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Background: Comprehensive and up-to-date data on differences in dietary intake according to various sociodemographic factors are needed to understand the potential impact of dietary factors on disease risks in the United States., Methods: Usual dietary intake assessed by a food frequency questionnaire was examined in relation to race, sex, and educational attainment using baseline data obtained from randomly selected samples of 15,800 middle-aged black and white men and women who participated in the Atherosclerosis Risk in Communities Study., Results: In almost all comparisons, higher educational attainment was associated with recommended dietary intake patterns--lower per energy intakes of meats, eggs, chicken with skin, and whole milk and higher intakes of fruits, vegetables, fish, chicken without skin, and low-fat milk. As expected from these food intake patterns, higher educational attainment was associated with lower intakes of saturated fatty acid and cholesterol and with higher intakes of dietary fiber and various micronutrients. Compared with women's diets, men's diets were slightly more atherogenic (in whites only) based upon Keys score and had lower micronutrient levels. Although there were large differences in the food intakes between blacks and whites, the differences in nutrient intakes were generally smaller. However, intakes of cholesterol and vitamin A were somewhat higher and intakes of saturated fatty acid, calcium, and potassium were lower among blacks than in whites., Conclusions: This community-based study clearly demonstrated that regardless of race and sex, high educational attainment is associated with recommended dietary intake patterns. Continuing efforts to improve general educational level and to promote healthy dietary habits among those with low socioeconomic status are warranted.

Associations between atherosclerosis and dietary fat and cholesterol have been demonstrated in numerous animal experiments. The relation between these dietary components and atherosclerosis has not previously been reported in a population-based study among human beings. The associations of dietary fat and cholesterol with carotid artery wall thickness (atherosclerosis) were investigated in a population-based study, the Atherosclerosis Risk in Communities (ARIC) Study, from 1987 to 1989. Participants were 2,095 black women, 5,146 white women, 1,318 black men and 4,589 white men, aged 45-64 years, recruited from four US communities: Jackson, Mississippi; Forsyth County, North Carolina; Washington County, Maryland; and Minneapolis, Minnesota. Habitual diet was assessed with a food frequency questionnaire. Wall thickness was measured with B-mode ultrasound. After adjustment for age and energy intake, animal fat, saturated fat, monounsaturated fat, cholesterol, and Keys' score were positively related to wall thickness, while vegetable fat and polyunsaturated fat were inversely related to wall thickness. These associations persisted after further adjustment for smoking and hypertension and were consistent across the four race and sex groups. Thus, elements of habitual dietary intake were consistently associated with carotid artery wall thickness, compatible with their putatively atherogenic and antiatherogenic properties.

Although elevated blood pressure is an important predictor of cardiovascular disease and stroke in the elderly, little information exists on the distribution and risk factor correlates of blood pressure in this group. As part of the Cardiovascular Health Study, a population-based cohort study of 5201 men and women aged 65 to 101 years, we investigated correlates of systolic and diastolic blood pressure. Multiple regression analyses were conducted for all participants and a subgroup of 2482 without coronary heart disease and not on antihypertensive therapy (the "healthier" subgroup). In the total group, independent predictors of diastolic blood pressure included heart rate, aortic root dimension, creatinine, hematocrit, alcohol use, and black race (positive associations) and internal carotid artery wall thickness, mitral early/late peak flow velocity, white blood cell count, cigarette smoking, and age (negative associations). Positive predictors of systolic blood pressure included mitral late peak flow velocity, left ventricular mass, common carotid artery wall thickness, serum albumin, factor VII, diabetes, alcohol use, and age; negative predictors were coronary heart disease, uric acid, height, and smoking. In the healthier subgroup, positive predictors of diastolic blood pressure included heart rate, hematocrit, serum albumin, creatinine, and body weight, whereas mitral early/late peak flow velocity, serum potassium, smoking, and age inversely related to diastolic pressure. For the same group, common carotid artery wall thickness, left ventricular mass, serum albumin, factor VII, high-density lipoprotein cholesterol, and age were directly related to systolic blood pressure, whereas serum potassium was inversely related. Both systolic and diastolic pressures varied considerably by geographic site.(ABSTRACT TRUNCATED AT 250 WORDS)

Objectives: To estimate the incidence of newly treated hypertension and to describe the patterns of antihypertensive medication use among those aged 65 years and older., Design: Medicare eligibility lists from four US communities (Forsyth County, North Carolina; Washington County, Maryland; Sacramento County, California; and Pittsburgh, Pa) were used to obtain a representative sample of 5201 community-dwelling elderly for the Cardiovascular Health Study, a prospective cohort study of risk factors for coronary heart disease and stroke. Participants were examined at baseline and again 1 year later. The two examinations included standardized questionnaires, blood pressure measurements, and the assessment of medication use by medication inventory. In this cohort analysis, we excluded 231 subjects (4.4%) who did not return for follow-up, 69 (1.3%) who had missing data for medications, and another 495 (9.5%) who were taking "antihypertensive" medications for an indication other than high blood pressure., Interventions: None., Results: Among the 4406 participants, 1613 used antihypertensive medications at both visits. Between the two visits, 144 started and 115 stopped antihypertensive therapy. Among nonusers at baseline, the annual incidence of newly treated hypertension was 5.2% in women and 5.6% in men. Due to the number of participants who stopped therapy, the overall prevalence of antihypertensive treatment increased only slightly, from 40.7% to 41.1% in women and from 37.1% to 38.2% in men, during 1 year of follow-up. After adjustment for age, systolic blood pressure, number of antihypertensive drugs, diabetes, and cardiovascular disease, the newly treated hypertensives were about half as likely as the previously treated hypertensives to receive diuretics (odds ratio [OR], 0.59; P = .008) or beta-blockers (OR, 0.52; P = .01); and they were about twice as likely to receive calcium channel blockers (OR, 1.88; P < .004) or angiotensin converting enzyme inhibitors (OR, 2.40; P < .001). A similar pattern of within-person changes over time was apparent among the continuous users., Conclusions: Between June 1990 and June 1991, physicians were increasingly prescribing angiotensin converting enzyme inhibitors and calcium channel blockers in place of diuretics and beta-blockers for the treatment of hypertension in elderly patients, especially for those just starting therapy.

The effect of age, sex, diabetes, hypertension, pulse rate and cigarette smoking on extracranial carotid artery plaque thickness evaluated by B-mode ultrasonography was investigated in a cross-sectional study of 698 white men, 730 white women, 77 black men and 76 black women as part of a clinical ultrasound registry. Subjects were between 24 and 98 years of age, with a mean age of 63 years. Arterial locations evaluated were: proximal, mid and distal common carotid; the bifurcation; and the proximal and mid internal and external carotids. In a general linear multivariate analysis with plaque thickness at each site as the outcome variable, cigarette smoking and age were the two most consistent risk factors, and affected plaque thickness at all the investigated sites. Hypertension affected more sites than diabetes, men had more plaques than women, and except for the common carotid, whites had more plaques than blacks. Thus, risk factors were not uniformly associated with atherosclerosis at all sites of the extracranial carotid arteries.