5-6-04

Your Disease Risk: Relative Risks (Diabetes, Heart Disease, Osteoporosis, Stroke)

Key: Scoring REF= reference level 1= weak 2= mod 3= strong 4= v.strong

(-) decr risk RR 0.7-25/d

Ref +1 +2 +3

≤ 10 yrs > 10 yrs

+1 Ref

Never/sometimes Regularly

Ref +1

Yes No

+2 Ref

Yes No

+2 Ref

Past smoking (Cessation duration)

Environmental tobacco smoke exposure

Hypertension

Diabetes mellitus

4

5-6-04

Heart Disease (con’t) Total cholesterol Binary Yes

+2

No

Ref

Range(mg/dL) ≤ 159

Ref

160-199

+1

200-239

+2

240-279

+3

≥280

+4

< 40 (mg/dL)

+2

≥ 40

Ref

≥ 3 hr/w < 3 hr/w

-2 Ref

≥ 2 svg/w < 2 svg/w

-2 Ref

≥ 5 svg/d < 5 svg/d

-2 Ref

≥ 3 svg/d < 3 svg/d

-2 Ref

≥ 3 svg/w < 3 svg/w

-1 Ref

≥ 2 svg/d

+1

< 2 svg/d

Ref

≥ 4 svg/w

+1

< 4 svg/w

Ref

≥ 4 svg/w

-1

< 4 svg/w

Ref

≥ 1 svg/d < 1 svg/d

-2 Ref

≥ 4 times/w < 4 times/w

-1 Ref

≥ 4 times/w < 4 times/w

-1 Ref

HDL

Physical activity Fish intake Fruit/veg intake Cereal fiber/whole grain Nut intake Saturated fat (butter, lard, red meat, cheese, or whole milk intake)

Transunsaturated fat (stick margarine, veg shortening, store-bought baked good, or deep fried food intake)

Mono & polyunsaturated fat (liquid veg oil, oil-based salad dressing intake)

Alcohol intake Multivitamin/B complex supplement Vitamin E

* not included in risk score calculation

5

5-6-04

Heart Disease (con’t) References: Age, sex, family history American Heart Association. http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/riskfact.html Weight Baik I, Ascherio A, Rimm EB, Giovanucci E, Spiegelman D, Stampfer MJ, Willett WC. Adiposity and Mortality in Men. American Journal of Epidemiology 2000;152 (3):264-271. Rimm EB, Stampfer MJ, Giovannucci E, Ascherio A, Spiegelman D, Colditz GA, Willett WC. Body Size and Fat Distribution as Predictors of Coronary Heart Disease among Middle-aged and Older US Men. American Journal of Epidemiology 1995; 141 (12): 1117-1127. Willet WC, Manson JE, Stampfer MJ, Colditz GA, Rosner B, Speizer FE, Hennekens CH. Weight, Weight Change, and Coronary Heart Disease in Women, Risk Within the ‘Normal’ Weight Range. Jama 1995; 273(6): 461-465. Waist size Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, Willett WC, Manson JE. Abdominal Adiposity and Coronary Heart Disease in Women. JAMA 1998; 280: 1843-1848. Rimm EB, Stampfer MJ, Giovannucci E, Ascherio A, Spiegleman D, Colditz GA, Willett WC. Body Size and Fat Distribution as Predictors of Coronary Heart Disease Among Middle-aged and Older US Men. American Journal of Epidemiology 1995; 141 (12): 1117-1127. Current smoking Welin L, Eriksson H, Larsson B, Svardsudd K, Wilhelmsen L, Tibblin G. Risk Factors for Coronary Heart Disease during 25 Years of Follow-up. Cardiology 1993; 82: 223-228. Past smoking Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson JE, Rosner B, Hunter DJ. Smoking Cessation and Decreased Risks of Total Mortality, Stroke, and Coronary Heart Disease Incidence Among Women: A Prospective Cohort Study. National Institutes of Health, National Cancer Institute. Changes in CigaretteRelated Disease Risks and Their Implication for Prevention and Control: 541. Passive smoking Kawachi I, Colditz GA, Speizer FE, Manson JE, Stampfer MJ, Willett WC, Hennekens CH. A Prospective Study of Passive Smoking and Coronary Heart Disease. Circulation 1997; 95(10): 2374-9. Glantz SA, Parmley WW. Passive Smoking and Heart Disease. Mechanisms and Risk. JAMA 1995; 273(13): 1047-53. Postmenopausal hormones Grodstein F, Stampfer MJ, Colditz GA, Willett WC, Manson JE, Joffe M, Rosner B, Fuchs C, Hankinson SE, Hunter DJ, Hennekens CH, Speizer FE. Postmenopausal Hormone Therapy and Mortality. NEJM 1997; 336 (25); 1769-75.

6

5-6-04

Heart Disease (con’t) Hypertension Wilson PWF, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of Coronary Heart Disease Using Risk Factor Categories. Circulation 1998; 97: 1837-1847. Stamler J, Dyer AR, Shekelle RB, Neaton J, Stamler R. Relationship of Baseline Major Risk Factors to Coronary and All-Cause Mortality, and to Longevity: Findings from Long-Term Follow-Up of Chicago Cohorts. Cardiology 1993; 82: 191-222. Diabetes Kannel WB, McGee DL. Diabetes and Cardiovascular Disease. The Framingham Study. JAMA 1979; 241(9): 2035-8. Total cholesterol Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JD. Relationship of Baseline Serum Cholesterol Levels in 3 Large Cohorts of Younger Men to Long-term Coronary, Cardiovascular, and AllCause Mortality and to Longevity. JAMA 2000; 284: 311-318. HDL cholesterol Castelli WP, Garrison RJ, Wilson PWF, Abbott RD, Kalousdian S, Kannel WB. Incidence of Coronary Heart Disease and Lipoprotein Cholesterol Levels. JAMA 1986; 256: 2835-2838. Kannel WB, Castelli WP, Gordon T. Cholesterol in the Prediction of Atherosclerotic Disease. Annals of Internal Medicine 1979; 90: 85-91. Gordon DJ, Knoke J, Probstefield JL, Superko R, Tyroler HA. High-Density Lipoprotein Cholesterol and Coronary Heart Disease in Hypercholesterolemic Men: The Lipid Research Clinics Coronary Primary Prevention Trial. Circulation 1986; 74(6): 1217-1225. Gordon DJ, Probstfield Jl, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, Jacobs DR Jr, Bangdiwala S, Tyroler HA. High-Density Lipoprotien Cholesterol and Cardiovascular Disease Four Prospective American Studies. Circulation 1989; 79 (1): 8-15. Exercise Pate RR, Pratt M, Blair SN. Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, eath GW, King AC, Kriska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS, Patrick K, Pollock ML, Rippe JM, Sallis J, Wilmore JH. Physical Activity and Public Health – A Recommendation for the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402-407. Fish intake Hu FB, Manson JE, Willett WC. Types of Diatary Fat and Risk of Coronary Heart Disease: A Critical Review. Journal of the American College of Nutrition 2001; 20(1); 5-19. Das UN. Beneficial Effect(s) of n-3 Fatty Acids in Cardiovascular Diseases: but, Why and How? Prostaglandins, Leukotrienes and Essential Fatty Acids 2000; 63(6): 351-362. Fruit and vegetable intake Joshipura KJ, Hu FB, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, Colditz GA, Ascherio A, Rosner B, Spiegelman D, Willett W. The Effect of Fruit and Vegetable Intake on Risk for Coronary Heart Disease. Annals of Internal Medicine 2001; 134(12): 1106-1114.

7

5-6-04

Heart Disease (con’t) Whole grain intake Anderson JW, Hanna TJ, Xuejun P, Kryscio RJ. Whole Grain Foods and Heart Disease Risk. Journal of the American College of Nutrition 2000; 19 (3): 291S-299S. Rimm EB, Ascherio A, Giovannucci E, Spiegelman D, Stampfer MJ, Willett WC. Vegetable, Fruit, and Cereal Fiber Intake and the Risk of Coronary Heart Disease Among Men. JAMA 1996; 275(6): 447-51. Nut intake Hu FB, Stampfer MJ, Manson JE, Rimm EB, Colditz GA, Rosner BA, Speizer FE, Hennekens CH, Willett WC. Frequent Nut Consumption and Risk of Coronary Heart Disease in Women: Prospective Cohort Study. BMJ 1998; 317: 1341-1345. Saturated fat intake Hu FB, Manson JE, Willett WC. Types of Diatary Fat and Risk of Coronary Heart Disease: A Critical Review. Journal of the American College of Nutrition 2001; 20(1); 5-19. Trans fat intake Hu FB, Manson JE, Willett WC. Types of Diatary Fat and Risk of Coronary Heart Disease: A Critical Review. Journal of the American College of Nutrition 2001; 20(1); 5-19. Unsaturated fats intake Hu FB, Manson JE, Willett WC. Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review. Journal of the American College of Nutrition 2001; 20(1); 5-19. Alcohol intake Goldberg DM, Soleas GJ, Levesque M. Moderate Alcohol Consumption: The Gentle Face of Janus. Clinical Biochemistry 1999; 32(7): 505-518. Multivitamin/B complex use Folsom AR, Nieto FJ, McGovern PG, Tsai MY, Malinow MR, Eckfeldt JH, Hess DL, Davis CE. Prospective Study of Coronary Heart Disease Incidence in Relation to Fasting Total Homocysteine, Related Genetic polymorphisms, and B Vitamins The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 1998; 98:204-210. Vitamin E use Stampfer MJ, Rimm EB. Epidemiological Evidence for Vitamin E in Prevention of Cardiovascular Disease. Am J Clin Nutr 1995; 62(6 suppl): 1365S-1369S. Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC. Vitamin E Consumption and the Risk of Coronary Heart Disease in Men. N Engl J Med 1993; 328(20): 1450-6. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC. Vitamin E Consumption and the Risk of Coronary Disease in Women. N Engl J Med 1993; 328(20): 1444-9. ###

8

5-6-04

Osteoporosis Risk Factor

Category

Impact

Female

+2

Male

Ref

Sex

Age * Personal history (osteoporosis/bone loss) * Family history (Mother/father) Yes No/don’t know

+1 Ref

African-American Others

-2 Ref