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Purpose: We sought to assess the long-term association of bone mineral density with total, cardiovascular, and non-cardiovascular mortality.Methods: The First National Health and Nutrition Examination Survey data were obtained from a nationally representative sample of non-institutionalized civilians. A cohort aged 45 through 74 years at baseline (1971-1975) was observed through 1992. Subjects were followed for a maximum of 22 years. Included in the analyses were 3501 white and black subjects. Death certificates were used to identify a total of 1530 deaths.Results: Results were evaluated to determine the relative risk for death per 1 SD lower bone mineral density, after controlling for age at baseline, smoking status, alcohol consumption, history of diabetes, history of heart disease, education, body mass index, recreational physical activity, and blood pressure medication. Bone mineral density showed a significant inverse relationship to mortality in white men and blacks, but did not reach significance in white women. Based on 1 SD lower bone mineral density, the relative risk for white men was 1.16 (95% confidence interval (CI), 1.07-1.26, p<.01), while for white women the relative risk was 1.10 (95% CI, 0.99-1.23, p=.07), and in blacks the relative risk was 1.22 (95% CI, 1.05-1.42, p<.01). Bone mineral density was also associated with non-cardiovascular mortality in all three race-gender groups. An association between bone mineral density and cardiovascular mortality was found only in white men.Conclusions: Bone mineral density is a significant predictor of death from all causes (white men, blacks), cardiovascular (white men only) and other causes combined, in whites and blacks. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This cross-sectional population-based study assessed the association of jogging with femoral bone mineral density (BMD) in men. METHODS: Data are from a nationally representative sample of 4254 men aged 20 to 59 years from the Third National Health and Nutrition Examination Survey (NHANES III). Total femoral BMD was measured by dual energy x-ray absorptiometry. Jogging was self-reported. RESULTS: Jogging (any vs none) was strongly associated with higher BMD in multivariate models (P < .01) for both young and middle-aged men. Men who jogged 9 or more times per month had higher BMD levels than those who jogged only 1 to 8 times per month (P = .01). CONCLUSIONS: Jogging is associated with higher femoral neck BMD in men. Additional large-scale studies that measure all aspects of jogging are warranted. [ABSTRACT FROM AUTHOR]

Background: Quantifying the economic burden of cardiovascular disease and stroke over the coming decades may inform policy, health system, and community-level interventions for prevention and treatment., Methods: We used nationally representative health, economic, and demographic data to project health care costs attributable to key cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia) and conditions (coronary heart disease, stroke, heart failure, atrial fibrillation) through 2050. The human capital approach was used to estimate productivity losses from morbidity and premature mortality due to cardiovascular conditions., Results: One in 3 US adults received care for a cardiovascular risk factor or condition in 2020. Annual inflation-adjusted (2022 US dollars) health care costs of cardiovascular risk factors are projected to triple between 2020 and 2050, from $400 billion to $1344 billion. For cardiovascular conditions, annual health care costs are projected to almost quadruple, from $393 billion to $1490 billion, and productivity losses are projected to increase by 54%, from $234 billion to $361 billion. Stroke is projected to account for the largest absolute increase in costs. Large relative increases among the Asian American population (497%) and Hispanic American population (489%) reflect the projected increases in the size of these populations., Conclusions: The economic burden of cardiovascular risk factors and overt cardiovascular disease in the United States is projected to increase substantially in the coming decades. Development and deployment of cost-effective programs and policies to promote cardiovascular health are urgently needed to rein in costs and to equitably enhance population health.

Background: The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs)., Methods: The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains., Results: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics., Conclusions: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs)., Methods: The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains., Results: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics., Conclusions: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs)., Methods: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy., Results: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics., Conclusions: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs)., Methods: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease., Results: Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics., Conclusions: The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs)., Methods: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals., Results: Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics., Conclusions: The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Competing Interests: The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

If the control of infectious diseases was the public health success story of the first half of the 20th century, then the decline in mortality from coronary heart disease and stroke has been the success story of the century's past 4 decades. The early phase of this decline in coronary heart disease and stroke was unexpected and controversial when first reported in the mid-1970s, having followed 60 years of gradual increase as the US population aged. However, in 1978, the participants in a conference convened by the National Heart, Lung, and Blood Institute concluded that a significant recent downtick in coronary heart disease and stroke mortality rates had definitely occurred, at least in the US Since 1978, a sharp decline in mortality rates from coronary heart disease and stroke has become unmistakable throughout the industrialized world, with age-adjusted mortality rates having declined to about one third of their 1960s baseline by 2000. Models have shown that this remarkable decline has been fueled by rapid progress in both prevention and treatment, including precipitous declines in cigarette smoking, improvements in hypertension treatment and control, widespread use of statins to lower circulating cholesterol levels, and the development and timely use of thrombolysis and stents in acute coronary syndrome to limit or prevent infarction. However, despite the huge growth in knowledge and advances in prevention and treatment, there remain many questions about this decline. In fact, there is evidence that the rate of decline may have abated and may even be showing early signs of reversal in some population groups. The National Heart, Lung, and Blood Institute, through a request for information, is soliciting input that could inform a follow-up conference on or near the 40th anniversary of the original landmark conference to further explore these trends in cardiovascular mortality in the context of what has come before and what may lie ahead., Competing Interests: Disclosure None, (© 2017 American Heart Association, Inc.)

Context: Serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) contribute to atherosclerosis and its clinical consequences. Between the periods 1988-1994 and 1999-2002, mean TC and mean LDL-C declined in adults. During this time, there was an increase in the percentage of adults receiving lipid-lowering medications. Geometric mean triglyceride levels increased but mean high-density lipoprotein cholesterol (HDL-C) remained unchanged. OBJECTIVE To examine trends in serum lipids in adults between 1988 and 2010. DESIGN, SETTING, AND PARTICIPANTS Three distinct US cross-sectional National Health and Nutrition Examination Surveys, 1988-1994 (n = 16,573), 1999-2002 (n = 9471), and 2007-2010 (n = 11,766)., Main Outcome Measures: Mean TC, LDL-C, HDL-C, non-HDL-C, and geometric mean triglyceride levels and the prevalence of lipid-lowering medication use., Results: Mean TC declined from 206 (95% CI, 205-207) mg/dL in 1988-1994 to 196 (95% CI, 195-198) mg/dL in 2007-2010 (P <.001 for linear trend); mean LDL-C declined from 129 (95% CI, 127-130) mg/dL to 116 (95% CI, 114-117) mg/dL (P <.001 for linear trend). Mean non-HDL-C declined from 155 (95% CI, 153-157) mg/dL in 1988-1994 to 144 (95% CI, 143-145) mg/dL in 2007-2010 (P <.001 for linear trend). Mean HDL-C increased from 50.7 (95% CI, 50.0-51.0) mg/dL during 1988-1994 to 52.5 (95% CI, 51.8-53.2) mg/dL in 2007-2010 (P =.001 for linear trend). Geometric mean serum triglyceride levels increased from 118 (95% CI, 114-121) mg/dL in 1988-1994 to 123 (95% CI, 119-127) mg/dL in 1999-2002 and decreased to 110 (95% CI, 107-113) mg/dL in 2007-2010 (P <.001 for quadratic trend). The prevalence of lipid-lowering medication use increased from 3.4% (95% CI, 2.9%-3.9%) in 1988-1994 to 15.5% (95% CI, 14.7%-16.3%) in 2007-2010 (P <.001 for linear trend). Among adults not receiving lipid-lowering medications, trends in lipids were similar to those reported for adults overall. Among obese adults, mean TC, non-HDL-C, LDL-C, and geometric mean triglycerides declined between 1988 and 2010., Conclusion: Between 1988 and 2010, favorable trends in lipid levels have occurred among adults in the United States.

Objective: The aim of this longitudinal study is to examine the relationship between weight loss from maximum body weight, body mass index (BMI), and mortality in a nationally representative sample of men and women., Design: Longitudinal cohort study., Subjects: In all, 6117 whites, blacks, and Mexican-Americans 50 years and over at baseline who survived at least 3 years of follow-up, from the Third National Health and Nutrition Examination Survey Linked Mortality Files (1988-1994 with passive mortality follow-up through 2000), were included., Measurements: Measured body weight and self-reported maximum body weight obtained at baseline. Weight loss (maximum body weight minus baseline weight) was categorized as <5%, 5-<15%, and >or=15%. Maximum BMI (reported maximum weight (kg)/measured baseline height (m)(2)) was categorized as healthy weight (18.5-24.9), overweight (25.0-29.9), and obese (>or=30.0)., Results: In all, 1602 deaths were identified. After adjusting for age, race, smoking, health status, and preexisting illness, overweight men with weight loss of 15% or more, overweight women with weight loss of 5-<15%, and women in all BMI categories with weight loss of 15% or more were at increased risk of death from all causes compared with those in the same BMI category who lost <5%; hazard ratios ranged from 1.46 to 2.70. Weight loss of 5-<15% reduced risk of death from cardiovascular diseases among obese men., Conclusions: Weight loss of 15% or more from maximum body weight is associated with increased risk of death from all causes among overweight men and among women regardless of maximum BMI.

Purpose: The aim of this study is to determine the association of bone mineral density and mortality over a median follow-up of 9 years., Methods: The baseline data used are from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of non-institutionalized civilians. A cohort of 5,769 non-Hispanic whites, non-Hispanic blacks, and Mexican Americans aged 50 years and older at baseline (1988-1994) was followed through 2000 for overall mortality using the restricted-use NHANES III Linked Mortality File (1,741 deaths). Total proximal femoral bone mineral density was measured by dual-energy x-ray absorptiometry and categorized into quartiles. Cox proportional hazards models were used to estimate the relative risk of death after adjusting for multiple risk factors., Results: Compared with subjects in the highest quartile of bone mineral density, those in the lowest quartile had greater risk of death (relative risk, 1.53; 95% confidence interval: 1.08-2.18; P=0.02). There was no significant interaction of bone mineral density with race or ethnicity., Conclusion: Low bone mineral density was associated with increased risk of death.

Unlabelled: We used serum 25(OH)D data from NHANES III and incident hip fracture cases identified using linked mortality and Medicare records, and found that serum 25(OH)D was significantly related to reduced hip fracture risk in non-Hispanic white adults >or=65 yr of age., Introduction: The role of vitamin D status in reducing fracture risk is unclear. We examined the relationship between serum 25 hydroxyvitamin D [25(OH)D] and incident hip fracture risk in older non-Hispanic white adults., Materials and Methods: The study sample consisted of 1917 white men and women >or=65 yr of age who were examined in the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), a nationally representative survey. Incident hip fractures were ascertained using linked mortality and Medicare records that were obtained for NHANES III participants. Serum 25(OH)D values were measured with a radioimmunoassay kit. Cox proportional hazards models were used to estimate the relative risk (RR) of hip fracture by serum 25(OH)D level., Results: There were 156 incident hip fracture cases in the sample. Cases were older, had lower BMD and body mass index, more prevalent spine or wrist fractures and weight loss before baseline, and ate fewer kilocalories and less calcium than noncases. After adjusting for these differences, serum 25(OH)D values exceeding 60 nM were significantly related to hip fracture risk. For example, the multivariate-adjusted RR was 0.64 (95% CI, 0.46-0.89) among individuals with serum 25(OH)D values >or=62.5 nM compared with those with values below this level. When grouped into quartiles, the multivariate-adjusted RR for the second, third, and fourth versus the first quartile of serum 25(OH)D were 0.50 (95% CI, 0.25-1.00), 0.41 (95% CI, 0.24-0.70), and 0.50 (95% CI, 0.29-0.86), respectively., Conclusions: Serum 25(OH)D was related to a significantly lower hip fracture risk in this cohort of older white adults, even after adjusting for several relevant confounding variables. The relationship did not seem to be linear across all values. Our results support other studies suggesting that serum 25(OH)D values exceeding 60 nM are associated with health benefits.

Purpose: The aim of this study is to determine the long-term association of bone mineral density and cardiovascular disease mortality., Methods: The data used are from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of noninstitutionalized civilians. A cohort of white, black, and Mexican-American persons ages 50 years and older at baseline (1988-1994) was followed through 2000 for coronary heart disease (CHD; n = 4690) and stroke mortality (n = 5272) using the NHANES III Linked Mortality File., Results: Death certificates were used to identify 369 CHD and 166 stroke deaths. Results were evaluated to determine the relative risk of CHD or stroke per one standard deviation lower bone mineral density after adjusting for multiple risk factors. In Cox proportional hazards models, risk of CHD death and risk of stroke death were not associated with low bone mineral density among men. For women, no significant associations were found for stroke (relative risk, 1.34; 95% confidence interval, 0.86-2.07, p = 0.20) or CHD (relative risk, 1.26; 95% confidence interval, 0.88, 1.80; p = 0.21)., Conclusions: Low bone mineral density was not associated with risk of cardiovascular disease in men. Among women with low bone mineral density, risk of CHD and stroke were elevated, but no significant associations were found.

Purpose: We sought to corroborate a reported association of hypertension with bone mineral density (BMD) in postmenopausal women., Methods: Data are from a nationally representative sample of 2738 women aged 50 years and older from the Third National Health and Nutrition Examination Survey. Total proximal femoral bone mineral density was measured by using dual-energy x-ray absorptiometry. Hypertension is defined as blood pressure of 140/90 mm Hg or greater or recent blood pressure medication use., Results: Compared with the fourth quartile of BMD, age- and race-adjusted relative odds of hypertension were decreased in the first quartile (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.38-0.67; p < 0.01). However, the association was diminished and no longer significant after adjusting for body mass index (OR, 0.96; 95% CI, 0.69-1.36; p = 0.83) and additional risk factors in multivariate models (OR, 0.92; 95% CI, 0.65-1.30; p = 0.62)., Conclusions: No association between hypertension and BMD was observed after controlling for body mass index and other confounders.

Purpose: To examine the association of elevated counts of white blood cell types with increased risk of coronary heart disease (CHD) and death., Methods: Data were examined from the NHANES-I Epidemiologic Follow-up Study., Results: Relative risks for death at ages 25 to 74 comparing the upper and lower tertiles of neutrophil count were: all causes 1.29 (95% CL, 1.14, 1.47), and cardiovascular causes 1.39 (95% CL, 1.15, 1.67) after adjusting for baseline risk factors., Conclusions: The increased risk of CHD and death from all causes and cardiovascular diseases appeared to be only partially due to effects of smoking. No association was seen for lymphocytes or monocytes.

Objective: Since hip fracture is the most devastating consequence of osteoporosis from a public health standpoint, addressing whether depression is predictive of fracture risk is important. The purpose of this study is to determine whether individuals with high depressive symptomatology are more likely to suffer an osteoporotic hip fracture than subjects with intermediate or low depressive symptomatology., Methods: Data from the first National Health and Nutrition Examination Survey (NHANES I) were obtained from a nationally representative sample of noninstitutionalized civilians. A cohort aged 25 through 74 at baseline (1971-1975) was observed through 1992. Subjects were followed-up for a maximum of 22 years. Included in the analyses were 6,195 white and black subjects. Ninety-five percent of the original cohort completed the study. Hospital records and death certificates were used to identify a total of 122 hip fracture cases., Results: In an unadjusted Cox proportional hazards regression model for all individuals, depression was predictive of hip fracture (hazard ratio [HR]=1.90; 95% confidence interval [CI]=1.13, 3.21; p=0.016). In a multivariate proportional hazards model controlling for (1) age at baseline, (2) gender, (3) race, (4) body mass index, (5) smoking status, (6) alcohol consumption, and (7) physical activity level, high depressive symptomatology remained predictive of hip fracture (HR=1.70; 95% CI=0.99, 2.91; p=0.055)., Conclusions: This study gives evidence of a prospective association between depression and hip fracture. Additional studies are needed to verify these findings and to elucidate the pathways for the effects of depression on hip fracture incidence.

Aims: We aimed to assess potential associations between different leucocyte components and coronary heart disease (CHD) in a prospective cohort study, and to put these findings in context of other relevant prospective studies in a meta-analysis., Methods and Results: We report data on differential leucocyte count and CHD derived from the first National Health and Nutrition Examination Survey (NHANES I) and the NHANES 1 Epidemiologic Follow-up Study (NHEFS) involving 4625 individuals followed, on average, for 18 years. The NHEFS involved 914 incident CHD cases and yielded an adjusted risk ratio of 1.09 (0.93-1.29) comparing individuals with neutrophil counts in the top third versus those in the bottom third of the population. In a meta-analysis involving the NHEFS and four other studies comprising a total of 1764 incident CHD cases, the association of CHD with neutrophil counts was somewhat stronger than those with other specific leucocyte components (combined risk ratio=1.33 [1.17-1.50]) but there was substantial heterogeneity between the separate studies (Chi2(4), p <0.001)., Conclusions: Although the present synthesis provides the most comprehensive assessment so far of specific leucocyte components in CHD, additional prospective data will be needed to resolve whether neutrophil counts are much stronger predictors of CHD risk than other components.

A number of studies have found hypertension prevalence to be higher in the southeast region of the United States than in other U.S. regions. To test the hypotheses that hypertension incidence is higher in the southeast than in other regions, and that higher levels of known hypertension risk factors in the southeast explain the difference in incidence, data from a nationally representative, longitudinal cohort study of a sample drawn from the U.S. population, the NHANES I Epidemiologic Follow-Up Study (1971-1984), were analyzed. In the United States, age-adjusted relative odds of incident hypertension between 1971 and 1984 did not vary consistently with region or with urbanization level. There was only a trend of higher relative odds in nonmetropolitan areas than in suburbs in the southeast in younger white men and older white women. Thus, convincing evidence to support the hypothesis of elevated hypertension incidence in the southeast region or in nonmetropolitan areas was not obtained. Further studies of region and hypertension incidence are needed to assess regional variation in larger, more recent cohorts.

Background and Purpose: We sought to assess the long-term predictive usefulness of bone mineral density (BMD) for stroke incidence and stroke mortality., Methods: The First National Health and Nutrition Examination Survey data were obtained from a nationally representative sample of noninstitutionalized civilians. A cohort of 3402 white and black subjects 45 through 74 years of age at baseline (1971 to 1975) was observed through 1992. Hospital records and death certificates were used to identify a total of 416 new stroke cases., Results: Results were evaluated to determine the relative risk (RR) for stroke per 1-SD decrease in BMD, after controlling for age at baseline, smoking status, alcohol consumption, history of diabetes, history of heart disease, education, body mass index, recreational physical activity, and blood pressure medication. In Cox proportional-hazards analyses, incidence of stroke was not associated with a decrease in BMD in any of the 3 race-sex groups: white men (RR, 1.01; 95% CI, 0.86 to 1.19; P=0.88), white women (RR, 1.13; 95% CI, 0.93 to 1.38; P=0.21), or blacks (RR, 0.93; 95% CI, 0.72 to 1.21; P=0.60). No association between BMD and stroke mortality was found (RR, 1.03; 95% CI, 0.86 to 1.23; P=0.77)., Conclusions: In a large national study, no significant associations of BMD and stroke incidence or mortality were found for whites or blacks.

The purpose of this study was to test the hypothesis that educational attainment and poverty index are inversely associated with incidence of stroke in blacks and in whites. The NHANES I Epidemiologic Follow-up Study data were analyzed. We analyzed 2953 women and 2661 men with no history of stroke before baseline (1971-1975), using the incidence of stroke through 1992, years of education, and poverty index at baseline. In white men aged 45 to 74, Cox regression models showed an inverse age-adjusted association with education that did not attain statistical significance. In white women, those with 12 or more years of education had significantly lower age-adjusted risk of stroke compared with those with less than 8 years. A test for linear trend was significant when adjusting for age (P = 0.0005). In blacks, stroke risk was significantly lower in those with 8 or more years of education than in those with <8 years in adjusted models. In each group, Cox regression models showed an inverse, graded, age-adjusted association with poverty index that attained statistical significance. After controlling for multiple confounders and risk mediators, the association was diminished and nonsignificant., (Published by Elsevier Science Inc.)

We sought to test the hypothesis that increased consumption of fish is associated with decreased incidence of essential hypertension. Data on fish consumption and incidence of hypertension from a national cohort of 5,394 blacks and whites normotensive at baseline and followed 10 years in the NHANES I Epidemiologic Follow-up Study (NHEFS) were analyzed. Our results showed that whites aged 25-74 years had no significant association of fish consumption with incidence of hypertension. In black women, after adjusting for multiple risk factors, those who increased their fish intake from <1 time/week to > or = 1 time/week had RR = 0.42, 95% CI 0.22-0.81, p = 0.009. However, those with high intake both times had adjusted RR = 0.75, 95% CI 0.45-1.26, p = 0.28. No consistent significant associations of fish consumption with hypertension incidence were found, perhaps because fish consumption in this population was low. Further studies are needed in blacks.

Although weight loss increases bone loss and hip fracture risk in older women, little is known about the relation between weight loss in middle-aged women and subsequent hip fracture risk. The objective of this study was to determine the association between weight loss from reported maximum body weight in middle-aged and older women and the risk of hip fracture. Data were from a nationally representative sample of 2180 community-dwelling white women aged 50-74 years from the Epidemiologic Follow-up Study of the first National Health and Nutrition Examination Survey (NHEFS). In this prospective cohort study, incident hip fracture was ascertained during 22 years of follow-up. The adjusted relative risks associated with weight loss of 10% or more from maximum body weight were elevated for both middle-aged (RR 2.54; 95% CI 1.10-5.86) and older women (RR 2.04; 95% CI 1.37-3.04). For both ages combined, women in the lowest tertile of body mass index at maximum who lost 10% or more of weight had the highest risk of hip fracture (RR 2.37; 95% CI 1.32-4.27). Weight loss from maximum reported body weight in women aged 50-64 years and 65-74 years increased their risk of hip fracture, especially among those who were relatively thin. Weight loss of 10% or more from maximum weight among both middle-aged and older women is an important indicator of hip fracture risk.

Objective: The objective of this study was to assess baseline levels of depression as a risk factor for stroke among white and black men and women., Methods: A population-based cohort of 6095 stroke-free white and black men and women aged 25 to 74 years in the NHANES I Epidemiologic Followup Study were followed for an average of 16 years to a maximum of 22 years. The association between stroke and baseline self-reported depressive symptomatology was analyzed using Cox proportional hazards models adjusting for baseline age, race, sex, education, smoking status, body mass index, alcohol use, nonrecreational physical activity, serum cholesterol level, history of diabetes, history of heart disease, and systolic blood pressure. Hospital records and death certificates were used to identify stroke cases; a total of 483 cases were identified., Results: In age-adjusted models for all persons, white men, white women, and black persons of both sexes, depression was predictive of stroke. In risk-adjusted models for all persons (relative risk (RR) = 1.73, 95% confidence interval (CI) = 1.30-2.31) and for white men (RR = 1.68, 95% CI = 1.02-2.75), depression remained predictive of stroke. For white women, depression (RR = 1.52, 95% CI = 0.97-2.38) reached borderline significance (p = .07). For black persons, depression (RR = 2.60, 95% CI = 1.40-4.80) demonstrated a higher risk of stroke. A series of supplemental analyses also supported the association between depression and stroke., Conclusions: Depression is predictive of stroke across all strata. This nationally representative study gives evidence of a prospective association between depression and stroke.

Few data are available on risk for coronary heart disease in African American women with diabetes mellitus, a well-established coronary risk factor in European American women. This study tests the hypothesis that medical history of diabetes predicts coronary heart disease incidence in African American women in a national cohort. Participants in the NHANES I Epidemiologic Follow-up Study in this analysis were 1035 African American and 5732 European American women aged 25-74 years without a history of coronary heart disease. Average follow-up for survivors was 19 years (maximum 22 years). Risk of incident coronary heart disease by baseline diabetes status was estimated. Proportional hazards analyses for African American women aged 25-74 revealed significant associations of coronary heart disease risk with diabetes after adjusting for age (RR = 2.40; 95% CI, 1.58-3.64, P < 0.01). After adjusting for age, smoking, and low education, there was an elevated risk in diabetics age 25-74 (RR = 2. 34; 95% CI, 1.54-3.56, P < 0.01); this association did not differ significantly from that for European American women. Excess coronary incidence in African American compared to European American women aged 25-64 was statistically explained by controlling for diabetes history, age, education, and smoking but only partly explained by age and diabetes history. In African American women aged 25-74, diabetes was also associated with increased coronary heart disease, cardiovascular, and all-cause mortality. The population attributable risk of coronary heart disease incidence associated with a medical history of diabetes was 8.7% in African American women and 6.1% in European American women. Medical history of diabetes was a significant predictor of coronary heart disease incidence and mortality in African American women and explained some of the excess coronary incidence in younger African American compared to European American women.

Objectives: This study assessed associations of risk factors with coronary heart disease incidence in African Americans., Methods: The participants in the NHANES I Epidemiologic Follow-Up Study included in this analysis were 1641 Black and 9660 White persons who were aged 25 to 74 years when examined and who did not have a history of coronary heart disease. Average follow-up for survivors was 19 years., Results: Significant, independent risk factors for coronary heart disease were age, systolic blood pressure, and smoking in Black women and age, systolic blood pressure, serum cholesterol, low education, and low family income in Black men. In this cohort, 19% of incident coronary heart disease in Black women and 34% in Black men might be prevented if systolic blood pressure were below 140 mm Hg. In Black men, attributable risk for low education (46%) was even higher than that for elevated blood pressure., Conclusions: Elevated systolic blood pressure and smoking were predictive of coronary heart disease incidence in African Americans. Estimates of population attributable risk were highest for elevated systolic blood pressure in women and education less than high school in men. Further studies of serum lipids, education, and coronary heart disease in Black women are needed.

This prospective population-based study assessed predictors of hip fracture risk in white men. Participants were members of the Epidemiologic Follow-up Study cohort of the First National Health and Nutrition Examination Survey, a nationally representative sample of noninstitutionalized civilians who were followed for a maximum of 22 years. A cohort of 2879 white men (2249 in the nutrition and weight-loss subsample, 1437 in the bone density subsample) aged 45-74 years at baseline (1971-1975) were observed through 1992. Ninety-four percent of the original cohort were successfully traced. Hospital records and death certificates were used to identify a total of 71 hip fracture cases (61 in the nutrition and weight-loss subsample, 26 in the bone-density subsample). Among the factors evaluated were age at baseline, previous fractures other than hip, body mass index, smoking status, alcohol consumption, nonrecreational physical activity, weight loss from maximum, calcium intake, number of calories, protein consumption, chronic disease prevalence, and phalangeal bone density. The risk adjusted relative risk (RR) of hip fracture was significantly associated with presence of one or more chronic conditions (RR = 1.91, 95% confidence interval [CI] = 1.19-3.06), weight loss from maximum > or = 10% (RR = 2.27, 95% CI 1.13-4.59), and 1 SD change in phalangeal bone density (RR = 1.73, 95% CI 1.11-2.68). No other variables were significantly related to hip fracture risk. Although based on a small number of cases, this is one of the first prospective studies to relate weight loss and bone density to hip fracture risk in men.

Proportional-hazards analyses for African-American women aged 25 to 74 revealed a variable association of coronary heart disease risk with baseline serum total cholesterol (after adjusting for age fifth vs first quintile: RR = 1.62, 95% confidence interval [CI] 0.89 to 2.98, p = 0.12; after adjusting for age, systolic blood pressure, body mass index, smoking, history of diabetes, low education, and low family income: RR = 1.88, 95% CI 1.02 to 3.45, p = 0.04). Perhaps due to the relatively small number of events, the association of serum total cholesterol with coronary heart disease incidence in African-American women was not consistently significant.

Objectives: The NHANES I Epidemiologic Followup Study (NHEFS) is a longitudinal study that uses as its baseline those adult persons 25-74 years of age who were examined in the first National Health and Nutrition Examination Survey (NHANES I). NHEFS was designed to investigate the association between factors measured at baseline and the development of specific health conditions. The three major objectives of NHEFS are to study morbidity and mortality associated with suspected risk factors, changes over time in participants' characteristics, and the natural history of chronic disease and functional impairments., Methods: Tracing and data collection in the 1992 Followup were undertaken for the 11,195 subjects who were not known to be deceased in the previous surveys. No additional information was collected in the 1992 NHEFS for the 3,212 subjects who were known to be deceased before the 1992 NHEFS data collection period., Results: By the end of the 1992 NHEFS survey period, 90.0 percent of the 11,195 subjects in the 1992 Followup cohort had been successfully traced. Interviews were conducted for 9,281 subjects. An interview was conducted for 8,151 of the 8,687 surviving subjects; 551 interviews were administered to a proxy respondent because the subject was incapacitated. A proxy interview was conducted for 1,130 of the 1,392 decedents identified in the 1992 NHEFS. In addition, 10,535 facility stay records were collected for 4,162 subjects reporting overnight facility stays. Death certificates were obtained for 1,374 of the 1,392 subjects who were identified as deceased since last contact. Approximately 32 percent of the NHEFS cohort is known to be deceased with a death certificate available for 98 percent of the 4,604 NHEFS decedents.

Background: Relatively few data are available on risk for or survival with coronary heart disease in African-American persons., Objective: To determine whether incidence of coronary heart disease, rate of survival with the disease, and rate of coronary surgery differ between ethnic groups., Design: Prospective cohort study., Setting: United States., Participants: Persons who responded to the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study. Included in this analysis were 11406 white persons and African-American persons aged 25 to 74 years who had no history of coronary heart disease. Average follow-up for survivors was 19 years (maximum, 22 years)., Measurements: Incident coronary heart disease., Results: Compared with that in white persons, the age-adjusted risk for coronary heart disease was higher in African-American women aged 25 to 54 years (relative risk, 1.76 [95% CI, 1.36 to 2.29]) but was lower in African-American men within each age subgroup. The age-adjusted risk was lower in African-American men for all ages combined (25 to 74 years) (relative risk, 0.78 [CI, 0.65 to 0.93] for coronary heart disease and 0.62 [CI, 0.42 to 0.92] for acute myocardial infarction). The higher rate in African-American women aged 25 to 54 years could be explained statistically by the higher risk factor levels in these women. Ethnic groups did not significantly differ in survival after the first hospitalization for coronary heart disease. However, the incidence of coronary procedures after hospitalization for coronary heart disease was markedly lower in African-American persons than in white persons (age- and sex-adjusted relative risk, 0.40 [CI, 0.16 to 0.99])., Conclusions: Total incidence of coronary heart disease is higher in African-American women aged 25 to 54 years than in white women of the same ages and is lower in African-American men aged 25 to 74 years than in white men of the same ages.