Vincent L. Freeman

Association of A1C levels with vitamin D status in U.S. Adults: data from the national health and nutrition examination survey.

OBJECTIVE Data relating vitamin D status with indices of glucose homeostasis as manifested by A1C in the U.S. adult population are few. RESEARCH DESIGN AND METHODS We examined the association between serum 25 hydroxyvitamin D [25(OH)D] and A1C levels in 9,773 adults (age ≥18 years old) participating in the 2003–2006 National Health and Nutrition Examination Survey. Multivariate linear regression analyzed the association after accounting for potential confounders. RESULTS Serum 25(OH)D levels were inversely associated with A1C levels in subjects age 35–74 years (P = 0.0045) and those who did not report a history of diabetes (P = 0.0282). CONCLUSIONS These findings support a mechanistic link between serum vitamin D concentrations, glucose homeostasis, and the evolution of diabetes in a large segment of the U.S. adult population. Screening people with elevated A1C levels for vitamin D insufficiency should be considered.

Admixture and Population Stratification in African Caribbean Populations

Throughout biomedical research, there is growing interest in the use of ancestry informative markers (AIMs) to deconstruct racial categories into useful variables. Studies on recently admixed populations have shown significant population substructure due to differences in individual ancestry; however, few studies have examined Caribbean populations. Here we used a panel of 28 AIMs to examine the genetic ancestry of 298 individuals of African descent from the Caribbean islands of Jamaica, St. Thomas and Barbados. Differences in global admixture were observed, with Barbados having the highest level of West African ancestry (89.6%± 2.0) and the lowest levels of European (10.2%± 2.2) and Native American ancestry (0.2%± 2.0), while Jamaica possessed the highest levels of European (12.4%± 3.5) and Native American ancestry (3.2%± 3.1). St. Thomas, USVI had ancestry levels quite similar to African Americans in continental U.S. (86.8%± 2.2 West African, 10.6%± 2.3 European, and 2.6%± 2.1 Native American). Significant substructure was observed in the islands of Jamaica and St. Thomas but not Barbados (K=1), indicating that differences in population substructure exist across these three Caribbean islands. These differences likely stem from diverse colonial and historical experiences, and subsequent evolutionary processes. Most importantly, these differences may have significant ramifications for case‐control studies of complex disease in Caribbean populations.

PROSTATIC LEVELS OF FATTY ACIDS AND THE HISTOPATHOLOGY OF LOCALIZED PROSTATE CANCER

PURPOSE The consumption of various fatty acids has been associated with advanced stage and fatal prostate cancer. While numerous mechanisms have been postulated, to our knowledge there physiological data linking exposure and prognosis in humans are lacking. We examined prostatic levels of individual fatty acids in relation to the prevalence of histopathological characteristics associated with invasiveness and the risk of progression in 49 men undergoing radical prostatectomy for localized prostate cancer. MATERIALS AND METHODS Fatty acids were measured using capillary gas chromatography in fresh nonmalignant prostate tissue collected at surgery. Markers of invasiveness and increased risk of progression (Gleason sum 7 or greater, perineural invasion, anatomical or surgical margin involvement, extracapsular extension, seminal vesical involvement and stage T3 tumor) were evaluated separately. Each marker was dichotomized into a yes (case) and no (control) level with patients grouped accordingly. Mean concentrations were compared using the Wilcoxon rank sum test. RESULTS The percent of total prostatic polyunsaturated fat and polyunsaturated-to-saturated fat ratios were significantly lower in the presence of perineural invasion, seminal vesical involvement and stage T3 tumor (p = 0.02 to 0.049). alpha-Linolenic acid was significantly lower when tumor extended to an anatomical or surgical margin (p = 0.008). The omega-3 and omega-3-to-omega-6 fatty acid ratios were 1.5 to 3.3-fold lower in cases than in controls, reaching borderline significance in nearly all comparisons (p = 0.052 to 0.097). Saturated and monounsaturated fatty acids were not associated with the traits examined. CONCLUSIONS These data suggest that polyunsaturated fatty acids and perhaps essential fatty acids in particular help to regulate prostate carcinogenesis in humans.

A comparative study of hypertension prevalence, awareness, treatment and control rates in St Lucia, Jamaica and Barbados

Background Cardiovascular diseases represent the most common cause of death in the English-speaking Caribbean, and hypertension represents the most important predisposing condition. However, direct between-country comparative studies in the Caribbean have not previously been undertaken. Objective To obtain estimates of hypertension prevalence, awareness, treatment and control in three countries in the Caribbean. Design Population-based samples of adults aged 25–74 years in St Lucia, Barbados and Jamaica were surveyed regarding their cardiovascular health and their blood pressures were measured using a highly standardized protocol. A reference site was available from a collaborative study among blacks in metropolitan Chicago, Illinois, USA. Results At the 160/95 mmHg threshold, age-adjusted hypertension prevalence estimates for Jamaica, St Lucia and Barbados were 17.5, 18.3 and 21.5%, respectively, and 24.7, 26.9 and 27.9%, respectively, at the 140/90 mmHg threshold. The corresponding estimate for the Chicago site at the 140/90 mmHg threshold was 33.2%. The gradient in prevalence resembled the gradient in body mass index (25.7 kg/m2 in Jamaica to 29.3 kg/m2 in the USA). At the 160/95 mmHg threshold, the proportion of all hypertensives who were aware of their disease, pharmacologically treated and controlled was highest in Barbados (90, 85 and 72%, respectively) and lowest in St Lucia (74, 59 and 35%, respectively). Men, particularly those aged less than 55 years, were less likely to have their hypertension treated and controlled. Conclusions Compared with estimates from earlier independent surveys, considerable progress has been made in hypertension detection and control in these countries, which should lead to sizable reductions in the burden of cardiovascular disease.

Inverse association between prostatic polyunsaturated fatty acid and risk of locally advanced prostate carcinoma.

An effect of fatty acids has been implicated in men with advanced‐stage prostate carcinoma and in men who have died of the disease. To evaluate the influence of fatty acids in men with prostate carcinoma at earlier stages, the authors examined the relation between prostatic concentrations of fatty acids and locally advanced prostate carcinoma in men with clinically organ‐confined disease.

Determinants of Mortality Following a Diagnosis of Prostate Cancer in Veterans Affairs and Private Sector Health Care Systems

OBJECTIVES We compared patterns of mortality among men with prostate cancer at 2 Department of Veterans Affairs (VA) and 2 private-sector hospitals in the Chicago area. METHODS Mortality rates for 864 cases diagnosed between 1986 and 1990 were estimated using Cox proportional hazards models that incorporated age; income; cancer stage, differentiation, and treatments; and baseline comorbidity. RESULTS Race tended to associate with all-cause mortality irrespective of health care setting (Blacks vs Whites: hazard rate ratio [HRR] = 1.68 [95% confidence interval (CI) = 1.06, 2.67]; P <.001 in the private sector; HRR = 1.50 [95% CI = 0.94, 2.38]; P =.088 in the VA). However, comorbidity determined risk in the VA, whereas age and income predicted risk in the private sector. CONCLUSIONS Determinants of all-cause mortality in men with prostate cancer vary according to health care setting.

Race and the histologic grade of prostate cancer

We collected data on the histologic grade, stage, and age at diagnosis of 4,114 cases of prostate cancer (1,380 blacks, and 2,734 whites) in the Chicago area. The relationship between histologic grade (high = poorly or undifferentiated vs. low = well or moderatly differentiated) and race (black vs. white) was examined using logistic regression. After adjusting for stage (localized, regional, and distant), the odds of high histologic grade prostate cancer in blacks compared to whites equaled 1.7 (95% CI [1.4, 2.0], P < 0.0001). These data suggest that blacks have a significantly higher burden of high histologic grade prostate cancer than whites, even after adjustment for stage at presentation. This higher burden may explain, in part, their higher mortality rate from prostate cancer given the U.S. black vs. white difference in prostate cancer mortality of a similar magnitude. Prostate 30: 74–84, 1997.

Gleason Grading of Prostate Cancer Level of Concordance Between Pathologists at the University Hospital of the West Indies

Our aim was to study the level of interobserver concordance in the Gleason scores of prostate needle biopsy specimens reported at 1 institution. A retrospective review of all prostate needle biopsy specimens in which a diagnosis of adenocarcinoma was made during the year 2000 was conducted. Parameters evaluated included the Gleason score, Gleason grades identified, the percentage of Gleason grades 4 and 5, and the percentage of tumor in the biopsy specimen. Our results demonstrated a 60% overall concordance in consensus Gleason scores, which increased to 80% when considered in groups of a Gleason score of less than 7 vs 7 or more. The greatest discordance seemed to be in distinguishing Gleason score 6 from 7 and was more frequent among biopsy specimens with lower tumor volumes, particularly among those with less than 30% involvement. A small percentage of Gleason grade 4 pattern might predict disagreement as well. Strategies for improving accuracy of Gleason score 7 should be devised, and consensus diagnosis for biopsy specimens that demonstrate a low percentage of tumor volume is recommended.

Brief smoking cessation intervention: A prospective trial in the urology setting

PURPOSE Urologists have an important role in the treatment of tobacco related diseases, such as kidney and bladder cancer. Despite this role, urologists receive little training in promoting tobacco cessation. We prospectively evaluated a brief smoking cessation intervention offered by a urologist at an outpatient clinic. MATERIALS AND METHODS Between 2009 and 2011 adult smokers from a single institution urology clinic were enrolled in a prospective, brief intervention trial or in usual care as controls. All patients were assessed by the validated Fagerström test for nicotine dependence and the readiness to quit questionnaire. Trial patients received a 5-minute brief smoking cessation intervention. The primary outcome was abstinence at 1 year and the secondary outcome was the number of attempts to quit. Multivariate logistic regression was used to identify factors associated with the quit rate and quit attempts. RESULTS A total of 179 patients were enrolled in the study, including 100 in the brief smoking cessation intervention, 41 in the brief smoking cessation intervention plus nicotine replacement therapy and 38 usual care controls. Of the participants 81.0% were 40 years old or older with a mean ± SD 11.26 ± 7.23 pack-year smoking history. Mean readiness to quit and tobacco dependence scores were similar in the 2 arms (p = 0.25 and 0.92, respectively). The 1-year quit rate in the brief smoking cessation intervention group was 12.1% vs 2.6% in the usual care group (OR 4.44, p = 0.163) Adding nicotine replacement therapy increased the quit rate to 19.5% (vs usual care OR 9.91, p = 0.039). Patients who received the brief smoking cessation intervention were significantly more likely to attempt to quit (OR 2.31, p = 0.038). Increased readiness scores were associated with an increased quit rate and increased quit attempts. CONCLUSIONS Urologists can successfully implement a brief smoking cessation intervention program. Our study highlights the role of the urologist in providing smoking cessation assistance and the significant impact of brief, simple advice about quitting smoking on the smoker quit rate.

Racial Differences in Survival Among Men With Prostate Cancer and Comorbidity at Time of Diagnosis

OBJECTIVES This study evaluated the effect of comorbidity at diagnosis on racial differences in survival among men with prostate cancer. METHODS Clinical and demographic data were abstracted from records of 864 patients diagnosed at 4 Chicago area hospitals between 1986 and 1990. Comorbidity was scored on the basis of clinical information in the Charlson index. Cause-specific relative mortality adjusted for age, stage, differentiation, and treatment was compared across Charlson scores with Cox proportional hazards functions. RESULTS Blacks had significantly greater mortality from prostate cancer and other causes (vs Whites, relative risk [95% confidence interval] = 1.84 [1.22, 2.79] and 1.69 [1.33, 2.29], respectively; P <.001). However, differences disappeared as initial comorbidity increased (1.75 [1.33, 2.31] vs 0.90 [0.59, 1.29] for scores = 0 and > or =5, respectively). CONCLUSIONS Absence of a significant preexisting medical diagnosis is associated with a higher risk for excess mortality among Black men diagnosed with prostate cancer.