Systolic Blood Pressure In Women Research Articles

Effects of diet and physical activity factors on blood pressure in nine provinces of China: a longitudinal analysis

To study the effects of diet and physical activity factors on blood pressure in nine provinces, using the multilevel model. Data was collected in the China Health and Nutrition Survey (CHNS). A total of 6706 men and 7140 women aged above 18 who attended at least one of the surveys in the year of 1997, 2000, 2004 and 2006 were selected, and a two-level male and female random intercept-slope growth models were applied to estimate the relationship between the intake of daily salt, vegetable, fruit, fat, protein as well as the time spent on the moderate or heavy physical activity and blood pressure. After controlling for age, education, BMI, drinks and total energy intake, mean of the daily salt intake per person was positively associated with systolic blood pressure in women (β = 0.0481, s(x(-)) = 0.0178, P < 0.01). Mean of the daily vegetable intake per person was negatively associated with systolic blood pressure in men and women, with the regression coefficients as -0.0063, -0.0068 respectively, indicating that if mean of the daily vegetable intake per person increased by 100 g, the systolic blood pressure would decrease by 0.6 mm Hg (1 mm Hg = 0.133 kPa) or more. In addition, the daily vegetable intake was also negatively associated with diastolic blood pressure (P < 0.01). Daily fruit intake was negatively associated with systolic blood pressure both in men and women, with regression coefficients as -0.0029 and -0.0031 respectively. Time spent on the moderate or heavy physical activity was also negatively associated with systolic blood pressure in both men and women, and diastolic blood pressure in women (P < 0.05). No relationship was found between daily fat, protein intake and blood pressure. Daily salt, vegetable, fruit intake, time spent on the moderate or heavy physical activity were associated with blood pressure in both men and women. Programs on integrated lifestyle modifications including dietary salt reduction, eating more vegetable and fruits, increasing physical activity level, plus weight control were critical for the control of high blood pressure.

Deleterious Associations of Sitting Time and Television Viewing Time With Cardiometabolic Risk Biomarkers

OBJECTIVEWe examined the associations of sitting time and television (TV) viewing time with continuously measured biomarkers of cardio-metabolic risk in Australian adults.RESEARCH DESIGN AND METHODSWaist circumference, BMI, resting blood pressure, triglycerides, HDL cholesterol, fasting and 2-h postload plasma glucose, and fasting insulin were measured in 2,761 women and 2,103 men aged ≥30 years (mean age 54 years) without clinically diagnosed diabetes from the 2004–2005 Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Multivariate linear regression analyses examined associations of self-reported sitting time and TV viewing time (hours per day) with these biomarkers, adjusting for potential confounding variables.RESULTSFor both women and men, sitting time was detrimentally associated with waist circumference, BMI, systolic blood pressure, fasting triglycerides, HDL cholesterol, 2-h postload plasma glucose, and fasting insulin (all P < 0.05), but not with fasting plasma glucose and diastolic blood pressure (men only). With the exception of HDL cholesterol and systolic blood pressure in women, the associations remained significant after further adjustment for waist circumference. TV viewing time was detrimentally associated with all metabolic measures in women and all except HDL cholesterol and blood pressure in men. Only fasting insulin and glucose (men only) remained deleteriously associated with TV viewing time after adjustment for waist circumference.CONCLUSIONSIn women and men, sitting time and TV viewing time were deleteriously associated with cardio-metabolic risk biomarkers, with sitting time having more consistent associations in both sexes and being independent of central adiposity. Preventive initiatives aimed at reducing sitting time should focus on both nonleisure and leisure-time domains.

KLOTHO gene polymorphisms G-395A and C1818T are associated with lipid and glucose metabolism, bone mineral density and systolic blood pressure in Japanese healthy subjects

Background We investigated the association of KLOTHO gene single nucleotide polymorphisms (SNPs) with various laboratory data in 476 Japanese healthy subjects. Methods The genotyping of G-395A in the promoter region and C1818T in exon 4 was performed using PCR with confronting 2-pair primers assay. Results Multivariate analysis adjusted for age demonstrated that in men, body-fat ratio was high, and HDL cholesterol level was low in A allele carriers of G-395A compared with GG. In women, glucose was high in A allele carriers of G-395A compared with GG, and also in T allele carriers of C1818T compared with CC. When divided into 2 groups according to age, in men < 60 y, body mass index, body-fat ratio and waist circumference were high in A carriers of G-395A compared with GG. In women < 60 y, bone mineral density was high in A allele carriers of G-395A compared with GG, and systolic blood pressure and glucose were high in T carriers of C1818T compared with CC. Conclusions KLOTHO gene SNPs G-395A and C1818T are associated with lipid metabolism in men, and glucose metabolism, bone mineral density and systolic blood pressure in women.

Abdominal Subcutaneous Adipose Tissue: A Protective Fat Depot?

OBJECTIVEObesity is associated with increased metabolic and cardiovascular risk. The ectopic fat hypothesis suggests that subcutaneous fat may be protective, but this theory has yet to be fully explored.RESEARCH DESIGN AND METHODSParticipants from the Framingham Heart Study (n = 3,001, 48.5% women) were stratified by visceral adipose tissue (VAT) into sex-specific tertiles. Within these tertiles, age-adjusted abdominal subcutaneous adipose tissue (SAT) tertiles were examined in relation to cardiometabolic risk factors.RESULTSIn the lowest VAT tertile, risk factor prevalence was low, although systolic blood pressure in women and rates of high triglycerides, impaired fasting glucose, hypertension, and the metabolic syndrome in men increased with increasing SAT tertile (all P < 0.04). In contrast, in the top VAT tertile, lower triglycerides were observed in men with increasing SAT (64.4% high triglycerides in SAT tertile 1 vs. 52.7% in SAT tertile 3, P = 0.03). Similar observations were made for women, although results were not statistically significant (50.6% high triglycerides in SAT tertile 1 vs. 41.0% in tertile 3, P = 0.10). Results in the highest VAT tertile were notable for a lack of increase in the prevalence of low HDL in men and women and in rates of impaired fasting glucose in men with increasing subcutaneous fat, despite sizable differences in BMI across SAT tertiles (27.1 to 36.3 kg/m2[women]; 28.1 to 35.7 kg/m2[men]).CONCLUSIONSAlthough adiposity increases the absolute risk of metabolic and cardiovascular disease, abdominal subcutaneous fat is not associated with a linear increase in the prevalence of all risk factors among the obese, most notably, high triglycerides.

Lifestyle and the Risk of Cardiovascular Disease in Women: Is Physical Activity an Equal Opportunity Benefactor?

Cardiovascular disease is the number one killer of women in the United States. It is estimated that 36.6% of women older than age 20 have some form of cardiovascular disease. In 2004, an estimated 459 100 women died from cardiovascular disease, more than 10 times the number of women who died from breast cancer that same year. Regular physical activity of moderate intensity, such as brisk walking, reduces the risk of cardiovascular disease and mortality in women. The benefits of more vigorous exercise are not clear, but the apparent lack of a dose-response relationship between exercise intensity and cardiovascular benefit may be the result of the design of many epidemiologic and interventional studies. Studies examining the benefits of greater cardiorespiratory fitness for women are limited, but the data suggest that they are similar to that of men. Women may require greater caloric expenditure than men for weight reduction, but this issue may be confounded by other variables such as caloric intake and spontaneous physical activity. The risk of cardiovascular disease associated with type 2 diabetes is much greater in women than in men. Regular physical activity and greater cardiorespiratory fitness are associated with a lower incidence and prevalence of type 2 diabetes in women. Greater cardiorespiratory fitness has also been found to be protective of the metabolic syndrome, but the benefit of physical activity is unclear. Limited evidence suggests that moderate-intensity activities can lower systolic blood pressure in women. There is a pressing need for more research into the health benefits of regular physical activity in women.

441. Renin angiotensin system polymorphisms are associated with pregnancy complications

Preeclampsia (PE), small for gestational age (SGA) and preterm birth (PTB) together affect 20% of first pregnancies. Currently there is no reliable way to identify women at risk. Polymorphims in genes in the renin angiotensin system (RAS) may be associated with impaired placentation and poor maternal response to pregnancy and hence predict risk for pregnancy complications. We aimed to determine if three functional polymorphisms in RAS genes, namely, AGT M235T, ACE (I/D) and AT1R A1166C are associated with pregnancy complications. Pregnancy trios were prospectively recruited from two public hospitals in Adelaide. Pregnancies were classified into normal (n = 110), PE (n = 26), SGA (n = 47), PE+SGA (n = 12), gestational hypertension (GH, n = 17), PTB (n = 20). PE, PE +SGA and GH were also grouped together as hypertension. Parental blood and maternal blood pressure was sampled or measured at 15 weeks gestation. Cord blood was sampled after delivery. DNA was extracted from buffy coats and genotyped using high resolution melt analyses. Maternal plasma [ACE] was measured by ELISA. Data were analysed by ANOVA and Fisher's exact test. Likelihood ratios (LR) were calculated where appropriate. Maternal ACE I/D was associated with hypertension (P = 0.001, LR = 14.8) and SGA (P = 0.019, LR = 10). Paternal AT1R A1166C was associated with PTB (P = 0.01, LR = 7.4). For ACE I/D, plasma [ACE] in women with DD was 33% and 62% higher than ID and II, respectively (both P &lt; 0.001). Systolic blood pressure in women with DD was 6% higher than II (P = 0.04). Our data suggest that RAS polymorphisms are associated with pregnancy complications. Furthermore, maternal ACE genotype determines plasma [ACE] and affects blood pressure at 15 weeks gestation, well before symptoms manifest. Our data also suggest that paternal genotype may be important in determining risk for pregnancy complications, consistent with the role of paternity in their aetiology.

Adherence to Mediterranean diet and anthropometric and metabolic parameters in an observational study in the ‘Alto Molise’ region: The MOLI-SAL project

Background and aims The Mediterranean diet is reportedly a healthy eating pattern with protective effects on chronic diseases. The aim of this study was to assess the relationship between adherence to the Mediterranean diet and anthropometric and metabolic variables in a rural setting in southern Italy, in the context of a health screening initiative. Methods and results Five hundred and twenty-two healthy participants from the “Alto Molise” region in southern Italy were studied. Blood pressure, glucose, and total cholesterol were measured using automatic devices. Food intake was evaluated with a semi-quantitative food-frequency questionnaire, and the Mediterranean adequacy index (MAI) was calculated. The median value of MAI in the population studied was 3.0 (1.5–5.4) in men and 2.4 (1.2–5.1) in women. In women, the stronger contributors to MAI were dairy products (42.5%), sweets (29.3%) and meat (19.4%), while in men they were cereals (39.1%), meat (18.6%), dairy products (16.9%) and sweets (16.1%). In multiple linear regression analysis MAI was positively associated with age in both sexes ( P = 0.0044 in men and P = 0.0054 in women) and with systolic blood pressure in women ( P = 0.012). After stratification of women by age, systolic blood pressure was significantly associated with MAI only in older persons ( P = 0.040) but not at younger ages (interaction effect P < 0.0001). Conclusions Adherence to the Mediterranean diet depends on age, possibly because in younger people the traditional Mediterranean style diet is decreasing, even in rural areas of southern Italy. Age also influences the association between MAI and metabolic variables such as systolic blood pressure in women.

Domestic Physical Activity in Relationship to Multiple CVD Risk Factors

Public health recommendations emphasize regular participation in moderate intensity physical activity (at least 5 days per week, 30 minutes or more per day), including domestic activities (e.g., heavy housework). The contribution of domestic activities in improving cardiovascular disease risk remains unclear. This cross-sectional study aimed at determining the independent associations of domestic activity and other activity types with multiple cardiovascular disease (CVD) risk factors (resting pulse rate, obesity, total cholesterol, high-density lipoprotein cholesterol, blood pressure, C-reactive protein). The sample comprised of 14,836 adults (ages 16 years and over) living in households in England in 2003. Interviews assessed participation in at least moderate intensity physical activity (domestic activity, walking, and sports), and nurses measured blood pressure and took blood samples. Analyses were done in 2006. A total of 24.2% of men and 19.8% of women met the activity recommendations, dropping to a total of 17.6% and 13.0% when domestic activity was excluded. With the exception of systolic blood pressure in women, domestic activity was not related to a favorable profile of any other CVD risk factors. There was a trend for lower body mass index and waist circumference and higher high-density lipoprotein cholesterol with increased participation in walking. Sports participation was related to a favorable profile for all risk factors excluding systolic blood pressure in men and cholesterol and C-reactive protein in women. The odds of being obese (body mass index more than 30 kg/m(2)) were lower with increased participation in walking and sports. Despite its high prevalence, domestic physical activity was not associated with improvements in CVD risk factors. These results suggest that physical activity recommendations may need to focus on physical activities other than those performed in and around the household.

Patients With Severe Disorders At Risk for Multiple Illnesses

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPatients With Severe Disorders At Risk for Multiple IllnessesJim RosackJim RosackSearch for more papers by this authorPublished Online:5 Jan 2007https://doi.org/10.1176/pn.42.1.0017aNearly 40 percent of patients admitted to an inpatient unit with psychotic or mood disorders were found to have metabolic syndrome—a constellation of signs and symptoms that, taken together, are an intermediate step in the development of type II diabetes, cardiovascular disease, and ultimately a significantly elevated risk of early death.The finding comes from a new report by Richard Bermudes, M.D., now an assistant clinical professor of psychiatry at the University of California, Davis, and colleagues in the December 2006, Psychosomatics. The research was completed without outside funding while Bermudes was a junior attending at the University of Cincinnati Medical Center.Bermudes and his coauthors noted that the widespread and growing use of second-generation antipsychotics (SGAs) for off-label indications and patient populations has been well documented over the last five to seven years. Numerous peer-reviewed reports have also detailed the propensity of as many as 30 percent of patients taking the medications to experience a gain of more than 10 percent of their baseline weight after beginning treatment with an SGA.In addition, SGAs have been associated with elevations of serum triglycerides, cholesterol, and abnormalities in glucose metabolism, all of which are signals of impending metabolic syndrome. Other research, Bermudes added, indicated that patients with severe psychiatric disorders have elevated rates of cardiovascular disease and diabetes.Therefore, Bermudes and his colleagues hypothesized that a group of patients with primary psychotic and mood disorders who are taking SGAs would be at especially high risk of having metabolic syndrome.They studied 102 adult patients with a primary diagnosis of a mood or psychotic disorder admitted to the inpatient psychiatry service at the University of Cincinnati Medical Center from November 2003 through March 2004. The researchers retrospectively collected data on height, weight, clinical laboratory findings (including fasting triglyceride, HDL cholesterol, and glucose levels), and blood pressure.Metabolic syndrome was defined using the following diagnostic guidelines in the Third Report of the National Cholesterol Education Program Adult Treatment Panel (ATP III):Waist circumference greater than 40 inches in men or 35 inches in womenElevated serum triglycerides higher than 150mg/dLLow serum HDL (less than 40mg/dL in men or less than 50 mg/dL in womenSystolic blood pressure above 130 mm Hg or diastolic pressure above 85 mg Hg)Fasting plasma glucose level above 110 mg/dL).In accordance with the ATP III guidelines, patients in the study were said to have metabolic syndrome if three of the five criteria were present.Overall, 38.6 percent of the group of severely ill psychiatric inpatients met criteria for metabolic syndrome. Bermudes noted that the Third National Health and Nutrition Examination Survey (NHANES III), which collected patient data from 1988 through 1994, estimated the rate of metabolic syndrome in the general population to be about 21 percent.In the cohort of patients studied by Bermudes and colleagues, those with metabolic syndrome were significantly older (average age 44 compared with 35 for those without metabolic syndrome), had larger waist circumferences (46.3 inches compared with 38.4 inches), and larger body mass indices (34.9 versus 27). Metabolic syndrome was also associated with Caucasian ethnicity and higher incomes.“Our study indicated that more than 2 in 3 mentally ill patients had the metabolic syndrome and therefore harbored what is usually a clinically silent and unidentified elevated risk for cardiovascular disease and type II diabetes,” Bermudes and his colleagues said.“Psychiatrists should consider measuring [blood pressure] and waist circumference, two components of the metabolic syndrome, which are easily assessed in the office setting,” they suggested. In this sample, patients who had elevated blood pressure and large waist circumference met criteria for the full metabolic syndrome 86 percent of the time.“All patients taking atypical antipsychotics require monitoring of weight, fasting glucose, and lipids,” the researchers concluded.“ Failure to monitor metabolic parameters and intervene early may result in continued high rates of morbidity in severely mentally ill patients secondary to complications of [cardiovascular disease] and diabetes.”Because the root causes of metabolic syndrome for a majority of individuals with chronic mental illness may be poor diet, insufficient physical activity, and side effects from medications, “the high prevalence of the syndrome underscores an urgent need to develop comprehensive efforts directed at controlling the obesity epidemic and improving physical activity levels within the population of chronic mentally ill patients.”“The Prevalence of the Metabolic Syndrome in Psychiatric Inpatients With Primary Psychotic and Mood Disorders” is posted at<www.psy.psychiatryonline.org/cgi/content/abstract/47/6/491>.▪ ISSUES NewArchived

Association of Genetic Polymorphisms of Endothelin-Converting Enzyme-1 Gene with Hypertension in a Japanese Population and Rare Missense Mutation in Preproendothelin-1 in Japanese Hypertensives

Endothelin-1 (EDN1), a 21-amino acid peptide, is a potent vasoconstrictor with various pharmacological responses. EDN1 is synthesized from a 212-amino acid precursor protein, preproEDN1, through multiple proteolytic steps. Endothelin-converting enzyme (ECE) cleaves a Trp73-Val74 peptide bond in big-EDN1 to give rise to mature EDN1. In this study, we examined the possible association of genetic variations in ECE1 with hypertension in a general Japanese population and searched for missense mutations in and around the EDN1 polypeptide. We genotyped 5 single nucleotide polymorphisms (SNPs) in the ECE1 gene in 1,873 individuals from a general Japanese population and identified one SNP associated with hypertension in women (rs212528: TT vs. TC+CC: odds ratio=1.40; 95% confidence intervals: 1.04-1.89; p=0.026), after adjusting for confounding factors. The systolic blood pressure in women with the CC genotype was 6.44 mmHg higher than that in those with the TT genotype (p=0.007), after adjusting for the same factors. Next, to identify the missense mutations that may influence the biological activity of EDN1, we sequenced the genomic region that encodes EDN1 in 942 Japanese hypertensive patients. We identified a novel missense mutation, G36R, in one hypertensive patient, but no mutations were observed in EDN1. A gene polymorphism in EDN1, Lys198Asn, has been reported to be associated with hypertension in obese subjects. Taken together, these findings reveal that the EDN-ECE pathway is an important system involved in essential hypertension in Japanese.

A Quantitative Trait Loci-Specific Gene-by-Sex Interaction on Systolic Blood Pressure Among American Indians

Age-adjusted systolic blood pressure is higher in males than females. Genetic factors may account for this sex-specific variation. To localize sex-specific quantitative trait loci (QTL) influencing blood pressure, we conducted a genome scan of systolic blood pressure, in males and females, separately and combined, and tested for aggregate and QTL-specific genotype-by-sex interaction in American Indian participants of the Strong Heart Family Study. Blood pressure was measured 3 times and the average of the last 2 measures was used for analyses. Systolic blood pressure was adjusted for age and antihypertensive treatment within study center. We performed variance component linkage analysis in the full sample and stratified by sex among 1168 females and 726 males. Marker allele frequencies were derived using maximum likelihood estimates based on all individuals, and multipoint identity-by-descent sharing was estimated using Loki. We detected suggestive evidence of a QTL influencing systolic blood pressure on chromosome 17 at 129 cM between markers D17S784 and D17S928 (logarithm of odds [LOD] = 2.4). This signal substantially improved when accounting for QTL-specific genotype-by-sex interaction (P = 0.04), because we observed an LOD score of 3.3 for systolic blood pressure in women on chromosome 17 at 136 cM. The magnitude of the linkage signal on chromosome 17q25.3 was slightly attenuated when participants taking antihypertensive medications were excluded, although suggestive evidence for linkage was still identified (LOD = 2.8 in women). Accounting for interaction with sex improved our ability to detect QTLs and demonstrated the importance of considering genotype-by-sex interaction in our search for blood pressure genes.

Effect of Sex on the Cardiovascular Response to Adrenaline in Humans

Cardiovascular responsiveness to stress conditions differs between men and women. It is not known to what extent this observation is explained by differences in the release of stress hormones like adrenaline, or by differences in the response to adrenaline. Therefore, we quantified the hemodynamic response to infusion of adrenaline (0.04, 0.06, and 0.08 microg x kg(-1) x min(-1) for 20 minutes each) in 8 healthy men and 8 healthy premenopausal women. Arterial plasma adrenaline levels were measured before and after infusion. Heart rate and intra-arterial blood pressure were monitored throughout the experiment. Arterial plasma adrenaline levels increased similarly in both sexes. There was a larger increase in systolic blood pressure in women compared with men (17.6 +/- 2.8 versus 5.1 +/- 3.1 mm Hg, P < 0.01). In contrast, men showed a larger increase in heart rate compared with women (20.3 +/- 1.4 versus 11.2 +/- 2.8 bpm, P < 0.01). In conclusion, these data suggest that the cardiovascular response to adrenaline is predominantly alpha-adrenergic in premenopausal women, and predominantly beta-adrenergic in age-matched men.

Postmenopausal oral estrogen therapy and blood pressure in normotensive and hypertensive subjects: the Estrogen in the Prevention of Atherosclerosis Trial

To determine if 17beta-estradiol increases blood pressure in postmenopausal women. A total of 222 healthy postmenopausal women were randomly assigned to either 1 mg micronized 17beta-estradiol daily or placebo for 2 years. Blood pressure measurements were obtained every other month and common carotid artery intima-media thickness measured every 6 months. Statistical analyses comparing longitudinal changes in systolic and diastolic blood pressure between treatment groups used a mixed general linear model including interaction terms to evaluate variations by age or estradiol level. Both placebo and estradiol groups showed small declines in systolic and diastolic blood pressure during the trial among the normotensive subjects and subjects on antihypertensive medications. However, the decline did not differ significantly between the groups. Treatment effects on systolic blood pressure differed significantly by the age of the subject (interaction P value = 0.04) with younger women on estradiol showing on average a rise in systolic blood pressure, and older women a decline. The association between serum estradiol level and systolic blood pressure showed a similar modification with age (P = 0.03). Changes in systolic blood pressure in women on estradiol were positively correlated with intima-media thickness progression (P = 0.03). Overall, 17beta-estradiol did not influence changes in blood pressure in normotensive or hypertensive women. The effect of 17beta-estradiol treatment on systolic blood pressure may be influenced by a woman's age. Estradiol may increase systolic blood pressure in younger postmenopausal women, while having the opposite effect in older postmenopausal women.

Potential atherogenic roles of lipids, lipoprotein(a) and lipid peroxidation in preeclampsia

To evaluate changes in lipid profile, serum levels of malondialdehyde (MDA) and lipoprotein(a) (Lp(a)) and placental MDA in preeclamptic women, and to evaluate the atherogenic role of these changes in the pathophysiology of pre-eclampsia. A cross-sectional study was performed in 20 normal pregnant women, 25 women with mild preeclampsia and 28 women with severe preeclampsia in the third trimester. MDA, which is the endproduct of lipid peroxidation, was measured in placental tissue by the thiobarbituric acid (TBA) method of Ohkawa and colleagues and in serum by the TBA method of Asakawa and Matsushita. Serum lipid levels were measured by with an autoanalyzer, serum apolipoprotein (Apo) A-I and Apo B were measured by nephelometric assay and serum Lp(a) level using a nephelometric agglutination assay method. In preeclamptic and normal pregnant women, multiple comparisons between groups were performed by one-way analysis of variance supplemented with Tukey's HSD post hoc test. The association between placental and serum concentrations among groups was analyzed using the Pearson correlation test. Serum levels of MDA, Lp(a), total cholesterol, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and placental MDA were significantly higher, and high-density lipoprotein cholesterol (HDL-C) and Apo A-I levels were significantly lower, in severely preeclamptic and mildly preeclamptic women than in the normal pregnant women, but no difference was observed in Apo B among groups. Serum level of Lp(a) was positively correlated with body mass index in severely preeclamptic women (r=0.489, p=0.008). A significant positive correlation was also found between serum level of MDA and systolic blood pressure in women with severe preeclampsia (r=0.375, p=0.049). Our findings suggest that high Lp(a), lipid peroxidation, LDL-C and TG, and low HDL-C and Apo A-I levels, are important risk factors for atherosclerosis among preeclamptic women.

Future uncertainty and socioeconomic inequalities in health: the Whitehall II study

Over the past 20 years, socioeconomic inequalities in mortality have widened, while job security and financial security have decreased. This paper examines the Whitehall II study, a longitudinal study of white-collar British civil servants. In the Whitehall II cohort socioeconomic gradients in morbidity and cardiovascular risk factors at Phase 5 (1997–99) were generally steeper than at Phase 1 (1985–88). We examine the contribution of job and financial insecurity to these at Phase 5 in 6770 women and men, all of whom were white-collar civil servants at Phase 1. Steep, inverse employment grade gradients were observed for all health measures at Phase 5, except cholesterol and systolic blood pressure in women. Gradients in the sub-population of non-employed participants tended to be steeper than gradients for participants in employment, although, with the exception of self-rated health and General Health Questionnaire (GHQ) score in men, differences were non-significant. Steep gradients in job insecurity were observed among employed participants ( p⩽0.01), and in financial insecurity among both employed and non-employed participants ( p⩽0.001), particularly non-employed men. With the exception of depression, adjustment for job insecurity had little effect on the employment grade gradients in morbidity. However, financial insecurity contributed substantially to gradients in self-rated health, longstanding illness, and depression in both employed and non-employed men, and additionally to GHQ score and diastolic blood pressure in the latter. Adjustment for financial insecurity in non-employed women substantially attenuated gradients in self-rated health, GHQ score and depression. These findings imply that the specific effects of job insecurity in this cohort may be less important than the more general effects of financial insecurity in determining inequalities in health.

Dehydroepiandrosterone-sulfate serum levels and common age-related diseases: results from a cross-sectional Italian study of a general elderly population

The association of low serum dehydroepiandrosterone sulfate (DHEAS) levels with age, lifestyle, general health status indicators, and specific diseases was investigated in 436 men and 544 women of 65–97 yr old. In both sexes low serum DHEAS levels were associated with age, alcohol intake, number of current medications, and decreased thyroid function. Low DHEAS was also associated with low serum albumin in men and low systolic blood pressure in women. Compared to healthy men ( n=106) age-adjusted serum DHEAS levels were significantly lower in men with atrial fibrillation, chronic obstructive lung disease, dementia, parkinsonism, cancer, diabetes, hypothyroidism, and in institutionalized men. Compared to healthy women ( n=100) age-adjusted serum DHEAS levels were significantly lower in women with occlusive arterial disease, chronic obstructive lung disease, and osteoporosis. After controlling for differences in lifestyle and general health status parameters, low DHEAS levels remained statistically associated only with atrial fibrillation in men and osteoporosis in women, and it cannot be excluded that these association were spurious, due to multiple comparisons. These data suggest that in elderly people low serum DHEAS levels are more a non-specific indicator of aging and health status than a risk indicator of specific diseases.

Bone mineral density in women with essential hypertension

Recent studies have reported the abnormalities in calcium metabolism at the systemic level in human hypertension as well as in experimental hypertension. Because bone is the largest store of calcium in the body, the bone calcium content and mineralization may represent the entire calcium balance. The present study was undertaken to investigate the bone mineral density (BMD) in women with essential hypertension by means of the dual-energy X-ray absorptiometric (DXA) method. The DXA analysis showed a significant decrease in BMD in female hypertensive subjects compared with normotensive subjects. In addition, the BMD was inversely correlated with systolic blood pressure in women. The 24-h urinary calcium excretion was significantly greater in female hypertensive subjects than in female normotensive subjects. Furthermore, the greater the urinary calcium excretion, the lower the BMD in women. The values of serum total calcium, total magnesium, ionized calcium, and 1, 25(OH) 2 vitamin D were not different between hypertensive and normotensive subjects. The results of the present study demonstrated that DXA provided an index of whole calcium balance, and suggest that high blood pressure might be associated with reduced BMD in female hypertension.

Time trends of major coronary risk factors in a northern Italian population (1986-1994). How remarkable are socioeconomic differences in an industrialized low CHD incidence country?

The goals are to estimate time trends (1986-1994) of major coronary risk factors in an industrialized low CHD incidence population and to assess education class (EC) differences in risk factor prevalence and in time trends. Three population surveys were conducted in 1986-1987, 1989-1990 and 1993- 1994 on independent and two-stage age- and gender-stratified random samples (1906 men and 1941 women) of 35-64 year old residents of Brianza, an affluent region of northern Italy. The protocol for data collection, clinical measurements and biochemical determinations adhered to the WHO MONICA manual and underwent repeated quality control assessments. EC were identified according to gender- and 5-year birth-cohort specific tertiles. In the initial, middle and final surveys 1258, 1259 and 1330 subjects were enrolled, corresponding to participation rates of 70.1%, 70.3% and 74.3%, respectively. Over the 8-year period, in men systolic blood pressure and smoking habits declined, body mass index and serum total cholesterol increased. In women systolic blood pressure showed a constant reduction, total cholesterol and BMI increased and the prevalence of smokers remained stable. Overall inverse associations with EC were found for body mass index, for prevalence of cigarette smokers in men and for systolic blood pressure in women. Decreases in blood pressure were more evident in the lowest EC. Cigarette smoking was on the decline in the higher EC in men. BMI and total cholesterol increased in all EC with the notable exception of the 'low' EC in women. Favourable changes of the risk factor profile in the low socio-economic classes may have contributed to reduce CHD rates in this population. Specific policies oriented to lowest socio-economic classes are needed to continue to combat the smoking epidemic.

Cardiovascular correlates of behavioral dominance and hostility during dyadic interaction

The present study examined cardiovascular correlates of expression of, and exposure to, naturally occurring behavioral dominance and hostility during dyadic social interaction. Unacquainted men and women undergraduates participated in three mixed-gender interactions with the same partner while their blood pressure and heart rate were assessed. Videotaped records of the interactions were coded for behavioral dominance and hostility. Exposure effects were apparent for women's systolic blood pressure and men's heart rate, with significantly greater reactivity shown by participants whose partners exhibited more dominance or hostility, respectively. Also, women's expression of dominance was positively and significantly associated with their heart rate reactivity. In addition to providing further evidence that emotion-related features of the social environment contribute to cardiovascular reactivity, these results illustrate that dominance merits attention as a correlate of cardiac stress reactivity, independent of hostility.

Blood pressure increase with impaired glucose tolerance in young adult american blacks.

Hypertension and non-insulin-dependent diabetes mellitus are more prevalent in blacks than whites. The convergence of these 2 disorders augments the expression and severity of cardiovascular disease. The purpose of this study was to determine whether alterations in glucose metabolism are related to an increase in blood pressure (BP). This study was conducted on 304 nondiabetic blacks (mean age=32 years). Measurements in all subjects included BP, anthropometric measures, oral glucose tolerance test, insulin clamp to measure insulin sensitivity, and plasma lipids. The sample was stratified according to plasma glucose on oral glucose tolerance test to normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM). A 2-way ANOVA was performed to determine differences between the metabolic groups. With the use of American Diabetic Association criteria, 20.4% of the samples were classified as IGT and 5.9% were diabetic. A significant increase in BP existed from NGT to IGT to DM, which was stronger in women than men (systolic blood pressure in women: NGT=122, IGT=127, and DM=140 mm Hg, P<0.001) with a significant linear trend (P<0.001). With the use of body mass index as a covariate, the group difference in BP remained significant (P=0.006). Measures of insulin sensitivity demonstrated significant metabolic group differences (P<0.001) with a linear trend (P<0.001) of decreasing insulin sensitivity from NGT to DM. These results indicate that early alterations in glucose metabolism effects an upward shift in BP. The higher BP in IGT and DM may be due to vascular endothelial cell resistance to insulin action.