LOW INCOME IS LINKED TO A HIGHER RISK OF MORTALITY AND INCIDENT CARDIOVASCULAR (CV) EVENTS IN OLDER ADULTS: A 23-YEAR FOLLOW-UP OF CARDIOVASCULAR HEALTH STUDY (CHS)

In geriatric research of non-fatal events, participants often die during the study follow-up without having the non-fatal event of interest. Cause-specific (CS) hazard regression and Fine-Gray (FG) subdistribution hazard regression are the two most common estimation approaches addressing such competing risk. We explain how the conventional CS approach and the FG approach differ and why many FG estimates of associations are counter-intuitive. Additionally, we clarify the indirect link between models for hazard and models for cumulative incidence. The methodologies are contrasted on data from the Cardiovascular Health Study, a population-based study in adults aged 65 years and older.

Download Full-text

Risk Factors for Incident Carotid Artery Revascularization among Older Adults: The Cardiovascular Health Study

Cerebrovascular Diseases Extra ◽

10.1159/000452426 ◽

2016 ◽

Vol 6 (3) ◽

pp. 129-139 ◽

Cited By ~ 1

Author(s):

Parveen K. Garg ◽

Willam J.H. Koh ◽

Joseph A. Delaney ◽

Ethan A. Halm ◽

Calvin H. Hirsch ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Carotid Artery ◽

Cardiovascular Health ◽

Multivariable Analysis ◽

Population Based ◽

Health Study ◽

Cardiovascular Health Study ◽

Increased Risk

Background: Population-based risk factors for carotid artery revascularization are not known. We investigated the association between demographic and clinical characteristics and incident carotid artery revascularization in a cohort of older adults. Methods: Among Cardiovascular Health Study participants, a population-based cohort of 5,888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993), 5,107 participants without a prior history of carotid endarterectomy (CEA) or cerebrovascular disease had a carotid ultrasound at baseline and were included in these analyses. Cox proportional hazards multivariable analysis was used to determine independent risk factors for incident carotid artery revascularization. Results: Over a mean follow-up of 13.5 years, 141 participants underwent carotid artery revascularization, 97% were CEA. Baseline degree of stenosis and incident ischemic cerebral events occurring during follow-up were the strongest predictors of incident revascularization. After adjustment for these, factors independently associated with an increased risk of incident revascularization were: hypertension (HR 1.53; 95% CI: 1.05-2.23), peripheral arterial disease (HR 2.57; 95% CI: 1.34-4.93), and low-density lipoprotein cholesterol (HR 1.23 per standard deviation [SD] increment [35.4 mg/dL]; 95% CI: 1.04-1.46). Factors independently associated with a lower risk of incident revascularization were: female gender (HR 0.51; 95% CI: 0.34-0.77) and older age (HR 0.69 per SD increment [5.5 years]; 95% CI: 0.56-0.86). Conclusions: Even after accounting for carotid stenosis and incident cerebral ischemic events, carotid revascularization is related to age, gender, and cardiovascular risk factors. Further study of these demographic disparities and the role of risk factor control is warranted.

Download Full-text

Serum Individual Nonesterified Fatty Acids and Risk of Heart Failure in Older Adults

Cardiology ◽

10.1159/000513917 ◽

2021 ◽

pp. 1-8

Author(s):

Luc Djousse ◽

Mary L. Biggs ◽

Nirupa R. Matthan ◽

Joachim H. Ix ◽

Annette L. Fitzpatrick ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Fatty Acids ◽

Cardiovascular Health ◽

Cox Regression ◽

Hormone Replacement ◽

Health Study ◽

Cardiovascular Health Study ◽

Nonesterified Fatty Acids

Background: Heart failure (HF) is highly prevalent among older adults and is associated with high costs. Although serum total nonesterified fatty acids (NEFAs) have been positively associated with HF risk, the contribution of each individual NEFA to HF risk has not been examined. Objective: The aim of this study was to examine the association of individual fasting NEFAs with HF risk in older adults. Methods: In this prospective cohort study of older adults, we measured 35 individual NEFAs in 2,140 participants of the Cardiovascular Health Study using gas chromatography. HF was ascertained using review of medical records by an endpoint committee. Results: The mean age was 77.7 ± 4.4 years, and 38.8% were male. During a median follow-up of 9.7 (maximum 19.0) years, 655 new cases of HF occurred. In a multivariable Cox regression model controlling for demographic and anthropometric variables, field center, education, serum albumin, glomerular filtration rate, physical activity, alcohol consumption, smoking, hormone replacement therapy, unintentional weight loss, and all other measured NEFAs, we observed inverse associations (HR [95% CI] per standard deviation) of nonesterified pentadecanoic (15:0) (0.73 [0.57–0.94]), γ-linolenic acid (GLA) (0.87 [0.75–1.00]), and docosahexaenoic acid (DHA) (0.73 [0.61–0.88]) acids with HF, and positive associations of nonesterified stearic (18:0) (1.30 [1.04–1.63]) and nervonic (24:1n-9) (1.17 [1.06–1.29]) acids with HF. Conclusion: Our data are consistent with a higher risk of HF with nonesterified stearic and nervonic acids and a lower risk with nonesterified 15:0, GLA, and DHA in older adults. If confirmed in other studies, specific NEFAs may provide new targets for HF prevention.

Download Full-text

Abstract 19269: Relations and Predictive Value of Post-load and Fasting Glucose for Incident Cardiovascular Disease and Mortality in Older Adults: the Cardiovascular Health Study

Circulation ◽

10.1161/circ.130.suppl_2.19269 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Erika Brutsaert ◽

Sanyog Shitole ◽

Mary Lou Biggs ◽

Kenneth Mukamal ◽

Ian De Boer ◽

...

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Old Age ◽

Risk Prediction ◽

Cardiovascular Health ◽

Fasting Glucose ◽

Community Dwelling ◽

Health Study ◽

Cardiovascular Health Study

Introduction: Elders have a high prevalence of post-load hyperglycemia, which may go undetected with standard screening. Post-load glucose has shown more robust associations with cardiovascular disease (CVD) and death than fasting glucose, but data in advanced old age are sparse. Whether post-load glucose improves risk prediction for CVD and death after accounting for fasting glucose has not been examined. Methods: Fasting and 2-hour post-load glucose were measured at baseline (1989) and follow-up (1996) visits in a prospective study of community-dwelling adults initially ≥65 years old (Cardiovascular Health Study). To evaluate if previously reported associations of fasting and post-load glucose with incident CVD from the baseline visit persist later in life, and apply to mortality, we focused on the 1996 visit (n=2394). To determine the incremental value of post-load glucose for risk prediction, we examined whether it could significantly reclassify baseline (1989) participants (≤75 years) into cholesterol treatment categories based on recent guidelines (n=2542). Results: Among participants in the 1996 visit (mean age 77), there were 543 incident CVD events and 1698 deaths during median follow-up of 11.2 years. In fully adjusted models, both fasting and 2-hour glucose were associated with CVD (HR per SD, 1.13 [1.03-1.25] and 1.17 [1.07-1.28], respectively) and mortality (HR per SD, 1.12 [1.07-1.18] and 1.14 [1.08-1.20]). After mutual adjustment, however, the associations for fasting glucose with either outcome were abolished, but those for post-load glucose remained unchanged. Among subjects ≤75 years old in 1989, there were 416 CVD events and 740 deaths at 10-year follow-up. Post-load glucose did not enhance reclassification using the 7.5% 10-year risk threshold, nor did it improve the C-statistic. Conclusion: In adults surviving to advanced old age, post-load glucose was associated with CVD and mortality independently of fasting glucose, but not vice versa, although there was no associated improvement in risk prediction. These findings affirm the robust association of post-load glucose with CVD and death late in life, but do not support the value of routine oral glucose tolerance testing for prediction of these outcomes in older adults.

Download Full-text

Plasma phospholipid and dietary α-linolenic acid, mortality, CHD and stroke: the Cardiovascular Health Study

British Journal Of Nutrition ◽

10.1017/s0007114514001925 ◽

2014 ◽

Vol 112 (7) ◽

pp. 1206-1213 ◽

Cited By ~ 20

Author(s):

Amanda M. Fretts ◽

Dariush Mozaffarian ◽

David S. Siscovick ◽

Colleen Sitlani ◽

Bruce M. Psaty ◽

...

Keyword(s):

Older Adults ◽

Linolenic Acid ◽

Cardiovascular Mortality ◽

Lower Risk ◽

Cardiovascular Health ◽

Plasma Phospholipid ◽

Health Study ◽

Cardiovascular Health Study ◽

Risk Of Mortality ◽

Long Chain

Previous studies have suggested that long-chain n-3 fatty acids derived from seafood are associated with a lower risk of mortality, CHD and stroke. Whether α-linolenic acid (ALA, 18 : 3n-3), a plant-derived long-chain essential n-3 fatty acid, is associated with a lower risk of these outcomes is unclear. The aim of the present study was to examine the associations of plasma phospholipid and dietary ALA with the risk of mortality, CHD and stroke among older adults who participated in the Cardiovascular Health Study, a cohort study of adults aged ≥ 65 years. A total of 2709 participants were included in the plasma phospholipid ALA analysis and 2583 participants were included in the dietary ALA analysis. Cox regression was used to assess the associations of plasma phospholipid and dietary ALA with the risk of mortality, incident CHD and stroke. In minimally and multivariable-adjusted models, plasma phospholipid ALA was found to be not associated with the risk of mortality, incident CHD or stroke. After adjustment for age, sex, race, enrolment site, education, smoking status, diabetes, BMI, alcohol consumption, treated hypertension and total energy intake, higher dietary ALA intake was found to be associated with a lower risk of total and non-cardiovascular mortality; on comparing the highest quintiles of dietary ALA with the lowest quintiles, the HR for total mortality and non-cardiovascular mortality were found to be 0·73 (95 % CI 0·61, 0·88) and 0·64 (95 % CI 0·52, 0·80), respectively. Dietary ALA was found to be not associated with the risk of cardiovascular mortality, incident CHD or stroke. In conclusion, the results of the present suggest study that dietary ALA, but not plasma phospholipid ALA, is associated with a lower risk of total and non-cardiovascular mortality in older adults.

Download Full-text

Frailty and driving status associated with disability: a 24-month follow-up longitudinal study

BMJ Open ◽

10.1136/bmjopen-2020-042468 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042468

Author(s):

Takehiko Doi ◽

Kota Tsutsumimoto ◽

Hideaki Ishii ◽

Sho Nakakubo ◽

Satoshi Kurita ◽

...

Keyword(s):

Older Adults ◽

Cardiovascular Health ◽

Community Setting ◽

Community Dwelling ◽

Health Study ◽

Cardiovascular Health Study ◽

Term Care ◽

Frailty Status ◽

A Prospective Study

ObjectivesTo examine the relationship of driving status and frailty with disability in older adults.DesignA prospective study.Setting and participantsThe study included 8533 participants (mean age: 72.0±6.1 years (range: 60–98 years), women: 54.1%) in a community setting.MeasuresDriving status and frailty were assessed at baseline. The clinical definition of frailty was used according to the Japanese Cardiovascular Health Study index. Disability was prospectively determined using a record of Japanese long-term care insurance (LTCI).ResultsDuring the follow-up period (mean duration: 23.5 months), 58 (0.7%) participants were regarded as moving out of the city, 80 (0.9%) participants had died and 311 (3.6%) participants were certified by LTCI. The proportion of disability was 1.3% among the not-frail group and 5.3% among the frail group. The proportion of disability was 2.5% in participants who were currently driving and 7.5% in those not driving. Based on frailty status and driving, participants were further classified into four groups: not frail and currently driving (n=2945), not frail and not driving (n=642), frail and currently driving (n=3598) and frail and not driving (n=1348). Compared with older adults who are not frail and driving, the combined status of frail and not driving (adjusted HR: 2.28; 95% CI: 1.47 to 3.52) and frail and driving (HR: 1.91; 95% CI: 1.30–2.81) were risk factors for disability.ConclusionsNot driving and frail were associated with a risk of disability in community-dwelling older adults.

Download Full-text

Abstract P348: Long-term Cognitive Decline in Older Adults After Incident Coronary Heart Disease or After First Receipt of Coronary Artery Bypass Grafting Surgery or Percutaneous Coronary Intervention

Circulation ◽

10.1161/circ.141.suppl_1.p348 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Jacqueline E Kunzelman ◽

Rachel M Gabor ◽

Monica Scrobotovici ◽

Natalie J Blades ◽

W T Longstreth ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Cardiovascular Health ◽

Artery Bypass ◽

Coronary Intervention ◽

Health Study ◽

Cardiovascular Health Study ◽

Percutaneous Coronary

Objective: We investigated two hypotheses: First, incident CHD, defined as myocardial infarction or definite angina, leads to faster long-term cognitive decline. Second, among those with CHD, treatment with CABG surgery or PCI leads to slower long-term cognitive decline. Methods: The Cardiovascular Health Study is a cohort of US adults aged 65+. Global cognitive ability was assessed annually up to 9 times from 1990 to 1998 with the 100-point Modified Mini-Mental State Examination (3MS). We estimated trajectories of 3MS scores in the absence of stroke, adjusting for demographics, health behaviors, and comorbidities. For hypothesis 1, we compared 3MS trajectory after incident CHD with 3MS trajectory in the absence of CHD, censoring at first receipt of CABG/PCI. For hypothesis 2, among participants with CHD, we compared 3MS trajectory after first receipt of CABG/PCI with 3MS trajectory without CABG/PCI. Results: For hypothesis 1, of 4,122 participants, 398 had incident CHD during a mean of 5.9 years of follow-up. Figure Panel A shows model-predicted mean 3MS trajectories without CHD (blue) and after incident CHD (red) diagnosed at ages 70, 75, 80, or 85. Model-predicted 3MS score declined faster after incident CHD, especially for CHD diagnosed at age 80 or later. For example, after incident CHD at age 85, predicted 5-year decline in mean 3MS score through age 90 was 13.9 points (95% CI: 11.0, 16.7) versus 8.9 points (95% CI: 8.1, 9.7) among those without CHD. For hypothesis 2, of 1,183 participants who had prevalent or incident CHD, 118 had their first CABG/PCI during a mean of 4.1 years of follow-up. Model-predicted 3MS score declined faster after first receipt of CABG/PCI ( Figure Panel B ). Conclusions: Older adults diagnosed with incident CHD had faster average cognitive decline than those without CHD. However, treatment with CABG/PCI did not slow cognitive decline among those with CHD. This finding may be due to adverse effects of CABG/PCI on brain health or CABG/PCI recipients having more severe CHD or more cerebral atherosclerosis.

Download Full-text

Abstract P007: Arterial Stiffness is Associated With Increased Risk of Incident Dementia in the Older Elderly: The Cardiovascular Health Study Cognition Study

Circulation ◽

10.1161/circ.137.suppl_1.p007 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Chendi Cui ◽

Akira Sekikawa ◽

Lewis Kuller ◽

Oscar Lopez ◽

Anne Newman ◽

...

Keyword(s):

Older Adults ◽

Arterial Stiffness ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Risk Of Death ◽

Incident Dementia ◽

Increased Risk ◽

Age And Sex

Introduction: Arterial stiffness is related to aging, hypertension, and obesity, and higher carotid-femoral pulse wave velocity (PWV) is associated with brain amyloid deposition. We hypothesized that higher cfPWV was associated with incident dementia in older adults (mean age 78) of the Cardiovascular Health Study Cognition Study (CHS-CS). Methods: Pittsburgh CHS-CS participants (n=532) without dementia at baseline (1998-99) had annual cognitive exams through 2013. CfPWV (m/sec) was measured from pulse velocity waveforms on 356 participants between 1996-2000, who were slightly younger, more educated, with less mild cognitive impairment (MCI) than those not included. Associations of cfPWV [continuous (transformed: -1/cfPWV) and quartile] with time-to-event [cfPWV measurement to dementia or death (competing event), or end of follow-up] were assessed in Cox proportional hazards model with competing risk of death. Results: Over 15-year follow-up, 212 (59.6%) dementia cases (median onset time=4 years) and 87 (24.4%) deaths occurred prior to dementia diagnosis. Adjusted for age and sex, incident dementia was related to higher cfPWV [hazard ratio (HR)=1.52 per -1/cfPWV, 95%CI=1.04, 2.24] (Table). Results were similar when further adjusted for education, race, ApoE4 , hypertension, diabetes, MCI, and abnormal white matter (WMG) or ventricular grade (VG). Results persisted in separate models that excluded those with ApoE4 + (n=79), diabetes (n=40), MCI (n=65) or abnormal WMG or VG (n=136). In stratified models, results were stronger for age ≥80 vs. <80 and for hypertension vs. no hypertension. Pulse pressure (PP), another index of arterial stiffness, was not associated with incident dementia (age- and sex-adjusted HR=1.01 per mmHg PP, 95%CI=0.99, 1.01). Conclusions: Higher cfPWV, but not higher PP, was significantly associated with incident dementia in the older adults. Interventions to slow arterial stiffness with aging may reduce the risk of dementia among older individuals.

Download Full-text