in risk functions, specifically for cholesterol, were explained by social status: black males and lower social status white males had similar risk functions, different from those of higher social status white males. Black males and lower social status white males had almost identical survival curves, each less favorable than those of higher social status white males.

Fasting triglycerides as predictors of total and chd mortality in Evans County, Georgia

Abstract The association of fasting serum triglyceride concentrations with total and CHD mortality was examined after a 4.5-yr follow-up of the Evans County cohort. Among 1183 black and white examinees free of ischemic heart disease at intake, serum triglyceride levels at baseline were not predictive of mortality from all causes, nor from CHD in men of both races and in black women. Among white women aged 50 yr and older, high serum triglyceride concentrations were predictive of CHD mortality when contrasted with low triglyceride levels. This finding persisted after adjustment for age, diastolic blood pressure, smoking status, serum cholesterol, relative weight and diabetes.

The combined effect of smoking and coffee drinking on LDL and HDL cholesterol.

Conflicting reports on the effect of smoking and coffee drinking on lipoproteins prompted us to study the combined effect of these two associated, widely prevalent habits in 361 persons randomly sampled from the Evans County cohort. Low-density lipoprotein (LDL) cholesterol levels were significantly higher among persons who smoked cigarettes and consumed five or more cups of coffee per day than among nonsmokers who abstained from coffee. Conversely, high-density lipoprotein (HDL) cholesterol was higher in persons who did not smoke or drink coffee than in coffee-consuming smokers. However, this trend was not statistically significant. Triglycerides and very low-density lipoprotein (VLDL) cholesterol were highest among smokers who drank five or more cups of coffee per day, but these differences did not reach statistical significance. Lipoprotein cholesterol levels were adjusted for age, sex and body mass. Smoking and coffee drinking interact in affecting LDL and total cholesterol, but coffee drinking alone did not appear to affect blood lipids.

Apolipoprotein A-I, A-II and C-II in black and white residents of Evans County.

Plasma levels of lipids, lipoprotein-cholesterol and three major apolipoproteins (ApoA-I, A-II and C-II) were studied in 318 black and white males and females randomly sampled in Evans County, Georgia. Black-white differences in lipid and lipoprotein-cholesterol concentrations were observed, with low-density fractions higher in whites and high-density fractions higher in blacks. Plasma levels of ApoA-I but not ApoA-II were higher in blacks than in whites and in females than in males. ApoC-II concentrations were lower in black than in white men and women. Black-white differences in atherogenic lipoprotein fractions were statistically explained (in the sense of association, not necessarily of causal process) by the differences in ApoC-II concentrations between the race groups. Black-white diflerences in antiatherogenic high-density lipoprotein-cholesterol were greater than statistically predicted by differences in ApoA lipoprotein levels. The findings are indicative of black-white differences in lipoprotein composition.