Nurses’ Health Study disease

Data from the classic Nurses Health Study, followed up in 1994, reflected no difference in all-cause mortality between women who had ever used oral contraceptives and those who had never used them (7). There was also no increase in mortality associated with duration of use and no relation with time since first use or time since last use. Similarly, in the OFPA (Oxford) study, the overall 20-year mortality risk for oral contraceptive users compared with women using diaphragms or IUCDs was 0.9, suggesting no effect (8). Although the number of deaths from each cause was small, the pattern is consistent with the risks found in other studies. Oral contraceptive users had somewhat higher death rates from ischemic heart disease and cervical cancer, but lower rates of ovarian cancer mortality. Breast cancer mortality was similar for oral contraceptive users and non-users. 

Stampfer MJ, Willett WC, Colditz GA, Speizer FE, Hennekens CH. Past use of oral contraceptives and cardiovascular disease a meta-analysis in the context of the Nurses Health Study. Am J Obstet Gynecol 1990 163(1 Pt 2) 285-91. 

Inflammation is an important factor in the development of cardiovascular disease. Most clinical studies involving inflammation parameters have been relatively small. The Nurses Health Study involving 727 women was the largest study designed to determine the effects of n-3 fatty acids on biomarkers of inflammation and endothelium activation (Lopez-Garcia et al., 2004). They found an inverse association between ALA intake and plasma concentrations of C-reactive protein (a marker for inflammation), Interlukin-6, and E-selectin. Bemelmans et al. (2004) also found an inverse association between C-reactive protein and ALA intake in a randomized, double-blind placebo-controlled study involving 103 hypercholesterolemic subjects. 

Cambridge Heart Antioxidant Study DATATOR Deprenyl and Tocopherol Antioxidative Therapy of Rarkinsonism FMC, Finnish Mobile Clinic Health Examination Survey GISSI, Gruppo Italiano Studio Soprawivenza Infarto HOPE, Heart Outcome Prevention Evaluation HPFS, Health Professional Follow-up Study NHS, Nurses Health Study PPR Primary Prevention Project SPACE, Secondary Prevention with Antioxidants of Cardiovascular disease in End-stage renal disease VEAPS, Vitamin E Atherosclerosis Prevention Study VECAT Vitamin E Cataract Age-related maculopathy Trial. 

A study on diet and colon cancer was reported by W. Willett s group (Willett et at., 1990) (Table 11.3). The study examined various components of the diet, such as fiber, fat, and meat. The fiber component was divid into cereal fiber and fruit fiber. The fat component was divided into meat fat, dairy fat, saturated fat, and unsaturated fat. The meat component was divided into beef, pork, and lamb, and into rare versus well-done Styles of cooking. The body mass index, as defined in the Obesity chapter, was also recorded. The study was part of the Nurses Health Study Cohort, which was inibated in 1976 and involved 121,700 female nurses. Every 2 years, the nurses filled in a questionnaire that asked about various risk factors for disease. The questionnaire asked, for example, about 61 foods and their frequency In the diet. The foods were chosen to allow epidemiologists to make broad statements regarding the component nutrients. 

Gallbladder disease is a commonly cited complication of oral estrogen use. The Nurses Health Study showed that the age-adjusted relative risk of cholecystectomy is 2.2 for women currently taking 0.625 mg CEE. In this stndy, the risk of cholecystectomy increased with duration of hormone therapy nse and did not resolve after discontinnation. Transdermal estrogen is an alternative to oral therapy for women at high risk for cholelithiasis. 

A robust database exists from observational studies, clinical studies/trials, animal studies, and in vitro studies demonstrating that fatty acids play a key role in chronic disease risk. Population studies show a positive correlation between coronary heart disease (CHD) risk and dietary SFA (Hu et al., 1997 Keys, 1970 Kromhout et al., 1995) and an inverse association with PUFA (Hu et al., 1997). The Nurses Health Study (Hu et al., 1997) reported an inverse relationship between the PUFA SFA ratio and CHD risk. By all estimates, replacing 5% of energy from SFA with PUFA or MUFA would reduce risk of CHD by -48 and 36%, respectively. The relationship between dietary fat intake and risk of CHD is illustrated in Figure 20.2. Tram fatty... 

Acronyms and abbreviations PHSl, Physician s Health Study 1 CHAOS, Cambridge Heart Antioxidant Study ATBC, Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study NHS, Nurses Health Study CVD, cardiovascular disease ALS, amyotrophic lateral sclerosis NMD A, (V-methyl-D-aspartate glutamate receptors. 

Liu S, Stampfer MJ, Hu FB, et al. Whole-grain consumption and risk of coronary heart disease results from the Nurses Health Study. Am J Clin Nutr. 1999 70 412-419. 

Food consiunption patterns that include whole grains also appear protective for cardiovascular disease. Van Dam et al. report that intake of refined diets that do not include whole grains were associated with higher serum cholesterol levels and lower intakes of micronutrients. A prudent dietary pattern, including intake of whole grains, was associated with lower C-reactive protein levels and endothelial dysfunction, an early step in the development of atherosclerosis. Whole-grain food intake was also associated with lower levels of C-reactive protein in the Nurses Health Study. 

The Nurses Health Study (Puett et al. 2008) examined the association of chronic particulate exposures with all-cause mortality, incident nonfatal myocardial infarction, and fatal coronary heart disease (CHD) in a prospective cohort of 66,250 women from the Nurses Health Study in north-eastern US metropolitan areas. In an age- and season-of-the-year-adjusted models, 10 pg/m increases in 12-month average exposures to PMio were associated with increased all-cause mortality (RR 1.16, 95% Cl 1.05-1.28) and fatal CHD (1.43, 95% Cl 1.10-1.86). 

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