Determinants of black-white differences in the risk of cerebral infarction. The National Health and Nutrition Examination Survey Epidemiologic Follow-up Study.

OBJECTIVE: To determine whether blacks in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study remained at increased risk for cerebral infarction after adjusting for stroke risk factors and sociodemographic factors. METHODS: A cohort study involving 8203 whites and 1362 blacks who participated in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. During the 13-year follow-up, 538 and 122 cerebral infarctions occurred in whites and blacks, respectively. RESULTS: The black-white risk for cerebral infarction varied by age (P = .007 for race-age interaction). Compared with whites of the same age, blacks aged 35 to 44 years were at significantly increased risk for cerebral infarction (relative risk, 2.62; 95% confidence interval, 1.23 to 5.57), while older blacks, those older than 64 years, were not at increased risk (relative risk, 1.14; 95% confidence interval, 0.90 to 1.46). The relative risk for cerebral infarction decreased to 2.07 (95% confidence interval, 0.97 to 4.42) in younger blacks and 0.82 (95% confidence interval, 0.29 to 2.33) in older blacks after adjustment for age, sex, education, history of heart disease, diabetes, systolic blood pressure, treatment for hypertension, Quetelet index, and serum hemoglobin and magnesium levels. CONCLUSIONS: These results indicate that much of the increased risk for cerebral infarction experienced by blacks can be explained by their higher prevalence of stroke risk factors, especially diabetes, hypertension, and lower educational attainment. Younger blacks, however, may still be at increased risk after adjusting for stroke risk factors.

Black-white differences in stroke risk among young adults.

BACKGROUND AND PURPOSE: Little information is available regarding black-white differences in stroke incidence in young adults. METHODS: Cerebral infarction and intracerebral hemorrhage rates among adults 15 to 44 years of age were studied in Baltimore City and Baltimore County for 1988. Diagnoses were based on neurologist review of data obtained from medical records at 41 hospitals by neurological nurses. RESULTS: The cerebral infarction rates per 100,000 were 22.8 for black males, 10.3 for white males, 20.7 for black females, and 10.8 for white females. The intracerebral hemorrhage rates per 100,000 were 14.2 for black males, 4.6 for white males, 4.8 for black females, and 1.5 for white females. CONCLUSIONS: Blacks had significantly (P < .05) higher rates than whites for both cerebral infarction and intracerebral hemorrhage. Cerebral infarction rates are high in Baltimore compared with Florence, Italy, or Stockholm, Sweden.

Serum cholesterol levels and cancer mortality in 361,662 men screened for the Multiple Risk Factor Intervention Trial.

Several prospective studies have demonstrated an association between low serum cholesterol level and subsequent mortality from cancer. This finding was explored in the large cohort (361,662) of men aged 35 to 57 years who were screened for possible randomization to the Multiple Risk Factor Intervention Trial. Mortality follow-up revealed a significant excess of cancer in the lowest decile of serum cholesterol level during the early years of follow-up, which attenuated over time. In contrast, the association between high serum cholesterol and coronary heart disease did not diminish during the average of seven years of follow-up. These findings are consistent with the inference that the association between low serum cholesterol level and cancer is at least in part due to an effect of preclinical cancer on serum cholesterol level. A subset of the cohort (12,866 men) participated in the randomized Multiple Risk Factor Intervention Trial protocol, which called for annual measurements of serum cholesterol level. Among the 150 of these men who died of cancer during the trial, cholesterol level fell 22.7 mg/dL (0.59 mmol/L) more than in the survivors over an equivalent period. These data are consistent with the foregoing inference.

Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial.

The Multiple Risk Factor Intervention Trial was a randomized clinical trial that studied the efficacy of multiple risk factor reduction in lowering coronary heart disease mortality in high-risk men. Nutrition counseling based on a fat-modified eating pattern resulted in a significant reduction of total cholesterol and low-density lipoprotein cholesterol. However, based on further analysis not involving comparisons of randomized groups, the reduction in total cholesterol appeared to be blunted by the effects of the antihypertensive medication utilized in the stepped-care therapy in this study. The use of diuretics was associated with an increase in triglycerides and a lesser decrease in total plasma cholesterol when compared with non-diuretic users. The use of diuretic therapy was also associated with a slight decrease in high-density lipoprotein cholesterol, when compared with changes in those not receiving diuretic therapy. The combination of diuretics plus propranolol was related to a substantial decrease in high-density lipoprotein cholesterol in both the Special Intervention and Usual Care participants. The changes in lipoproteins for men receiving diuretic therapy are probably influenced substantially by nutritional factors, especially weight change. Concomitant nutritional changes must be considered when analyzing the short- and long-term effects of therapy with diuretics or other antihypertensive drugs on lipoprotein metabolism.