Alcohol consumption and the 5-year incidence of age-related maculopathy: the Beaver Dam eye study

OBJECTIVE: This study evaluated alcohol consumption as a risk factor for incidence of age-related maculopathy (ARM). DESIGN: Persons aged 43 to 86 years in 1988 in Beaver Dam, Wisconsin, were examined from 1988 through 1990 and 1993 through 1995, n = 3684. The presence and severity of ARM at both examinations were determined from gradings of stereoscopic fundus photographs using the Wisconsin Age-related Maculopathy Classification System. Alcohol consumption was determined by self-report. RESULTS: Men drinking at least 78 g/week of alcohol from beer had a higher 5-year age-adjusted incidence of early ARM (10.6%) than did men who did not drink beer (6.9%), but the test for trend was only borderline significant (P = 0.08). However, incidence of soft indistinct drusen (P = 0.01), increased drusen area (P < 0.01), and confluent drusen (P = 0.02) are all associated with beer drinking in men. Increased retinal pigment and retinal pigment epithelial depigmentation are not associated with beer drinking in men or women nor are any lesions associated with total alcohol consumption or consumption from liquor or wine in either men or women. CONCLUSIONS: Except for an association of beer drinking with retinal drusen in men, consumption of alcoholic beverages is not likely to be an important risk factor for incidence of ARM.     

High free fatty acid concentration: an independent risk factor for hypertension in the Paris Prospective Study

BACKGROUND: An inconsistent relationship has been reported between insulin and hypertension incidence. Free fatty acids are related to insulin-resistance and may have a direct effect on hypertension. We examined the effect of free fatty acids on hypertension incidence, taking into account other abnormalities of the insulin-resistance syndrome. METHODS: In all, 2968 non-hypertensive and non-diabetic Caucasian men were followed for 3 years. Hypertension incidence was defined as systolic blood pressure (SBP) > or =160 mmHg or diastolic blood pressure (DBP) > or =95 mmHg or drug treatment for hypertension. RESULTS: Free fatty acid elevation was a highly significant risk factor for hypertension when controlled for age, family history of hypertension, alcohol consumption, body mass index, iliac circumference and weight change. Further controlling for SBP, heart rate and fasting insulin and glucose did not decrease its predictive power (hazard rate ratio [RR] = 1.58, 95% confidence interval [CI]: 1.30-1.91 comparing the 90th to the 10th percentiles at fasting; RR = 1.54, 95% CI: 1.33-1.79 at 2 h). In a forward stepwise model controlled for age, family history of hypertension, alcohol consumption and SBP, the selected variables explaining the occurrence of hypertension were, in order, weight change, 2-h free fatty acids, iliac circumference and fasting free fatty acids, whereas body mass index, heart rate, insulin, glucose and other lipids did not enter into the model. CONCLUSIONS: Free fatty acids elevation, when controlled for all known risk factors and other abnormalities of the insulin-resistance syndrome, is a risk factor for hypertension. These results highlight the possible benefits of treatment using free fatty acid oxidation inhibitors.     

Isolation and characterization of lectins and lectin-alliinase complexes from bulbs of garlic (Allium sativum) and ramsons (Allium ursinum)

PURPOSE: To evaluate the ophthalmic phenotype in families with three or more individuals who have age-related maculopathy. METHODS: Eight families were identified at academic centers in Massachusetts and North Carolina. Macular findings were graded based on a modification of the grading system used in the Age-Related Eye Disease Study (AREDS). RESULTS: All families had at least three members with stage 3 (extensive drusen change) or higher maculopathy in at least one eye, and six families had at least two members with advanced maculopathy (stage 4, geographic atrophy of the retinal pigment epithelium, or stage 5, exudative maculopathy). Both stages 4 and 5 maculopathy were observed among different individuals in four families. Individuals with stage 3 maculopathy were members of families with more advanced maculopathy (six families) and were of similar age as more severely affected family members but tended to be older than those with stage 2. CONCLUSION: The phenotypic appearance of the macula in families with multiple affected individuals is heterogeneous and representative of the spectrum of macular findings typically associated with age-related maculopathy.     

Histochemical and laser scanning microscopy characterization of the hydroxyapatite-bone interface: an experimental study in rabbits

OBJECTIVES: To assess the relationship between haematocrit and risk of stroke. DESIGN: Prospective study of a cohort of men followed up for 9.5 years. SETTING: General practices in 24 towns in England, Scotland and Wales (British Regional Heart Study). SUBJECTS: A total of 7735 men aged 40-59 years at screening, selected at random from one general practice in each of 24 towns. MAIN OUTCOME MEASURES: Fatal and non-fatal strokes. RESULTS: During a follow-up period of 9.5 years for all men there were 123 stroke events (33 fatal) in the 7346 men in whom the haematocrit level had been determined. In the cohort as a whole, risk of stroke was significantly raised at haematocrit levels > or = 51% (relative risk [RR] = 2.5; 95% confidence intervals [CI] 1.2-5.0) after adjustment for age, social class, smoking, body mass index, physical activity, presence of diabetes and pre-existing ischaemic heart disease. Further adjustment for systolic blood pressure did not attenuate this association (RR = 2.4; 95% CI 1.2-4.9). A raised haematocrit was associated with an increase of stroke only in men with hypertension (systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 90 mmHg or on regular antihypertensive treatment). No increased risk of stroke was seen at the higher haematocrit level (> or = 51%) in normotensive men. At haematocrit levels below 51%, hypertension was associated with a three-fold increase in risk of stroke compared with normotension (RR = 3.4, 95% CI 2.3, 5.1). At haematocrit levels > or = 51%, hypertension was associated with a nine-fold increase in risk of stroke compared with normotension (RR = 9.3; 95% CI 4.2, 21.0). Exclusion of men receiving regular antihypertensive therapy did not alter the strong associations seen. CONCLUSION: The data suggest that an elevated haematocrit is an independent risk factor for stroke and that it interacts synergistically with elevated blood pressure.     

Is insulin an independent risk factor for hypertension? The Paris Prospective Study

BACKGROUND: The link between hyperinsulinaemia and hypertension has been examined in few prospective studies and often diminished after adjustment for obesity, central adiposity and baseline blood pressures. METHODS: The incidence of hypertension was studied as a function of baseline insulin and glucose in 4149 Caucasian, non-hypertensive, non-diabetic middle-aged men from the Paris Prospective Study. Blood pressures were measured over the 3 years of follow-up; hypertension incidence was defined as systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg or drug treatment for hypertension. RESULTS: Fasting and 2-hour glucose and insulin were predictive of hypertension, after controlling for the known risk factors: age, excessive alcohol consumption and family history of hypertension (FHH). However, after further controlling for body mass index and central adiposity (the iliac circumference), insulin was no longer predictive in men without an FHH. When weight variation was also taken into account, and further adjustment made for baseline blood pressure and heart rate, fasting insulin, only, was predictive when the subject had a weight increase, independently of FHH. Fasting glucose was predictive of hypertension except in the case of no change or weight decrease and a negative FHH; 2-hour glucose was predictive in the presence of a positive FHH. CONCLUSIONS: Insulin and glucose levels were both risk factors for hypertension, and this risk was enhanced in the case of a positive FHH. However, obesity, especially central obesity, confounded these relationships and might be an intermediary factor in the relationship between insulin and hypertension.     

Giant pigment epithelial tear and exudative retinal detachment complicating choroidal effusions

PURPOSE: To report a case of a giant pigment epithelial tear and transient exudative retinal detachment occurring in a patient with hypotonic choroidal effusions after trabeculectomy. METHODS: Case report and brief literature review. RESULT: The retinal and choroidal detachments settled, disclosing an extremely large crescentic pigment epithelial defect in the temporal midperiphery. CONCLUSIONS: An exudative retinal detachment secondary to a peripheral pigment epithelial rip may complicate choroidal effusions. Recognition of this association may prevent unnecessary investigation or surgery.     

Pulsed-field gel electrophoresis is more efficient than ribotyping and random amplified polymorphic DNA analysis in discrimination of Pasteurella haemolytica strains

OBJECTIVE: Factors such as size of hyphema, intraocular pressure, initial visual acuity, and use of steroids or antifibrinolytic drugs may be associated with the likelihood of rebleeding in traumatic hyphema. The association of the visual outcome with secondary hemorrhage has been questioned. DESIGN: Randomized, placebo-controlled, clinical trial. PARTICIPANTS: Two hundred and thirty-eight patients who had hyphema develop after blunt trauma. INTERVENTION: Eighty patients received oral tranexamic acid, 80 patients received placebo, and 78 patients received oral prednisolone. MAIN OUTCOME MEASURES: Secondary hemorrhage and vision at the time of discharge from the hospital were measured. RESULTS: Rebleeding occurred in 43 (18%) of the patients and was prevented significantly by oral tranexamic acid compared with the placebo (odds ratios [OR] = 0.39; 95% confidence interval [CI], 0.17, 0.89). Occurrence of secondary hemorrhage had weak associations with initial high intraocular pressure (OR = 2.7; 95% CI, 0.99, 7.3) and initial visual acuity of 6/60 or less (OR = 1.8; 95% CI, 0.9, 3.7). Secondary hemorrhage had no statistical association with age, gender, oral prednisolone, size of hyphema, and retinal damage. Visual acuity of 6/60 or less at the time of discharge was significantly associated with rebleeding (OR = 10.5; 95% CI, 3.7, 29.2), initial visual acuity of 6/60 or less (OR = 9.9; 95% CI, 2.8, 38.0), retinal damage (OR = 14.6; 95% CI, 3.8, 55.8), and male gender (OR = 6.5; 95% CI, 1.4, 31.9). Final visual acuity had no significant statistical association with age, use of oral prednisolone or tranexamic acid, and size of hyphema. CONCLUSIONS: High intraocular pressure and low vision at the time of first examination may be associated with increased chance of rebleeding. Retinal damage, secondary hemorrhage, male gender, and initial poor vision are associated with a worse visual outcome in patients with traumatic hyphema.     

Age-related macular disease in rural southern Italy

OBJECTIVE: To report the prevalence of age-related maculopathy (ARM) in Salandra, a small, isolated southern Italian community, to test the hypothesis that an environmental factor, scarce in such a remote community but ubiquitous in modern industrial societies, might modify the risk of developing ARM. DESIGN: Population-based cross-sectional survey. MAIN OUTCOME MEASURES: Prevalence of advanced age-related macular degeneration (ARMD) (geographic atrophy or exudative maculopathy) and ARM (large, soft drusen or retinal pigment epithelium changes, or both) defined by fundus biomicroscopy and 30 degrees stereoscopic, macular photography. Self-sustenance was assessed by interview of participants and local shop retailers. The degree of genetic isolation was computed using a model that fits the genetic population structure with the frequency distribution of surnames in the community. RESULTS: A full ophthalmic examination was undertaken in 366 (63.5%) of 576 eligible participants, 354 (96.7%) of whom had clinical or photographic assessment for the presence of ARMD and 310 (84.6%) of whom had drusen characteristics graded on color transparencies for ARM. The overall prevalence of ARMD was 1.1%. Drusen larger than 50 microns and more numerous than 10 were found in 4.5% of subjects. Salandra was the birthplace of 87.2% of participants and for 77.3% of both parents of each subject. People in the community tended to consume homegrown products. CONCLUSION: The prevalence of ARM may be lower in this self-sustained farming community than elsewhere in the industrialized world.     

Serum beta carotene, alpha tocopherol, and age-related maculopathy: the Blue Mountains Eye Study

PURPOSE: To assess associations between serum beta carotene, alpha tocopherol, and age-related maculopathy. METHODS: We studied 156 subjects with age-related maculopathy matched for age, sex, and month of blood collection to 156 control subjects without age-related maculopathy. Subjects were identified from the Blue Mountains Eye Study: those with late age-related macular degeneration and early age-related maculopathy using examination and grading of retinal photographs, and control subjects without age-related maculopathy randomly sampled from the study population. RESULT: Neither serum alpha tocopherol nor beta carotene was significantly associated with age-related maculopathy. CONCLUSION: These findings provide no evidence of a protective association between serum alpha tocopherol or beta carotene and age-related maculopathy.     

Depression, family environment, and adolescent suicidal behavior

OBJECTIVE: To assess the specific influence of family relationship difficulties, over and above the effect of depression, on the risk of adolescent suicidal behavior. METHOD: The study was based on the clinical data summaries, "item sheets," of children and adolescents who attended the Maudsley Hospital during the 1970s and 1980s. Two hundred eighty-four cases of suicidal behavior, defined as suicidal ideas, attempts, or threats (mean age 13.9 years, SD 2.6), were compared with 3,054 nonsuicidal controls, using stepwise logistic regression controlling for age and sex. RESULTS: The following variables were each independently associated with suicidal behavior: an operationally defined depressive syndrome, odds ratio (OR) = 4.4 (95% CI 3.1 to 6.3); family discord, OR = 1.5 (95% CI 1.1 to 2.0); disturbed mother-child relationship, OR = 1.5 (95% CI 1.1 to 2.0); and familial lack of warmth, OR = 1.6 (95% CI 1.1 to 2.3). Twenty-seven percent of the suicidal cases met operational criteria for depression. In a separate analysis of nondepressed cases (n = 198), female gender, OR = 2.4 (95% CI 1.7 to 3.2), and conduct symptoms, OR = 1.4 (95% CI 1.02 to 1.95), were independent risk factors for suicidal behavior. Among the depressed cases (n = 73), gender and conduct symptoms did not affect the risk of suicidal behavior. CONCLUSIONS: Although depression is the largest single risk factor for teenage suicidal behavior, family relationship difficulties make a significant independent contribution to this risk. Depression also interacts with gender, so that the excess risk of suicidal behavior in females is confined to nondepressed cases.     

Are spouses of patients with hypertension at increased risk of having hypertension? A population-based case-control study

BACKGROUND: Studies of couples, who tend to share an environment but are genetically dissimilar, can shed light on the contribution of environmental factors to hypertension. There has been renewed interest in these environmental factors following the re-analysis of the INTERSALT study. AIM: To determine whether patients whose spouses have hypertension are at increased risk of hypertension, using a population-based case-control study. METHOD: The total study population consisted of all 3923 patients over 30 years old registered with one general practice. Male cases with hypertension were matched to male controls without hypertension. Female cases with hypertension were matched to female controls without hypertension. The variables were: diagnosed hypertension; having a spouse with diagnosed hypertension; age; sex; weight; height; body-mass index; couple status; diabetes; and systolic and diastolic blood pressure readings. RESULTS: On multivariate analysis, when age, body-mass index, diabetes, couple status, and having a blood pressure reading were included, men whose spouses had hypertension had a two-fold increased risk of hypertension (adjusted odds ratio (OR) 2.24; 95% CI 1.77-2.72; P = 0.001). Similarly, on multivariate analysis, women whose spouses had hypertension had a two-fold increased risk of hypertension (adjusted OR = 2.23; 95% CI 1.75-2.72; P = 0.001). The risk for both male and female subjects persisted after adjustment for other variables. There was a significant correlation between systolic (r = 0.41; P < 0.0001) and diastolic (r = 0.25; P < 0.0001) blood pressures between spouse pairs. CONCLUSION: The independent association between having a spouse with hypertension and increased risk of hypertension supports the view that there are significant environmental factors in the aetiology of hypertension. The finding has implications for the screening and treatment of hypertension in primary care.     

Insertion/deletion polymorphism in the angiotensin-converting enzyme gene associated with macroangiopathy and blood pressure in patients with non-insulin-dependent diabetes mellitus

In the search for new risk factors for diabetic macroangiopathy the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme gene was studied in 237 consecutive patients (125 men and 112 women) with non-insulin-dependent diabetes. The female population showed an excess of ischemic electrocardiographic changes or definite myocardial infarctions in the patients homozygous for the deletion [D/D; odds ratio (OR) 2.8; 95% confidence interval (CI) 1.4-5.3] and in the insertion/deletion heterozygotes (I/D; OR 1.8; CI 1.1-3.1) compared with the patients homozygous for the insertion (I/I). In the total series coronary heart disease, cerebrovascular disease, and claudication were more often observed in the patients with I/D (OR 1.5; CI 1.0-2.2) or the D/D genotype patients (OR 1.7; CI 1.1-2.6) than in those with the genotype I/I. The systolic blood pressure was lower in patients with genotype I/I (138 +/- 19 mmHg) than in those with the genotype I/D (149 +/- 22 mmHg) or D/D (150 +/- 21 mmHg; P < 0.02). The prevalence of hypertension and the median urinary albumin excretion rate also tended to be lowest in the I/I genotype patients. Multiple logistic analysis revealed that in women the angiotensin-converting enzyme D/D genotype is independently associated with coronary heart disease. Our findings suggest that variation at the angiotensin-converting enzyme gene locus is one of the factors involved in the predisposition of diabetic patients to the development of arterial disease and hypertension.     

Relation of Helicobacter pylori infection to 13-year mortality and incident ischemic heart disease in the caerphilly prospective heart disease study

BACKGROUND: Associations have been suggested between Helicobacter pylori seropositivity, cardiovascular risk factors, and ischemic heart disease (IHD). The effect of this common infection on mortality is uncertain. METHODS AND RESULTS: Plasma specimens collected during 1979 to 1983 from 1796 men in Caerphilly, South Wales, were analyzed for IgG antibodies to H pylori. Cause of death and occurrence of incident IHD events were ascertained over an average of 13.7 years from death certificates, hospital records, and ECG changes at 5-yearly follow-up examinations. Seventy percent of men were seropositive. The prevalence of IHD at entry was similar in men with and without H pylori antibodies (odds ratio [OR], 1.10; 95% CI, 0.87 to 1.40). Seropositivity was significantly (P<0.05) associated with poorer socioeconomic status currently and in childhood, shorter stature, and poorer ventilatory function at entry but not with age, smoking, body mass index, blood pressure, total cholesterol, HDL cholesterol, LDL cholesterol, fibrinogen, plasma viscosity, or heat shock protein antibodies. Thirteen-year incidence of IHD was not significantly associated with H pylori (OR, 1.05; 95% CI, 0.80 to 1.39), but there was a stronger relationship with all-cause mortality (OR, 1.46; 95% CI, 1.12 to 1.92) and fatal IHD (OR, 1.54; 95% CI, 1.03 to 2.30). After adjustment for cardiovascular risk factors and both adult and childhood socioeconomic status, ORs were slightly reduced and lost statistical significance (OR=1.32 [95% CI, 0.99 to 1.78] for all-cause mortality and OR=1.52 [95% CI, 0.99 to 2.34] for fatal IHD). CONCLUSIONS: H pylori infection is unlikely to be as strong a risk factor for IHD as some previous studies have suggested, but its relationship to mortality, including fatal IHD, deserves further investigation. The mechanism underlying these associations is unlikely to involve hypertension, circulating lipid profile, fibrinogen, or cross-reacting antibodies to bacterial heat shock proteins.     

Evidence for cAMP-independent mechanisms mediating the effects of adrenomedullin, a new inotropic peptide

OBJECTIVE: To determine the relation of skeletal body build and obesity to blood pressure and the prevalence of hypertension. DESIGN: Cross-sectional data obtained from the baseline recruitment of the EPIC-Potsdam Study, which is part of the European Prospective Investigation into Cancer and Nutrition (EPIC). SUBJECTS: A total of 10,303 subjects (4387 men, aged 40-65 y and 5916 women, aged 35-65 y) were recruited between January 1995 and July 1996. MEASUREMENTS: Anthropometric measures included body mass index (BMI), waist-hip ratio (WHR) and metrik index (MIX) as a measure of body build that is derived from the relation of chest depth and breadth to body height. Systolic and diastolic blood pressure was obtained using automatic oscillometric devices. Hypertension was defined as blood pressure > or = 160/95 mmHg or current use of antihypertensive medication. Information on lifestyle factors were obtained by personal interview. STATISTICAL ANALYSIS: Logistic regression was used to define the association of categories of BMI, WHR, and MIX and the prevalence of hypertension. Odds ratios (ORs) of being hypertensive were estimated comparing the highest to the lowest quintile, adjusting for age, smoking status, alcohol intake level, educational attainment, physical activity categories, and each of the anthropometric variables. RESULTS: The simultaneously adjusted OR of being hypertensive, comparing the highest vs the lowest category, was for BMI 2.3 (95% confidence interval (CI) = 1.6-3.2) in men and 1.8 (95% CI = 1.4-2.5) in women, for WHR 1.8 (95% CI = 1.4-2.4) in men and 1.5 (95% CI = 1.2-2.0) in women, and for MIX (largest chest size vs lowest chest size relative to body height) 2.0 (95% CI = 1.4-2.8) in men and 2.2 (95% CI = 1.6-3.1) in women. CONCLUSION: In addition to measures of overall obesity (BMI) as well as central obesity (WHR), skeletal body build (MIX) was independently associated with the prevalence of hypertension. The biological mechanism relating MIX to hypertension, however, is still unclear and needs further exploration.     

Risk factors for myocardial infarct: a case-control study in Oporto, Portugal

A case-control study of coronary heart disease (CHD) was conducted in Oporto, Portugal. The cases series consisted of 100 consecutive patients with first time acute myocardial infarction who were admitted to the Coronary and Intermediate Care Units of a major teaching hospital. The community controls were 198 individuals without evidence of CHD by the Rose questionnaire and electrocardiography, selected by random digit dialing, with a participation rate of 70%. Data was collected by trained interviewers using a structured questionnaire and blood samples were obtained for selected laboratory data. The main analysis was made through unconditional logistic regression with calculations of odds ratios (OR). Age, OR: 1.5 (95% CI: 0.8-2.9), male gender, OR: 6.7 (3.6-12.3), family history of premature CHD, OR: 2.4 (1.4-4.3), diabetes, OR: 3.4 (1.6-7.4), antecedents of hypertension, OR:1.9 (1.1-3.1), history of high cholesterol levels, OR: 2.3 (1.4-3.9), high levels of physical activity, OR: 2.0 (0.9-4.1) and tobacco smoking, OR: 8.3 (3.8-18.5) were significant risk factors of acute myocardial infarction. After controlling for demographic variables and for the mutual confounding effects of the risk factors, the investigated factors that remained significantly associated with the risk of developing acute myocardial infarction were male gender, OR: 17.3 (4.8-62.3), family history of CHD, OR: 3.6 (1.4-9.6), diabetes, OR: 4.2 (1.0-18.1), high cholesterol levels OR: 2.7 (1.2-6.1) and smoking habits, OR: 7.7 (1.8-32.4). A negative association with high education levels was significant after controlling for all the variables, OR: 0.01 (0.01-0.5).     

The rarity of clinically significant rise in intraocular pressure after laser peripheral iridotomy with apraclonidine

OBJECTIVE: To determine the incidence of intraocular pressure (IOP) rise of varying degrees after laser peripheral iridotomy (LPI) in patients with and without glaucoma treated perioperatively with pilocarpine and apraclonidine. DESIGN: A retrospective chart review. PARTICIPANTS: A total of 289 eyes in 179 patients with narrow occludable angles (NOA) (N = 148), open-angle glaucoma or ocular hypertension (OAG) (N = 115), or chronic-angle closure glaucoma (CACG) (N = 26) were reviewed. MAIN OUTCOME MEASURES: The difference between preoperative and postoperative IOP, absolute postoperative IOP, and the need for acute IOP-lowering treatment was noted. RESULTS: Only 1.1% (95% confidence interval [CI], 0.03%-5.8%; 1 of 94) of patients and 0.7% (95% CI, 0.02%-3.7%; 1 of 148) of eyes with NOA experienced a rise of more than 10 mmHg 1 to 2 hours after LPI. The incidence of postoperative IOP greater than 25 mmHg and acute postoperative IOP-lowering management was 0% (95% CI, 0%-3.8%). Intraocular pressure in 1 of 115 eyes (0.9%, 95% CI, 0.02%-4.7%) with OAG rose more than 10 mmHg, requiring acute treatment. None of the 26 CACG eyes experienced a rise of more than 10 mmHg (95% CI, 0%-13.2%). CONCLUSION: The IOP rise that requires further intervention after LPI with the perioperative use of pilocarpine and apraclonidine is very uncommon. In patients with NOA, routine postiridotomy IOP monitoring may not be required.     

Hormone replacement therapy as a risk factor for epithelial ovarian cancer: results of a case-control study

OBJECTIVE: To evaluate the role of hormone replacement therapy (HRT) as a risk factor for the development of epithelial ovarian cancer. METHODS: A case-control study was performed that used 491 patients with epithelial ovarian cancer frequency matched for age at diagnosis (+/-5 years) with a control population of 741 patients with malignancies of nonestrogen-dependent tissues. The odds ratio (OR) for the development of epithelial ovarian cancer was estimated using logistic regression analysis with adjustment for age at diagnosis, parity, oral contraceptive use, smoking history, family history of epithelial ovarian cancer, age at menarche, menopausal status, income, and education. RESULTS: One hundred of 491 patients (20.4%) in the study population had ever used HRT, and 160 of 741 patients (21.6%) in the control population had ever used HRT (OR 0.85; 95% confidence interval [CI] 0.62, 1.2). A significant association between HRT and specific histologic subtypes of epithelial ovarian cancer was not demonstrable for serous cystadenocarcinoma (OR 1.2, 95% CI 0.8, 1.7), Clear cell carcinoma (OR 1.1, 95% CI 0.4, 3.4), or endometrioid carcinoma (OR 0.4; 95% CI 0.2, 1.2). A significant association between duration of use of HRT and the risk of developing epithelial ovarian cancer was not demonstrable for under 5 years (OR 0.8; 95% CI 0.5, 1.2), 5-9 years (OR 0.6; 95% CI 0.3, 1.1), or 10 or more years (OR 0.6; 95% CI 0.3, 1.4). CONCLUSION: A significant association between the use of HRT and the risk of developing epithelial ovarian cancer, even with prolonged exposure, is not demonstrable.     

Comments on a meta-analysis of the relation between dietary calcium intake and blood pressure

The role of dietary calcium in the etiology of hypertension is controversial. In 1995, Cappuccio et al. (American Journal of Epidemiology,1995;142:935-45) examined this issue in a meta-analysis of observational studies published between 1983 and 1993. The author of the present paper reviewed the original studies underlying this meta-analysis and discovered that data from one study had been inappropriately extracted and converted, leading to an understatement of the calcium-blood pressure relation by a factor of about 30. This review also raised questions about the extraction and conversion of data from several other studies and about the statistical methods used. The author repeated the meta-analyses and discovered an unadjusted regression slope between dietary calcium and systolic blood pressure of -0.34 mmHg/100 mg per day (95% confidence interval (CI) -0.46 to -0.22) for men, -0.15 mmHg/100 mg per day (95% CI -0.19 to -0.11) for women, and -0.39 mmHg/100 mg per day (95% CI -0.47 to -0.31) for men and women. For diastolic blood pressure, the pooled regression slope for men was -0.22 mmHg/100 mg per day (95% CI -0.32 to -0.13), while for women it was -0.051 mmHg/100 mg per day (95% CI -0.090 to -0.012); for men and women it was -0.35 mmHg/100 mg per day (95% CI -0.67 to -0.02). These slopes are still modest but are larger than those reported in the original analysis. However, since all of these analyses were based on zero-order correlations or regressions, extreme caution must be exercised in interpreting the results.     

A case report of jejunal carcinoma in a patient with tuberous sclerosis]

It remains uncertain if law enforcement officers experience an elevated cardiovascular disease morbidity and, if so, whether their profession contributes to this incidence. Consequently, the self-reported incidence of cardiovascular disease (CVD) (coronary heart disease, myocardial infarction, stroke, coronary artery bypass graft surgery, angioplasty) and CVD risk factors (age, diabetes, elevated body mass index (> or = 27.8 kg.m-2), hypercholesterolemia, hypertension, tobacco use) in 232 male retirees, > or = 55 years of age, from the Iowa Department of Public Safety were compared with 817 male Iowans of similar age. CVD incidence was higher in the law enforcement officers than the general population (31.5% vs 18.4%, P < 0.001). Using multiple logistic regression, factors found to be associated with CVD included the law enforcement profession (odds ratio [OR] = 2.34; 95% confidence interval [95% CI] = 1.5-3.6), hypercholesterolemia (OR = 2.37; 95% CI = 1.7-3.3); diabetes (OR = 2.22; 95% CI = 1.4-3.6), hypertension (OR = 1.79; 95% CI = 1.3-2.5), tobacco use (OR = 1.67; 95% CI = 1.07-2.6), and age (OR = 1.06; 95% CI = 1.03-1.08). These results suggest that employment as a law enforcement officer is associated with an increased cardiovascular disease morbidity and this relationship persists after considering several conventional risk factors.     

Demographic determinants of hepatitis C virus seroprevalence among blood donors

OBJECTIVE: To measure demographic determinants of hepatitis C virus (HCV) seroprevalence among blood donors in the United States. DESIGN: Cross-sectional epidemiological study. SETTING: Five blood centers in different regions of the United States. SUBJECTS: A total of 862,398 consecutive volunteer blood donors with one or more nonautologous donations from March 1992 through December 1993. METHODS: Demographic data collection, serological screening with second-generation anti-HCV enzyme immunoassay, and confirmation with anti-HCV recombinant immunoblot. RESULTS: There were 3126 donors with at least one blood donation confirmed HCV-seropositive, for a crude prevalence of 3.6 per 1000. Age-specific HCV seroprevalence rose from 0.5 per 1000 donors younger than 20 years to a maximum of 6.9 per 1000 in donors aged 30 to 39 years and declined in older age groups. There was interaction between age and educational attainment, with 30- to 49-year-olds with less than a high school diploma at highest risk of HCV infection (odds ratio [OR], 33.0; 95% confidence interval [CI], 23.0 to 47.2 compared with those younger than 30 years with a bachelor's degree or higher degree). Other independent risk factors for HCV seropositivity included male sex (OR, 1.9; 95% CI, 1.8 to 2.1), black race (OR, 1.7; 95% CI, 1.6 to 1.9), Hispanic ethnicity (OR, 1.3; 95% CI, 1.1 to 1.5), previous blood transfusion (OR, 2.8; 95% CI, 2.5 to 3.1), and first/only time donor status (OR, 4.2; 95% CI, 3.9 to 4.5 compared with repeat donors). Seropositivity for human T-lymphotropic virus types I and II, human immunodeficiency virus, or hepatitis B core antigen was highly associated with HCV seropositivity (OR, 10.4; 95% CI, 9.6 to 11.4 for one vs no marker). CONCLUSIONS: Despite a low overall HCV prevalence in blood donors in the United States, there is a marked variation in HCV seroprevalence by demographic subgroup, even after controlling for prior blood transfusion, a recognized risk factor for HCV. Further study of the prevalence of other parenteral risk factors such as past injection drug use among blood donors is needed.