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Search Results: 1 - 10 of 326014 matches for " Earl S Ford "
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Why have total cholesterol levels declined in most developed countries?
Simon Capewell, Earl S Ford
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-641
Abstract: Total cholesterol levels in whole populations have fallen substantially in the USA, UK and most other developed countries. This has greatly contributed to decreases in cardiovascular disease deaths. The evidence identifying diet as the major contributor to these historical falls in cholesterol is powerful and consistent. Large falls occurred before statins were introduced. Additional substantial falls occurred before statins were widely used.Now, up to 14% adults in Western populations currently receive statins for primary prevention. Furthermore, because diet is now only slowly improving, the statin contribution currently appears proportionately larger.In conclusion, diet change explains most of the historical falls in cholesterol. Until very recently, the contribution from statins has been surprisingly modest. Furthermore, many middle income countries may have neither the resources nor the infrastructure for mass statin therapy.Further substantial falls in cholesterol are therefore unlikely to be obtained simply by increased use of statins or dietary advice to individuals if unsupported by the wider environment. This further emphasises the need for more effective structural policies. Regulatory and fiscal interventions could easily eradicate industrial transfats, halve the intake of dietary saturated fat, and subsidise healthier fats.In recent decades, mean population total cholesterol levels have fallen by as much as 1.0 mmol/l (40 mg/dl) in most developed countries. Understanding why is crucial for planning future health strategies to prevent cardiovascular disease (CVD). Cholesterol has major public health importance as a powerful cause of atherosclerosis and thrombosis, hence coronary heart disease and ischemic stroke. Every 1% fall in mean population total cholesterol levels decreases CVD mortality by approximately 2.5% [1]. Thus, recent population cholesterol falls explain up to 25% of the concomitant decreases in cardiovascular mortality in the USA, Canada
Trends in Total and Low-Density Lipoprotein Cholesterol among U.S. Adults: Contributions of Changes in Dietary Fat Intake and Use of Cholesterol-Lowering Medications
Earl S. Ford, Simon Capewell
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0065228
Abstract: Objective Our aim was to examine the relative contributions of changes in dietary fat intake and use of cholesterol-lowering medications to changes in concentrations of total cholesterol among adults in the United States from 1988–1994 to 2007–2008. Method We used data from adults aged 20–74 years who participated in National Health and Nutrition Examination Surveys from 1988–1994 to 2007–2008. The effect of change in dietary fat intake on concentrations of total cholesterol was estimated by the use of equations developed by Keys, Hegsted, and successors. Results Age-adjusted mean concentrations of total cholesterol were 5.60 mmol/L (216 mg/dl) during 1988–1994 falling to 5.09 mmol/L (197 mg/dl) in 2007–2008 (P<0.001). No significant changes in the intake of total fat, saturated fat, polyunsaturated fat, and dietary cholesterol were observed from 1988–1994 to 2007–2008. However, the age-adjusted use of cholesterol-lowering medications increased from 1.6% to 12.5% (P<0.001). The various equations suggested that changes in dietary fat made minimal contributions to the observed trend in mean concentrations of total cholesterol. The increased use of cholesterol-lowering medications was estimated to account for approximately 46% of the change. Discussion Mean concentrations of total cholesterol among adults in the United States have declined by ~4% since 1988–1994. The increased use of cholesterol-lowering medications has apparently accounted for about half of this small fall. Further substantial decreases in cholesterol might be potentially achievable by implementing effective and feasible public health interventions to promote the consumption of a more healthful diet by US adults. Disclaimer The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Temporal changes in concentrations of lipids and apolipoprotein B among adults with diagnosed and undiagnosed diabetes, prediabetes, and normoglycemia: findings from the National Health and Nutrition Examination Survey 1988–1991 to 2005–2008
Earl S Ford, Chaoyang Li, Allan Sniderman
Cardiovascular Diabetology , 2013, DOI: 10.1186/1475-2840-12-26
Abstract: We used data from 3202 participants aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) III (1988–1991) and 3949 participants aged ≥20 years from NHANES 2005–2008.Among participants of all four groups, unadjusted and adjusted mean concentrations of total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B, but not triglycerides, decreased significantly. Among participants with prediabetes and normoglycemia, unadjusted and adjusted mean concentrations of high-density lipoprotein cholesterol increased significantly. Adjusted mean log-transformed concentrations of triglycerides decreased in adults with undiagnosed diabetes and prediabetes. During 2005–2008, unadjusted concentrations of apolipoprotein B ≥80 mg/dl were observed in 72.8% of participants with diagnosed diabetes, 87.9% of participants with undiagnosed diabetes, 86.6% of participants with prediabetes, and 77.2% of participants with normoglycemia. The unadjusted use of cholesterol-lowering medications rose rapidly, especially among participants with diabetes (from ~1% to ~49%, P <0.001). The use of fenofibrate, gemfibrozil, and niacin rose significantly only among adults with diagnosed diabetes (from ~2% to ~8%, P?=?0.011).Lipid profiles of adults with diabetes improved during the approximately 16-year study period. Nevertheless, large percentages of adults continue to have elevated concentrations of apolipoprotein B.During the last several decades, diabetes has emerged as a major public health problem in the United States as the incidence and prevalence of obesity has escalated rapidly [1,2]. The lifetime probability of developing this disease is approximately 32.8% for men and 38.5% for women [3], and an estimated 25.6 million adults have diabetes [4]. Furthermore, diabetes has an enormous impact on health care costs in the United States; in 2007, for example, the economic costs attributable to this condition were est
An Analysis of Language as a Barrier to Receiving Influenza Vaccinations among an Elderly Hispanic Population in the United States
William S. Pearson,Guixiang Zhao,Earl S. Ford
Advances in Preventive Medicine , 2011, DOI: 10.4061/2011/298787
Abstract: Background. The Hispanic population in the United States is growing, and disparities in the receipt of healthcare services as a result of limited English proficiency have been demonstrated. We set out to determine if Spanish language preference was a barrier to receiving influenza vaccinations among Hispanic persons 65 years and older in the USA. Methods. Differences in the receipt of vaccinations by language preference were tested with both Chi-square analyses and adjusted logistic regression analyses. Results. Findings suggest that elderly Hispanic persons, 65 years of age and older, who prefer to communicate in Spanish instead of English, are significantly less likely to have received influenza vaccinations when compared to their Hispanic counterparts who prefer to communicate in English. Conclusions. Influenza infections can more often be fatal in older persons and may disparately affect minority populations such as Hispanic persons. Therefore, understanding barriers to the receipt of effective preventive health measures is necessary. 1. Introduction Morbidity and mortality resulting from seasonal influenza infection continues to be a significant concern for residents of the United States, and this is especially true among the country’s elderly population [1]. It is estimated that on average there are over a quarter of a million hospitalizations and approximately thirty six thousand deaths due to seasonal influenza annually [2], and that direct medical costs due to influenza infection average $10.4 billion every year [3]. Vaccinations against influenza are recommended for people who want to reduce the risk of getting influenza or transmitting it to others, and up until 2010, were specifically recommended for at-risk groups, including persons 65 years of age and older [4, 5]. Currently, all persons six months of age and older are recommended annual influenza vaccination [6]. As the U.S. population continues to age and grow, more people, especially vulnerable populations, will be at risk for developing this costly and potentially deadly disease. Recent census data indicate that the fastest growing ethnic group in the United States is Hispanic, with a total estimated population of 43 million persons in 2005 [7]. Projections by the U.S. Census Bureau suggest that by the year 2050, the number of Hispanic persons in the United States will more than double [8]. As the Hispanic population within the United States has increased, Spanish has become the primary language of many Hispanic households in the United States [9]. In fact, in 2006, the U.S. Census
Weight control behaviors in overweight/obese U.S. adults with diagnosed hypertension and diabetes
Guixiang Zhao, Earl S Ford, Chaoyang Li, Ali H Mokdad
Cardiovascular Diabetology , 2009, DOI: 10.1186/1475-2840-8-13
Abstract: Using self-reported data from 143,386 overweight/obese participants (aged ≥ 18 years) in the 2003 Behavioral Risk Factor Surveillance System, we examined the proportion of overweight/obese adults who tried to lose weight and their weight control strategies by hypertension and/or diabetes status.Among all participants, 58% of those with hypertension, 60% of those with diabetes, and 72% of those with both diseases tried to lose weight, significantly higher than the 50% of those with neither condition (Bonferroni corrected P < 0.017 for all comparisons). The multivariate-adjusted odds ratio (AOR) for trying to lose weight was 1.11 (95% confidence interval [CI]: 1.05–1.17) in participants with hypertension, 1.02 (95% CI: 0.90–1.15) in participants with diabetes, and 1.18 (95% CI: 1.07–1.29) in participants with both diseases (participants with neither condition as the referent). Among 78,446 participants who tried to lose weight, 23% of those with hypertension only and 28% of those with both hypertension and diabetes reported adopting a low fat/low calorie (LF/LC) diet in controlling their weight, significantly higher than 19% of those with neither disease (Bonferroni corrected P < 0.017 for all comparisons). Participants with both diseases had a significantly lower percentage of adopting physical activity in controlling their weight than those with neither condition (6% versus 12%, P < 0.01). After multivariate adjustment, the AOR for adopting a LF/LC diet plus physical activity to lose weight was 1.46 (95% CI: 1.15–1.84) in participants with both diseases. The AOR for adopting a LF/LC diet only to lose weight was 1.72 (95% CI: 1.35–2.20) in participants with both diseases and was 1.21 (95% CI: 1.03–1.40) in participants with hypertension only.The proportion of overweight/obese patients with diagnosed hypertension and/or diabetes who attempted to lose weight remains suboptimal and the weight control strategies varied significantly among these patients.The rising trend
The impact of cognitive functioning on mortality and the development of functional disability in older adults with diabetes: the second longitudinal study on aging
Lisa C McGuire, Earl S Ford, Umed A Ajani
BMC Geriatrics , 2006, DOI: 10.1186/1471-2318-6-8
Abstract: Participants included 559 US adults (232 males and 327 females) ≥ 70 years old who had diabetes and who were free from cognitive impairment were examined using an adapted Telephone Interview of Cognitive Status (TICS), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL).Multivariate logistic regression was conducted to investigate the independent contribution of cognitive functioning to three mutually exclusive outcomes of death and two measures of functional disability status. The covariates included in the model were participants' sex, age, race, marital status, educational level, duration of diabetes, cardiovascular disease (CVD) status, and self-rated health. Persons with diabetes who had the lowest levels of cognitive functioning relative to the highest level of cognitive functioning had a greater odds of dying (AOR = 0.80, 95% CI = 0.67–0.96) or becoming disabled (AOR = 0.87, 95% CI = 0.78–0.97) compared to those people who were disability free.Older adults with diabetes and low normal levels of cognition, yet within normal ranges, were approximately 20% more likely to die and 13% more likely to become disabled than those with higher levels of cognitive functioning over a 2-year period. Brief screening measures of cognitive functioning could be used to identify older adults with diabetes who are at increased risk for mortality and functional disability, as well as those who may benefit from interventions to prevent or minimize further disablement and declines in cognitive functioning.Cognitive dysfunction appears to be an additional complication of diabetes [1]. Accelerated declines in cognitive functioning have been consistently reported for older and middle-aged adults with diabetes [1-9]. In a recent systematic analysis, Cukierman and colleagues concluded that people with diabetes had a 1.2 to 1.5-fold greater change over time in measures of cognitive functioning and that the odds of future dementia was increased 1.6-fold[1]
Factors Associated with Vitamin D Deficiency and Inadequacy among Women of Childbearing Age in the United States
Guixiang Zhao,Earl S. Ford,James Tsai,Chaoyang Li
ISRN Obstetrics and Gynecology , 2012, DOI: 10.5402/2012/691486
Analysis of five-year trends in self-reported language preference and issues of item non-response among Hispanic persons in a large cross-sectional health survey: implications for the measurement of an ethnic minority population
William S Pearson, William S Garvin, Earl S Ford, Lina S Balluz
Population Health Metrics , 2010, DOI: 10.1186/1478-7954-8-7
Abstract: Data from the 2003-2007 United States Census and the Behavioral Risk Factor Surveillance System were used to compare trends in population growth and survey sample size as well as differences in survey response based on language preference among a Hispanic population. Percentages of item non-response on selected survey questions were compared for Hispanic respondents choosing to complete the survey in Spanish and those choosing to complete the survey in English. The mean number of attempts to complete the survey was also compared based on language preference among Hispanic respondents.The sample size of Hispanic persons in the Behavioral Risk Factor Surveillance System saw little growth compared to the actual growth of the Hispanic population in the United States. Significant differences in survey item non-response for nine of 15 survey questions were seen based on language preference. Hispanic respondents choosing to complete the survey in Spanish had a significantly fewer number of call attempts for survey completion compared to their Hispanic counterparts choosing to communicate in English.Including additional measures of acculturation and increasing the sample size of Hispanic persons in a national health survey such as the Behavioral Risk Factor Surveillance System may result in more precise findings that could be used to better target prevention and health care needs for an ethnic minority population.Recent US Census data indicate that the fastest-growing ethnic group in the United States is Hispanic, with a total estimated population of approximately 45 million persons in 2008 [1]. Projections by the US Census Bureau suggest that by the year 2050, the number of Hispanic persons in the US will more than double [2]. Because of the increase in the Hispanic population within the US, Spanish has become the primary language of many Hispanic households. In fact, in 2006, the US Census Bureau estimated that the number of persons aged 5 years and older who spoke predom
Serum Non-high-density lipoprotein cholesterol concentration and risk of death from cardiovascular diseases among U.S. adults with diagnosed diabetes: the Third National Health and Nutrition Examination Survey linked mortality study
Chaoyang Li, Earl S Ford, James Tsai, Guixiang Zhao, Lina S Balluz, Samuel S Gidding
Cardiovascular Diabetology , 2011, DOI: 10.1186/1475-2840-10-46
Abstract: We analyzed data from 1,122 adults aged 20 years and older with diagnosed diabetes who participated in the Third National Health and Nutrition Examination Survey linked mortality study (299 deaths from CVD according to underlying cause of death; median follow-up length, 12.4 years).Compared to participants with serum non-HDL-C concentrations of 35 to 129 mg/dL, those with higher serum levels had a higher risk of death from total CVD: the RRs were 1.34 (95% CI: 0.75-2.39) and 2.25 (95% CI: 1.30-3.91) for non-HDL-C concentrations of 130-189 mg/dL and 190-403 mg/dL, respectively (P = 0.003 for linear trend) after adjustment for demographic characteristics and selected risk factors. In subgroup analyses, significant linear trends were identified for the risk of death from ischemic heart disease: the RRs were 1.59 (95% CI: 0.76-3.32) and 2.50 (95% CI: 1.28-4.89) (P = 0.006 for linear trend), and stroke: the RRs were 3.37 (95% CI: 0.95-11.90) and 5.81 (95% CI: 1.96-17.25) (P = 0.001 for linear trend).In diabetics, higher serum non-HDL-C concentrations were significantly associated with increased risk of death from CVD. Our prospective data support the notion that reducing serum non-HDL-C concentrations may be beneficial in the prevention of excess death from CVD among affected adults.Non-high-density lipoprotein cholesterol (non-HDL-C) concentration is a composite marker of several atherogenic lipoproteins, including low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and lipoprotein (a) [1]. Non-HDL-C concentration can be measured by subtracting high-density lipoprotein cholesterol (HDL-C) concentration from total serum cholesterol concentration and it may be used as a candidate biometrical equivalent to apolipoprotein B100 in diabetes [2]. Serum total cholesterol and LDL cholesterol have been used as major laboratory measures in clinical practice to assess cardiovascular risk in the general population and disease m
The impact of obesity on time spent with the provider and number of medications managed during office-based physician visits using a cross-sectional, national health survey
William S Pearson, Kavitha Bhat-Schelbert, Earl S Ford, Ali H Mokdad
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-436
Abstract: Obesity status was determined for 9,280 patient visits made by persons aged 18 years or older in the 2006 National Ambulatory Medical Care Survey. Multivariate analyses compared obese and non-obese visits, stratified by sex, for duration of the visit and the number of medications mentioned at the visit.Average duration of visit was higher among visits with patients determined to be obese. However, these differences were not considered significant after statistical testing. Visits made by obese female patients were significantly more likely to involve more than two prescription medications (OR 1.26, 95% CI 1.05 - 1.51) and visits made by obese male patients were significantly more likely to involve more than two prescription medications (OR 1.46, 95% CI 1.16 - 1.83) as compared to visits made by non-obese patients.Time spent with the provider was found to be greater among visits with obese patients, but not significantly different from visits with non-obese patients. The number of medications for each visit was found to be significantly greater for visits where the patient was considered to be obese. Increased time for the visit and increased numbers of medication for each visit translate into increased costs. These findings document the impact of obesity on our health care system and have great implications on medical care cost and planning.Obesity continues to be an important health problem in the United States. Over the past two decades, the trends in the prevalence of overweight and obesity have steadily risen and began to level off in 2002 with 65.7% of adults classified as overweight or obese and 30.2% obese [1]. More recent estimates report that 66.3% of adults are overweight or obese, and 32.2% are obese [2].With the sustained high rates of overweight and obesity, a heavy cost is levied on the U.S. health care system. According to Finkelstein and colleagues, the direct medical cost of overweight and obesity in the U.S. was $78.5 billion in 1998 [3] and more r
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