Associations of Cytomegalovirus Infection With All-Cause and Cardiovascular Mortality in Multiple Observational Cohort Studies of Older Adults

Abstract Background Whether latent cytomegalovirus (CMV) infection in older adults has any substantial health consequences is unclear. Here, we sought associations between CMV-seropositivity and IgG titer with all-cause and cardiovascular mortality in 5 longitudinal cohorts. Methods Leiden Longevity Study, Prospective Study of Pravastatin in the Elderly at Risk, Longitudinal Study of Aging Danish Twins, and Leiden 85-plus Study were assessed at median (2.8–11.4 years) follow-up . Cox regression and random effects meta-analysis were used to estimate mortality risk dependent on CMV serostatus and/or IgG antibody titer, in quartiles after adjusting for confounders. Results CMV-seropositivity was seen in 47%–79% of 10 122 white community-dwelling adults aged 59–93 years. Of these, 3519 had died on follow-up (579 from cardiovascular disease). CMV seropositivity was not associated with all-cause (hazard ratio [HR], 1.05; 95% confidence interval [CI], .97–1.14) or cardiovascular mortality (HR, 0.97; 95% CI, .83–1.13). Subjects in the highest CMV IgG quartile group had increased all-cause mortality relative to CMV-seronegatives (HR, 1.16; 95% CI, 1.04–1.29) but this association lost significance after adjustment for confounders (HR, 1.13; 95% CI, .99–1.29). The lack of increased mortality risk was confirmed in subanalyses. Conclusions CMV infection is not associated with all-cause or cardiovascular mortality in white community-dwelling older adults.

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Animal protein intake is inversely associated with mortality in older adults: the InCHIANTI study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab334 ◽

2021 ◽

Author(s):

Tomás Meroño ◽

Raúl Zamora-Ros ◽

Nicole Hidalgo-Liberona ◽

Montserrat Rabassa ◽

Stefania Bandinelli ◽

...

Keyword(s):

Older Adults ◽

Total Energy ◽

Cardiovascular Mortality ◽

Protein Intake ◽

Cox Regression ◽

Clinical Information ◽

Community Dwelling ◽

Animal Protein ◽

Plant Protein

Abstract Background In general, plant protein intake was inversely associated with mortality in studies in middle-aged adults. Our aim was to evaluate the long-term associations of animal and plant protein intake with mortality in older adults. Methods A prospective cohort study including 1,139 community-dwelling older adults (mean age 75 years, 56% women) living in Tuscany, Italy, followed for 20 years (InCHIANTI study) was analyzed. Dietary intake by food frequency questionnaires and clinical information were assessed five times during the follow-up. Protein intakes were expressed as percentages of total energy. Time-dependent Cox regression models adjusted for confounders were used to assess the association between plant and animal protein intake, and mortality. Results During the 20-years of follow up (mean: 12y), 811 deaths occurred (292 of cardiovascular- and 151 of cancer-related causes). Animal protein intake was inversely associated with all-cause (HR per 1% of total energy from protein increase, 95%CI: 0.96, 0.93-0.99) and cardiovascular mortality (HR per 1% of total energy from protein increase, 95%CI: 0.93, 0.87-0.98). Plant protein intake showed no association with any of the mortality outcomes, but an interaction with baseline hypertension was found for all-cause and cardiovascular mortality (p<0.05). Conclusions Animal protein was inversely associated with all-cause and cardiovascular mortality in older adults. Further studies are needed to provide recommendations on dietary protein intake for older adults.

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The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis

The British Journal of Psychiatry ◽

10.1192/bjp.2019.74 ◽

2019 ◽

Vol 215 (2) ◽

pp. 449-455 ◽

Cited By ~ 17

Author(s):

Jingkai Wei ◽

Ruixue Hou ◽

Xiaotao Zhang ◽

Huiwen Xu ◽

Liyang Xie ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Late Life ◽

Community Dwelling ◽

Late Life Depression ◽

Prospective Cohort Studies ◽

Community Dwelling Older Adults

BackgroundLate-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.AimTo estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults.MethodWe conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings.ResultsA total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression.ConclusionLate-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.Declaration of interestNone.

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Forgiveness Interventions for Older Adults: A Review

Journal of Clinical Medicine ◽

10.3390/jcm10091866 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1866

Author(s):

Javier López ◽

Maria Inés Serrano ◽

Isabel Giménez ◽

Cristina Noriega

Keyword(s):

Older Adults ◽

Intervention Studies ◽

Satisfaction With Life ◽

Meta Analysis ◽

Specific Treatment ◽

Community Dwelling ◽

Group Treatments ◽

Receive Treatment ◽

Community Dwelling Older Adults

A meta-analysis of the efficacy of forgiveness interventions in older adults was conducted. International databases (Medline, PsycINFO, Scopus, Web of Science) were searched for studies published from 1990 to 2020 that attempted to promote forgiveness in older adults. Most intervention studies are group treatments targeted towards community-dwelling older adults. Participants in these studies are mainly women. The intervention objectives and contents vary widely and often criteria are not well-defined. Participants that received forgiveness interventions reported significantly higher levels of forgiveness than participants that did not receive treatment. Additionally, forgiveness interventions resulted in more changes in depression, stress and anger than no intervention conditions. Forgiveness treatment also enhances positive states (satisfaction with life, subjective happiness, and psychological wellbeing). The reported effects are moderate. The specific treatment model (e.g., Enright’s, Worthington’s) and format (e.g., group-based interventions and individually delivered programs) do not differentially predict better outcomes. In conclusion, future intervention studies should include more male participants and utilize a broader range of follow-up periods. Caution must be exercised because of the limited number of studies developed to date; researchers must be cautious when generalizing the results.

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Association of Systolic and Diastolic Blood Pressure With All-Cause Mortality Among Community-Dwelling Older Adults: A Prospective Observational Study

Journal of Aging and Health ◽

10.1177/08982643211055245 ◽

2021 ◽

pp. 089826432110552

Author(s):

Qian Lian ◽

Tazeen H. Jafar ◽

John C. Allen ◽

Stefan Ma ◽

Rahul Malhotra

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Diastolic Blood Pressure ◽

Mortality Risk ◽

Cox Regression ◽

Community Dwelling ◽

Representative Study ◽

Hazard Ratios ◽

Nationally Representative ◽

Community Dwelling Older Adults

Objectives To assess the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with mortality among older adults in Singapore. Methods Association of SBP and DBP measured in 2009 for 4443 older adults (69.5±7.4 years; 60–97 years) participating in a nationally representative study with mortality risk through end-December 2015 was assessed using Cox regression. Results Higher mortality risk was observed at the lower and upper extremes of SBP and DBP. With SBP of 100–119 mmHg as the reference, multivariable mortality hazard ratios [HRs (95% confidence interval)] were SBP <100 mmHg: 2.41 (1.23–4.72); SBP 160–179 mmHg: 1.51 (1.02–2.22); and SBP ≥180 mmHg: 1.78 (1.12–2.81). With DBP of 70–79 mmHg as the reference, HRs were DBP <50 mmHg: 2.41 (1.28–4.54) and DBP ≥110 mmHg: 2.16 (1.09–4.31). Discussion Management of high blood pressure among older adults will likely reduce their mortality risk. However, the association of excessively low SBP and DBP values with mortality risk needs further evaluation.

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Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16142527 ◽

2019 ◽

Vol 16 (14) ◽

pp. 2527 ◽

Cited By ~ 13

Author(s):

Sansano-Nadal ◽

Giné-Garriga ◽

Brach ◽

Wert ◽

Jerez-Roig ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Active Control ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Community Dwelling ◽

Exercise Interventions ◽

Mean Differences

Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.

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Trimethyllysine Predicts All-Cause and Cardiovascular Mortality in Community-Dwelling Adults and Patients With Coronary Heart Disease

European Heart Journal Open ◽

10.1093/ehjopen/oeab007 ◽

2021 ◽

Author(s):

Espen Ø Bjørnestad ◽

Indu Dhar ◽

Gard F T Svingen ◽

Eva R Pedersen ◽

Mads M Svenningsson ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Community Dwelling ◽

Health Study ◽

Community Based ◽

Increased Risk ◽

Established Coronary Heart Disease

Abstract Aims Trimethyllysine (TML) is involved in carnitine synthesis, serves as a precursor of trimethylamine N-oxide (TMAO) and is associated with cardiovascular events in patients with established coronary heart disease (CHD). We prospectively examined circulating TML as a predictor of all-cause and cardiovascular mortality in community-dwelling adults and patients with CHD. Methods and Results By Cox regression modelling, risk associations were examined in 6393 subjects in the community-based Hordaland Health Study (HUSK). A replication study was conducted among 4117 patients with suspected stable angina pectoris in the Western Norway Coronary Angiography Cohort (WECAC). During a mean follow-up of 10.5 years in the HUSK-cohort, 884 (13.8%) subjects died, of whom 287 from cardiovascular causes. After multivariable adjustments for traditional cardiovascular risk factors, the hazard ratio (HR) (95% CI) for all-cause mortality comparing the 4th vs. 1st TML-quartile was 1.66 (1.31-2.10, p < 0.001). Particularly strong associations were observed for cardiovascular mortality (HR [95% CI] 2.04 [1.32-3.15, p = 0.001]). Corresponding risk-estimates in the WECAC (mean follow-up of 9.8 years) were 1.35 [1.10-1.66, p = 0.004] for all-cause and 1.45 [1.06-1.98, p = 0.02] for cardiovascular mortality. Significant correlations between plasma TML and TMAO were observed in both cohorts (rs≥0.42, p < 0.001); however, additional adjustments for TMAO did not materially influence the risk associations, and no effect modification by TMAO was found. Conclusion Elevated TML-levels were associated with increased risk of all-cause and cardiovascular mortality both in subjects with and without established CHD.

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All-cause mortality over a three-year period among community-dwelling older adults in Southern Brazil

Revista Brasileira de Epidemiologia ◽

10.1590/1980-549720210015 ◽

2021 ◽

Vol 24 ◽

Author(s):

Ana Clara Ledezma Greiner de Souza ◽

Caroline Cardozo Bortolotto ◽

Andréa Dâmaso Bertoldi ◽

Elaine Tomasi ◽

Flávio Fernando Demarco ◽

...

Keyword(s):

Older Adults ◽

Cox Regression ◽

Early Death ◽

Community Dwelling ◽

Epidemiological Surveillance ◽

Daily Life Activities ◽

All Cause Mortality ◽

Community Dwelling Older Adults

ABSTRACT: Objective: To evaluate all-cause mortality in approximately three years of follow-up and related sociodemographic, behavioral and health factors in community-dwelling older adults in Pelotas, RS. Methods: This was a longitudinal observational study that included 1,451 older adults (≥ 60 years) who were interviewed in 2014. Information on mortality was collected from their households in 2016–2017 and confirmed with the Epidemiological Surveillance department of the city and by documents from family members. Associations between mortality and independent variables were assessed by crude and multiple Cox regression, with hazard ratio with respective 95% confidence intervals (95%CI). Results: Almost 10% (n = 145) of the participants died during an average of 2.5 years of follow-up, with a higher frequency of deaths among males (12.9%), ?80 years (25.2%), widowhood (15.0%), no education (13.8%) and who did not work (10.5%). Factors associated with higher mortality were: being a male (HR = 2.8; 95%CI 1.9 – 4.2), age ?80 years (HR = 3.9; 95%CI 2.4 – 6.2), widowhood (HR = 2.2; 95%CI 1.4 – 3.7), physical inactivity (HR = 2.3; 95%CI 1.1 – 4..6), current smoking (HR = 2.1; 95%CI 1.2 – 3.6), hospitalizations in the previous year (HR = 2.0; 95%CI 1.2 – 3.2), depressive symptoms (HR = 2.0; 95%CI 1.2 – 3,4) and dependence for two or more daily life activities (HR = 3.1; 95%CI 1,7 – 5.7). Conclusion: The identification of factors that increased the risk of early death makes it possible to improve public policies aimed at controlling the modifiable risk factors that can lead to aging with a better quality of life.

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Effect of Exercising with Others on Incident Functional Disability and All-Cause Mortality in Community-Dwelling Older Adults: A Five-Year Follow-Up Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17124329 ◽

2020 ◽

Vol 17 (12) ◽

pp. 4329 ◽

Cited By ~ 1

Author(s):

Yuya Fujii ◽

Keisuke Fujii ◽

Takashi Jindo ◽

Naruki Kitano ◽

Jaehoon Seol ◽

...

Keyword(s):

Older Adults ◽

Functional Disability ◽

Cox Regression ◽

Mail Survey ◽

Exercise Group ◽

Community Dwelling ◽

Cox Regression Analysis ◽

Exercise Habits ◽

All Cause Mortality

We clarified the effect of exercising with others on the risks of incident functional disability and all-cause mortality among community-dwelling adults. We used an inventory mail survey with a five-year follow-up for 1520 independently living older adults (mean age: 73.4 ± 6.3 years) in Kasama City, Japan. Subjects responded to a self-reported questionnaire in June 2014. Exercise habits and the presence of exercise partners were assessed. Subjects were classified into three groups: Non-exercise, exercising alone, and exercising with others. Follow-up information and date of incident functional disability and death during the five-year follow-up were collected from the database. To compare the association between exercise habits and functional disability and mortality, Cox regression analysis was conducted. Compared with the non-exercise group, exercising with others had significantly lower hazard ratios (HRs) for functional disability (0.59, 95% confidence interval (CI) 0.40–0.88) and mortality (0.40, 95% CI 0.24–0.66) in the covariate models. Compared with exercising alone, exercising with others decreased the HRs for incident functional disability (0.53, 95% CI: 0.36–0.80) and mortality (0.50, 95% CI 0.29–0.85) rates in the unadjusted model; these associations were not significant in the covariate models. Exercising with others can contribute to functional disability prevention and longevity.

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The association of weight change and all-cause mortality in older adults: a systematic review and meta-analysis

Age and Ageing ◽

10.1093/ageing/afaa231 ◽

2020 ◽

Author(s):

Tagrid A Alharbi ◽

Susan Paudel ◽

Danijela Gasevic ◽

Joanne Ryan ◽

Rosanne Freak-Poli ◽

...

Keyword(s):

Older Adults ◽

Weight Loss ◽

Weight Gain ◽

Mortality Risk ◽

Weight Change ◽

Meta Analysis ◽

Community Dwelling ◽

Weight Fluctuation ◽

All Cause Mortality ◽

The Impact

Abstract Objective there may be age-related differences in the impact of weight change on health. This study systematically reviewed the evidence on the relationship between weight change and all-cause mortality in adults aged 65 years and older. Methods MEDLINE, EMBASE and CINAHL were searched from inception to 11 June 2020, PROSPERO CRD 42019142268. We included observational studies reporting on the association between weight change and all-cause mortality in older community-dwelling adults. A random-effects meta-analysis was performed to calculate pooled hazard ratios and scored based on the Agency for Healthcare Research and Quality guidelines. Results a total of 30 studies, including 1,219,279 participants with 69,255 deaths, demonstrated that weight loss was associated with a 59% increase in mortality risk (hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.45–1.74; P < 0.001). Twenty-seven studies that reported outcomes for weight gain (1,210,116 participants with 65,481 deaths) indicated that weight gain was associated with a 10% increase in all-cause mortality (HR: 1.10; 95%CI: 1.02, 1.17; P = 0.01). Four studies investigated weight fluctuation (2,283 events among 6,901 participants), which was associated with a 63% increased mortality risk (HR: 1.66; 95%CI: 1.28, 2.15). No evidence of publication bias was observed (all P > 0.05). Conclusion for community-dwelling older adults, weight changes (weight loss, gain or weight fluctuation) are associated with an increased risk of all-cause mortality risk relative to stable weight. Further research is needed to determine whether these associations vary depending upon initial weight, and whether or not the weight loss/gain was intentional.

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Meta-analysis: Early Age at Natural Menopause and Risk for All-Cause and Cardiovascular Mortality

BioMed Research International ◽

10.1155/2021/6636856 ◽

2021 ◽

Vol 2021 ◽

pp. 1-14

Author(s):

Luyao Huan ◽

Xiangling Deng ◽

Mengyang He ◽

Shunhong Chen ◽

Wenquan Niu

Keyword(s):

Mortality Risk ◽

Cardiovascular Mortality ◽

Data Extraction ◽

Meta Analysis ◽

Premature Menopause ◽

Early Age ◽

Early Menopause ◽

Natural Menopause ◽

All Cause Mortality

Aims. The aim of this meta-analysis was to comprehensively evaluate the association of early age at natural menopause with the risk for all-cause and cardiovascular mortality. Methods. Literature retrieval was done on August 4, 2020. Article selection and data extraction were completed independently and in duplicate. Early age at natural menopause was grouped into premature menopause (<40 years), early menopause (40-44 years), and relatively early menopause (45-49 years). Effect-size estimates are summarized as hazard ratio (HR) or relative risk (RR) with 95% confidence interval (CI). Results. Sixteen articles involving 321,233 women were meta-analyzed. Overall analyses revealed a statistically significant association of early age at natural menopause with all-cause mortality risk ( H R adjusted = 1.08 , 95% CI: 1.03 to 1.14, P = 0.002 ; R R adjusted = 1.05 , 95% CI 1.01 to 1.08, P = 0.005 ), but not with cardiovascular mortality risk. In dose-response analyses, the association with all-cause mortality was significant for premature menopause with ( H R adjusted = 1.10 ; 95% CI: 1.01 to 1.21; P = 0.034 ) and without ( R R adjusted = 1.34 ; 95% CI: 1.08 to 1.66; P = 0.007 ) considering follow-up intervals. As for cardiovascular mortality, marginal significance was noted for premature menopause after considering follow-up intervals ( HR = 1.09 ; 95% CI: 1.00-1.19; P = 0.045 ). Subgroup analyses indicated that gender, country, and follow-up periods were possible causes of heterogeneity. There was an overall low probability of publication bias. Conclusions. Our findings indicate that premature menopause is a promising independent risk factor for both all-cause and cardiovascular mortality.

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