91 research outputs found
Cardiovascular disease in women : an epidemiological study of atherogenic factors
Cardiovascular disease is generally considered to be a disorder of men. One
reason for this is the low incidence of the disease in women at younger age. At
older age. however. cardiovascular disease also becomes the most important
cause of mortality in women: at age 40. 15% of the mortality in women is due
to this disease compared to 45% at age 70.1 Currently. there is an increased
recognition of the public health importance of cardiovascular disease in women.
but data on cardiovascular risk factors are limited. The investigation of the
determinants of cardiovascular disease in women was the main purpose of the
work underlying the studies presented in this thesis.
Traditionally. epidemiologists have studied cardiovascular disease by examination
of the relation between potential risk factors and the prevalence or
incidence of cardiovascular events. One of the disadvantages of these studies is
that events reflect a near end-stage of disease which limits the study of risk
factors at earlier stages of disease. The majorunderlyingprocess of cardiovascular
disease is atherosclerosis. To study atherosclerosis non-invasively in asymptomatic
non-hospitalized subjects it is necessary to rely on vessels other than
the coronary or cerebral. In the studies presented in this thesis the presence of
radiographically detectable calcified plaques in the aorta was used as a measure
of atherosclerosis. Its ability to reflect a generalized process was studied by
examination of the association of aortic atherosclerosis with cardiovascular
morbidity and mortality using follow-up data of 1.359 men and 1,597 women
of the EPOZ study (Epidemiological Preventive Organization Zoeterrneer). and
of 2,336 men and 2,873 women of the Framingham Study
Serum cholesterol is a risk factor for myocardial infarction in elderly men and women: The Rotterdam Study
Objective. To investigate the associations of serum total and HDL cholesterol with the risk of myocardial infarction in men and women of 55 years and over. Design. The Rotterdam Study is a population-based prospective cohort study. In total 2453 men and 3553 women of 55 years and older were included in this study. The mean duration of follow-up was 4 years. Main outcome measures. Relative risks were estimated with Cox's proportional- hazard analysis. Cholesterol was analysed as a continuous variable and in sex-specific quartiles. Results. In subjects aged 55 years and older the relative risk of myocardial infarction was 1.9 in men (95% confidence interval 1.1-3.3) and 3.2 in women (1.5-6.4) in the highest compared to the lowest serum total cholesterol quartile (Q4 vs. Q1). In men and women of 70 years and older, total cholesterol remained an important risk factor for myocardial infarction (Q4 vs. Q1 relative risk 3.2; 1.3-7.7 and 2.9; 1.3- 6.6, respectively). For HDL cholesterol, the relative risk in the highest compared to the lowest quartile (Q4 vs. Q1) was 0.5 in men (0.3-0.9) and 0.4 in women (0.2-0.9). HDL cholesterol was a weaker predictor in men after the age of 70 (Q4 vs. Q1 0.8; 0.3-2.1). In women of 70 years and older the relative risk was also not significant (Q4 vs. Q1 0.6; 0.3-1.3), although the trend over the quartiles was still significant. Conclusion. Serum total cholesterol remains an important risk factor for myocardial infarction in men and women aged 70 years and older, whilst HDL cholesterol at older age remains important in women only
Variance heterogeneity analysis for detection of potentially interacting genetic loci: Method and its limitations
Background: Presence of interaction between a genotype and certain factor in determination of a trait's value, it is expected that the trait's variance is increased in the group of subjects having this genotype. Thus, test of heterogeneity of variances can be used as a test to screen for potentially interacting single-nucleotide polymorphisms (SNPs). In this work, we evaluated statistical properties of variance heterogeneity analysis in respect to the detection of potentially interacting SNPs in a case when an interaction variable is unknown.Results: Through simulations, we investigated type I error for Bartlett's test, Bartlett's test with prior rank transformation of a tr
Progression of aortic calcification is associated with metacarpal bone loss during menopause: a population-based longitudinal study
offerosclerosis and osteoporosis are major causes of morbidity and
mortality in postmenopausal women and have been suggested to be
associated. No study has examined whether progression of atherosclerotic
calcification is associated with bone loss. In the present study, we
examined progression of aortic calcification, diagnosed by radiographic
detection of calcified deposits in the abdominal aorta, in relation to
metacarpal bone loss, as assessed by metacarpal radiogrammetry, during
menopause. Initially premenopausal women (n=236), aged 45 to 57 years at
baseline, were followed for 9 years. We additionally assessed the
cross-sectional association between the extent of aortic calcification and
metacarpal bone mass and density in 720 postmenopausal women. Twenty-five
percent of women going through menopause showed progression of aortic
calcification. The average loss of metacarpal bone mass among women with
progression of aortic calcification was 3.2 mm(2), and their loss of
metacarpal bone density was 7.2 mm(2) %, whereas in women without
progression of aortic calcification, these losses were 2.0 mm(2) and 5.6
mm(2) %, respectively, adjusted for age and years of follow-up (P<0.05).
Additional adjustment for age at menopause, body mass index, blood
pressure, smoking, diabetes mellitus, and use of hormone replacement
therapy, thiazide, and loop diuretics did not influence these results. In
postmenopausal women, a graded inverse cross-sectional association between
the extent of aortic calcification and metacarpal bone mass and density
was found. In conclusion, our results indicate that progression of
atherosclerotic calcification is associated with increased bone loss in
women during menopause
Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study
BACKGROUND: Dietary flavonoids may protect against cardiovascular disease,
but evidence is still conflicting. Tea is the major source of flavonoids
in Western populations. OBJECTIVE: The association of tea and flavonoid
intake with incident myocardial infarction was examined in the general
Dutch population. DESIGN: A longitudinal analysis was performed with the
use of data from the Rotterdam Study-a population-based study of men and
women aged >or=55 y. Diet was assessed at baseline (1990-1993) with a
validated semiquantitative food-frequency questionnaire. The analysis
included 4807 subjects with no history of myocardial infarction, who were
followed until 31 December 1997. Data were analyzed in a Cox regression
model, with adjustment for age, sex, body mass index, smoking status,
pack-years of cigarette smoking, education level, and daily intakes of
alcohol, coffee, polyunsaturated fat, saturated fat, fiber, vitamin E, and
total energy. RESULTS: During 5.6 y of follow-up, a total o
Spatial QRS-T angle predicts cardiac death in a general population
AIMS: The aim of this study was to assess the prognostic importance of the
spatial QRS-T angle for fatal and non-fatal cardiac events. METHODS AND
RESULTS: Electrocardiograms (ECGs) were recorded in 6134 men and women
aged 55 years and over from the prospective population-based Rotterdam
Study. Spatial QRS-T angles were categorized as normal, borderline or
abnormal. Using Cox's proportional hazards model, abnormal angles showed
increased hazard ratios of cardiac death (age-and sex-adjusted hazard
ratio 5.2 (95% CI 4.0-6.8)), non-fatal cardiac events (2.2 (1.5-3.1)),
sudden death (5.6 (3.7-8.5)) and total mortality (2.3 (2.0-2.7)). None of
the classical cardiovascular and ECG predictors provided larger hazard
ratios. After adjustment for these predictors, the association of abnormal
spatial QRS-T angles with all fata
Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study
BACKGROUND: Overt hypothyroidism has been found to be associated with
cardiovascular disease. Whether subclinical hypothyroidism and thyroid
autoimmunity are also risk factors for cardiovascular disease is
controversial. OBJECTIVE: To investigate whether subclinical
hypothyroidism and thyroid autoimmunity are associated with aortic
atherosclerosis and myocardial infarction in postmenopausal women. DESIGN:
Population-based cross-sectional study. SETTING: A district of Rotterdam,
The Netherlands. PARTICIPANTS: Random sample of 1149 women (mean age +/-
SD, 69.0 +/- 7.5 years) participating in the Rotterdam Study.
MEASUREMENTS: Data on thyroid status, aortic atherosclerosis, and history
of myocardial infarction were obtained at baseline. Subclinical
hypothyroidism was defined as an elevated thyroid-stimulating hormone
level (>4.0 mU/L) and a normal serum free thyroxine level (11 to 25 pmol/L
[0.9 to 1.9 ng/dL]). In tests for antibodies to thyroid peroxidase, a
serum level greater than 10 IU/mL was considered a positive result.
RESULTS: Subclinical hypothyroidism was present in 10.8% of participants
and was associated with a greater age-adjusted prevalence of aortic
atherosclerosis (odds ratio, 1.7 [95% CI, 1.1 to 2.6]) and myocardial
infarction (odds ratio, 2.3 [CI, 1.3 to 4.0]). Additional adjustment for
body mass index, total and high-density lipoprotein cholesterol level,
blood pressure, and smoking status, as well as exclusion of women who took
beta-blockers, did not affect these estimates. Associations were slightly
stronger in women who had subclinical hypothyroidism and antibodies to
thyroid peroxidase (odds ratio for aortic atherosclerosis, 1.9 [CI, 1.1 to
3.6]; odds ratio for myocardial infarction, 3.1 [CI, 1.5 to 6.3]). No
association was found between thyroid autoimmunity itself an
J-shaped relation between blood pressure and stroke in treated hypertensives
The objective of this study was to investigate the relationship between
hypertension and risk of stroke in the elderly. The study was performed
within the framework of the Rotterdam Study, a prospective
population-based cohort study. The risk of first-ever stroke was
associated with hypertension (relative risk, 1.6; 95% CI, 1.2 t
Insulin resistance and the risk of stroke and stroke subtypes in the nondiabetic elderly
Insulin resistance, which plays a key role in the development of diabetes mellitus, is a putative modifiable risk factor for stroke. The aim of this study was to investigate if markers of insulin resistance were associated with risk of stroke in the general elderly population. This study was part of the large population-based Rotterdam Study and included 5,234 participants who were aged 55 years or older and stroke free and diabetes free at baseline (1997-2001). Fasting insulin levels and homeostasis model assessment for insulin resistance were used as markers for insulin resistance. Cox regression was used to determine associations between insulin resistance markers and stroke risk, adjusted for age, sex, and potential confounders. During 42,806 person-years of follow-up (median: 8.6 years), 366 first-ever strokes occurred, of which 225 were cerebral infarctions, 42 were intracerebral hemorrhages, and 99 were unspecified strokes. Fasting insulin levels were not associated with risk of any stroke, cerebral infarction, or intracerebral hemorrhage. Homeostasis model assessment for insulin resistance, which almost perfectly correlated with fasting insulin levels, was also not associated with risk of stroke or stroke subtypes. In conclusion, in this population-based cohort study among nondiabetic elderly, insulin resistance markers were not associated with risk of stroke or any of its subtypes
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