@article {591, title = {Antidiabetic treatment trends in a cohort of elderly people with diabetes. The cardiovascular health study, 1989-1997.}, journal = {Diabetes Care}, volume = {22}, year = {1999}, month = {1999 May}, pages = {736-42}, abstract = {

OBJECTIVE: This study characterizes the pharmaceutical treatment of type 2 diabetes from 1989-1990 to 1996-1997 in an elderly cohort.

RESEARCH DESIGN AND METHODS: A total of 5,888 adults aged > or = 65 years were recruited and attended a baseline clinic visit in 1989-1990 (n = 5,201, original cohort) or 1992-1993 (n = 687. African-American [new] cohort) as participants of the Cardiovascular Health Study. Fasting serum glucose (FSG) was measured at baseline. Medication use was ascertained by drug inventory at all annual clinic visits. Diabetes was defined at baseline as insulin or oral hypoglycemic agent (OHA) use or as having an FSG > or = 7.0 mmol/l (126 mg/dl), the current consensus definition of diabetes.

RESULTS: A total of 387 (7\%) original (FSG = 9.8 mmol/l [177 mg/dl]) and 115 (17\%) new (FSG = 10.6 mmol/l [191 mg/dl]) cohort members had pharmacologically treated diabetes at baseline. Among those in the original and in the new cohorts who survived follow-up, respectively, OHA use decreased from 80 to 48\% (P < 0.001) and from 67 to 50\% (P < 0.003) and insulin use increased from 20 to 33\% (P = 0.001) and from 33 to 37\% (P = 0.603). There were 396 (8\%) original (FSG = 8.8 mmol/l [159 mg/dl]) and 45 (7\%) new (FSG = 10.0 mmol/l [181 mg/dl]) cohort members with diabetes untreated at baseline. Among them, respectively, OHA use reached 38 and 30\% and insulin use reached 6 and 16\% in 1996-1997.

CONCLUSIONS: Diabetes was common in this elderly cohort, and > 80\% of treated patients with diabetes at baseline were not achieving fasting glucose goals of < or = 6.7 mmol/l (120 mg/dl). Many untreated at baseline remained untreated after 7 years of follow-up.

}, keywords = {Aged, Blood Glucose, Cardiovascular Diseases, Cohort Studies, Diabetes Mellitus, Drug Therapy, Female, Follow-Up Studies, Humans, Hypoglycemic Agents, Insulin, Male, Prospective Studies, Risk Factors, Time Factors, United States}, issn = {0149-5992}, doi = {10.2337/diacare.22.5.736}, author = {Smith, N L and Heckbert, S R and Bittner, V A and Savage, P J and Barzilay, J I and Dobs, A S and Psaty, B M} } @article {588, title = {Hormone replacement therapy, inflammation, and hemostasis in elderly women.}, journal = {Arterioscler Thromb Vasc Biol}, volume = {19}, year = {1999}, month = {1999 Apr}, pages = {893-9}, abstract = {

Lipid-lowering by postmenopausal hormone therapy (HRT) explains only partly the assumed coronary risk reduction associated with therapy. To explore other possible mechanisms, we studied associations of HRT use with inflammation and hemostasis risk markers in women >/=65 years of age. Subjects were selected from 3393 participants in the fourth year examination of the Cardiovascular Health Study, an observational study of vascular disease risk factors. After excluding women with vascular disease, we compared levels of inflammation and hemostasis variables in the 230 women using unopposed estrogen and 60 using estrogen/progestin, with those of 196 nonusers selected as controls. Compared with nonusers, unopposed estrogen use was associated with 59\% higher mean C-reactive protein (P<0.001), but with modestly lower levels of other inflammation indicators, fibrinogen, and alpha-1 acid glycoprotein (P<0.001). Factor VIIc was 16\% higher among estrogen users (P<0.001), but this was not associated with higher thrombin production (prothrombin fragment 1-2), or increased fibrin breakdown (D-dimer). Concentration of plasminogen activator inhibitor-1 was 50\% lower in both using groups (P<0.001) compared with nonusers, and this was associated with higher plasmin-antiplasmin complex: 8\% higher in estrogen and 18\% higher in estrogen/progestin users (P<0. 05). Relationships between the markers and hormone use were less pronounced in estrogen/progestin users, with no association for C-reactive protein except in women in upper 2 tertiles of body mass index (P for interaction, 0.02). The direction and strength of the associations of HRT use with inflammation markers differed depending on the protein, so it is not clear whether HRT confers coronary risk reduction through an inflammation-sensitive mechanism. Associations with hemostasis markers indicated no association with evidence of procoagulation and a possible association with increased fibrinolytic activity.

}, keywords = {Aged, Biomarkers, Case-Control Studies, Cross-Sectional Studies, Estrogens, Female, Hemostasis, Hormone Replacement Therapy, Humans, Inflammation, Progestins, Random Allocation, United Kingdom, United States}, issn = {1079-5642}, doi = {10.1161/01.atv.19.4.893}, author = {Cushman, M and Meilahn, E N and Psaty, B M and Kuller, L H and Dobs, A S and Tracy, R P} } @article {659, title = {Post-menopausal hormone therapy and concentrations of protein C and antithrombin in elderly women.}, journal = {Br J Haematol}, volume = {114}, year = {2001}, month = {2001 Jul}, pages = {162-8}, abstract = {

The effects of post-menopausal hormone therapy (HRT) on blood coagulation in elderly women are not well defined. We studied associations of HRT use with levels of natural anticoagulant proteins in a cross-sectional study of 3393 women > or = 65 years of age participating in the Cardiovascular Health Study. Protein C antigen and antithrombin were measured in all users (n = 230 unopposed oestrogen; 60 oestrogen/progestin) and a comparison group of 196 age- and race-matched non-users. Compared with non-users, oestrogen use was associated with higher protein C (4.80 vs. 4.30 microg/ml, P < 0.01). Results were similar for oestrogen/progestin (P > 0.05). In both user groups, antithrombin was lower than in non-users (109\% for each vs. 115\% in non-users, P < 0.001). Adjustment for factors related to prescription of HRT and to anticoagulant protein levels had little impact on the results. For antithrombin, associations with HRT were larger for thinner Caucasian women and black women. Venous thrombosis from HRT may be mediated partly by alterations in antithrombin, but not protein C concentrations. This study extends previous observations to older women, the group at highest risk of venous thromboembolism. Studies of HRT-induced alterations in anticoagulant function in relation to the occurrence of thrombosis with HRT are required.

}, keywords = {Aged, Antithrombins, Black People, Body Mass Index, Cross-Sectional Studies, Estrogen Replacement Therapy, Female, Humans, Logistic Models, Postmenopause, Progestins, Protein C, Risk Factors, Venous Thrombosis, White People}, issn = {0007-1048}, doi = {10.1046/j.1365-2141.2001.02911.x}, author = {Cushman, M and Psaty, B M and Meilahn, E N and Dobs, A S and Kuller, L H} }