Tavia Gordon’s research while affiliated with General Electric and other places

• Drinking habits and other characteristics were observed for 20 years in a cohort of 5,209 Framingham, Mass, men and women. During this period the average amount of alcohol consumed rose 63%. The percent increase was greater for women than men and greater for younger persons than older. Serum uric acid and phospholipid concentrations were higher at higher levels of alcohol consumption. Lipoprotein levels of 0 to 12 and 100 to 400 Svedberg units were positively associated with alcohol consumption in men but negatively associated with alcohol consumption in women. Blood pressure was higher in nondrinkers than light drinkers, but among drinkers BPs were higher at higher consumption levels. While cigarette smokers had lower BPs than nonsmokers, this seemed to be due to their lower weight. Persons who increased their alcohol consumption during follow-up had a small mean increase in serum phospholipid and uric acid levels, BP, and weight relative to the average changes for these variables. (Arch Intern Med 1983;143:1366-1374)

In a prospective study of more than 10000 Yugoslav men it was found that consumption of alcoholic beverages was inversely related to non-sudden death from coronary heart disease (CHD) and positively related to death from trauma. The consequence was an apparently U-shaped relation between alcohol consumption and death, the lowest mortality being among moderate drinkers. Excess mortality from trauma was evident only among men under 55 and only for those who reported at entry to the study that they had been drunk during the preceding week. Alcohol consumption as reported at entry was unrelated to subsequent mortality from liver cirrhosis or any form of cancer. An enlarged liver, however, was associated with higher death rates for liver cirrhosis. This raises the possibility that some of the men were heavy drinkers preceding their entry to the study but were no longer drinking heavily at the time of entry. Enlarged liver, however, was also related to hypertension and to chronic obstructive pulmonary disease and thus was not a specific indicator of alcohol abuse in this population. Recent drunkenness but not frequency of drinking was related to death from trauma and liver cirrhosis and to sudden CHD death. In short, both the pattern of drinking and the usual level of alcohol consumption appear to be related to mortality in this population.

In a prospective study of more than 10 000 Yugoslav men it was found that consumption of alcoholic beverages was inversely related to non-sudden death from coronary heart disease (CHD) and positively related to death from trauma. The consequence was an apparently U-shaped relation between alcohol consumption and death, the lowest mortality being among moderate drinkers. Excess mortality from trauma was evident only among men under 55 and only for those who reported at entry to the study that they had been drunk during the preceding week. Alcohol consumption as reported at entry was unrelated to subsequent mortality from liver cirrhosis or any form of cancer. An enlarged liver, however, was associated with higher death rates for liver cirrhosis. This raises the possibility that some of the men were heavy drinkers preceding their entry to the study but were no longer drinking heavily at the time of entry. Enlarged liver, however, was also related to hypertension and to chronic obstructive pulmonary disease and thus was not a specific indicator of alcohol abuse in this population. Recent drunkenness but not frequency of drinking was related to death from trauma and liver cirrhosis and to sudden CHD death. In short, both the pattern of drinking and the usual level of alcohol consumption appear to be related to mortality in this population.

In a prospective study of more than 10,000 Yugoslav men residing in Bosnia and Croatia, who were first examined in 1964--1965, consumption of alcoholic beverages was related inversely to the subsequent appearance of coronary heart disease clinically manifest as myocardial infarction or nonsudden coronary heart disease death. Consumption of alcoholic beverages was not so related to sudden cardiac death. Men who drank most frequently had half the subsequent incidence of overall coronary heart disease as men who seldom or never drank. This finding was true for urban residents only. Serum cholesterol and Quetelet index were also related to coronary heart disease in urban areas but not in rural areas. The inverse relation of alcohol consumption to coronary heart disease incidence was statistically significant even after taking into account differences in blood pressure, serum cholesterol levels, cigarette smoking and other variables. The apparent absence of protection against sudden death may be due to chance or it may reflect the deleterious effects of high alcohol consumption on the myocardial cells and increased vulnerability to lethal arrhythmias in an especially lean population. There is, in fact, a specific association of recent drunkenness with sudden death in this population. Conceivably, the acute effect of heavy drinking may be a dominant factor in the incidence of sudden death for this population.

In two large general populations of Yugoslav men from Tuzia, Bosnia, and Remetinec, Croatia, examined in 1964-1965, it was found that a greater alcohol consumption was accompanied by higher blood pressures, higher pulse rates, and higher concentrations of serum cholesterol and hematocrit. A greater consumption was also associated with an enlarged liver, as well as a higher prevalence rate of chronic bronchitis and thrombophlebitis. All these were statistically significant even after allowing for differences in cigarette smoking and demographic characteristics. Pulse rate, liver size, and varices appear to be specifically associated with a history of episodes of drunkenness. There were significant differences in drinking habits by place of residence, religious background, years of schooling, and kind of work. These were allowed for in evaluating the relationship of drinking to other characteristics. Two anomalous findings were low prevalence rates for diabetes and gastritis among those drinking most frequently.

Blackwelder WC [National Institute of Allergy and Infectious Diseases, Westwood Building, Room 739, National Institutes of Health, Bethesda, Maryland 20205, USA], Kagan A, Gordon T andRhoads GG. Comparison of methods for diagnosing angina pectoris: The Honolulu Heart Study. International Journal of Epidemiology 1981, 10: 211–215. Data from the Honolulu Heart Study suggest that the examining physician's clinical diagnosis, based on questioning the subject about chest pain, was more sensitive than the Rose questionnaire in detecting angina pectoris in a population of Japanese men. The 2 methods appear equally specific for coronary heart disease.

• Based on six years of follow-up evaluations of the Framingham, Mass, men and women aged 49 to 82 years, it was found that a low-density lipoprotein (LDL) cholesterol concentration was associated with a low incidence of coronary heart disease (CHD) risk but with a statistically significant excess of stroke incidence in women and of deaths from non-CHD causes in both sexes. There was no suggestion that an elevated HDL cholesterol level was associated with an excess incidence of any of the cardiovascular end points considered or of death. An inverse relation of high-density lipoprotein (HDL) cholesterol level with CHD and its major consequences, CHD death and congestive heart failure, was observed. Triglyceride determinations seem to add little information respecting cardiovascular risk to that elicited from HDL and LDL cholesterol and other known cardiovascular risk factors. While the relation of HDL and LDL cholesterol with CHD is paralleled by findings from a variety of sources, the inverse relation of LDL cholesterol with stroke in women and with death from non-CHD causes requires additional confirmation and exploration. (Arch Intern Med 1981;141:1128-1131)