Physical fitness and incidence of hypertension in healthy normotensive men and women

We measured physical fitness, assessed by maximal treadmill testing in 4,820 men and 1,219 women aged 20 to 65 years. Participants had no history of cardiovascular disease and were normotensive at baseline. We followed up these persons for one to 12 years (median, four years) for the development of hypertension. Multiple logistic risk analysis was used to estimate the independent contribution of physical fitness to risk of becoming hypertensive. After adjustment for sex, age, follow-up interval, baseline blood pressure, and baseline body-mass index, persons with low levels of physical fitness (72% of the group) had a relative risk of 1.52 for the development of hypertension when compared with highly fit persons. Risk of hypertension developing also increased substantially with increased baseline blood pressure.     

A prospective study of diet quality and mortality in women

Context  Most studies of diet and health care have focused on the role of single nutrients, foods, or food groups in disease prevention or promotion. Few studies have addressed the health effects of dietary patterns, which include complex mixtures of foods containing multiple nutrients and nonnutrients. Objective  To examine the association of mortality with a multifactorial diet quality index. Design and Setting  Data from phase 2 (1987-1989) of a prospective cohort study of breast cancer screening, the Breast Cancer Detection Demonstration Project, with a median follow-up of 5.6 years. Participants  A total of 42,254 women (mean age, 61.1 years) who completed the food frequency questionnaire portion of the survey. Main Outcome Measure  All-cause mortality by quartile of Recommended Food Score (RFS; the sum of the number of foods recommended by current dietary guidelines [fruits, vegetables, whole grains, low-fat dairy, and lean meats and poultry] that were reported on the questionnaire to be consumed at least once a week, for a maximum score of 23). Results  There were 2065 deaths due to all causes in the cohort. The RFS was inversely associated with all-cause mortality. Compared with those in the lowest quartile, subjects in the upper quartiles of the RFS had relative risks for all-cause mortality of 0.82 (95% confidence interval [CI], 0.73-0.92) for quartile 2, 0.71 (95% CI, 0.62-0.81) for quartile 3, and 0.69 (95% CI, 0.61-0.78) for quartile 4 adjusted for education, ethnicity, age, body mass index, smoking status, alcohol use, level of physical activity, menopausal hormone use, and history of disease (²₁ for trend=35.64, P<.001 for trend). Conclusions  These data suggest that a dietary pattern characterized by consumption of foods recommended in current dietary guidelines is associated with decreased risk of mortality in women.      

A prospective investigation of pulmonary embolism in women and men.

OBJECTIVE. The aim of this study was to compare, in women and men suspected of pulmonary embolism, the frequency, risk factors, diagnosis, and presentation of pulmonary embolism as well as the accuracy of the ventilation/perfusion scan (V/Q scan) as a diagnostic tool. DESIGN. Data were collected during a prospective study (the Prospective Investigation of Pulmonary Embolism Diagnosis) to establish the accuracy of the V/Q scan compared with pulmonary angiograms. SETTING. Six tertiary medical centers in Massachusetts, Michigan, Connecticut, Pennsylvania, and North Carolina. PARTICIPANTS. Patients suspected of pulmonary embolism for whom a request was made for a V/Q scan or pulmonary angiogram (496 women and 406 men). RESULTS. Women 50 years old and under had a decreased frequency of pulmonary embolism compared with men of that age (16% vs 32%), but there was no difference in patients over 50 years old (Breslow-Day test, P less than .01). Risk factors for pulmonary embolism, the usefulness of the V/Q scan, and 1-year mortality were not different for women and men. Estrogen use in women was not associated with an increased frequency of pulmonary embolism, except in women using oral contraceptives who had undergone surgery within 3 months; four of five (80%) had emboli compared with four of 28 (14%) age-matched surgical patients not using estrogens (P less than .01). CONCLUSION. Women 50 years old and under (even young women using oral contraceptives) who were suspected of having pulmonary emboli and were enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis study had a smaller frequency of pulmonary embolism than men of that age, The risk factors for pulmonary embolism were the same for women and men, except that women using oral contraceptives had an increased risk of pulmonary embolism following surgery. Although the V/Q scan was a useful tool in the preliminary evaluation for pulmonary embolism in these women, a pulmonary angiogram was often needed for accurate diagnosis.     

A prospective study of egg consumption and risk of cardiovascular disease in men and women

CONTEXT: Reduction in egg consumption has been widely recommended to lower blood cholesterol levels and prevent coronary heart disease (CHD). Epidemiologic studies on egg consumption and risk of CHD are sparse. OBJECTIVE: To examine the association between egg consumption and risk of CHD and stroke in men and women. DESIGN AND SETTING: Two prospective cohort studies, the Health Professionals Follow-up Study (1986-1994) and the Nurses' Health Study (1980-1994). PARTICIPANTS: A total of 37851 men aged 40 to 75 years at study outset and 80082 women aged 34 to 59 years at study outset, free of cardiovascular disease, diabetes, hypercholesterolemia, or cancer. MAIN OUTCOME MEASURES: Incident nonfatal myocardial infarction, fatal CHD, and stroke corresponding to daily egg consumption as determined by a food-frequency questionnaire. RESULTS: We documented 866 incident cases of CHD and 258 incident cases of stroke in men during 8 years of follow-up and 939 incident cases of CHD and 563 incident cases of stroke in women during 14 years of follow-up. After adjustment for age, smoking, and other potential CHD risk factors, we found no evidence of an overall significant association between egg consumption and risk of CHD or stroke in either men or women. The relative risks (RRs) of CHD across categories of intake were less than 1 per week (1.0), 1 per week (1.06), 2 to 4 per week (1.12), 5 to 6 per week (0.90), and > or =1 per day (1.08) (P for trend = .75) for men; and less than 1 per week (1.0), 1 per week (0.82), 2 to 4 per week (0.99), 5 to 6 per week (0.95), and > or =1 per day (0.82) (P for trend = .95) for women. In subgroup analyses, higher egg consumption appeared to be associated with increased risk of CHD only among diabetic subjects (RR of CHD comparing more than 1 egg per day with less than 1 egg per week among diabetic men, 2.02 [95% confidence interval, 1.05-3.87; P for trend = .04], and among diabetic women, 1.49 [0.88-2.52; P for trend = .008]). CONCLUSIONS: These findings suggest that consumption of up to 1 egg per day is unlikely to have substantial overall impact on the risk of CHD or stroke among healthy men and women. The apparent increased risk of CHD associated with higher egg consumption among diabetic participants warrants further research.     

A prospective study of cigarette smoking and risk of cataract in men.

OBJECTIVE--To examine the association between cigarette smoking and the incidence of cataract. DESIGN, SETTING, AND PARTICIPANTS--The design was a prospective cohort study using data from the Physicians' Health Study, a randomized trial of aspirin and beta carotene among 22,071 US male physicians aged 40 to 84 years that began in 1982. This analysis includes the 17,824 physicians who did not report cataract at baseline and did provide complete risk factor information. Based on information reported at baseline, 10% were current smokers, 39% were past smokers, and 51% were never smokers. MAIN OUTCOME MEASURE--An incident cataract was defined as a self-report confirmed by medical record review to have been first diagnosed after randomization, age-related in origin, and responsible for a decrease in best corrected visual acuity to 20/30 or worse. MAIN RESULTS--During 60 months of follow-up, 557 incident cataracts among 371 participants were confirmed. Compared with never smokers, current smokers of 20 or more cigarettes per day had a statistically significant increase in the risk of cataract (relative risk [RR], 2.16; 95% confidence interval [Cl], 1.46 to 3.20; P less than .001). Similar results were obtained after simultaneously controlling for other potential cataract risk factors in a logistic regression model (RR, 2.05; 95% Cl, 1.38 to 3.05; P less than .001). Among the 557 eyes with cataract, nuclear sclerotic changes were present in 442 while posterior subcapsular changes were present in 204. After controlling for other potential cataract risk factors, current smokers of 20 or more cigarettes per day had statistically significant increases in nuclear sclerosis (RR, 2.24; 95% Cl, 1.47 to 3.41; P less than .001) and posterior subcapsular (RR, 3.17; 95% Cl, 1.81 to 5.53; P less than .001) cataract. Past smokers had an elevated risk of posterior subcapsular (RR, 1.44; 95% Cl, 0.97 to 2.13; P = .07) but not nuclear sclerosis cataract. For current smokers of fewer than 20 cigarettes per day, no increased risks were observed of total, nuclear sclerosis, or posterior subcapsular cataract. CONCLUSIONS--These data provide support for the hypothesis that cigarette smoking increases the risk of developing both nuclear sclerosis and posterior subcapsular cataract.     

Musculoskeletal status of men and women who entered a fitness programme

The musculoskeletal status at entry into a fitness programme and the incidence of injuries during the first four months of the programme were evaluated in 991 men and women who were aged 20-63 years. At entry, about half of the subjects reported having received treatment for musculoskeletal ailments previously, or that currently they were experiencing musculoskeletal pain and/or discomfort, and about one-third of the subjects reported one or more movement limitations. New injuries during the first four months of the programme were reported by 38% of subjects, with an average duration of impairment of 3.8 weeks, and 43% of those who were injured sought medical treatment. The most frequent type, location, and cause of injury were "joint sprains/strains" (66%), the lower leg (70%), and jogging (33%), respectively. Musculoskeletal problems (previous treatment, current pain or discomfort or movement limitations) in the leg did not predict leg injuries during the programme, but back problems did predict back injuries. Age, sex, body mass index, a parental history of musculoskeletal disease, a sporting history, and the frequency of vigorous exercise during the first four months did not predict injury. The study emphasized: first, the vulnerability of previously-sedentary persons to musculoskeletal injury and the consequent need for care in the management of fitness programmes; secondly, the need for the evaluation of such programmes if they are to have a rational rather than an intuitive basis; and thirdly, the need for epidemiological research on the musculoskeletal system as a basis for systematic efforts, partly through education and ergonomics, to reduce wear and tear on the musculoskeletal system.     

Group- vs home-based exercise training in healthy older men and women. A community-based clinical trial

OBJECTIVE.--To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy, sedentary older adults. DESIGN.--Year-long randomized, controlled trial comparing (1) higher-intensity group-based exercise training; (2) higher-intensity home-based exercise training; (3) lower-intensity home-based exercise training; or (4) assessment-only control. SETTING.--General community located in northern California. PARTICIPANTS.--One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease. One out of nine persons contacted through a community random-digit-dial telephone survey and citywide promotion were randomized. INTERVENTIONS.--For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise training, five 30-minute endurance training sessions per week were prescribed at 60% to 73% of peak treadmill heart rate. MAIN OUTCOME MEASURES.--Treadmill exercise test performance, exercise participation rates, and heart disease risk factors. RESULTS.--Compared with controls, subjects in all three exercise training conditions showed significant improvements in treadmill exercise test performance at 6 and 12 months (P less than .03). Lower-intensity exercise training achieved changes comparable with those of higher-intensity exercise training. Twelve-month exercise adherence rates were better for the two home-based exercise training conditions relative to the group-based exercise training condition (P less than .0005). There were no significant training-induced changes in lipid levels, weight, or blood pressure. CONCLUSIONS.--We conclude that (1) this community-based exercise training program improved fitness but not heart disease risk factors among sedentary, healthy older adults; (2) home-based exercise was as effective as group exercise in producing these changes; (3) lower-intensity exercise training was as effective as higher-intensity exercise training in the home setting; and (4) the exercise programs were relatively safe.     

Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality

Context  For women, impact of cardiovascular risk factors measured in young adulthood, particularly favorable (low-risk) profile, on mortality has been difficult to assess due to low short-term death rates. Objective  To assess the relationship of baseline coronary risk factor status to mortality from coronary heart disease (CHD), cardiovascular diseases (CVDs), and all causes in young women. Design  Prospective cohort study. Setting and Participants  A total of 7302 women aged 18 to 39 years without prior CHD or major electrocardiographic abnormalities screened between 1967 and 1973 for the Chicago Heart Association Detection Project in Industry. Risk groups were defined using national guidelines for values of systolic and diastolic blood pressure, serum cholesterol level, body mass index, presence of diabetes, and smoking status. Participants were divided into 4 groups: low risk, 0 risk factors high but 1 or more unfavorable, 1 only risk factor high, and 2 or more risk factors high. Main Outcome Measures  All-cause mortality, CHD mortality, and CVD mortality; hazard ratio of outcome measures comparing low-risk group with other groups. Results  Only 20% met low-risk criteria; 59% had high levels of 1 or more risk factors. During an average follow-up of 31 years, there were 47 CHD deaths, 94 CVD deaths, and 469 deaths from all causes. The age-adjusted CVD death rate per 10 000 person-years was lowest for low-risk women and increased with the number of risk factors, ie, 1.5, 1.7, 5.0, and 9.1 for low-risk; 0, 1, and 2 or more risk factors high, respectively. Multivariate-adjusted CVD mortality hazard ratio for low-risk women was 0.19 (95% confidence interval, 0.08-0.45) compared with women with 2 or more risk factors high. Similar patterns were observed for CHD and all-cause mortality and for both blacks and whites. Conclusion  For women with favorable levels for all 5 major risk factors at younger ages, CHD and CVD are rare; long-term and all-cause mortality are much lower compared with others.      

Estrogen replacement therapy and ovarian cancer mortality in a large prospective study of US women

CONTEXT: Postmenopausal estrogen use is associated with increased risk of endometrial and breast cancer, 2 hormone-related cancers. The effect of postmenopausal estrogen use on ovarian cancer is not established. OBJECTIVES: To examine the association between postmenopausal estrogen use and ovarian cancer mortality and to determine whether the association differs according to duration and recency of use. DESIGN AND SETTING: The American Cancer Society's Cancer Prevention Study II, a prospective US cohort study with mortality follow-up from 1982 to 1996. PARTICIPANTS: A total of 211 581 postmenopausal women who completed a baseline questionnaire in 1982 and had no history of cancer, hysterectomy, or ovarian surgery at enrollment. MAIN OUTCOME MEASURE: Ovarian cancer mortality, compared among never users, users at baseline, and former users as well as by total years of use of estrogen replacement therapy (ERT). RESULTS: A total of 944 ovarian cancer deaths were recorded in 14 years of follow-up. Women who were using ERT at baseline had higher death rates from ovarian cancer than never users (rate ratio [RR], 1.51; 95% confidence interval [CI], 1.16-1.96). Risk was slightly but not significantly increased among former estrogen users (RR, 1.16; 95% CI, 0.99-1.37). Duration of use was associated with increased risk in both baseline and former users. Baseline users with 10 or more years of use had an RR of 2.20 (95% CI, 1.53-3.17), while former users with 10 or more years of use had an RR of 1.59 (95% CI, 1.13-2.25). Annual age-adjusted ovarian cancer death rates per 100 000 women were 64.4 for baseline users with 10 or more years of use, 38.3 for former users with 10 or more years of use, and 26.4 for never users. Among former users with 10 or more years of use, risk decreased with time since last use reported at study entry (RR for last use <15 years ago, 2.05; 95% CI, 1.29-3.25; RR for last use >/=15 years ago, 1.31; 95% CI, 0.79-2.17). CONCLUSIONS: In this population, postmenopausal estrogen use for 10 or more years was associated with increased risk of ovarian cancer mortality that persisted up to 29 years after cessation of use.     

多重动脉粥样硬化患者踝臂指数与全因、心因性死亡的相关性研究

目的探讨踝臂指数作为冠心病独立危险因素的地位和作用。通过随访,评估不同ABI水平对于具有多重动脉粥样硬化危险因素的住院患者长期预后的意义、目前所需采取的措施。方法多中心随机抽取符合条件的3 732例住院患者,分为≤0.4,0.4相似文献   

Body weight and mortality among men and women in China

Context  The effect of underweight and obesity on mortality has not been well characterized in Asian populations. Objective  To examine the relationship between body mass index (BMI) and mortality in Chinese adults. Design, Setting, and Participants  A prospective cohort study in a nationally representative sample of 169 871 Chinese men and women aged 40 years or older. Data on body weight and covariables were obtained at a baseline examination in 1991 using a standard protocol. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4% (n = 158 666). Main Outcome Measures  Body mass index and all-cause mortality. Results  After excluding those participants with missing body weight or height values, 154 736 adults were included in the analysis. After adjustment for age, sex, cigarette smoking, alcohol consumption, physical activity, education, geographic region (north vs south), and urbanization (urban vs rural), a U-shaped association between BMI and all-cause mortality was observed (P<.001). Using those participants with a BMI of 24.0 to 24.9 as the reference group, the relative risks of all-cause mortality across categories of BMI were 1.65 (95% confidence interval [CI], 1.54-1.77) for BMI less than 18.5, 1.31 (95% CI, 1.22-1.41) for BMI 18.5 to 19.9, 1.20 (95% CI, 1.11-1.29) for BMI 20.0 to 20.9, 1.12 (95% CI, 1.04-1.21) for BMI 21.0 to 21.9, 1.11 (95% CI, 1.03-1.20) for BMI 22.0 to 22.9, 1.09 (95% CI, 1.01-1.19) for BMI 23.0 to 23.9, 1.00 (95% CI, 0.92-1.08) for BMI 25.0 to 26.9, 1.15 (95% CI, 1.06-1.24) for BMI 27.0 to 29.9, and 1.29 (95% CI, 1.16-1.42) for BMI 30.0 or more. The U-shaped association existed even after excluding participants who were current or former smokers, heavy alcohol drinkers, or who had prevalent chronic illness at the baseline examination, or who died during the first 3 years of follow-up. A similar association was observed between BMI and mortality from cardiovascular disease, cancer, and other causes. Conclusions  Our results indicate that both underweight and obesity were associated with increased mortality in the Chinese adult population. Furthermore, our findings support the use of a single common recommendation for defining overweight and obesity among all racial and ethnic groups.      

健康男女青年血液的粘弹特性

The measurement of visco-elastic properties of blood of the Chinese is very important for theoretical research and clinical practice. This paper reports the study of the visco-elastic properties, rheological parameters and several biochemical components of the whole blood in 146 healthy young students. No significant difference in the concentrations of globulin, cholesterol, fibrinogen and blood sugar between the male group and female group could be found. The level of albumin, hemoglobin and triglyceride in the male group was significantly higher than that in the female group. The rheological measurement demonstrated that plasma viscosities in both the male and female groups had no significant differences and that the values of HCT, apparent viscosities at high (51.2 s-1) and low (0.512 s-1) shear rates and AI in the male group had higher values of ESR and OD than the female group. The visco-elastic parameters of whole blood, including eta', eta", G' and lambda, were higher in the male group than the female group. The physiological meaning of these differences between the groups is also discussed in the paper.     

A prospective study of cigarette smoking and risk of cataract surgery in women.

OBJECTIVE--To examine prospectively the association between cigarette smoking and the risk of cataract extraction in women. DESIGN--Prospective cohort study beginning in 1980 with 8 years of follow-up. SETTING--United States, multistate. PARTICIPANTS--Registered nurses 45 to 67 years of age and free of diagnosed cancer. There were 50,828 women included in 1980 and others were added as they became 45 years of age. MAIN OUTCOME MEASURE--Incidence of senile cataract extraction. RESULTS--We documented 493 incident senile cataracts diagnosed and extracted during 470,302 person-years of follow-up. The age-adjusted relative risk (RR) among women who smoked at least 65 pack-years was 1.63 (95% confidence interval [Cl], 1.18 to 2.26; P for trend, .02). A similar increase in RR was noted when smoking was assessed in terms of number of cigarettes currently smoked or number of cigarettes smoked by past smokers. Results were also similar after adjusting for other potential risk factors for cataract. Smoking was also strongly associated with posterior subcapsular cataract specifically (RR, 2.59; 95% Cl, 1.49 to 4.50 for greater than or equal to 65-pack-year smokers relative to nonsmokers. CONCLUSION--Smoking appears to increase the risk of cataract extraction.     

环境烟草烟雾与从不吸烟的中国妇女的死亡率：前瞻性队列研究

目的：评价源自丈夫、工作场所以及生命早期家庭成员的环境烟草烟雾暴露与中国妇女全死因、恶性肿瘤或心血管疾病死亡率的关系。设计：中国上海正在进行的前瞻性队列研究。参加人员：72829名从不吸烟妇女中有65180人提供了其丈夫的吸烟资料，有66520人提供了源自工作场所和生命早期家庭成员的烟草烟雾暴露资料。主要的评价结果指标：全死因死亡率以及恶性肿瘤、心血管疾病死亡专率。按暴露状况分层的累积死亡率以及风险比。结果：源自丈夫的烟草烟雾暴露（主要是现时暴露）与全死因死亡率增加有显著联系，风险比（HR）为1．15，95％可信区间为1.01～1．31，与心血管疾病死亡率增加也有联系（1、37，1．06～1．78）。源自工作场所的烟草烟雾暴露与恶性肿瘤死亡率增加有联系（1、19，0．94～1．50），特别是肺癌（1．79，1．09～2．93）。生命早期暴露与心血管疾病死亡率增加有联系（1．26，0．94～1．69）。结论：在中国妇女中环境烟草烟雾暴露与全死因死亡率以及肺癌和心血管疾病死亡率的中等度增加有关。     

基于事件前瞻记忆脑神经机制的功能磁共振成像研究

目的 应用功能磁共振成像(fMRI)技术探讨前瞻记忆(PM)的脑区激活及神经机制.方法 共有15名健康志愿者入组,以基于事件前瞻记忆(双任务范式,包括进行中任务和前瞻记忆任务)作为刺激任务,应用GRE-EPI序列采集血氧水平依赖性(BOLD) fMRI信号.应用SPM8软件对图像数据进行预处理和统计分析.结果 (1)相对于对照任务,进行中任务主要激活双侧前额叶额极(x,y,z =6/-2,54/42,- 8/- 12,t=3.71),右侧的体感联合区(x,y,z=14,- 62,64,t=4.64)、颞上回(x,y,z=42,- 46,16,t=3.95)及旁中央小叶(x,y,z=10,- 22,76,t=4.01),差异具有统计学意义(P＜0.01).(2)前瞻记忆任务主要激活双侧前额叶额极(x,y,z=-2/6,42/54,- 12/- 12,=3.28)及旁中央小叶(x,y,z=- 30/10,-22/-22,72/76,t=4.25),左侧中央后回(x,y,z=-38,-46,64,t=3.13)及枕叶(x,y,z=-30,-70,0,=3.97),差异具有统计学意义(P＜0.01).结论 前额叶额极(布罗德曼10区,BA10区)是前瞻记忆的关键激活脑区,BA10区内侧可能参与对外部线索的监控,支持前瞻记忆的BA10门控假说.