Association of Brain Natriuretic Peptide With Mortality in Exceptionally Long-Lived Families

Abstract Natriuretic peptides are produced within the heart and released in response to increased chamber wall tension and heart failure (HF). N-Terminal prohormone Brain Natriuretic Peptide (NT-proBNP) is a specific natriuretic peptide commonly assayed in persons at risk for HF. In these individuals, NT-proBNP is associated with future disease prognosis and mortality. However, its association with mortality among healthy older adults remains unknown. Therefore, we determined the association of NT-proBNP with all-cause mortality over a median follow-up of 10 years in 3253 individuals free from HF at baseline in the Long Life Family Study, a study of families recruited for exceptional longevity. We performed cox proportional hazards analysis (coxme in R) for time-to event (mortality), adjusted for field center, familial relatedness, age, sex, education, smoking, alcohol, physical activity, BMI, diabetes, hypertension, and cancer. In addition, we performed secondary analyses among individuals (N=2457) within the normal NT-proBNP limits at baseline (<125pg/ml aged <75 years; <450pg/ml aged ≥75 years). Overall, individuals were aged 32-110 years (median 67 years; 44% male), had mean NT-proBNP of 318.5 pg/ml (median 91.0 pg/ml) and 1066 individuals (33%) died over the follow-up period. After adjustment, each 1 SD greater baseline NT-proBNP was associated with a 1.30-times increased hazard of mortality (95% CI: 1.24-1.36; P<0.0001). Results were similar in individuals with normal baseline NT-proBNP (HR: 1.21; 95% CI: 1.11-1.32; P<0.0001). These results suggest that NT-proBNP is a strong and specific biomarker for mortality in older adults independent of current health status, even in those with clinically-defined normal NT-proBNP.

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Elevated plasma growth and differentiation factor 15 predicts incident anemia in older adults aged 60 years and older

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa324 ◽

2020 ◽

Author(s):

Yuko Yamaguchi ◽

Marta Zampino ◽

Toshiko Tanaka ◽

Stefania Bandinelli ◽

Yusuke Osawa ◽

...

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Differentiation Factor ◽

Hazards Model ◽

Increased Risk ◽

The Relationship

Abstract Background Anemia is common in older adults and associated with greater morbidity and mortality. The causes of anemia in older adults have not been completely characterized. Although elevated circulating growth and differentiation factor 15 (GDF-15) has been associated with anemia in older adults, it is not known whether elevated GDF-15 predicts the development of anemia. Methods We examined the relationship between plasma GDF-15 concentrations at baseline in 708 non-anemic adults, aged 60 years and older, with incident anemia during 15 years of follow-up among participants in the Invecchiare in Chianti (InCHIANTI) Study. Results During follow-up, 179 (25.3%) participants developed anemia. The proportion of participants who developed anemia from the lowest to highest quartile of plasma GDF-15 was 12.9%, 20.1%, 21.2%, and 45.8%, respectively. Adults in the highest quartile of plasma GDF-15 had an increased risk of developing anemia (Hazards Ratio 1.15, 95% Confidence Interval 1.09, 1.21, P<.0001) compared to those in the lower three quartiles in a multivariable Cox proportional hazards model adjusting for age, sex, serum iron, soluble transferrin receptor, ferritin, vitamin B12, congestive heart failure, diabetes mellitus, and cancer. Conclusions Circulating GDF-15 is an independent predictor for the development of anemia in older adults.

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Nonfatal Stroke and All-Cause Mortality among Community-Dwelling Older Adults Living in Rural Ecuador: A Population-Based, Prospective Study

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_79_18 ◽

2018 ◽

Vol 09 (04) ◽

pp. 551-555

Author(s):

Oscar H. Del Brutto ◽

Robertino M. Mera ◽

Victor J. Del Brutto

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Rural Setting ◽

Nonfatal Stroke ◽

All Cause Mortality ◽

History Of ◽

Univariate Analyses

ABSTRACT Background: Stroke is a leading cause of disability in developing countries. However, there are no studies assessing the impact of nonfatal strokes on mortality in rural areas of Latin America. Using a population-based, prospective cohort study, we aimed to assess the influence of nonfatal strokes on all-cause mortality in older adults living in an underserved rural setting. Methods: Deaths occurring during a 5-year period in Atahualpa residents aged ≥60 years were identified from overlapping sources. Tests for equality of survivor functions were used to estimate differences between observed and expected deaths for each covariate investigated. Cox proportional hazards models were used to estimate Kaplan–Meier survival curves of variables reaching significance in univariate analyses. Results: Of 437 individuals enrolled over 5 years, follow-up was achieved in 417 (95%), contributing 1776 years of follow-up (average 4.3 ± 1.3 years). Fifty-one deaths were detected, for an overall cumulative 5-year mortality rate of 12.2% (8.9%–15.6%). Being older than 70 years of age, having poor physical activity, edentulism, and history of a nonfatal stroke were related to mortality in univariate analyses. A fully adjusted Cox proportional hazards model showed that having history of a nonfatal stroke (P = 0.024) and being older than 70 years of age (P = 0.031) independently predicted mortality. In contrast, obesity was inversely correlated with mortality (P = 0.047). Conclusions: A nonfatal stroke and increasing age increase the risk of all-cause mortality in inhabitants of a remote rural village. The body mass index is inversely related to death (obesity paradox).

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Indicators of Crash Risk in Older Adults: A Longitudinal Analysis From the ACTIVE Study

Journal of Aging and Health ◽

10.1177/08982643211031346 ◽

2021 ◽

pp. 089826432110313

Author(s):

Karlene K. Ball ◽

Olivio J. Clay ◽

Jerri D. Edwards ◽

Bernadette A. Fausto ◽

Katie M. Wheeler ◽

...

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Secondary Data ◽

Cox Proportional Hazards ◽

Crash Risk ◽

Significant Finding ◽

Site Location ◽

Cox Proportional Hazards Models ◽

Male Sex

Objective: This study aims to examine indicators of crash risk longitudinally in older adults ( n = 486). Method: This study applied secondary data analyses of the 10 years of follow-up for the ACTIVE study combined with state-recorded crash records from five of the six participating sites. Cox proportional hazards models were first used to examine the effect of each variable of interest at baseline after controlling for miles driven and then to assess the three cognitive composites as predictors of time to at-fault crash in covariate-adjusted models. Results: Older age, male sex, and site location were each predictive of higher crash risk. Additionally, worse scores on the speed of processing cognitive composite were associated with higher crash risk. Discussion: Results support previous findings that both age and male sex are associated with higher crash risk. Our significant finding of site location could be attributed to the population density of our testing sites and transportation availability.

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Cardiorespiratory Fitness without Exercise Testing Can Predict All-Cause Mortality Risk in a Representative Sample of Korean Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16091633 ◽

2019 ◽

Vol 16 (9) ◽

pp. 1633 ◽

Cited By ~ 2

Author(s):

Moongu Song ◽

Inhwan Lee ◽

Hyunsik Kang

Keyword(s):

Older Adults ◽

Cardiorespiratory Fitness ◽

Exercise Testing ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Geriatric Population ◽

Hazard Ratios ◽

All Cause Mortality ◽

Using Data

This study examined the association between cardiorespiratory fitness (CRF) without exercise testing and all-cause mortality in Korean older adults. The present study was carried out using data from the 2008 and 2011 Living Profiles of Older People Survey. A total of 14,122 participants aged 60 years and older (57% women) completed the 2008 baseline and 2011 follow-up assessments (i.e., socioeconomic status, health behaviors and conditions, and prevalence of chronic diseases), and they were included for the final analyses. CRF was estimated (eCRF) with sex-specific algorithms and classified as lower (lowest 25%), middle (middle 50%), and upper (highest 25%). Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) across eCRF categories. In total, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.059 (0.814~1.378) for the middle eCRF group, and 1.714 (1.304~2.253) for the lower eCRF group. In men, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.011 (0.716~1.427) for the middle eCRF group, and 1.566 (1.098~2.234) for the lower eCRF group. In women, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.064 (0.707~1.602) for the middle eCRF group, and 1.599 (1.032~2.478) for the lower eCRF group. The current findings suggest that eCRF may have an independent predictor of all-cause mortality, underscoring the importance of promoting physical activity to maintain a healthful level of CRF in Korean geriatric population.

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Association between Estimated Cardiorespiratory Fitness and All-cause Mortality in Underweight Older Adults

Exercise Science ◽

10.15857/ksep.2020.29.2.146 ◽

2020 ◽

Vol 29 (2) ◽

pp. 146-153

Author(s):

Inhwan Lee ◽

Byungroh Kim

Keyword(s):

Older Adults ◽

Cardiorespiratory Fitness ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

National Database ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Study Participants

PURPOSE: This study investigated the association between estimated cardiorespiratory fitness (eCRF) and all-cause mortality in underweight older adults.METHODS: Data from the 2006 Korean longitudinal study of aging (KLoSA) involving 348 study participants aged 60 years and older (58.0% women) was analyzed in this study. CRF was estimated with sex- and age-specific algorithms developed by the fitness registry and the importance of exercise national database (FRIEND). Participants were classified into lowest 25% (Q1), lower 25% (Q2), middle 25% (Q3), and highest 25% (Q4) on the basis of individual eCRF distributions. Cox proportional hazards regression was used to calculate hazard ratio (HR) and 95% confidence interval (CI) according to eCRF levels.RESULTS: During 7.8±3.2-year follow-up period, a total of 175 deaths occurred from all causes. Cox regression analysis showed that HR of all-cause mortality was 0.686 (95% CI, 0.474-0.991, p=.045) for Q2, 0.382 (95% CI, 0.253-0.575, p<.001) for Q3, and 0.248 (95% CI, 0.155-0.397, p<.001) for Q4 compared to Q1 as reference (HR=1). The HR of Q4 for all-cause mortality remained significant even after adjustments for covariates, including age and marital status.CONCLUSIONS: The current findings suggest that high eCRF is associated with a decreased risk of all-cause mortality in underweight older adults.

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Fitness vs. fatness as determinants of survival in non-institutionalized older adults: The EXERNET multi-center study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab179 ◽

2021 ◽

Author(s):

David Navarrete-Villanueva ◽

Alba Gómez-Cabello ◽

Alejandro Gómez-Bruton ◽

Eva Gesteiro ◽

Irene Rodríguez-Gómez ◽

...

Keyword(s):

Older Adults ◽

Physical Fitness ◽

Proportional Hazards ◽

Reference Group ◽

Health Indicators ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

High Fat ◽

Low Fat

Abstract Background Physical fitness and body composition are important health indicators, nevertheless their combined pattern inter-relationships and their association with mortality are poorly investigated. Methods This longitudinal study is part of the Spanish EXERNET-Elder project. Person-months follow-up were calculated from the interview date, performed between June 2008 and November 2009, until date of death or censoring on March 2018 (whichever came first). In order to be included, participants had to fulfill the following criteria: 1) be over 65 years old, 2) live independently at home, 3) not suffer dementia and/or cancer and 4) have a BMI above 18.5. Body fat and weight were assessed by a bioelectrical impedance analyzer. Fitness was measured with the Senior Fitness and the one leg static balance tests. The Spanish Death Index was consulted for the death’s identification. Cluster analysis was performed to identify Fat-Fit patterns and traditional cut points and percentiles to create the Fat-Fit groups. Cox proportional hazards regression models were used to calculate the hazard ratios of death in clustered Fat-Fit patterns and in traditional Fat-Fit groups. Results A total of 2299 older adults (76.8% of women) were included with a baseline mean age of 71.9 ± 5.2 years. A total of 196 deaths (8.7% of the sample) were identified during the 8 years of follow up. Four clustered Fat-Fit patterns (Low fat-Fit, Medium fat-Fit, High fat-Unfit and Low fat-Unfit) and nine traditional Fat-Fit groups emerged. Using the Low fat-Fit pattern as the reference, significantly increased mortality was noted in High fat-Unfit (HR: 1.68, CI: 1.06 - 2.66) and Low fat-Unfit (HR: 2.01, CI: 1.28 - 3.16) groups. All the traditional Fit groups showed lower mortality risk when compared to the reference group (obese-unfit group). Conclusions Physical fitness is a determinant factor in terms of survival in community-dwelling older adults, independently of adiposity levels.

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Physical activity combined with sedentary behaviour in the risk of mortality in older adults

Revista de Saúde Pública ◽

10.11606/s1518-8787.2021055003461 ◽

2021 ◽

Vol 55 ◽

pp. 60

Author(s):

Lucas Lima Galvão ◽

Rizia Rocha Silva ◽

Sheilla Tribess ◽

Douglas Assis Teles Santos ◽

Jair Sindra Virtuoso Junior

Keyword(s):

Physical Activity ◽

Older Adults ◽

Sedentary Behaviour ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Risk Of Mortality ◽

Long Time ◽

Activity Questionnaire

OBJECTIVE To examine the effects of physical activity (PA) and sedentary behaviour (SB), in isolation and combination, on all-cause mortality in older adults. METHODS Prospective, population-based cohort study. The data were collected from first wave in 2015 and the follow-up continued until 2020. The sample consisted of 332 older adult people aged ≥ 60 years-old, out of which 59 died. The level of PA and SB was assessed by the International Physical Activity Questionnaire (IPAQ). The older adults were divided into PA categorized as sufficiently active and insufficiently active and into high and low SB. We built four combinations of PA and SB. Also, we used the Cox proportional hazards regression with a 95% confidence interval with hazard ratio estimate so as to verify the mortality risks between PA, SB, and the combinations of PA and SB. RESULTS Insufficiently active individuals had higher risks of mortality compared to sufficiently active people. We observed no associations between SB and mortality separately; however, when evaluated in a combined way, insufficiently active individuals and with a high SB time had a higher chance of mortality compared to active individuals with a low SB time. CONCLUSION Our isolated analyses demonstrate that complying with PA recommendations reduces the risk of mortality; however, no association was found between the time of PA exposure with the time of SB. When analysing the combination, being physically inactive and with a long time of SB showed higher mortality rates, with SB being an enhancer of this risk. The results of this study show the interdependence of SB for PA performed at moderate to vigorous intensity. The understanding of this interrelation must be considered in the formulation of public health guidelines.

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Association between Estimated Cardiorespiratory Fitness and All-cause Mortality in Underweight Older Adults

Exercise Science ◽

10.15857/es.2020.29.2.146 ◽

2020 ◽

Vol 29 (2) ◽

pp. 146-153

Author(s):

Inhwan Lee ◽

Byungroh Kim

Keyword(s):

Older Adults ◽

Cardiorespiratory Fitness ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

National Database ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Study Participants

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Increased Hemoglobin A1c Time in Range Reduces Adverse Health Outcomes in Older Adults With Diabetes

10.2337/figshare.14515170 ◽

2021 ◽

Author(s):

Julia C. Prentice ◽

David C. Mohr ◽

Libin Zhang ◽

Donglin Li ◽

Aaron Legler ◽

...

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Glycemic Variability ◽

Baseline Period ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Target Range ◽

Patient Specific ◽

Time In Range

Objective: <a>Short and long-term glycemic variability are risk factors for diabetes complications</a>. However, there are no validated A1c target ranges or measures of A1c stability in older adults. We evaluated the association of a patient-specific A1c variability measure, A1c time in range (A1c TIR), on major adverse outcomes. Research Design and Methods: We conducted a retrospective observational study using administrative data from the Department of Veterans Affairs and Medicare from 2004 - 2016. Patients were ≥65 years old with diabetes and at least four A1c tests during a three-year baseline period. A1c TIR was the percentage of days during the baseline in which A1c was in an individualized target range (from 6.0-7.0% up to 8.0-9.0%) based on clinical characteristics and predicted life expectancy. Increasing A1c TIR was divided into categories of 20% increments and linked to mortality and cardiovascular disease (CVD) (i.e. myocardial infarction [MI] and stroke). Results: The study included 402,043 Veterans (mean [SD] age, 76.9 [5.7] years; 98.8% male). During an average of 5.5 years of follow-up, A1c TIR had a graded relationship with mortality and CVD. Cox proportional hazards models showed lower A1c TIR was associated with increased mortality (A1c TIR 0-<20%; Hazard Ratio (HR) = 1.22; 95% CI, 1.20-1.25) and CVD (A1c TIR 0-<20%; HR = 1.14; 95% CI, 1.11-1.19) when compared to A1c TIR 80-100%. Competing risk models and shorter follow-up (e.g. 24 months) showed similar results. Conclusion: In older adults with diabetes, maintaining A1c levels within individualized target ranges is associated with lower risk of mortality and CVD.

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THE ASSOCIATION BETWEEN VITAMIN K STATUS AND CARDIOVASCULAR DISEASE IN OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.2393 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S644-S644

Author(s):

M Kyla Shea ◽

Daniel Weiner ◽

Gergory Matuszek ◽

Sarah L Booth ◽

Stephen Kritchevsky ◽

...

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Vitamin K ◽

Proportional Hazards ◽

Vascular Tissue ◽

Cox Proportional Hazards ◽

Body Composition Study ◽

Cox Proportional Hazards Models ◽

Health Aging

Abstract A role for vitamin K in cardiovascular disease (CVD) has been proposed because vitamin K-dependent proteins are present in vascular tissue. We evaluated the association between vitamin K status and incident CVD and mortality in older adults from the Health, Aging, and Body Composition Study (Health ABC), and conducted a replication analysis using the Multi-ethnic Study of Atherosclerosis (MESA). In both cohorts circulating phylloquinone (vitamin K1), measured from baseline fasting blood samples, was categorized as ≤0.5nM, >0.5-≤1.0nM, and >1.0nM. Multivariable Cox proportional hazards models assessed the association between circulating phylloquinone and risk of a composite of CVD and mortality. In Health ABC (n=1246, mean age 74 years, 57% female, 58% Caucasian), over a median 11.5 follow-up years, participants with ≤0.5 nM plasma phylloquinone (n=351) had a 27% higher risk for CVD and mortality compared to those with >1.0nM (n=457) [adjusted hazard ratio (95% confidence interval) (HR(95%CI)): 1.27(1.06-1.52)]. However, the risk for CVD and mortality did not differ between those with >0.5-≤1.0nM (n=438) and with >1.0nM plasma phylloquinone [HR(95%CI): 1.03(0.87-1.52)]. Serum phylloquinone was similarly associated with CVD and mortality in MESA, over a median 12.1 follow-up years (n=764, mean age 62 years, 54% female, 35% Caucasian) [HR(95%CI), compared to those with >1.0nM (n=368): <0.5nM (n=253): 1.54(1.03-2.32); 0.5-≤1.0nM (n=153): 1.23(0.76, 1.98)]. Lower circulating phylloquinone was associated with a higher CVD and mortality risk in two independent cohorts. Additional studies are needed to corroborate our findings and clarify if certain segments of the population can derive cardiovascular benefit from improving vitamin K status.

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