Professor Emeritus, Medicine - Stanford Prevention Research Center
C.F.Rehnborg Professorship in Disease Prevention, Stanford University School of Medicine (1989 - 1999)
Director, Stanford Prevention Research Center, Stanford University School of Medicine (1972 - 1999)
Honors & Awards
Member, Alpha Omega Alpha, University of California School of Medicine, San Francisco (1952)
Gold-Headed Cane, Awarded yearly to the top student, University of California School of Medicine, San Francisco (1952)
Elected Member, Institute of Medicine of the National Academy of Sciences (1978)
Awardee of the James D. Bruce Award for Distinguished Contributions in Preventive Medicine, American College of Physicians (1983)
Fellow, The Center for Advanced Study in the Behavioral Sciences (1983-1984)
Myrdal Prize for Evaluation Practice, American Evaluation Association (1986)
Preventive Cardiology Academic Award, National Heart, Lung and Blood Institute (1989-1994)
Charles A. Dana Award for Pioneering Achievemnts in Health, Dana Foundation (1990)
National Cholesterol Award for Public Education, National Heart Lung and Blood Institute (1991)
President, Society of Behavioral Medicine (1991-1992)
Research Achievement Award, American Heart Association (1992)
Order of Saint George, Autonomous Government of Catalonia (1996)
Joseph Stokes Preventive Cardiology Award, American Society of Preventive Cardiology (1999)
The Fries Prize for the person who most improved the public's health, The Fries Foundation (2005)
Community and International Work
The Stanford Chronic Disease Working Group
policy framework development
The Stanford Center for Disease Prevention
Opportunities for Student Involvement
IOM Committee for Prevention of CVD in Developing Countries, Washington, DC
low and middle-income countries
Opportunities for Student Involvement
Current Research and Scholarly Interests
Chronic disease prevention, epidemiology of chronic diseases, community-based education for disease prevention, global health, politics and public health.
Graduate and Fellowship Programs
Promoting culturally targeted chronic disease prevention research through an adapted participatory research approach: The Qassim-Stanford Universities project.
Translational behavioral medicine
2011; 1 (2): 289-298
The Kingdom of Saudi Arabia (KSA), similar to other countries in the Eastern Mediterranean, has been experiencing a recent rapid increase in the prevalence of chronic diseases and associated risk factors. To begin to take advantage of the chronic disease prevention and health promotion (CDPHP) knowledge available from other nations, researchers at a newly established University in the Qassim Province of the KSA have partnered with Stanford University in the United States of America. To ensure that CDPHP research and interventions are culturally relevant and appropriate, a participatory research approach has been adopted where local researchers are the target "community." Contextual challenges of conducting CDPHP research in the KSA, at the individual, social/cultural, organizational and environmental/policy levels, are identified, as well as examples of CDPHP intervention strategies that may be culturally appropriate at each level.
View details for DOI 10.1007/s13142-011-0033-3
View details for PubMedID 24073051
- Promoting culturally targeted chronic disease prevention research through adaptation of a participatory research approach: the Qassim-Stanford Universities Project Translational Behavioral Medicine 2011: 289-298
- Multi-Country Analysis of Palm Oil Consumption and Cardiovascular Disease Mortality for Countries at Different Stages of Economic Development Globalization and Health 2011
Effect of Ginkgo biloba (EGb 761) on treadmill walking time among adults with peripheral artery disease - A randomized clinical trial
JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION
2008; 28 (4): 258-265
Medical therapies for treatment of peripheral artery disease (PAD) are limited. Ginkgo biloba has been reported to increase maximal and pain-free walking distance among patients with PAD; however, the evidence is inconsistent. The objective of this study was to compare the effects of 300 mg/d of Ginkgo biloba (EGb 761) versus placebo on treadmill walking time and related cardiovascular measures among patients with PAD.A double-blind, placebo-controlled, parallel design trial with a 4-month duration was used. Participants were 62 adults, aged 70 +/- 8 years (mean +/- SD), with claudication symptoms of PAD. The primary study outcomes were maximal and pain-free walking time on a treadmill. Secondary outcomes included flow-mediated vasodilation, a measure of antioxidant status as assessed by determining antibody levels to epitopes of oxidized low-density lipoprotein, and questionnaires addressing walking impairment and quality of life.Maximal treadmill walking time increased by 20 +/- 80 and 91 +/- 242 seconds in the placebo and the EGb 761 groups, respectively (P = .12). Pain-free walking time increased by 15 +/- 31 and 21 +/- 43 seconds, respectively (P = .28). No significant differences were detected between groups for any of the secondary outcomes.In older adults with PAD, Ginkgo biloba produced a modest but insignificant increase in maximal treadmill walking time and flow-mediated vasodilation. These data do not support the use of Ginkgo biloba as an effective therapy for PAD, although a longer duration of use should be considered in any future trials.
View details for Web of Science ID 000258583000005
View details for PubMedID 18628657
Effect of Ginkgo biloba (EGb 761) aggregation and platelet and aspirin on platelet analysis among older adults at risk of cardiovascular disease: a randomized clinical trial
BLOOD COAGULATION & FIBRINOLYSIS
2007; 18 (8): 787-793
Several case reports have implicated Ginkgo biloba in clinically adverse bleeding disorders. Ginkgo biloba has been reported to increase pain-free walking distance among patients with peripheral artery disease (PAD). Standard PAD therapy includes 325 mg/day aspirin. The objective of this study was to examine potential adverse effects of concomitant aspirin and Ginkgo biloba on platelet function. Ginkgo biloba (EGb 761, 300 mg/day) was compared with placebo for effects on measures of platelet aggregation among adults consuming 325 mg/day aspirin in a randomized, double-blind, placebo-controlled, parallel design trial of 4-week duration. Participants were adults, age 69 +/- 10 years, with PAD or risk factors for cardiovascular disease. Outcome measures included platelet function analysis (PFA-100 analyzer) using ADP as an agonist (n = 26 placebo; n = 29 ginkgo), and platelet aggregation using ADP, epinephrine, collagen and ristocetin as agonists (n = 21 placebo; n = 23 ginkgo). Participants kept daily logs of bleeding or bruising episodes. There were no clinically or statistically significant differences between treatment groups for any agonists, for either PFA-100 analysis or platelet aggregation. Reports of bleeding or bruising were infrequent and similar for both study groups. In conclusion, in older adults with PAD or cardiovascular disease risk, a relatively high dose of Ginkgo biloba combined with 325 mg/day daily aspirin did not have a clinically or statistically detectable impact on indices of coagulation examined over 4 weeks, compared with the effect of aspirin alone. No adverse bleeding events were observed, although the trial was limited to a small sample size.
View details for Web of Science ID 000251271200012
View details for PubMedID 17982321
Safety and efficacy of a ginkgo biloba-containing dietary supplement on cognitive function, quality of life, and platelet function in healthy, cognitively intact older adults
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
2007; 107 (3): 422-432
To determine if a ginkgo biloba-containing supplement improves cognitive function and quality of life, alters primary hemostasis, and is safe in healthy, cognitively intact older adults.Four-month, randomized, double-blind, placebo-controlled parallel design.Ninety men and women (age range 65 to 84 years) were recruited to a university clinic. Eligibility included those without dementia or depression, not taking psychoactive medications or medications or supplements that alter hemostasis.Ninety subjects were randomly assigned to placebo or a ginkgo biloba-based supplement containing 160 mg ginkgo biloba, 68 mg gotu kola, and 180 mg decosahexaenoic acid per day for 4 months.Assessments included: six standardized cognitive function tests, the SF-36 Quality of Life questionnaire, the Platelet Function Analyzer-100 (Dade Behring, Eschbom, Germany), and the monitoring of adverse events.Baseline characteristics and study hypotheses were tested using analysis of covariance. Tests were two-tailed with a 0.05 significance level.Seventy-eight subjects (87%) completed both baseline and 4-month testing (n=36 in placebo group, n=42 in ginkgo biloba group). At baseline, the participants' cognitive function was above average. One of six cognitive tests indicated significant protocol differences at 4 months (P=0.03), favoring the placebo. There were no significant differences in quality of life, platelet function, or adverse events.These finding do not support the use of a ginkgo biloba-containing supplement for improving cognitive function or quality of life in cognitively intact, older, healthy adults. However, high baseline scores may have contributed to the null findings. The ginkgo biloba product seems safe and did not alter platelet function, though additional studies are needed to evaluate the interaction of varying doses of ginkgo biloba and ginkgo biloba-containing supplements with medications and supplements that alter hemostasis.
View details for DOI 10.1016/j.jada.2006.12.011
View details for Web of Science ID 000244551100016
View details for PubMedID 17324660
The effect of a plant-based diet on plasma lipids in hypercholesterolemic adults - A randomized trial
ANNALS OF INTERNAL MEDICINE
2005; 142 (9): 725-733
A variety of food combinations can be used to meet national U.S. guidelines for obtaining 30% of energy or less from total fat and 10% of energy or less from saturated fat.To contrast plasma lipid responses to 2 low-fat diet patterns.Randomized clinical trial.4-week outpatient feeding study with weight held constant.120 adults 30 to 65 years of age with prestudy low-density lipoprotein (LDL) cholesterol concentrations of 3.3 to 4.8 mmol/L (130 to 190 mg/dL), body mass index less than 31 kg/m2, estimated dietary saturated fat at least 10% of calories, and otherwise general good health.Plasma lipid levels.Two diets, the Low-Fat diet and the Low-Fat Plus diet, designed to be identical in total fat, saturated fat, protein, carbohydrate, and cholesterol content, consistent with former American Heart Association Step I guidelines. The Low-Fat diet was relatively typical of a low-fat U.S. diet. The Low-Fat Plus diet incorporated considerably more vegetables, legumes, and whole grains, consistent with the 2000 American Heart Association revised guidelines.Four-week changes in the Low-Fat and Low-Fat Plus groups were -0.24 mmol/L (-9.2 mg/dL) versus -0.46 mmol/L (-17.6 mg/dL) for total cholesterol (P = 0.01) and -0.18 mmol/L (-7.0 mg/dL) versus -0.36 mmol/L (-13.8 mg/dL) for LDL cholesterol (P = 0.02); between-group differences were -0.22 mmol/L (-9 mg/dL) (95% CI, -0.05 to -0.39 mmol/L [-2 to -15 mg/dL]) and -0.18 mmol/L (-7 mg/dL) (CI, -0.04 to -0.32 mmol/L [-2 to -12 mg/dL]) for total and LDL cholesterol, respectively. The 2 diet groups did not differ significantly in high-density lipoprotein cholesterol and triglyceride levels.4-week duration.Previous national dietary guidelines primarily emphasized avoiding saturated fat and cholesterol; as a result, the guidelines probably underestimated the potential LDL cholesterol-lowering effect of diet. In this study, emphasis on including nutrient-dense plant-based foods, consistent with recently revised national guidelines, increased the total and LDL cholesterol-lowering effect of a low-fat diet.
View details for Web of Science ID 000228825800001
View details for PubMedID 15867404
- Platform for international action on cardiovascular disease Prevention and Control 2005; 1(2): 185-217
- The evolution of tobacco use and control in the United States: an interview with Dr. John Farquhar Am Jr Health Promot. 2005; 19 Suppl 3: 255-259
- Community-based health promotion Handbook of Epidemiology, Ahrens W, Peugot I (Eds) Chapter III 2005; 11: 1306-1321
Soy, garlic, and ginkgo biloba: their potential role in cardiovascular disease prevention and treatment.
Current atherosclerosis reports
2003; 5 (6): 468-475
There are hundreds of foods, nutrients, herbs, and botanicals that have "bioactive" constituents with potential human health benefits. Three of these are discussed in this review: soy, garlic, and ginkgo biloba. Each of these three choices involves an ingestible item composed of a complex mixture of bioactive agents. For each of these three, there is a large and growing body of research suggesting potential cardiovascular health benefits. And for each there is at least some level of disagreement or controversy. The focus of this review is on results from recent human clinical trials.
View details for PubMedID 14525680
Effects of plant-based diets high in raw or roasted almonds, or roasted almond butter on serum lipoproteins in humans
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION
2003; 22 (3): 195-200
To compare the lipid-altering effect of roasted salted almonds and roasted almond butter with that of raw almonds, as part of a plant-based diet.Thirty-eight free-living, hypercholesterolemic men (n = 12) and women (n = 26) with a mean total serum cholesterol (TC) of 245 + 29 mg/dL (mean + SD) followed a heart-healthy diet including 100g of one of three forms of almonds: roasted salted almonds, roasted almond butter or raw almonds for four weeks. Measurements of serum TC, triglycerides (TG), selected lipoproteins and blood pressure were taken at baseline and after four weeks.All three forms of almonds in the context of a heart-healthy diet significantly lowered low-density lipoprotein-cholesterol (LDL) from baseline to the completion of the study. Both raw and roasted almonds significantly lowered TC, whereas the decrease by almond butter (in a smaller cohort) did not reach statistical significance. High-density lipoprotein-cholesterol (HDL) did not significantly change with raw or roasted almonds but slightly increased with almond butter. At the end of the study, blood pressure did not change significantly from baseline values for any of the groups.These results suggest that unblanched almonds-whether raw, dry roasted, or in roasted butter form-can play an effective role in cholesterol-lowering, plant-based diets.
View details for Web of Science ID 000183518900002
View details for PubMedID 12805245
- Heart Disease: an all-out attack on risk (based on a roundtable) The Pfizer Journal 2003; 7 (4): 1-44
- Coronary Artery Disease Encyclopedia of Public Health, MacMillan Reference, New York 2002
- Results of a multifactor cardiovascular risk reduction program in the Czech Republic: the healthy Dubec project Inter J Behavioral Medicine 2002; 7 (1): 44-61
- Enfermedades Cardiacus: Todas la Informacion que Necesitas saber Acerca de tu Corazon Barcelona, Buenos Aires, Mexico: Paidos 2002
- Diagnosis heart disease: answers to your questions about recovery and lasting health New York, NY: WW Norton and Company 2001
- Health Interventions: Community-based International Encyclopedia of the Social and Behavioral Sciences, Pergamon, Oxford 2001: 6576-6581
Results of a multifactor cardiovascular risk reduction program in the Czech Republic: The healthy Dubec project
INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE
2000; 7 (1): 44-61
View details for Web of Science ID 000088751700004
Primordial prevention: The Path from Victoria to Catalonia
Symposium on Primordial Prevention of Cardiovascular Disease Risk Factors
ACADEMIC PRESS INC ELSEVIER SCIENCE. 1999: S3–S8
Primordial prevention seeks to prevent future disease by influencing its social determinants. Henry Blackburn's writings are prime portrayals of social factors causing premature cardiovascular disease (CVD). His classic paper, Diet and Mass Hyperlipidemia, identified changes needed in professional attitudes, medical economics, food production, food labeling, and food advertising. The 1982 WHO report, Coronary Heart Disease (Blackburn, rapporteur), introduced the term "primordial prevention," starting a cycle of initiatives, all with considerable influence worldwide. He participated in the now widely disseminated Victoria Declaration on Heart Health (1992), which contained 64 policy recommendations, many focussing on broad social forces that influence modern CVD epidemics. The path he initiated led to the Catalonia Declaration: Investing in Heart Health (1996), which echoed many of his pleas for resources necessary to influence CVD rates. Some roots of CVD's recent decline in many countries are thus clearly attributable to Blackburn's prescient wisdom and visionary scholarship.
View details for Web of Science ID 000084471300002
View details for PubMedID 10641810
Nutritional education in the community.
Nutrition, metabolism, and cardiovascular diseases : NMCD
1999; 9 (4): 56-71
View details for PubMedID 10715839
Managing job strain: A randomized, controlled trial of an intervention conducted by mail and telephone
JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
1999; 41 (4): 216-223
A randomized, clinical intervention focused on alleviating job strain was conducted over 6 months by mail and/or telephone with a total of 136 employees of Bank of America. Both the mail and mail plus telephone interventions evidenced positive results, with the mail plus telephone intervention being the more effective. Given the relative low cost of such mediated interventions, the results provide a basis for the further development of interventions that may demonstrate both clinical and cost effectiveness.
View details for Web of Science ID 000079795000003
View details for PubMedID 10224587
- Community-wide Prevention Programs--They Work Healthy Aging: Challenges and Solutions 1999
Determinants of cholesterol screening and treatment patterns - Insights for decision-makers
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
1998; 15 (3): 178-186
Adult cholesterol screening and treatment policies by the National Cholesterol Education Program recommend that physicians screen all adults aged > 20 [corrected]. On the other hand, the American College of Physicians recommends that healthy young adult men aged > 35 and premenopausal women aged > 45 not be screened due to concerns about the cost of and health risks associated with overuse of pharmacologic therapy in lieu of lifestyle modification.The objectives of this study were to determine the type of treatment (lifestyle vs. pharmacologic) that physicians actually prescribe for individuals screened for elevated cholesterol.Self-report data were derived from the 1989-1990 cross-sectional survey of the Stanford Five-City Project on 1,883 Latino and Anglo men and women aged 20 to 74 years of age. A four-stage sequential design was conducted using multiple stepwise regression analyses with a significance cutpoint of P < .01.Young adult men and women were significantly less likely to report ever having been screened (OR 1.02; 95% CI 1.07-1.09). Individuals of low socioeconomic status (SES) were also significantly less likely to report ever being screened (OR, 1.12; CI, 1.08-1.16), as were Latino men and women, regardless of age (OR 1.57; CI, 1.14-2.18). There were no significant differences in the pattern of physician care utilization among low SES or Latino individuals during the previous 12-month period. Among those under physician care to lower cholesterol, young adults were more likely to be prescribed lifestyle modification (OR, 0.95; CI, 0.92-0.98).Our results suggest that although young adults are less likely to be screened, if screened they are more likely to be prescribed lifestyle modification than pharmacologic treatment for elevated cholesterol. The lower prevalence of screening among low SES and Latino individuals suggests the need for policy discussions to reduce these disparities.
View details for Web of Science ID 000076101800003
View details for PubMedID 9791635
[California Proposition 99--an example to follow?].
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
1998; 118 (14): 2210-2214
View details for PubMedID 9656821
- Worksite Nutrition Programs International Labor Office Encyclopaedia of Occupational Health and Safety 1998: 15.32-15.36
- Managing job strain: A randomized controlled trial of an intervention conducted by mail and telephone AMERICAN JOURNAL OF HEALTH PROMOTION 1998; 12 (3): 166-169
Synthesis of findings and issues from community prevention trials
Conference on Community Trials for Cardiopulmonary Health - Directions for Public Health Practice, Policy and Research
ELSEVIER SCIENCE INC. 1997: S54–S68
View details for Web of Science ID A1997YD39500007
- Short- and long-term outcomes of a health promotion program in a small rural community AMERICAN JOURNAL OF HEALTH PROMOTION 1997; 11 (6): 411-414
- Private sector-funded community health promotion AMERICAN JOURNAL OF HEALTH PROMOTION 1997; 11 (6): 415-416
- Synthesis of findings and issues from community prevention trials Annals of Epidemiology 1997
- Effects of a plant-based diet rich in whole grains, sun-dried raisins and nuts on serum lipoproteins Vegetarian Nutrition: An International Journal 1997; 1/2: 58-63
- Program to Reduce Cardiovascular and Cerebrovascular Disease in the Czech Republic: Design and Methods of the Healthy Dubec Project International Quarterly of Community Health Education 1997; 16: 315-331
The case for dissemination research in health promotion and disease prevention
1st Canadian Conference on Dissemination Research - Strengthening Health Promotion and Disease Prevention
CANADIAN PUBLIC HEALTH ASSOC. 1996: S44–S49
The case for dissemination research stems from the major imbalance in research funds available for preventive medicine, relative to needs. For examples, in the United States in 1992 prevention research was only 0.32% of the health care budget and dissemination research was a small proportion of prevention research. The Canadian Heart Health Initiative is an excellent example of successful dissemination research, based on needs assessment and evaluation of widespread demonstration projects. Other examples include the California Tobacco Tax Initiative, community projects and practitioner training. Continued professional and public education are needed to counter the prevalent philosophy favouring curative medicine; such policy documents as the Victoria Declaration for Heart Health and the Catalonia Declaration Investing in Heart Health are steps in this direction. The dissemination research agenda is broad, including replication of success in different geographic and cultural setting. The final goal is to hasten technology transfer of useful health promotion methods throughout the world.
View details for Web of Science ID A1996WC57200009
View details for PubMedID 9002343
- Principles of Behavioral Change Introduction to Clinical Medicine, Philadelphia: BC Decker, Inc. 1996: 762-767
- Methodological and Substantive Issues in Substance Abuse Prevention Research American Behavioral Scientist 1996; 39 (7): 935-942
A program to reduce cardiovascular and cerebrovascular disease in the czech republic: design and methods of the healthy dubec project.
International quarterly of community health education
1996; 16 (4): 315-331
Cardiovascular Disease (CVD) morbidity and mortality rates in the Czech Republic are among the highest in the industrialized world. Due to the substantial burden CVD plays on the health and well being of the Czech society, a variety of health promotion/disease management strategies to reduce CVD risk need to be designed and implemented. A project that combined community-based health education programs designed to address pervasive perceptions and cultural traditions that influence lifestyle factors, with secondary and tertiary prevention clinical strategies to aggressively treat high-risk individuals was recently conducted in Dubec, a small Czech community. This article describes the methods used in this project (i.e., the Healthy Dubec Project) which took American-based technology and experiences in community risk reduction methods and clinical management strategies for high risk patients and adapted them to fit the Czech people and their attitudes about CVD risk behaviors.
View details for DOI 10.2190/7VN2-TBJ1-K911-8T28
View details for PubMedID 20841053
- A call to action to stem the epidemic of deaths from the use of firearms PREVENTIVE MEDICINE 1996; 25 (1): 87-87
- A Pound of Prevention Stanford Medicine 1996
- PREVALENCE, PROMOTION, AND PERSON - THE 3-PS OF FIREARM USE AMERICAN JOURNAL OF PUBLIC HEALTH 1995; 85 (10): 1453-1453
- THE PLACE OF HYPERTENSION CONTROL IN TOTAL CARDIOVASCULAR HEALTH - PERSPECTIVES OUTLINED BY THE VICTORIA-DECLARATION Policies for the Control of Hypertension in Populations - Joint Symposium of the Inter-American-Society-of-Hypertension/World-Hypertension-League TAYLOR & FRANCIS INC. 1995: 1107–11
COMMUNITY INTERVENTION TRIALS - REFLECTIONS ON THE STANFORD 5-CITY PROJECT EXPERIENCE
AMERICAN JOURNAL OF EPIDEMIOLOGY
1995; 142 (6): 576-586
In the past two decades several community intervention studies designed to lower the risk of cardiovascular disease in populations have been completed. These trials shared the rationale that the community approach was the best way to address the large population attributable risk of mild elevations of multiple risk factors, the interrelation of several health behaviors, and the potential efficiency of large-scale interventions not limited to the medical care system. These trials also shared several threats to internal validity, especially the small number of intervention units (usually cities) that could be studied. The purpose of this paper is to reflect on the lessons learned in one of the studies, the Stanford Five-City Project, which began in 1978. The anticipated advantages were observed, including the generalizability of the intervention components, the potential for amplification of interventions through diffusion in the community, and the efficiency of the mass media and other community programs for reaching the entire population. Numerous components of the intervention proved effective when evaluated individually, as was true in other community studies. However, the design limitations proved difficult to overcome, especially in the face of unexpectedly large, favorable risk factor changes in control sites. As a result, definitive conclusions about the overall effectiveness of the communitywide efforts were not always possible. Nevertheless, in aggregate, these studies support the effectiveness of communitywide health promotion, and investigators in the field should turn to different questions. The authors have learned how little they know of the determinants of population-level change and the characteristics that separate communities that change quickly in response to general health information from those that do not. Future studies in communities must elucidate these characteristics, while improving the effectiveness of educational interventions and expanding the role of environmental and health policy components of health promotion.
View details for Web of Science ID A1995RT89700003
View details for PubMedID 7653465
INCREASING DISPARITY IN KNOWLEDGE OF CARDIOVASCULAR-DISEASE RISK-FACTORS AND RISK-REDUCTION STRATEGIES BY SOCIOECONOMIC-STATUS - IMPLICATIONS FOR POLICY-MAKERS
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
1995; 11 (5): 318-323
During the 1980s extensive local and national cardiovascular health promotion campaigns were implemented to improve knowledge of risk reduction. This study analyzed changes from 1980 to 1990 in knowledge of acquired cardiovascular risk factors (i.e., actual, objective knowledge of adverse lifestyle factors affecting cardiovascular health); perceived knowledge of risk-reduction strategies (i.e., subjective knowledge about how to reduce the likelihood of cardiovascular disease); and interest in risk modification (i.e., interest in changing risk-factor habits) by socioeconomic status using level of education. The study population included 2,455 women and men 25-74 years of age from three population-based cross-sectional surveys in two northern California cities. We found significant differentials in baseline knowledge that widened over the 10-year study period, resulting in larger disparities across educational groups at the final survey in 1990 (P < .05). From 1980 to 1990, individuals with < 12 years of education experienced only slight improvement in their knowledge of cardiovascular risk factors (mean summary score of 4.4 increasing to 5.5, based on a 17-item questionnaire of risk factors); those with > or = 16 years of education experienced twice as much improvement (mean of 8.4 increasing to 11.1) (P < .05). There were similar time-effect disparities in knowledge of risk-reduction strategies (P < .05). In contrast, interest in risk modification was high for all educational groups and remained uniform across time. The continuing and widening disparity in knowledge between socioeconomic groups suggests the need for policymakers to reform existing cardiovascular risk-reduction education campaigns.
View details for Web of Science ID A1995RX84600008
View details for PubMedID 8573362
- Plant Sterols: Their Biological Effects in Humans Handbook of Lipids in Human Nutrition 1995; Chap 2.5: 101-105
- Healthy Dubec - Design of a Joint Czech-American Community Project for the Reduction of Cardiovascular and Cerebrovascular Disease (Adapted from the American Experience) Central European Journal of Public Health 1995; 4: 230-233
- Community-based Interventions for Smokers: The Commit Field Experience - Foreword Smoking and Tobacco Control, Monograph 1995; No. 6: iii-vi
EFFECTS OF INTENSIVE MULTIPLE RISK FACTOR REDUCTION ON CORONARY ATHEROSCLEROSIS AND CLINICAL CARDIAC EVENTS IN MEN AND WOMEN WITH CORONARY-ARTERY DISEASE - THE STANFORD-CORONARY-RISK-INTERVENTION-PROJECT (SCRIP)
1994; 89 (3): 975-990
Recent clinical trials have shown that modification of plasma lipoprotein concentrations can favorably alter progression of coronary atherosclerosis, but no data exist on the effects of a comprehensive program of risk reduction involving both changes in lifestyle and medications. This study tested the hypothesis that intensive multiple risk factor reduction over 4 years would significantly reduce the rate of progression of atherosclerosis in the coronary arteries of men and women compared with subjects randomly assigned to the usual care of their physician.Three hundred men (n = 259) and women (n = 41) (mean age, 56 +/- 7.4 years) with angiographically defined coronary atherosclerosis were randomly assigned to usual care (n = 155) or multifactor risk reduction (n = 145). Patients assigned to risk reduction were provided individualized programs involving a low-fat and -cholesterol diet, exercise, weight loss, smoking cessation, and medications to favorably alter lipoprotein profiles. Computer-assisted quantitative coronary arteriography was performed at baseline and after 4 years. The main angiographic outcome was the rate of change in the minimal diameter of diseased segments. All subjects underwent medical and risk factor evaluations at baseline and yearly for 4 years, and reasons for all hospitalizations and deaths were documented. Of the 300 subjects randomized, 274 (91.3%) completed a follow-up arteriogram, and 246 (82%) had comparative measurements of segments with visible disease at baseline and follow-up. Intensive risk reduction resulted in highly significant improvements in various risk factors, including low-density lipoprotein cholesterol and apolipoprotein B (both, 22%), high-density lipoprotein cholesterol (+12%), plasma triglycerides (-20%), body weight (-4%), exercise capacity (+20%), and intake of dietary fat (-24%) and cholesterol (-40%) compared with relatively small changes in the usual-care group. No change was observed in lipoprotein(a) in either group. The risk-reduction group showed a rate of narrowing of diseased coronary artery segments that was 47% less than that for subjects in the usual-care group (change in minimal diameter, -0.024 +/- 0.066 mm/y versus -0.045 +/- 0.073 mm/y; P < .02, two-tailed). Three deaths occurred in each group. There were 25 hospitalizations in the risk-reduction group initiated by clinical cardiac events compared with 44 in the usual-care group (rate ratio, 0.61; P = .05; 95% confidence interval, 0.4 to 0.9).Intensive multifactor risk reduction conducted over 4 years favorably altered the rate of luminal narrowing in coronary arteries of men and women with coronary artery disease and decreased hospitalizations for clinical cardiac events.
View details for Web of Science ID A1994NA76200008
View details for PubMedID 8124838
- The effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary atherosclerosis: The Stanford Coronary Risk Intervention Project (SCRIP) Circulation 1994; 89 (3): 975-90
Behavior change and compliance: keys to improving cardiovascular health. How health behavior relates to risk factors.
1993; 88 (3): 1376-1380
View details for PubMedID 8353903
MOVING TOWARD SYNERGY - MEDIA SUPPLEMENTATION IN THE STANFORD 5-CITY PROJECT
1993; 20 (4): 587-610
View details for Web of Science ID A1993LM06000005
IMPROVEMENTS IN CHOLESTEROL-RELATED KNOWLEDGE AND BEHAVIOR AND PLASMA-CHOLESTEROL LEVELS IN YOUTHS DURING THE 1980S
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
1993; 9 (3): 168-174
This article examines cholesterol-related knowledge, cholesterol-related behaviors, and plasma cholesterol levels in 12-24-year-olds, using data collected from four community-based cross-sectional surveys conducted 1979-1980, 1981-1982, 1985-1986, and 1989-1990. Participants included 1,552 individuals from randomly sampled households in two control cities (San Luis Obispo and Modesto, California) of the Stanford Five-City Project. Over the eleven-year study period, cholesterol-related knowledge improved in both control cities (P < .0002). Cholesterol-related behavior (P < .0003) and plasma cholesterol levels (P < .002) significantly improved only in San Luis Obispo (a college city with more 19-24-year-olds and a better-educated population than Modesto). In general, knowledge and behavior scores and plasma cholesterol levels were lower in these 12-24-year-olds than in 25-74-year-olds, although trends at all ages were similar over time and by demographic variables. Although the cholesterol-related interventions that began in the mid-1980s primarily targeted adults, these 12-24-year-olds' cholesterol-related knowledge improved (as did, to a lesser extent, their cholesterol-related behavior and plasma cholesterol levels). These findings have implications for upcoming youth-related cholesterol interventions.
View details for Web of Science ID A1993LJ66400006
View details for PubMedID 8347368
CARDIOVASCULAR-DISEASE RISK-FACTORS - IMPROVEMENTS IN KNOWLEDGE AND BEHAVIOR IN THE 1980S
AMERICAN JOURNAL OF PUBLIC HEALTH
1993; 83 (4): 590-593
This study surveyed 4158 adults residing in two control cities of the Stanford Five-City Project. Analysis of five cross-sectional surveys (conducted in 1979 through 1990) demonstrated improvements in respondents' general cardiovascular disease risk factor knowledge and behaviors. Cholesterol-related knowledge and behavior showed particularly marked improvements.
View details for Web of Science ID A1993KX08600027
View details for PubMedID 8460744
[The Victoria Declaration: a call to action].
Revista de sanidad e higiene pública
1993; 67 (2): 75-?
View details for PubMedID 7725058
- The Victoria Declaration on Heart Health, Declaration of the Advisory Board First International Heart Health Conference (Chair, Farquhar JW) 1993
- Moving Toward Synergy: Media Supplementation in the Stanford Five-City Project Communication Research 1993; 20 (4): 587-610
IMPROVED CHOLESTEROL-RELATED KNOWLEDGE AND BEHAVIOR AND PLASMA-CHOLESTEROL LEVELS IN ADULTS DURING THE 1980S
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1992; 268 (12): 1566-1572
To determine whether cholesterol-related knowledge and behavior and plasma cholesterol levels were stable until the inception of large-scale national interventions in the middle to late 1980s, whether they subsequently improved, and whether these levels varied by subgroups.Data were collected from 4173 adults aged 25 through 74 years in the two control cities (San Luis Obispo and Modesto, Calif) of the Stanford Five-City Project. Five separate, community-based surveys were conducted in 1979-1980, 1981-1982, 1983-1984, 1985-1986, and 1989-1990.Cholesterol-related knowledge and behavior and plasma cholesterol levels improved (P = .0001) in both cities after the early 1980s. Those who were more educated, female, older, or nonsmokers had significantly higher knowledge and behavior scores, and those who were younger, more educated, or normotensive had significantly lower plasma cholesterol levels.Improvements in this population's cholesterol-related knowledge and behavior and plasma cholesterol levels began in 1985-1986, suggesting that the extensive cholesterol interventions that began in the middle 1980s in the United States created positive cholesterol-related changes at the community level.
View details for Web of Science ID A1992JN25600027
View details for PubMedID 1518111
IMPACT OF A CLINICAL PREVENTIVE MEDICINE CURRICULUM FOR PRIMARY CARE FACULTY - RESULTS OF A DISSEMINATION MODEL
1992; 21 (4): 419-435
This study was designed to test a dissemination model for providing clinical preventive medicine (CPM) training to general internal medicine faculty across the United States.The model incorporated direct instruction of a few faculty as seminar facilitators who, in turn, taught a CPM curriculum to their faculty colleagues, who then could teach it to housestaff and students. The CPM curriculum consisted of six seminars that focused primarily on the risk factors for chronic diseases and on behavior change methods for modifying smoking, diet, and exercise.Faculty who participated in the seminars had significant pre- to post-test increase in knowledge and reported self-efficacy to implement CPM strategies with patients, as well as changes in CPM clinical practices. These faculty, in turn, successfully disseminated CPM information to their housestaff, who also had increases in self-efficacy and changed clinical practices regarding CPM topics.The successful implementation of the dissemination model attests to its viability as a mechanism for disseminating CPM curricula and increasing the emphasis on CMP issues in both clinical teaching and clinical encounters with patients.
View details for Web of Science ID A1992JH41200003
View details for PubMedID 1409485
- Media Use Habits and Education Campaign Recall in the Stanford Five-City Project Promoting Dietary Change in Communities: Applying Existing Models of Dietary Change to Population-based Interventions 1992: 259-276
- The Stanford Faculty Development Program: A dissemination approach to faculty development for medical teachers Teaching and Learning in Medicine 1992; 4 (3): 180-187
- Community perspective on socio-environmental interventions Promoting Dietary Change in Communities: Applying Existing Models of Dietary Change to Population-based Interventions 1992: 216-220
- Phases for Developing Community Trials: Lessons for Control of Alcohol Problems from Research in Cardiovascular Disease, Cancer, and Adolescent Health Prevention Research Center Publication 1992: 59-75
THE IMPACT OF PUBLIC CHOLESTEROL SCREENING ON DIET, GENERAL WELL-BEING, AND PHYSICIAN REFERRAL
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
1991; 7 (5): 268-272
Public cholesterol screenings have become common. To evaluate the public health impact of such events, we conducted a public cholesterol screening and, three months later, invited participants between the ages of 18 and 72 to return for follow-up. More than 77% (N = 143) returned. We collected information on diet and general well-being at baseline and follow-up, and we obtained information on further medical evaluation of the initial cholesterol value at follow-up. Diet improved regardless of baseline cholesterol level (overall diet score 2.10 baseline, 1.75 follow-up, P less than .001). There were no adverse psychosocial ("labeling") effects in persons told of elevated cholesterol levels. About one-third of individuals referred to their physicians for elevated cholesterol values discussed the cholesterol issue with their physicians, as did a similar proportion of those told of a desirable cholesterol level. Total cholesterol decreased from 218.5 to 211.6 mg/dL (P = 0.18, 95% CI for the change, -18.5 to +4.7 mg/dL). Public cholesterol screening did not appear to have any adverse effects and may lead to beneficial changes in diet in persons screened.
View details for Web of Science ID A1991HH02900003
View details for PubMedID 1790031
GUAR GUM AND PLASMA-CHOLESTEROL - EFFECT OF GUAR GUM AND AN OAT FIBER SOURCE ON PLASMA-LIPOPROTEINS AND CHOLESTEROL IN HYPERCHOLESTEROLEMIC ADULTS
ARTERIOSCLEROSIS AND THROMBOSIS
1991; 11 (5): 1204-1208
The hypolipidemic effect of guar gum (GG, 15 g/day) was compared with that of an oat fiber source (OFS, 77 g/day). Both treatments supplied the same amount of total dietary fiber (11 g/day) and were taken with water three times a day for 3 weeks at mealtime. Thirteen free-living adult men and women participated in the study. Their total plasma cholesterol (TC) was 244 +/- 21 mg/dl (mean +/- SD), and plasma triglycerides (TGLYs) were 149 +/- 93 mg/dl before the intervention. Diets were monitored to ensure that no changes occurred other than the replacement of carbohydrate calories for the 200 kcal/day supplied by the OFS. Combined averages for both of the crossover phases showed that GG induced a reduction in TC of 26 +/- 10 mg/dl and in low density lipoprotein cholesterol of 25 +/- 9 mg/dl. The OFS induced a reduction in TC of 9 +/- 13 mg/dl and in low density lipoprotein cholesterol of 11 +/- 4 mg/dl. Although both treatments were effective in reducing elevated TC, GG at the levels fed was significantly more effective (p less than 0.001) in reducing TC. Neither treatment induced significant changes in high density lipoprotein cholesterol or very low density lipoprotein cholesterol.
View details for Web of Science ID A1991GH33900009
View details for PubMedID 1655015
EFFECT OF LONG-TERM COMMUNITY-HEALTH EDUCATION ON BODY-MASS INDEX - THE STANFORD 5-CITY PROJECT
AMERICAN JOURNAL OF EPIDEMIOLOGY
1991; 134 (3): 235-249
Being overweight is a risk factor for cardiovascular heart disease and other medical problems. The purpose of this study was to examine the effect of a community-wide cardiovascular risk reduction trial (the Stanford Five-City Project) on body mass index. In the Stanford Five-City Project, two treatment cities (n = 122,800) received a 6-year mass media and community organization cardiovascular risk reduction intervention. Changes in the treatment cities were compared with two control cities (n = 197,500) for changes in knowledge of risk factors, blood pressure, plasma cholesterol level, smoking rate, body mass index, and resting pulse rate after 5-1/3 years of the education program. Both cohort and cross-sectional (independent) samples were used in the study. In the independent surveys, subjects in the treatment communities gained significantly less weight than subjects in the control communities (0.57 kg compared with 1.25 kg) over 6 years. In the cohort, there were no significant overall differences. The study provides some evidence that a community health education program may help reduce weight gain over time, but more effective methods must be developed if this important risk factor is to be favorably affected in broad populations.
View details for Web of Science ID A1991GB74600001
View details for PubMedID 1877583
- THE STANFORD CARDIOVASCULAR-DISEASE PREVENTION PROGRAMS ANNALS OF THE NEW YORK ACADEMY OF SCIENCES 1991; 623: 327-331
- EFFECTIVENESS OF A PERSONAL-HEALTH COURSE FOR MEDICAL-STUDENTS ACADEMIC MEDICINE 1991; 66 (4): 242-243
- Methods of communication to influence behaviour In: Oxford textbook of public health, 2nd edition. Holland WW, Detels R and Knox G (eds). Oxford, London: Oxford University Press, 1991; 2
- Institute of Medicine: Determinants of food choice and prospects for modifying food attitudes and behavior Improving America's Diet and Health: from Recommendations to Action, NW Washington, DC 1991: 33-82
PSYCHOSOCIAL PREDICTORS OF PHYSICAL-ACTIVITY IN ADOLESCENTS
1990; 19 (5): 541-551
Regular physical activity consistently demonstrates an inverse relationship with coronary heart disease and has positive effects on quality of life and other psychological variables. Despite the benefits of exercise, many youth and adults maintain a sedentary lifestyle. Interventions are needed, particularly with youth, to increase levels of physical activity. A better understanding of the psychosocial predictors of physical activity will aid in structuring these interventions. Longitudinal data from a cohort of 743 10th-grade students from the control condition of the Stanford Adolescent Heart Health Program were analyzed. Regression analysis indicated that psychosocial variables were significantly related to physical activity after controlling for baseline levels of physical activity and BMI. Associations with physical activity were found for intention to exercise, self-efficacy, stress, and direct social influence. The designers of future interventions should consider including program components that target these variables.
View details for Web of Science ID A1990DX46600005
View details for PubMedID 2235921
EFFECTS OF COMMUNITY-WIDE EDUCATION ON CARDIOVASCULAR-DISEASE RISK-FACTORS - THE STANFORD 5-CITY PROJECT
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1990; 264 (3): 359-365
To test whether communitywide health education can reduce stroke and coronary heart disease, we compared two treatment cities (N = 122,800) and two control cities (N = 197,500) for changes in knowledge of risk factors, blood pressure, plasma cholesterol level, smoking rate, body weight, and resting pulse rate. Treatment cities received a 5-year, low-cost, comprehensive program using social learning theory, a communication-behavior change model, community organization principles, and social marketing methods that resulted in about 26 hours of exposure to multichannel and multifactor education. Risk factors were assessed in representative cohort and cross-sectional surveys at baseline and in three later surveys. After 30 to 64 months of education, significant net reductions in community averages favoring treatment occurred in plasma cholesterol level (2%), blood pressure (4%), resting pulse rate (3%), and smoking rate (13%) of the cohort sample. These risk factor changes resulted in important decreases in composite total mortality risk scores (15%) and coronary heart disease risk scores (16%). Thus, such low-cost programs can have an impact on risk factors in broad population groups.
View details for Web of Science ID A1990DN16400032
View details for PubMedID 2362332
USING RESEARCH TO PREDICT LEARNING FROM A PR CAMPAIGN
PUBLIC RELATIONS REVIEW
1990; 16 (2): 61-77
View details for Web of Science ID A1990DF19600006
- Comprehensive health promotion in communities: An exercise in social marketing and community development. The Fifth Annual Charles A Dana Awards for Pioneering Achievements in Health and Education, New York 1990
CARDIOVASCULAR-DISEASE RISK REDUCTION FOR 10TH GRADERS - A MULTIPLE-FACTOR SCHOOL-BASED APPROACH
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1988; 260 (12): 1728-1733
All tenth graders in four senior high schools (N = 1447) from two school districts participated in a cardiovascular disease risk-reduction trial. Within each district, one school was assigned at random to receive a special 20-session risk-reduction intervention and one school served as a control. At a two-month follow-up, risk factor knowledge scores were significantly greater for students in the treatment group. Compared with controls, a higher proportion of those in the treatment group who were not exercising regularly at baseline reported regular exercise at follow-up. Almost twice as many baseline experimental smokers in the treatment group reported quitting at follow-up, while only 5.6% of baseline experimental smokers in the treatment group graduated to regular smoking compared with 10.3% in the control group. Students in the treatment group were more likely to report that they would choose "heart-healthy" snack items. Beneficial treatment effects were observed for resting heart rate, body mass index, triceps skin fold thickness, and subscapular skin fold thickness. The results suggest that it is feasible to provide cardiovascular disease risk-reduction training to a large segment of the population through school-based primary prevention approaches.
View details for Web of Science ID A1988Q100100023
View details for PubMedID 3411756
BLOOD CHOLESTEROL TREATMENT ATTITUDES OF COMMUNITY PHYSICIANS - A MAJOR PROBLEM
AMERICAN HEART JOURNAL
1988; 116 (3): 849-855
Blood cholesterol treatment attitudes of community physicians are an important component of the NIH recommendation to reduce blood cholesterol. To determine current blood cholesterol treatment attitudes, a survey of 2413 multispecialty Northern California physicians was conducted. A total of 793 physicians responded. Results show that treatment habits among medical specialties are similar with a tendency for lower initial treatment levels in the subspecialties of endocrinology and cardiology. No specialty or subspecialty group indicated an aggressive plasma lipid treatment attitude. The findings include the following: Mean values at which physicians reported treating hypercholesterolemia with medication (312 +/- 44 mg/dl) exceed the NIH definition of "high risk." Younger physicians treated hypercholesterolemia with diet at significantly lower blood cholesterol levels than did older colleagues (p = 0.04). Physicians exposed to the CPPT-LRC investigation did not show a difference in treatment attitudes with regard to blood cholesterol levels when compared to physicians without such an experience. The type of lipid-lowering medication used differs significantly among medical specialties and subspecialties. Physicians lack confidence in the precision of laboratory measurement of plasma lipids. Physician treatment attitudes require substantial change if the NIH cholesterol consensus conference goals are to be achieved.
View details for Web of Science ID A1988P905400023
View details for PubMedID 3414497
EFFECTS OF SOLID AND LIQUID GUAR GUM ON PLASMA-CHOLESTEROL AND TRIGLYCERIDE CONCENTRATIONS IN MODERATE HYPERCHOLESTEROLEMIA
AMERICAN JOURNAL OF CARDIOLOGY
1988; 62 (1): 51-55
Guar gum is a dietary fiber reported to decrease plasma cholesterol concentration. This study investigated the effect of guar therapy in 50 men with moderately elevated plasma cholesterol who were randomized to an 8-week study of guar therapy. Three forms of guar gum were used: a medium viscosity solid or liquid form, a high viscosity liquid form or placebo. When the medium viscosity guar therapy groups were combined, 4 weeks of therapy were shown to result in a substantial reduction in total and low density lipoprotein (LDL) cholesterol of 25 mg/dl and 23 mg/dl (p = 0.035 and 0.12), respectively. The high viscosity guar group had a reduction in total cholesterol and LDL cholesterol of 37 and 30 mg/dl, respectively (p less than 0.003 and p less than 0.02). Following 8 weeks of therapy, a return toward baseline values was observed. No significant changes were demonstrated in blood chemistries, triglyceride values, total high density lipoprotein (HDL) cholesterol or the HDL2 fraction of HDL cholesterol. The effect of the solid and liquid forms of guar on plasma cholesterol reduction was similar. This study shows that a nonpharmacologic dietary additive reduces plasma total and LDL cholesterol.
View details for Web of Science ID A1988P035300008
View details for PubMedID 2837895
PROMOTING DIETARY CHANGE IN ADOLESCENTS - A SCHOOL-BASED APPROACH FOR MODIFYING AND MAINTAINING HEALTHFUL BEHAVIOR
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
1988; 4 (2): 68-74
We examined the immediate and long-term effects of a school-based, behaviorally focused dietary change program for tenth-graders. Our behavioral change objectives included increased consumption of complex carbohydrates and decreased intake of saturated fats, sugar, and salt, particularly in the form of snack foods. We randomly assigned tenth-grade classes in two northern California high schools to either a five-session dietary change program or an assessment-only control group. We collected pre- and postprogram self-report data on 218 students in areas of dietary knowledge, behavior, attitudes, food availability in the home, and intentions and self-efficacy concerning eating in specific ways. We also observed school snack choices both directly and indirectly. Our results indicated significant changes in reported behavior, knowledge, and food availability at home, as well as changes in snack choices at school. We found these changes to be durable at one-year follow-up. Our findings suggest ways in which school-based programs focused on behavioral and environmental changes may be effective in promoting dietary changes at school and at home.
View details for Web of Science ID A1988N201600002
View details for PubMedID 3395493
Methods of message design: experiences from the Stanford Five City Project.
Scandinavian journal of primary health care. Supplement
1988; 1: 39-47
The Stanford Five City Project (FCP) is a long-term field experiment designed to investigate the impact of a comprehensive community-wide educational effort on cardiovascular disease risk factors and on cardiovascular disease, morbidity and mortality. Five theoretical models of individual, organization and community change guide the design, development, implementation and evaluation of educational programs. Data from formative research aid in the selection of target audiences and in development of messages and programs for these audiences. These data also give feedback about the extent to which these educational products accomplished their information and behavior-change goals. Formative research data collection methods include surveys, focus groups, interviews and unobtrusive measures. This paper describes how change theories and formative research are used to the comprehensive community-wide change effort for the Stanford FCP and how examples from the FCP can be used as a model for the successful development of other social change programs.
View details for PubMedID 3227201
PERMUTATION ANALYSES OF FAMILIAL ASSOCIATION ARRAYS FOR LIPOPROTEIN CONCENTRATIONS IN FAMILIES OF THE STANFORD-5 CITY PROJECT
AMERICAN JOURNAL OF EPIDEMIOLOGY
1987; 126 (6): 1126-1140
Permutation models are introduced as a formal method for assigning significance to association matrices that assess the correlation of spouse, parent-offspring, and sibling similarity over an entire class of data transformations (usually, the class of all increasing functions). Analysis of 218 nuclear families who participated in the Stanford Five City Project revealed that parent and offspring triglyceride concentrations correlated more strongly when data transformations emphasized contrasts among low to moderate levels, and that high density lipoprotein (HDL) cholesterol correlated more strongly between family members with relatively higher HDL cholesterol concentrations. Application of family weights to the association matrices revealed a tendency for greater correlation among sibling triglyceride concentrations in larger families. Parent-child, mother-child, father-child, parent-daughter, and sibling total cholesterol concentrations correlated significantly for all monotonically increasing transformations (designated strong association), and father-daughter and parent-son cholesterol concentrations correlated significantly for most increasing transformations of the data (moderate association). There were fewer significant associations for plasma triglyceride concentrations: parent-child and sibling (both strong), parent-daughter and mother-daughter (both moderate), and mother-child (weak). HDL cholesterol showed no strong or moderate familial associations and was weakly associated only among siblings. Thus, concordance in familial lipoprotein levels appears to be restricted to a narrower range of values for triglycerides and HDL cholesterol than total cholesterol levels, possibly reflecting in part the influences of diet or other environmental factors on specific regions of the HDL cholesterol or triglyceride distributions in casual blood samples.
View details for Web of Science ID A1987L240400013
View details for PubMedID 3687922
EFFECTS OF FENOFIBRATE ON PLASMA-LIPOPROTEINS IN HYPERCHOLESTEROLEMIA AND COMBINED HYPERLIPIDEMIA
AMERICAN JOURNAL OF MEDICINE
1987; 83 (5B): 50-59
To investigate the lipoprotein effect of fenofibrate in hypercholesterolemia or combined hyperlipidemia (types II A and II B hyperlipidemias, respectively), 240 patients were recruited and 227 randomized to a double-blind randomized trial lasting 24 weeks and 192 patients continued to participate in an open-label phase for another 24 weeks. A 100-mg dose of fenofibrate or a matching placebo was given three times daily. Fenofibrate side effects in excess of placebo affected 6 percent of fenofibrate users and were confined almost entirely to skin rashes. In 180 hypercholesterolemic patients randomly assigned to receive fenofibrate versus placebo, triglyceride and very low-density lipoprotein cholesterol levels decreased 38 percent, total cholesterol levels decreased 17.5 percent, and low-density lipoprotein cholesterol levels decreased 20.3 percent with fenofibrate treatment. High-density lipoprotein cholesterol levels increased 11.1 percent with a decrease in the low-density lipoprotein cholesterol: high-density lipoprotein cholesterol ratio of 27 percent. All differences were statistically significant (p less than 0.01). In combined hyperlipidemic (type II B) patients, triglyceride levels decreased by 45 percent, very low-density lipoprotein cholesterol levels decreased 52.7 percent, total cholesterol levels decreased 16 percent, low-density lipoprotein cholesterol levels decreased 6 percent, and high-density lipoprotein levels increased 15.3 percent for a low-density lipoprotein cholesterol: high-density lipoprotein cholesterol ratio decrease of 13 percent. All differences were again statistically significant (p less than 0.01). In both groups of patients, the onset of the drug effect was generally rapid, with maximal total and low-density lipoprotein cholesterol level lowering achieved within four weeks in hypercholesterolemic patients and maximal triglyceride and cholesterol level lowering in hypertriglyceridemic patients achieved in two weeks. Maximum high-density lipoprotein increases occurred after four weeks in type II A patients and 12 to 16 weeks in type II B patients. Fenofibrate is a well-tolerated drug in the fibric acid series and has putatively beneficial effects on triglyceride, very low-density lipoprotein, low-density lipoprotein, and high-density lipoprotein cholesterol concentrations in both type II A and type II B hyperlipidemic patients. If the lipid hypothesis of atherosclerosis applies to the lipoprotein changes induced by fenofibrate, reductions in cardiovascular disease risk in both type II A and II B hyperlipidemic patients should result from fenofibrate treatment.
View details for Web of Science ID A1987L222500008
View details for PubMedID 3318454
PERSPECTIVES ON ADOLESCENT SUBSTANCE USE - A DEFINED POPULATION STUDY
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1987; 258 (15): 2072-2076
We asked 1447 tenth graders to complete a survey on physical activity, nutrition, stress, and substance use and to undergo basic physical assessments. In a multiple regression analysis, increased level of substance use by both boys and girls was most strongly predicted by friends' marijuana use. For boys, this was followed by perceived safety of cigarette smoking; poor school performance; parents' education; and use of diet pills, laxatives, or diuretics for weight control, accounting for 44% of the overall variation in substance use. For girls, friends' marijuana use was followed by poor school performance; self-induced vomiting for weight control; perceived safety of cigarette smoking; use of diet pills, laxatives, or diuretics for weight control; parents' education; perceived adult attitudes about cigarettes; and nonuse of seat belts, accounting for 53% of the overall variance. Separate multiple regression analyses for each substance produced similar results. The homogeneity of the study population precluded ethnic comparisons. These findings suggest that for many purposes substance use may be considered a single behavior regardless of the specific substance(s) used and that substance use may exist as part of a syndrome of adolescent problem behaviors. In addition, the potent influence of perceived social environment suggests that a social influence resistance model may represent the most successful preventive strategy.
View details for Web of Science ID A1987K353200022
View details for PubMedID 3656622
THE COST-EFFECTIVENESS OF 3 SMOKING CESSATION PROGRAMS
AMERICAN JOURNAL OF PUBLIC HEALTH
1987; 77 (2): 162-165
This study analyzed the cost-effectiveness and distribution of costs by program stage of three smoking cessation programs: a smoking cessation class; an incentive-based quit smoking contest; and a self-help quit smoking kit. The self-help program had the lowest total cost, lowest per cent quit rate, lowest time requirement for participants, and was the most cost-effective. The most effective program, the smoking cessation class, required the most time from participants, had the highest total cost, and was the least cost-effective. The smoking contest was in-between the other two programs in total costs, per cent quit rate, and cost-effectiveness; it required the same time commitment from participants as the self-help program. These findings are interpreted within the context of community-based intervention in which the argument is made that cost-effectiveness is only one of several factors that should determine the selection of smoking cessation programs.
View details for Web of Science ID A1987F631000006
View details for PubMedID 3099586
EFFECTS OF FENOFIBRATE ON PLASMA-LIPIDS - DOUBLE-BLIND, MULTICENTER STUDY IN PATIENTS WITH TYPE-IIA OR TYPE-IIB HYPERLIPIDEMIA
1986; 6 (6): 670-678
Of 240 patients with Type IIa and IIb hypercholesterolemia recruited in 11 centers, 227 were randomized to double-blind treatment with either fenofibrate (100 mg three times daily) or matching placebo for 24 weeks. A group of 192 of these patients were studied for a further 24 weeks during which all received fenofibrate in open label fashion. For the 92 Type IIa patients receiving fenofibrate in the double-blind phase, there were significant reductions (p less than 0.01 compared to baseline) in total plasma cholesterol (-18%), LDL-cholesterol (-20%), VLDL-cholesterol (-38%) and total triglycerides (-38%). Mean plasma HDL-cholesterol in these patients increased by 11% (p less than 0.01). With the exception of LDL, which was not high before treatment, similar changes were seen in the 24 fenofibrate-treated Type IIb subjects. Lipid parameters of placebo-treated patients did not change significantly. This pattern of change was repeated in the open period for the 94 patients previously on placebo, while the 98 who had been on fenofibrate remained stable with small further reductions in total and LDL cholesterol (-38% and -5.5% respectively). Adverse effects were some allergic-type skin reactions early in treatment and an occasional increase in transaminases, BUN, or creatinine. The results were similar to those obtained in European open trials of fenofibrate and were better than the lipid changes seen at comparable times in the Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT) cholestyramine study.
View details for Web of Science ID A1986E964900009
View details for PubMedID 3535757
PERSONAL AND MEDIATED HEALTH COUNSELING FOR SUSTAINED DIETARY REDUCTION OF HYPERCHOLESTEROLEMIA
1986; 15 (3): 282-291
Methods of effective cardiovascular risk reduction that are suitable for use in clinical settings are needed. Several behavioral interventions were designed to be compatible with office-based medical practice, to be delivered by paraprofessional counselors, and to be of low intensity and low cost. Eighty-three hypercholesterolemic volunteers were assigned to one of three experimental conditions (face-to-face counseling, mail and telephone counseling, initial session only). Twenty-six nonrandomized subjects served as a no-contact group and were followed for 1 year. Participants in the first three groups received risk factor education, behavioral recommendations, and a packet of materials, while those in the face-to-face and mail/telephone counseling groups were contacted for five brief follow-up sessions over a 4-month period. At the 1-year follow-up evaluation, subjects in the face-to-face and mail/telephone counseling conditions showed decreases in plasma cholesterol of 6.2 and 4.6%, respectively (P less than 0.01), while the other two groups evidenced small increases. There were no differences by condition for plasma triglycerides, systolic or diastolic blood pressure, or weight. Low-intensity, low-cost behavioral interventions delivered by paraprofessionals can produce long-term decreases in a major cardiovascular risk factor. Physicians are encouraged to incorporate similar interventions into their practices.
View details for Web of Science ID A1986C729700006
View details for PubMedID 3749008
COMMUNITY SURVEILLANCE OF CARDIOVASCULAR-DISEASES IN THE STANFORD 5-CITY PROJECT - METHODS AND INITIAL EXPERIENCE
AMERICAN JOURNAL OF EPIDEMIOLOGY
1986; 123 (4): 656-669
The Stanford Five-City Project is a long-term field evaluation of the effects of community health education on cardiovascular disease risk factors and event rates. One major end point of the project is the difference between treatment and control group trends in morbidity and mortality rates ascertained through community-wide surveillance of deaths and hospital discharges. This surveillance system includes continuous review of death certificates and hospital discharge records, interviews with the families and physicians of decedents who died outside the hospital, abstraction of the hospital records of possible myocardial infarction and stroke cases (fatal and nonfatal), and systematic validation of diagnosis by the use of standard criteria. Initial experience with information access, availability of diagnostic information, costs, and reliability are described. This standardized approach to community surveillance of cardiovascular disease events rates, both fatal and nonfatal, is a feasible method for evaluating large-scale intervention programs and may be applicable to monitoring secular trends in the absence of intervention.
View details for Web of Science ID A1986A509900010
View details for PubMedID 3953544
- COMBINING BEHAVIORAL TREATMENTS TO REDUCE BLOOD-PRESSURE - A CONTROLLED OUTCOME STUDY BEHAVIOR MODIFICATION 1985; 9 (1): 32-54
ATTITUDES AND PRACTICES OF PHYSICIANS REGARDING HYPERTENSION AND SMOKING - THE STANFORD 5 CITY PROJECT
1985; 14 (1): 70-80
A survey was sent to 318 physicians in Monterey County, California, to assess their attitudes and practices regarding hypertension and cigarette smoking. After three mailings, 62% returned completed questionnaires. Eight percent of the respondents were smokers, 5% were women, and 34% were in primary care specialties. Older physicians and primary care specialists were less aggressive in their treatment of high blood pressure, but none of the assessed attitudes was significantly associated with treatment practice. Only half of the sample advised all patients to quit smoking. Physicians who doubted the effectiveness of their anti-smoking advice or who did not know what to say to smoking patients were less likely to provide advice. Most physicians felt that their smoking patients lacked sufficient motivation to quit. Programs to encourage physicians to increase smoking cessation activities should address these attitudes.
View details for Web of Science ID A1985AME1500007
View details for PubMedID 4034516
- THE COMMUNITY-BASED STRATEGY TO PREVENT CORONARY HEART-DISEASE - CONCLUSIONS FROM THE 10 YEARS OF THE NORTH KARELIA PROJECT ANNUAL REVIEW OF PUBLIC HEALTH 1985; 6: 147-193
ASSESSMENT OF HABITUAL PHYSICAL-ACTIVITY BY A 7-DAY RECALL IN A COMMUNITY SURVEY AND CONTROLLED EXPERIMENTS
AMERICAN JOURNAL OF EPIDEMIOLOGY
1985; 122 (5): 794-804
Assessment of habitual physical activity in epidemiologic and health education studies has been difficult. A seven-day physical activity recall interview was developed and administered in a community health survey, a randomized clinical trial, and two worksite health promotion programs during 1979-1982. These studies were conducted in several populations in California, Texas, Pennsylvania, and New Jersey. Energy expenditure estimates from the physical activity recall conformed to expected age- and sex-specific values in the cross-sectional community survey. Estimates of energy expenditure were also congruent with other questions on physical activity and job classification. In a randomized, one-year exercise trial, the physical activity recall detected increases in energy expenditure in the treated group and was positively associated with miles run during training (p less than 0.05). Changes in energy expenditure were associated with changes in maximal oxygen uptake (VO2max (r = 0.33, p less than 0.05) and body fatness (r = -0.50, p less than 0.01) at six months, and in high density lipoprotein-cholesterol (r = 0.31, p less than 0.05) and triglyceride (r = -0.41, p less than 0.01) at one year. The physical activity recall detected significant (p less than 0.01) increases in energy expenditure in treatment groups in two worksite health promotion projects. These data suggest that the physical activity recall provides useful estimates of habitual physical activity for research in epidemiologic and health education studies.
View details for Web of Science ID A1985AST7600009
View details for PubMedID 3876763
PHYSICAL EXERCISE IN PRIMARY AND SECONDARY PROPHYLAXIS OF ATHEROSCLEROSIS
1985; 57 (11): 36-39
View details for Web of Science ID A1985AVT5600008
THE STANFORD 5-CITY PROJECT - DESIGN AND METHODS
AMERICAN JOURNAL OF EPIDEMIOLOGY
1985; 122 (2): 323-334
The Stanford Five-City Project is a large experimental field study of community health education for the prevention of cardiovascular disease. It will provide data on fundamental questions in cardiovascular disease epidemiology, communication, health education, behavior change, and community organization, and will also test the ability of a potentially cost-effective program to prevent cardiovascular disease at the community level. This paper describes the purposes, hypotheses, design, and methods of the Five-City Project as a reference for future papers describing results. It is hypothesized that a 20% decrease in cardiovascular disease risk will lead to a significant decline in cardiovascular disease event rates in two treatment communities compared with three reference communities as a result of a six-year intervention program of community-wide health education and organization. Risk factor change will be assessed through four surveys of independent samples and in a repeatedly surveyed cohort. Cardiovascular disease event rates will be assessed through continuous community surveillance of fatal and nonfatal myocardial infarction and stroke.
View details for Web of Science ID A1985AME9500015
View details for PubMedID 4014215
- TEACHING PHYSICIANS TO PRACTICE WHAT THEY WILL PREACH JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1985; 253 (20): 2958-2959
- INCREASING RETURNS OF PHYSICIAN SURVEYS AMERICAN JOURNAL OF PUBLIC HEALTH 1984; 74 (9): 1043-1043
INDIRECT MEASURES OF CIGARETTE USE - EXPIRED-AIR CARBON-MONOXIDE VERSUS PLASMA THIOCYANATE
1984; 13 (1): 127-135
Indirect, biochemical measures of cigarette use are valuable in confirming smoking status in both cross-sectional and cessation studies. This study compares two such biochemical markers, expired-air carbon monoxide (CO) and plasma thiocyanate (SCN), in a representative population sample of 2,237 adults (ages 18-74) from the baseline survey of the Stanford Five City Project. CO and SCN are both significantly higher in self-reported smokers than in nonsmokers and correlate well with number of cigarettes smoked per day. CO appears to be more sensitive and specific than SCN in comparison to self-report, and CO misclassifies a significantly smaller number of nonsmokers, regular smokers, and light smokers (less than 9 cigarettes per day) than does SCN. Together, CO and SCN better classify smokers and nonsmokers than do either alone. Neither biochemical is a reliable indicator in irregular smokers (no cigarettes in past 48 hr). Despite its much shorter metabolic half-life, CO is a better indicator of cigarette use than is SCN in this cross-sectional study. CO is generally simpler and less expensive to measure than is SCN, and CO may be a preferable indirect measure of smoking status in some studies of smoking cessation.
View details for Web of Science ID A1984SN96700010
View details for PubMedID 6609353
THE ASSOCIATION OF BLOOD-PRESSURE AND DIETARY ALCOHOL - DIFFERENCES BY AGE, SEX, AND ESTROGEN USE
AMERICAN JOURNAL OF EPIDEMIOLOGY
1983; 118 (4): 497-507
This paper presents the results of an analysis of dietary alcohol use and blood pressure in representative population samples from four northern California cities surveyed in 1979-1980 as part of the Stanford Five City Project. The pooled samples included 883 men and 959 women aged 20-74 who were not taking blood pressure medications. Blood pressure was obtained while seated using a standard manometer. Alcohol was assessed by self-report of usual intake. In men, age-specific analysis revealed a positive association between dietary alcohol and both systolic (SBP) and diastolic blood pressure (DBP). The association was linear in men aged 20-34 and 50-74 and was stronger in the oldest men. Both linear and quadratic terms were significant for men aged 35-49. This association remained significant in a linear regression model that included age, relative weight, income, education, physical activity, cigarette use, and untimed urinary sodium/creatinine; for alcohol in ml/day in men aged 50-74, beta = 0.21, p = 0.0001, R2 = 0.32 for SBP; beta = 0.09, p = 0.0002, R2 = 0.18 for DBP. In women, alcohol use was significantly associated with blood pressure only in those above age 49 and was more striking in those not taking estrogens; this association was also independent of the same variables listed above for men (beta = 0.43, p = 0.0001, R2 = 0.23 for SBP; beta = 0.17, p = 0.001, R2 = 0.13 for DBP). Multiple logistic analyses with hypertension as a dichotomous dependent variable and including all subjects showed similar results. These results could be due to any one or more of the following hypotheses: 1) a biologic response to alcohol in older men and in older women that is different from the response in younger persons; 2) a delayed effect of alcohol use on blood pressure; 3) effects of a different pattern of alcohol use in the different age groups; or 4) the presence of some unmeasured confounding factor in the older age groups.
View details for Web of Science ID A1983RL60900006
View details for PubMedID 6637977
CHOLESTEROL, CANCER, AND PUBLIC-HEALTH POLICY
AMERICAN JOURNAL OF MEDICINE
1983; 75 (3): 494-508
A review of prospective cardiovascular epidemiologic studies reveals an inverse relationship between serum cholesterol levels and cancer mortality in half the studies in which this relationship has been examined. This inverse relationship has been demonstrated only for males, and is most consistently demonstrated for large bowel cancer. However, a review of international and intergroup epidemiologic data reveals that dietary fat intake is positively correlated with mortality rates for all cancers and for large bowel cancer. Internationally, there is also a positive correlation between mortality rates for ischemic heart disease and for cancer, as well as a positive correlation between mean population values of total serum cholesterol levels and cancer mortality. The biologic plausibility of the relationship between low serum cholesterol levels and cancer, and between high dietary fat intake and cancer are examined, with particular reference to large bowel cancer. Models are proposed to provide a coherent framework in which both low serum cholesterol levels and high dietary fat intake are risk factors for carcinogenesis. It is concluded that, on the basis of present knowledge, limitation of dietary fat and cholesterol intake is a prudent public health measure for the prevention of both coronary heart disease and cancer.
View details for Web of Science ID A1983RG77800021
View details for PubMedID 6614035
DOES WEIGHT-LOSS CAUSE THE EXERCISE-INDUCED INCREASE IN PLASMA HIGH-DENSITY LIPOPROTEINS
1983; 47 (2): 173-185
Studies showing an increase in plasma concentration of high density lipoprotein cholesterol (HDL-C) with moderate exercise have usually rejected the role of body weight change in the HDL-C raising process, ostensibly because the amount of weight lost has been negligible. To investigate HDL-C changes more thoroughly, we followed initially sedentary middle-aged men randomly assigned to either a moderate running (n = 36) or a sedentary control (n = 28) group for one year. Among runners, one-year changes in plasma HDL-C concentrations correlated strongly with their body weight changes (r = - 0.53, P less than 0.001). Curve-fitting procedures and regression analysis suggested that processes associated with weight change produce much of the plasma HDL-C changes induced by moderate exercise and that changes in HDL-C concentration predominantly reflect changes in the reputedly anti-atherogenic HDL2 sub-component. Further, the interaction between weight change and plasma HDL-C concentration was significantly different (P less than 0.001) in exercisers and controls suggesting that the metabolic consequences of exercise-induced weight change are different from the consequences of weight change in the sedentary state.
View details for Web of Science ID A1983QR12900006
View details for PubMedID 6870998
View details for PubMedCentralID PMC2821585
INCREASED EXERCISE LEVEL AND PLASMA-LIPOPROTEIN CONCENTRATIONS - A ONE-YEAR, RANDOMIZED, CONTROLLED-STUDY IN SEDENTARY, MIDDLE-AGED MEN
METABOLISM-CLINICAL AND EXPERIMENTAL
1983; 32 (1): 31-39
Eighty-one sedentary but healthy men aged 30-55 participated in a 1 yr randomized study of the effects of exercise on plasma lipoprotein concentrations. Forty-eight were assigned to a running program, while 33 remained as sedentary controls (an approximately 3:2 ratio). After 1 yr the running group had become significantly fitter and leaner than the control group. Lipoprotein concentration changes in the runners (vs. controls) uniformly favored reduced risk of coronary heart disease, but were not significant when all 46 participants with complete data were included. However, the 25 men who averaged at least eight miles (12.9 kilometers) per wk of running increased their plasma high-density-lipoprotein (HDL) cholesterol level by 4.4 mg/dl (p = 0.045) and their HDL2 mass level by 33 mg/dl (p = 0.059), vs. controls. Significant correlations were found for distance run per wk vs. change in plasma HDL-cholesterol (r = 0.48), HDL2 (r = 0.41), and low-density-lipoprotein cholesterol (r = -0.31). Changes in percent body fat and in HDL-cholesterol were correlated (r = -0.47) in runners. There appears to be a threshold at about 8 miles per wk above which a 1-yr running program leads to beneficial lipoprotein changes.
View details for Web of Science ID A1983PZ73400007
View details for PubMedID 6848894
Recruitment using mass media strategies.
1982; 66 (6): IV32-6
Use of mass media represents a recruitment strategy with a relatively moderate volume of initial contacts and entries, a moderate ratio of entries to initial contacts, and a relatively moderate effort level requirement for the recruitment team. In the CPPT, nine centers recruited participants directly through newspapers, radio or television or a combination. Media sources accounted overall for 4% of initial contacts, 11% of first protocol visits and 11% of entries. The media also served in an adjunctive role to other recruitment strategies. The yield from television and newspaper messages was generally better than that from radio. The flow of response varied appreciably among these types of media. Only one-fourth as many participants recruited through this strategy were excluded due to unwillingness to proceed at the first protocol visit as was observed among all sources.
View details for PubMedID 7127716
SELF-ADMINISTERED PROGRAMS FOR HEALTH BEHAVIOR-CHANGE - SMOKING CESSATION AND WEIGHT-REDUCTION BY MAIL
1982; 7 (1): 57-63
Forty smokers and 47 overweight individuals were recruited for a home correspondence program for either smoking cessation or weight loss. Participants were assigned to one of four programs for changing their respective health behaviors: (1) a home correspondence program conducted entirely by mail, (2) the mail program with supplemental financial contigency contracts tied to completion of written homework, (3) the correspondence programs supplemented both by homework contracts and by regular calls to a telephone answering system, and (4) a standard behavioral group program which acted as a comparison condition. Results showed that all three correspondence approaches produced significant changes in health behaviors equal to the changes experienced by participants in the standard group program. The implication of these findings for development of low cost programs for disease prevention are discussed.
View details for Web of Science ID A1982NE58500007
View details for PubMedID 7080885
RECRUITMENT USING MASS-MEDIA STRATEGIES
1982; 66 (6): 32-36
View details for Web of Science ID A1982PR37300009
DOES DIETARY HEALTH-EDUCATION REACH ONLY THE PRIVILEGED - THE STANFORD 3 COMMUNITY STUDY
1982; 66 (1): 77-82
The relationship of selected social factors to diet, weight and plasma cholesterol was studied in one control and two treatment towns before and after a 3-year, bilingual, mass-media health education program. Spanish-speaking persons reported higher dietary cholesterol and saturated fat than English-speaking participants at baseline, and this remained true after adjusting for the confounding influence of socioeconomic status (SES). Obesity was also more prevalent in Spanish-language and low-SES groups, but plasma cholesterol was not related to these sociodemographic factors. Over the 3 years of the education program, all groups reported 20-40% decreases in dietary cholesterol and saturated fat. These decreases were as large in low-SES groups as in high-SES groups; Spanish-speaking participants reported significantly greater decreases in dietary saturated fat (p = 0.02). Weight change was not related to either SES or language group, but change in plasma cholesterol was marginally more favorable in Spanish-speaking subjects (p = 0.06).
View details for Web of Science ID A1982NU21200012
View details for PubMedID 7083524
ASSOCIATION ARRAYS FOR THE STUDY OF FAMILIAL HEIGHT, WEIGHT, LIPID, AND LIPOPROTEIN SIMILARITY IN 3 WEST-COAST POPULATIONS
AMERICAN JOURNAL OF EPIDEMIOLOGY
1982; 116 (6): 1001-1021
A more refined understanding of familial similarity may be achieved through a collection of measures of dependence that is sensitive to a variety of nonlinear trends ans stochastic relationships between trait values. Parent-offspring, spouse, and sibling similarities are examined by association arrays that assess dependence between variables for appropriate classes of functions (e.g., the class of all increasing functions). The methodology is applied to height, weight, lipid, and lipoprotein variables collected in nuclear families at the Seattle, Stanford, and La Jolla Lipid Research Clinics. Among the results obtained using association arrays, there is the suggestion that spouse similarity for standardized weight is strongest for functions emphasizing the higher values of the wives' weight independent of the husbands' weight, and that sibling similarity for high density lipoprotein cholesterol concentrations appears strongest for functions emphasizing the higher values of the siblings. The results deduced from the method of association arrays are compared and contrasted with those obtained from standard correlations.
View details for Web of Science ID A1982PV00300014
View details for PubMedID 7148811
COMPARISON OF NUTRIENT INTAKE IN MIDDLE-AGED MEN AND WOMEN RUNNERS AND CONTROLS
MEDICINE AND SCIENCE IN SPORTS AND EXERCISE
1981; 13 (5): 310-315
Runners and other active individuals typically have plasma lipoprotein patterns different than their more sedentary peers. In an attempt to determine if these patterns could be explained by dietary differences, we studied nutrient intake in middle-aged (35-59 yr) men and women runners averaging 55-65 km/wk, and inactive controls. The runners were leaner (P less than or equal to 0.0001) and had higher caloric intakes (40-60% higher on a weight-adjusted basis); they also ate more fat and carbohydrate (P less than or equal to 0.01), and were more likely to consume alcoholic beverages. When nutrient intake was expressed as a percent of total calories, the runners ate less protein (P less than or equal to 0.001). The runners obtained a smaller percentage of calories from starch and a greater percentage from other carbohydrates. Differences in nutrient intake seemed unlikely to account for observed differences in plasma lipids and lipoproteins between the runners and controls.
View details for Web of Science ID A1981MX86900007
View details for PubMedID 7321828
EFFECT OF HEALTH-EDUCATION ON DIETARY BEHAVIOR - THE STANFORD 3 COMMUNITY STUDY
AMERICAN JOURNAL OF CLINICAL NUTRITION
1981; 34 (10): 2030-2038
A 2-yr mass media cardiovascular health education program in two communities was followed by a 3rd, maintenance yr of reduced effort. In each community, a representative cohort reported its dietary behavior annually to an interviewer using a questionnaire which estimated daily consumption of cholesterol and fat. Relative weight and plasma cholesterol were also measured annually. Both men and women in the treatment towns reported reductions in dietary cholesterol (23 to 34%) and saturated fat (25 to 30%) which were significantly larger than those reported in a 3rd, control community. Relative weight was increased in the control community when compared to the treatment towns, perhaps as a result of the aging of the cohorts. Similar patterns were observed for plasma cholesterol changes. The 2-yr changes were maintained or increased during the 3rd, maintenance yr. The changes in individual values for plasma cholesterol showed low level correlations with dietary cholesterol and saturated fat, but the association with weight change was more important. These results suggest that mass media health education can achieve lasting changes in diet, obesity, and plasma cholesterol on a community level.
View details for Web of Science ID A1981ML04600007
View details for PubMedID 7293934
- THE ROLE OF PUBLIC INFORMATION AND EDUCATION IN CIGARETTE-SMOKING CONTROLS CANADIAN JOURNAL OF PUBLIC HEALTH-REVUE CANADIENNE DE SANTE PUBLIQUE 1981; 72 (6): 412-420
GENETIC-ANALYSIS OF THE STANFORD LRC FAMILY STUDY DATA .1. STRUCTURED EXPLORATORY DATA-ANALYSIS OF HEIGHT AND WEIGHT MEASUREMENTS
AMERICAN JOURNAL OF EPIDEMIOLOGY
1981; 113 (3): 307-324
A new methodology for determining mode for inheritance of continuously distributed traits in nuclear families, structured exploratory data analysis (SEDA), is described and applied to height and weight measurements. The family data were collected as part of the Lipid Research Clinic's collaborative study (LRC) and consists of first degree relatives of Stanford University employees who were selected either as a 2% random sample or were identified through a high lipid value. The variables are all standardized using three methods of age and sex adjustment based on two reference populations. The analysis and interpretations are based on the following statistics and indices: 1) the major gene index (MGI (alpha); 2) two measures of correlations between the midparental value and offspring (MPCC); and 3) the offspring between parent functions (OBP (beta). Consistent with a number of other studies, the results support that height shows multifactorial inheritance while height is principally under the influence of non-genetic environmental factors. In contrast to the random families, the male children of the probands who were selected due to their high lipid values exhibit height measurements which appear to involve environmental components or some major gene concomitants. The difference between the random and high lipid families is supported by all three statistical methods.
View details for Web of Science ID A1981LG13100012
View details for PubMedID 7008584
- A COMPARISON OF STATISTICAL-METHODS FOR EVALUATING RISK FACTOR CHANGES IN COMMUNITY-BASED STUDIES - AN EXAMPLE FROM THE STANFORD 3-COMMUNITY STUDY JOURNAL OF CHRONIC DISEASES 1981; 34 (11): 565-571
Reply to Kasl and Levanthal et al.
Journal of consulting and clinical psychology
1980; 48 (2): 159-163
View details for PubMedID 7365053
- SKILLS TRAINING IN A CARDIOVASCULAR HEALTH-EDUCATION CAMPAIGN JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY 1980; 48 (2): 129-142
Relaxation therapy for essential hypertension: a Veterans Administration Outpatient study.
Journal of behavioral medicine
1979; 2 (1): 21-29
Twenty-nine patients who had been treated with antihypertensive medication for at least the preceding 6 months were randomly assigned to (1) therapist-conducted, face-to-face progressive, deep-muscle relaxation training for 10 weekly sessions, or (2) progressive deep-muscle relaxation therapy conducted mainly by home use of audio cassettes, or (3) nonspecific individual psychotherapy for 10 weekly sessions. No differences between the groups were found immediately after therapy; however, the therapist-conducted relaxation therapy group showed the greatest changes: -17.8 mm Hg systolic, -9.7 mm Hg diastolic at 6 months follow-up. Some significant trends in results among the three therapists were also found. No correlation existed between blood pressure changes and changes in dopamine-beta-hydroxylase (DbH) levels.
View details for PubMedID 400246
EVALUATION OF THE ECHOCARDIOGRAM AS AN EPIDEMIOLOGIC TOOL IN AN ASYMPTOMATIC POPULATION
1979; 60 (4): 921-929
An asymptomatic adult population of 196 men and women was studied with the echocardiogram to derive age- and sex-specific "normal" values for a number of clinically used echocardiograhic variables. The results are in general agreement with previously published normal values. Body position during the examination, age and sex influence the echocardiographic results; body surface area correction normalized most of these effects. The prevalence of occult abnormalities determined by the echocardiogram is 7%; the most common finding was mitral valve prolapse. Inter- and intraobserver variability was assessed. The interobserver differences found on analysis are statistically, but not clinically , significant. The echocardiogram appears to be a suitable tool to use in epidemiologic studies to detect selected cardiac abnormalities, but is limited for this purpose because some subjects in such a population cannot be adequately examined.
View details for Web of Science ID A1979HN05700026
View details for PubMedID 476895
- COMMUNITY-BASED MODEL OF LIFE-STYLE INTERVENTION TRIALS AMERICAN JOURNAL OF EPIDEMIOLOGY 1978; 108 (2): 103-111
SCHOOL OF COMMUNITY PEDIATRICS
1978; 12 (5): 388-392
Medical graduates need a new kind of instruction in the health care of children. The practice of general practitioners, clinical medical officers and paediatricians can be improved by it. The nature of a school, created for this purpose, its teaching programme, it first year of operation and its possible future are described.
View details for Web of Science ID A1978FP31300012
View details for PubMedID 723693
Perspectives on coronary risk. Part 1: you can cut the odds on coronary risk.
1977; 40 (2): 23-26
View details for PubMedID 583836
RELAXATION THERAPY AND HIGH BLOOD-PRESSURE
ARCHIVES OF GENERAL PSYCHIATRY
1977; 34 (3): 339-342
Thirty-one patients receiving medical treatment for essential hypertension were randomly distributed into three groups: (1) relaxation therapy, (2) nonspecific therapy, and (3) medical treatment only. The nonspecific therapy group spent the same amount of time with the therapists as the relaxation group but was not given a specific therapy. Blood pressures were measured at a different time and in a different place from the behavioral treatments. The relaxation therapy group showed a significant reduction in blood pressure postreatment compared with the nonspecific therapy and medical treatment only groups, even when those patients whose medication was increased were excluded from the data analysis. At follow-up six months post-treatment, the relaxation group showed a slight decrement in treatment effects, while both the nonspecific therapy and medical treatment only groups showed continued improvement; thus, there was not a significant difference between groups.
View details for Web of Science ID A1977CZ00100011
View details for PubMedID 320955
COMMUNITY EDUCATION FOR CARDIOVASCULAR HEALTH
1977; 1 (8023): 1192-1195
To determine whether community health education can reduce the risk of cardiovascular disease, a field experiment was conducted in three northern California towns. In two of these communities there were extensive mass-media campaigns over a 2-year period, and in one of these, face-to-face counselling was also provided for a small subset of high-risk people. The third community served as a control. People from each community were interviewed and examined before the campaigns began and one and two years afterwards to assess knowledge and behaviour related to cardiovascular disease (e.g., diet and smoking) and also to measure physiological indicators of risk (e.g., blood-pressure, relative weight, and plasma-cholesterol). In the control community the risk of cardiovascular disease increased over the two years but in the treatment communities there was a substantial and sustained decrease in risk. In the community in which there was some face-to-face counselling the initial improvement was greater and health education was more successful in reducing cigarette smoking, but at the end of the second year the decrease in risk was similar in both treatment communities. These results strongly suggest that mass-media education campaigns directed at entire communities may be very effective in reducing the risk of cardiovascular disease.
View details for Web of Science ID A1977DH15400014
View details for PubMedID 68285
Reducing the risk of cardiovascular disease: effects of a community-based campaign on knowledge and behavior.
Journal of community health
1977; 3 (2): 100-114
In 1972 the Stanford Heart Disease Prevention Program launched a three-community field study. A multimedia campaign was conducted for two years in two California communities (Watsonville and Gilroy), in one of which (Watsonville) it was supplemented by an intensive-instruction program with high-risk subjects. A third community (Tracy) was used as a control. The campaigns were designed to increase participants' knowledge of the risk factors for cardiovascular disease, to change such risk-producing behavior as cigarette smoking, and to decrease the participants' dietary intake of calories, salt, sugar, saturated fat, and cholesterol. Results of a sample survey indicate that substantial gains in knowledge, in behavioral modification, and in the estimated risk of cardiovascular disease can be produced by both methods of intervention. The intensive-instruction program, when combined with the mass-medica campaign, emerged as the most effective for those participants who were initially evaluated to be at high risk. The results after two years of intervention are reported for effects on knowledge and behavioral change for the total participant samples and for the high-risk subsamples in each of the three communities.
View details for PubMedID 617630
CARDIOVASCULAR RISK AND USE OF ESTROGENS OR ESTROGEN PROGESTAGEN COMBINATIONS - STANFORD 3-COMMUNITY STUDY
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1976; 235 (8): 811-815
Cardiovascular risk factors were assess in 986 women residing in three northern California communities. Women who reported current use of oral contraceptives had higher plasma triglyceride levels and systolic and diastolic blood pressures compared with women not using these agents, after adjusting for age and for the greater relative leannes of oral contraceptive users. Similar increases, albeit of lesser magnitude, were observed in women who used pure estrogens. Mexican-American women appeared to be more susceptible to the effects of estrogens, perhaps as a consequence of their greater degree of obesity.
View details for Web of Science ID A1976BF69400011
View details for PubMedID 946307
RESULTS OF A 2-YEAR HEALTH-EDUCATION CAMPAIGN ON DIETARY BEHAVIOR - STANFORD 3 COMMUNITY STUDY
1976; 54 (5): 826-833
A two-year, bilingual mass-media health education campaign was carried out in two communities with a third serving as control. In one of the two treated communities, personal couseling of high risk individuals ("intensive instruction") took place. Dietary behavior, before and after the campaigns, was assessed using a dietary questionnaire which estimated the average daily consumption by participants of cholesterol, saturated fat, and polyunsaturated fat. Both intensive instruction and the mass-media campaigns led to significant reductions (20-40%) in cholesterol and saturated fat consumption in both men and women, with intensively instructed men tending to outperform men exposed to mass-media alone. In general, the improvements in the treated communities were maintained over the two years of the study, whereas the initial small drops in the control community at the end of the first year were followed by recidivism during the second year. Polyunsaturated fat consumption fell slightly in all three communities so that increases in P/S ratios in the two treated communities were of only modest degree. Mean changes in plasma cholesterol concentration for the various cohorts under study were higly correlated with those which would have been predicted on the basis of the self-reported changes in dietary behavior. The results indicate that mass-media health education campaigns can lead to significant changes in dietary practices in the general population with potentially important public health implications.
View details for Web of Science ID A1976CJ65800021
View details for PubMedID 975479
BEHAVIORAL-SCIENCE APPLIED TO CARDIOVASCULAR HEALTH - PROGRESS AND RESEARCH NEEDS IN MODIFICATION OF RISK-TAKING HABITS IN ADULT POPULATIONS
HEALTH EDUCATION MONOGRAPHS
1976; 4 (1): 45-74
Epidemiological and experimental studies provide evidence that a complex of behavioral, biological and environmental factors interact in the etiology of many cardiovascular diseases. A survey of research and theory concerning training and counseling programs for adult populations is provided. Six basic behavioral recommendations are made for the maintenance of cardiovascular health. Problems in the design of mass media and interpersonal campaigns to alter the health habits of large populations are considered.
View details for Web of Science ID A1976BQ60900002
View details for PubMedID 1002491
DISTRIBUTION OF PLASMA LIPOPROTEINS IN MIDDLE-AGED MALE RUNNERS
METABOLISM-CLINICAL AND EXPERIMENTAL
1976; 25 (11): 1249-1257
Stimulated by increasing evidence of an inverse relationship between plasma high-density lipoprotein cholesterol level and frequency of coronary heart disease, we determined concentrations of fasting plasma cholesterol, triglyceride, and lipoproteins in 41 very active men (running greater than 15 miles/wk for the previous year) 35-59 years of age (mean age, 47) and in a comparison group of men of similar age, randomly selected from three northern California communities. The runners had significantly (p less than 0.05) decreased mean plasma triglyceride (70 versus 146 mg/100 ml), total plasma cholesterol (200 versus 210 mg/100 ml), and low-density lipoprotein (LDL) cholesterol (125 versus 139 mg/100 ml) concentrations, and a higher mean level of high-density lipoprotein (HDL) cholesterol (64 versus 43 mg/100 ml) than the comparison group (n equals 147 for HDL and LDL; n equals 743 for total cholesterol and triglycerides). These very active men exhibited a plasma lipoprotein profile resembling that of younger women rather tan of sedentary, middle-aged men. This characteristic, and apparently advantageous, pattern could be only partially accounted for by differences in adiposity between runners and control subjects.
View details for Web of Science ID A1976CL12700008
View details for PubMedID 185487
Affluence and cardiovascular risk factors in Mexican-Americans and other whites in three northern California communities.
Journal of chronic diseases
1975; 28 (11-12): 623-636
View details for PubMedID 1206086
- COMMUNICATION FOR HEALTH - UNSELLING HEART-DISEASE JOURNAL OF COMMUNICATION 1975; 25 (3): 114-126
- RENIN - ACTIVITY, REACTIVITY AND CONCENTRATION IN A POPULATION SURVEY - RELATIONSHIP TO BLOOD-PRESSURE ANGIOLOGY 1975; 26 (1): 31-41
EFFECTS OF WEIGHT REDUCTION ON OBESITY - STUDIES OF LIPID AND CARBOHYDRATE-METABOLISM IN NORMAL AND HYPERLIPOPROTEINEMIC SUBJECTS
JOURNAL OF CLINICAL INVESTIGATION
1974; 53 (1): 64-76
Considerable controversy exists over the purported role of obesity in causing hyperglycemia, hyperlipemia, hyperinsulinemia, and insulin resistance; and the potential beneficial effects of weight reduction remain incompletely defined. Hypertriglyceridemia is one of the metabolic abnormalities proposed to accompany obesity, and in order to help explain the mechanisms leading to this abnormality we have proposed the following sequential hypothesis: insulin resistance --> hyperinsulinemia --> accelerated hepatic triglyceride(TG) production --> elevated plasma TG concentrations. To test this hypothesis and to gain insight into both the possible role of obesity in causing the above metabolic abnormalities and the potential benefit of weight reduction we studied the effects of weight loss on various aspects of carbohydrate and lipid metabolism in a group of 36 normal and hyperlipoproteinemic subjects. Only weak to absent correlations (r = 0.03 - 0.46) were noted between obesity and the metabolic variables measured. This points out that in our study group obesity cannot be the sole, or even the major, cause of these abnormalities in the first place. Further, we have observed marked decreases after weight reduction in fasting plasma TG (mean value: pre-weight reduction, 319 mg/100 ml; post-weight reduction, 180 mg/100 ml) and cholesterol (mean values: pre-weight reduction, 282 mg/100 ml; post-weight reduction, 223 mg/100 ml) levels, with a direct relationship between the magnitude of the fall in plasma lipid values and the height of the initial plasma TG level. We have also noted significant decreases after weight reduction in the insulin and glucose responses during the oral glucose tolerance test (37% decrease and 12% decrease, respectively). Insulin and glucose responses to liquid food before and after weight reduction were also measured and the overall post-weight reduction decrease in insulin response was 48% while the glucose response was relatively unchanged. In a subgroup of patients we studied both the degree of cellular insulin resistance and the rate of hepatic very low density (VLDL) TG production before and after weight reduction. These subjects demonstrated significant decreases after weight reduction in both degree of insulin resistance (33% decrease) and VLDL-TG production rates (40% decrease). Thus, weight reduction has lowered each of the antecedent variables (insulin resistance, hyperinsulinemia, and VLDL-TG production) that according to the above hypothesis lead to hypertriglyceridemia, and we believe the overall scheme is greatly strengthened. Furthermore, the consistent decreases in plasma TG and cholesterol levels seen in all subjects lead us to conclude that weight reduction is an important therapeutic modality for patients with endogenous hypertriglyceridemia.
View details for Web of Science ID A1974R812200010
View details for PubMedID 4357617
MULTIFACTOR EDUCATION CAMPAIGN TO REDUCE CARDIOVASCULAR RISK IN 3 COMMUNITIES - PHYSIOLOGICAL RESULTS
LIPPINCOTT WILLIAMS & WILKINS. 1974: 101–
View details for Web of Science ID A1974U467200394
- MODERATE ETHANOL INGESTION AND PLASMA TRIGLYCERIDE LEVELS - STUDY IN NORMAL AND HYPERTRIGLYCERIDEMIC PERSONS ANNALS OF INTERNAL MEDICINE 1974; 80 (2): 143-149
- SEX DIFFERENCE IN KINETICS OF TRIGLYCERIDE-METABOLISM IN NORMAL AND HYPERTRIGLYCERIDAEMIC HUMAN SUBJECTS EUROPEAN JOURNAL OF CLINICAL INVESTIGATION 1974; 4 (2): 121-127
- REAPPRAISAL OF ROLE OF INSULIN IN HYPERTRIGLYCERIDEMIA AMERICAN JOURNAL OF MEDICINE 1974; 57 (4): 551-560
- DISTURBED RELATIONSHIP OF PLASMA-RENIN TO BLOOD-PRESSURE IN HYPERTENSION LANCET 1974; 2 (7893): 1337-1339
- RELATIONSHIP BETWEEN FASTING PLASMA LIPID-LEVELS AND ADIPOSE-TISSUE MORPHOLOGY METABOLISM-CLINICAL AND EXPERIMENTAL 1973; 22 (10): 1311-1317
- DO ORAL AND INTRAVENOUS GLUCOSE-TOLERANCE TESTS PROVIDE SIMILAR DIAGNOSTIC INFORMATION IN PATIENTS WITH CHEMICAL DIABETES-MELLITUS DIABETES 1973; 22 (3): 202-209
- RELATIONSHIP BETWEEN FASTING PLASMA-INSULIN LEVEL AND RESISTANCE TO INSULIN-MEDIATED GLUCOSE UPTAKE IN NORMAL AND DIABETIC SUBJECTS DIABETES 1973; 22 (7): 507-513
DISASSOCIATION OF PLASMA-INSULIN RESPONSE FROM BLOOD-GLUCOSE CONCENTRATION DURING GLUCOSE INFUSIONS IN NORMAL DOGS
METABOLISM-CLINICAL AND EXPERIMENTAL
1973; 22 (10): 1277-1286
View details for Web of Science ID A1973Q954500004
- DOES HYPERGLYCEMIA OR HYPERINSULINEMIA CHARACTERIZE PATIENT WITH CHEMICAL DIABETES LANCET 1972; 1 (7763): 1247-?
- IS THERE A DELAY IN PLASMA INSULIN RESPONSE OF PATIENTS WITH CHEMICAL DIABETES MELLITUS DIABETES 1971; 20 (6): 416-?
Evaluation of the dog as an experimental model for the study of insulin distribution and degradation in man.
journal of laboratory and clinical medicine
1970; 75 (2): 175-184
View details for PubMedID 5414402
- STUDY OF RELATIONSHIP BETWEEN PLASMA INSULIN CONCENTRATION AND EFFICIENCY OF GLUCOSE UPTAKE IN NORMAL AND MILDLY DIABETIC SUBJECTS DIABETES 1970; 19 (8): 571-?
COMPARISON OF IMPEDANCE TO INSULIN-MEDIATED GLUCOSE UPTAKE IN NORMAL SUBJECTS AND IN SUBJECTS WITH LATENT DIABETES
JOURNAL OF CLINICAL INVESTIGATION
1970; 49 (12): 2151-?
A technique was devised for a more accurate measurement than has been heretofore possible of one of the factors responsible for hyperglycemia in the complex syndrome of diabetes. This factor is termed impedance and represents the tissues' insensitivity or resistance to insulin-mediated glucose uptake. It was measured by use of steady-state exogenous insulin and glucose infusions during a period of pharmacological suppression of endogenous insulin secretion. Endogenous new glucose production was also inhibited. Impedance as calculated is a direct function of steady-state glucose concentrations, since exogenous insulin concentrations were similar in all studies. Two groups of normal weight subjects were studied. One had maturity onset latent diabetes, and the other (matched for age, weight, and per cent adiposity) was normal. Impedance was closely reproducible in the same individual and remained relatively constant during prolonged infusions. The diabetics had average infusion glucose concentrations (and thus impedance) 68% higher than the normal group, and it is of note that their previously measured glucose intolerance differed by a similar degree; that is, the diabetic's intolerance (as defined by mean weighted plasma glucose response after oral glucose) was 52% greater than that of the normal individuals.
View details for Web of Science ID A1970H941700002
View details for PubMedID 5480843
EVALUATION OF DOG AS AN EXPERIMENTAL MODEL FOR STUDY OF INSULIN DISTRIBUTION AND DEGRADATION IN MAN
JOURNAL OF LABORATORY AND CLINICAL MEDICINE
1970; 75 (2): 175-?
View details for Web of Science ID A1970F638600001
DERIVATION OF A 3 COMPARTMENT MODEL DESCRIBING DISAPPEARANCE OF PLASMA INSULIN-131I IN MAN
JOURNAL OF CLINICAL INVESTIGATION
1969; 48 (8): 1461-?
Insulin-(131)I was administered intravenously to normal subjects, to patients with maturity-onset diabetes and normal renal function, and to nondiabetic patients with renal failure. The ensuing plasma disappearance curves of immunoprecipitable radioactive insulin were determined, and these data were analyzed in a variety of ways. Firstly, fractional irreversible loss rates of insulin from plasma were calculated and found to be greatly diminished in patients with renal failure (t((1/2)) = 39 min), as compared with normal (t((1/2)) = 15 min) and diabetic subjects (t((1/2)) = 12 min). Secondly, plasma insulin-(131)I disappearance curves were resolved into sums of three exponentials by the method of "peeling," and values for the resultant three slopes and half-lives were determined. Patients with normal renal function had similar values for all parameters, while those patients with renal failure were differentiated on the basis of the slope of the last component, with a prolongation of its half-life to 275 min (approximately twice normal). Finally, a three pool model was formulated to describe the kinetics of plasma insulin disappearance in man, representing plasma (pool 1), interstitial fluid (pool 2), and all tissues in which insulin is utilized and degraded (pool 3). The proposed model adequately describing the disappearance curves of insulin-(131)I observed in all patients indicated that volumes (per cent body weight) of pool 1 (4.04) and pool 2 (10.11), calculated on the basis of the model and the experimental data, corresponded closely to estimates of plasma and interstitial fluid volumes obtained by independent means. It also demonstrated that patients with renal failure were characterized by a decreased removal rate of insulin from pool 3 and an increased recycling rate of insulin from pool 3 to pool 2. It is concluded that the proposed model represents a reasonable description of the kinetics of insulin distribution and degradation, and that its use provides quantitative insights into the physiology of insulin metabolism.
View details for Web of Science ID A1969D845200012
View details for PubMedID 5796358
- STEADY STATE PLASMA INSULIN RESPONSE TO CONTINUOUS GLUCOSE INFUSION IN NORMAL AND DIABETIC SUBJECTS DIABETES 1969; 18 (5): 273-?
INSULIN DELIVERY RATE INTO PLASMA IN NORMAL AND DIABETIC SUBJECTS
JOURNAL OF CLINICAL INVESTIGATION
1968; 47 (9): 1947-?
Removal of insulin-(131)I from plasma was studied in normal and diabetic subjects with both single injection and continuous infusion of isotope techniques. Patients were studied either in the fasting state or during steady-state hyperglycemia produced by a continuous intravenous glucose infusion. Steady-state plasma insulin concentration during these studies ranged from 10 to 264 muU/ml. Labeled insulin specific activity time curves consisted of more than one exponential, indicating that a multicompartmental system for insulin metabolism exists. A mathematical technique which is applicable to non-first order processes was used to calculate the rate at which insulin was lost irreversibly from the plasma insulin pool. A direct, linear relationship was found between insulin irreversible loss rate and plasma insulin concentration over the range of concentrations studied. This linearity implies lack of saturability of the insulin removal mechanism. Since the plasma insulin pool was in a steady state during these studies, insulin irreversible loss rate was equal to the rate at which newly secreted insulin was being delivered to the general circulation. Therefore, these results indicate that changes in plasma insulin concentration result from parallel changes in the rate of insulin delivery and not from changes in the opposite direction of the rate of insulin removal. A wide range of insulin delivery rates was found among patients with similar plasma glucose concentrations, suggesting that there exists considerable variability in responsiveness to endogenous insulin among these patients.
View details for Web of Science ID A1968B779600002
View details for PubMedID 5675421
- RESPONSE OF HEPATIC ALPHA-GLYCEROPHOSPHATE TO CHANGES IN HEPATIC GLUCOSE FORMATION METABOLISM-CLINICAL AND EXPERIMENTAL 1968; 17 (9): 776-?
ENDOGENOUS TRIGLYCERIDE TURNOVER IN LIVER AND PLASMA OF DOG
JOURNAL OF LIPID RESEARCH
1967; 8 (2): 114-?
Radioactive glycerol and S(f) > 20 lipoproteins labeled with it were used to study turnover of plasma S(f) > 20 and hepatic triglyceride in anesthetized dogs. From specific activity-time curves of these lipids after an injection of labeled material, a tentative and incomplete model for the kinetics of endogenous hepatic and plasma triglyceride was defined and partially validated. Pool sizes and turnover rates of triglyceride in liver and S(f) > 20 lipoproteins of plasma were then calculated in seven dogs. Hepatic triglyceride was composed of two compartments: 60% metabolically inert and 40% metabolically active. Although communication between these hepatic compartments surely occurred during the time course of these studies, it was not sufficient to be detected by our present methods. The metabolically active compartment turned over as a single pool but with two destinations: a quite variable proportion (an average of 61%) was secreted into plasma as S(f) > 20 triglyceride, and an average of 39% was presumably hydrolyzed within the liver. The fractional turnover rate of plasma S(f) > 20 triglyceride was 2-3 times that of hepatic triglyceride. This finding, and the parallel decline of specific activities of plasma S(f) > 20 and liver triglyceride after injection of labeled glycerol, confirm the rate-determining role of hepatic triglyceride. In this respect the dog differs importantly from man. Though turnover rates of plasma S(f) > 20 triglyceride fell in the same range in men and dogs, the relationship of turnover rate to plasma concentration of this lipid differed greatly between them. The model for the dog does resemble that previously reported for man, however, in the lack of major recycling of intact plasma triglyceride between the liver and plasma. Lack of such recycling, however, does not exclude return of plasma triglyceride into a hepatic triglyceride sink. The amount of such unidirectional uptake, if any, could not be determined by these techniques.
View details for Web of Science ID A19678990100007
View details for PubMedID 14564717
ROLE OF INSULIN IN ENDOGENOUS HYPERTRIGLYCERIDEMIA
JOURNAL OF CLINICAL INVESTIGATION
1967; 46 (11): 1756-?
Dietary carbohydrate accentuation of endogenous triglyceride production has been studied in 33 patients. A broad and relatively continuous spectrum of steady-state plasma triglyceride concentrations was produced in 31 of the 33 subjects during 3 wk of a high carbohydrate (fat-free) liquid formula diet. Two patients developed plasma triglyceride concentrations in excess of 2000 mg/100 ml, and these were the only patients we have studied in which carbohydrate induction of hypertriglyceridemia seemed to be associated with a defect in endogenous plasma triglyceride removal mechanisms. In the remaining 31 patients the degree of hypertriglyceridemia was highly correlated with the insulin response elicited by the ingestion of the high carbohydrate formula (P < 0.005). No significant correlation existed between fasting plasma triglyceride concentration and either plasma glucose or free fatty acid concentrations after the high carbohydrate diet, nor was the degree of hypertriglyceridemia related to degree of obesity. It is suggested that hypertriglyceridemia in most subjects results from an increase in hepatic triglyceride secretion rate secondary to exaggerated postprandial increases in plasma insulin concentration.
View details for Web of Science ID A1967A145100007
View details for PubMedID 6061748
- GLUCOSE INSULIN AND TRIGLYCERIDE RESPONSES TO HIGH AND LOW CARBOHYDRATE DIETS IN MAN JOURNAL OF CLINICAL INVESTIGATION 1966; 45 (10): 1648-?
HUMAN ERYTHROCYTE PHOSPHOGLYCERIDES. II.
Journal of the American Oil Chemists' Society
1965; 42: 615-616
View details for PubMedID 14328359
- KINETICS OF TRIGLYCERIDE TURNOVER OF VERY LOW DENSITY LIPOPROTEINS OF HUMAN PLASMA JOURNAL OF CLINICAL INVESTIGATION 1965; 44 (11): 1826-?
- VALIDATION OF AN INCOMPLETELY COUPLED 2-COMPARTMENT NONRECYCLING CATENARY MODEL FOR TURNOVER OF LIVER AND PLASMA TRIGLYCERIDE IN MAN JOURNAL OF LIPID RESEARCH 1965; 6 (1): 119-?
- EFFECTS OF DIETARY FATS ON HUMAN ERYTHROCYTE FATTY ACID PATTERNS JOURNAL OF CLINICAL INVESTIGATION 1963; 42 (5): 675-?
- HUMAN ERYTHROCYTE PHOSPHOGLYCERIDES .1. QUANTIFICATION OF PLASMALOGENS, FATTY ACIDS AND FATTY ALDEHYDES BIOCHIMICA ET BIOPHYSICA ACTA 1962; 60 (1): 80-?
- CARBOHYDRATE-INDUCED AND FAT-INDUCED LIPEMIA TRANSACTIONS OF THE ASSOCIATION OF AMERICAN PHYSICIANS 1961; 74: 134-?
PLASMA FIBRINOLYSIS IN MAN - EFFECT OF CHYLOMICRONS DERIVED FROM DIFFERENT DIETARY FATS
JOURNAL OF EXPERIMENTAL MEDICINE
1961; 113 (3): 587-?
The plasma fibrinolytic activity, measured in vitro, of 17 healthy normal young males was consistently and equally inhibited by prior ingestion of equal amounts of either a relatively saturated animal fat (butterfat) or a highly unsaturated vegetable fat (safflower oil). This effect was further studied by the addition of purified chylomicrons derived from ingestion of either butterfat, safflower oil, or egg yolk to an in vitro system. The inhibitory effect was quantitatively similar in all experiments despite wide variations in composition of the fed fat and pronounced differences in fatty acid composition of the lipids of the chylomicrons. It seems reasonable to suggest from our data that the proteins and the nonfatty acid portions of the chylomicron phospholipids may be important determinants of the inhibitory effect of chylomicrons on fibrinolysis.
View details for Web of Science ID A19614809B00003
View details for PubMedID 13698247
- STUDIES OF ADIPOSE TISSUE IN MAN - A MICROTECHNIC FOR SAMPLING AND ANALYSIS AMERICAN JOURNAL OF CLINICAL NUTRITION 1960; 8 (4): 499-511
The effect on human serum-lipids of a dietary fat, highly unsaturated, but poor in essential fatty acids.
1959; 1 (7064): 115-119
View details for PubMedID 13621653
- SYMPOSIUM ON SIGNIFICANCE OF LOWERED CHOLESTEROL LEVELS JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1959; 170 (18): 2198-2199
- EFFECT OF CHYLOMICRONS ON THE FIBRINOLYTIC ACTIVITY OF NORMAL HUMAN PLASMA INVITRO CIRCULATION RESEARCH 1959; 7 (2): 205-209
- THE ANALYSIS OF FATTY ACID MIXTURES BY GAS-LIQUID CHROMATOGRAPHY - CONSTRUCTION AND OPERATION OF AN IONIZATION CHAMBER INSTRUMENT NUTRITION REVIEWS 1959; 17 (8): 1-30
- RESPONSE OF SERUM LIPIDS AND LIPOPROTEINS OF MAN TO BETA-SITOSTEROL AND SAFFLOWER OIL - LONG-TERM STUDY CIRCULATION 1958; 17 (5): 890-899
- THE EFFECT OF BETA SITOSTEROL ON THE SERUM LIPIDS OF YOUNG MEN WITH ARTERIOSCLEROTIC HEART DISEASE CIRCULATION 1956; 14 (1): 77-82