Non-invasive ultrasonic imaging of the carotid bifurcation by duplex scanning and ultrasonic arteriography combined with pulsed Doppler spectrum analysis demonstrated patency of the external and internal carotid arteries distal to a common carotid occlusion in 3 patients. Common carotid occlusion is not invariably associated with thrombosis of the ipsilateral internal carotid artery. Identification of internal carotid patency by the use of ultrasonic techniques will permit surgical treatment in selected cases. Stroke, Vol 11, No 3, 1980

Lod scores are reported for 86 biochemical to cytogenetic marker comparisons in a Black kindred. Analysis with unconfirmed locus assignments resulted in 12 exclusions of close linkage.

Objectives: To examine the generalisability of multivariate risk functions from diverse populations in three contexts: ordering risk, magnitude of relative risks, and estimation of absolute risk.Design: Meta-analysis of prospective cohort studies.Patients: Participants from various epidemiological studies.Main outcome measure: Death from coronary heart disease (CHD).Results: The analysis included 105 420 men and 56 535 women 35-74 years of age and free of CHD at baseline from 16 observational studies with a total of 27 analytical groups. The area under the receiver operating characteristic curve (AUC) was used to judge the ability of the multivariate risk function to order risk correctly. AUCs ranged from 0.60 to 0.80. The AUCs differed significantly between the studies (p < 0.01) but were very similar for different risk functions applied to the same population, indicating similar ability to rank risk for different models. The magnitudes of the relative risks associated with major risk-factors (age, systolic blood pressure, serum total cholesterol, smoking, and diabetes) varied significantly across studies (p < 0.05 for homogeneity). The prediction of absolute risk was not very accurate in most of the cases when a model derived from one study was applied to a different study.Conclusions: When considered qualitatively, the major risk factors are associated with CHD mortality in a diverse set of populations. However, when considered quantitatively, there was significant heterogeneity in all three aspects: ordering risk, magnitude of relative risks, and estimation of absolute risk.

A long term study of diversity between two ethnic groups was developed in Evans County, Georgia. The findings are predicated on the genotypic-phenotypic interactions, with the multitude of environmental factors. The genetic-environmental interaction ultimately determines the individual's state of health or disease. For example, coronary heart disease prevalence and incidence rates were extremely low for blacks in Africa and four times lower than whites in rural South Georgia in the 1960s. Excessive hypertension and diabetes mellitus, and greater cerebrovascular disease mortality in black men, is now well known. Blood pressure levels studied in rural Africa were normal and did not rise with age, whereas blacks, conversely, demonstrated twice as much hypertension in South Georgia as whites and demonstrated an inverse relation between education and blood pressure (ie, the lower the education the higher the blood pressure). Cultural adaptation has accelerated hypertensive disease and strokes in blacks, while there remains an excess of atherosclerotic coronary heart disease in white men. Secular trends suggest that coronary heart disease is decreasing among white men but may be increasing in black men. Studies of ethnicity and biracial populations provide important cardiovascular disease associations with clinical risk factor studies.

Knapp RG, Schreiner PJ, Sutherland SE, Keil JE, Gilbert GE, Klein RL, Hames C, Tyroler HA. Serum lipoprotein(a) levels in elderly black and white men in the Charleston Heart Study. Clin Genet 1993: 44: 225–231. © Munksgaard, 1993 Lipoprotein(a) [Lp(a)] is an important genetic trait associated with cardiovascular disease. While Lp(a) levels have been demonstrated to be approximately twice as high in black adults and children compared with whites, this relationship has not been assessed in the elderly. During the 1987 recall of the Charleston Heart Study cohort, plasma Lp(a) [mg\dl] was measured on 113 white men and 83 black men. The average age of those having Lp(a) measurements was 71 years (\pm6) for white men and 72 years (\pm 9) for black men. The distribution of Lp(a) was skewed in both whites = (mean = 14.8, median = 8.2 mg\dl) and blacks (mean = 18.1, median = 12.8 mg/dl). The skewed distribution in elderly black men was in contrast to the bell‐shaped distribution commonly reported for younger blacks. The Charleston Heart Study data suggest a shift to lower values among elderly as compared to younger men, with the greatest shift occurring among the black men. For black men who have survived to the 7th, 8th, and 9th decades of life, Lp(a) levels appear to be approaching the lower levels of white men. Despite this shift in distribution among black men, there remained a statistically significant difference in Lp(a) between racial groups.

The association of passive smoking and cardiovascular disease (CVD) mortality was assessed in a cohort of 513 rural, married Black and White women who were disease-free and self-described as never-smokers at baseline in 1960. Over a 20-year period, 76 of 147 total deaths were attributed to CVD. Relative risk estimates adjusted for age, cholesterol, blood pressure, and body mass from proportional hazards models were 1.59 for CVD (95% CI = 0.99, 2.57) and 1.39 (CI = 0.99, 1.94) for all cause mortality among women with husbands who smoked cigarettes.

Epidemiologic studies suggest that low carotene intake and low levels of serum retinol may be associated with an increased risk of cancer. Likewise, in some animal studies vitamin E has been associated with a reduced rate of induced cancers. Therefore, we measured retinol, retinol-binding protein, vitamin E (alpha-tocopherol), and total carotenoids in serum collected in 1973 from 111 participants in the Hypertension Detection and Follow-up Program who were free of cancer at the time but were diagnosed as having cancer during the subsequent five years. These measurements were compared with those in 210 controls who were matched for age, sex, race, and time of blood collection, and who remained free of cancer. Mean values for retinol were similar for cases and controls (67.3 and 68.7 micrograms per deciliter, respectively [95 per cent confidence limits for case-control difference, -6.7 to 3.5]). Values were also similar for retinol-binding protein (6.01 and 5.94 mg per deciliter [-0.42 to 0.56]), and carotenoids (114.5 and 111.6 micrograms per deciliter [-9.1 to 15.9]). The mean base-line retinol level in the 18 subjects with subsequent lung cancer was higher than that in their matched controls (79.0 vs. 71.4 micrograms per deciliter, -4.9 to 19.7). Serum vitamin E levels were somewhat lower in subjects who later had cancer than in controls (1.16 and 1.26 mg per deciliter, -0.22 to 0.02), in part because of the confounding effect of serum cholesterol levels (when adjusted for lipid levels, the case-control difference was -0.05 mg per deciliter; -0.17 to 0.07). These data do not support hypotheses relating intake or serum levels of antioxidant vitamins to a reduced cancer risk.

Recent studies of the relationship between cholesterol and noncardiovascular disease, particularly cancer, have produced inconsistent results. The association of cholesterol with cancer, when present, appears stronger (or present only) for males than females (1). Several investigators report no association between cholesterol and cancer (2); others suggest that inverse associations are attributable to subclinical disease at time of cholesterol determination (3, 4). Kark et al. (5) reported an inverse association between cholesterol and cancer incidence, in the Evans County study population, followed for a period of fourteen years. Davis et al. (6) demonstrated that the association in the Evans County Study was curvilinear over a 20 year period. We extend the Evans County analyses testing the hypothesis that rural, lower social status, farming occupations modify the cholesterol cancer association.

Blood pressure levels were examined with regard to church attendance patterns in a group of white male heads of households who appeared in the 1967–1969 follow-up examination of the Evans County Cardiovascular Epidemiologic Study. A consistent pattern of lower systolic and diastolic blood pressures among frequent church attenders was found compared to that of infrequent attenders which was not due to the effects of age, obesity, cigarette smoking, or socioeconomic status.

Data on the distribution of triglyceride and total, LDL and HDL cholesterol are presented for age groups 40 yr and older. The populations represented came from Framingham, Albany, Honolulu, San Francisco, Evans County and Puerto Rico. They include white, Japanese and black persons and both sexes. Blood samples and lipid measurements were obtained after overnight fast by a common protocol as part of a cooperative study of lipoprotein phenotyping.

Examination of smoking habits in Evans County revealed the proportion of men smoking cigarettes to be 2–3 times that of women. At the 7 yr follow-up there was a decrease in the male rate whereas the female rate remained the same. There is generally no association between smoking status and either blood pressure at entry or blood pressure change over time. This lack of association in Evans County was evident in all 4 race-sex groups with the exception of diastolic blood pressure of white females at entry to the study and the change in diastolic blood pressure of black males at follow-up. Selective criteria were applied to the Evans County population to replicate the analyses of the Normative Aging and Framingham Studies. The Evans County data support the conclusions of the Framingham Study, that there is no difference in blood pressure changes between quitters and continuing smokers. Thus with respect to blood pressure change it apparently makes no difference if one continues to smoke or quit. And considering the health consequences of smoking, smokers should not be deterred from quitting for concern of a subsequent rise in blood pressure.

The characteristics of prevalence data on blood pressure and the natural history of hypertension have been examined in a black-white medical general practice located in the so-called high stroke belt region of the southeastern United States.

The present study was designed to test the hypothesis that a distinctive psycholgical pattern consisting of a low level of manifest hostility with elevated levels of anxiety and repression is associated with coronary heart disease and precedes its occurrence.

Physical working capacity and activity patterns were studied in a random sample of a rural population in which high social class white males (HSC-WM) were previously found to have a significantly greater prevalence of coronary heart disease than low social class white males (LSC-WM) or Negro males (NM).

Patterns of serum albumin and globulin fractions in Negro and white subjects by age, race, sex and social class are presented. Strength of association of these proteins with certain physiological variables is shown.

A study was carried out on twenty-six pairs of white men living in Evans County, Georgia, matched for age, and classified on the basis of a high or low serum cholesterol value. A repeat cholesterol determination confirmed the validity of the initial classification. Nutrient intake was assessed by means of a dietary interview during two time periods, fall and spring, for each subject. Exercise was evaluated on the basis of occupation. Significant correlations of serum cholesterol with dietary components were not found. However, a highly significant inverse relationship between exercise and cholesterol emerged.