@article {1447, title = {Properties of the random zero sphygmomanometer.}, journal = {Hypertension}, volume = {21}, year = {1993}, month = {1993 May}, pages = {632-7}, abstract = {

The random zero sphygmomanometer is widely used in studies involving blood pressure measurement because it is believed to eliminate digit preference and reduce measurement error. We performed blood pressure measurements sequentially using random zero and standard sphygmomanometers in random order in 1,356 participants in the Cardiovascular Health Study. Despite adherence to the manufacturer{\textquoteright}s instructions, we observed a substantially nonuniform distribution of zero levels generated by the random zero sphygmomanometer and a disturbing correlation between the zero level and blood pressures taken with the standard sphygmomanometer. With the random zero device, the pooled estimated slopes for the regression of standard systolic and diastolic pressures on the zero level were -0.71 and -0.17, respectively (both p < 0.0001). The only plausible explanation for this relation between the random zero device and the standard device is that by some unknown mechanism the subject{\textquoteright}s blood pressure is influencing the zero level. Systolic and diastolic blood pressures measured with the random zero device were, respectively, 1.65 and 1.84 mm Hg lower (both p < 0.0001) than standard blood pressures. Digit preference was detectable in the uncorrected blood pressure and zero level measured with the random zero device but was eliminated after calculation of the corrected blood pressure. For most epidemiological studies, the random zero sphygmomanometer offers no significant advantage over the standard sphygmomanometer. It may still be useful in those epidemiological studies and clinical trials where blinding is important.

}, keywords = {Aged, Blood Pressure, Blood Pressure Determination, Cohort Studies, Diastole, Humans, Regression Analysis, Systole}, issn = {0194-911X}, author = {Kronmal, R A and Rutan, G H and Manolio, T A and Borhani, N O} } @article {1428, title = {Prevalence and correlates of respiratory symptoms and disease in the elderly. Cardiovascular Health Study.}, journal = {Chest}, volume = {106}, year = {1994}, month = {1994 Sep}, pages = {827-34}, abstract = {

Spirometry was performed by 5,201 elderly participants of the Cardiovascular Health Study during their baseline examination and a subset of the ATS/DLD-78 respiratory questionnaire was administered by trained interviewers. In never smokers (46 percent of the cohort), the overall prevalence of chronic cough was 9 percent, chronic phlegm was 13 percent, attacks of wheezing with dyspnea were 8 percent, and grade 3 dyspnea on exertion was 10 percent. The prevalence of lung disease in current smokers (12 percent of the cohort) was 8/7 percent (men/women) with chronic bronchitis and 14/5 percent with emphysema. Overall, 6 percent reported asthma (a physician-confirmed history) and 12 percent reported hay fever. Using a logistic regression model, attacks of wheezing with dyspnea were strongly associated with a lower FEV1, coronary heart disease, heart failure, and a large waist size (in participants without a diagnosis of asthma, chronic bronchitis, or emphysema). Undiagnosed airways obstruction was twice as likely in women and those with lower income, and was associated with current and former smoking, pack-years of smoking, and chronic cough. Dyspnea on exertion (DOE) was three times or more likely if a participant reported heart failure, coronary heart disease, or emphysema; and much more likely if their FEV1 or FVC was substantially reduced. Dyspnea on exertion was also positively associated with older age, chronic bronchitis or asthma, a larger waist or hip size, pack-years of smoking, and less education. We conclude that DOE and attacks of wheezing with dyspnea are commonly associated with cardiovascular disease and a low FEV1 in those over 65 years and that airways obstruction frequently remains undiagnosed in the elderly.

}, keywords = {Aged, Aged, 80 and over, California, Cohort Studies, Female, Humans, Lung Diseases, Male, Maryland, Multivariate Analysis, North Carolina, Pennsylvania, Prevalence, Prognosis, Respiratory Tract Diseases, Spirometry, Surveys and Questionnaires}, issn = {0012-3692}, author = {Enright, P L and Kronmal, R A and Higgins, M W and Schenker, M B and Haponik, E F} } @article {787, title = {Predictors of falling cholesterol levels in older adults: the Cardiovascular Health Study.}, journal = {Ann Epidemiol}, volume = {14}, year = {2004}, month = {2004 May}, pages = {325-31}, abstract = {

PURPOSE: To estimate 4-year change in serum total cholesterol levels in a population-based sample of older adults and identify independent predictors of cholesterol decline.

METHODS: Prospective study of 2837 adults aged 65 years and older with serum cholesterol measured in 1992-1993 and 1996-1997.

RESULTS: Mean serum cholesterol levels declined 6.3 mg/dl between the two examinations. Declines were greater in white (-7.3 mg/dl) than black (-1.4 mg/dl) participants and in those in good/excellent health (-0.9 mg/dl) vs. fair/poor health (-3.1 mg/dl; both p < 0.01). Factors associated with greater decline on multivariate analysis included age, male gender, and higher white cell count, albumin, and baseline cholesterol. Cholesterol levels declined 2.0 mg/dl per 6 year increment in baseline age and 6.8 mg/dl more in men than women after adjustment for other factors. C-reactive protein levels were unrelated to cholesterol change.

CONCLUSION: Declining cholesterol levels were associated with male gender, advanced age, weight loss, and white blood cell count but not with C-reactive protein levels. The role of declining cholesterol synthesis, due to as yet undefined age-related changes or to cytokine-mediated reductions related to illness, should be examined to help clarify the mechanisms of the sometimes marked declines in cholesterol levels observed at advanced ages.

}, keywords = {African Americans, Age Factors, Aged, Cardiovascular Diseases, Cholesterol, European Continental Ancestry Group, Female, Forecasting, Health Status, Humans, Male, Medicare, Prospective Studies, Risk Factors, Sex Distribution, Sex Factors, United States}, issn = {1047-2797}, doi = {10.1016/j.annepidem.2003.09.006}, author = {Manolio, Teri A and Cushman, Mary and Gottdiener, John S and Dobs, Adrian and Kuller, Lewis H and Kronmal, Richard A} }