Depressive Symptoms, Inflammation, and Ischemic Stroke in Older Adults: A Prospective Analysis in the Cardiovascular Health Study

Background: Elevated depressive symptoms (EDS) are common in adults with heart failure (HF) and their joint prevalence is associated with worse short- (1 year) and long-term health outcomes. The contribution of EDS to healthcare costs and utilization in a contemporary population of older adults with HF is unknown. Hypothesis: Adults with HF who report EDS will have higher annual healthcare costs and use more resources than their counterparts without EDS. Methods: Participants from the Cardiovascular Health Study who developed HF between baseline and the 11-year follow up and whose data were linked to Medicare Part A and Part B claims were included in the analysis (n=441). HF was adjudicated based on review of medical records and physician questionnaires. EDS was determined if participants scored ≥8 on the abbreviated Centers for Epidemiologic Studies Depression scale. Medicare payments were adjusted using the Medical Consumer Price Index and represented in 2009 dollars. Annual healthcare utilization (i.e., total provider visits, inpatient and outpatient visits) is based on Part B. Linear regression with robust variance estimation was used to determine the relationship of EDS with medical costs or provider counts adjusted for confounders. Results: Participants were 75.9 years old (SD= 5.3), 55% female, 15% black, and 147 (33%) had EDS. Within 2 years, 19% of patients with EDS died vs. 14% in those without EDS. Differences in annual costs between participants with and without EDS were not statistically significant. However, participants with EDS had more provider visits than their counterparts (Table). Conclusion: Despite adults with HF and EDS using more healthcare resources than those without EDS, expenditures did not differ. Higher short-term mortality in adults with EDS could be an explanation.

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Fasting and Post-Glucose Load Measures of Insulin Resistance and Risk of Ischemic Stroke in Older Adults

Stroke ◽

10.1161/strokeaha.111.620773 ◽

2011 ◽

Vol 42 (12) ◽

pp. 3347-3351 ◽

Cited By ~ 30

Author(s):

Evan L. Thacker ◽

Bruce M. Psaty ◽

Barbara McKnight ◽

Susan R. Heckbert ◽

W.T. Longstreth ◽

...

Keyword(s):

Insulin Resistance ◽

Older Adults ◽

Ischemic Stroke ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Sensitivity Index ◽

Fasting Insulin ◽

Glucose Load ◽

Ischemic Stroke Risk

Background and Purpose— Few studies have assessed post-glucose load measures of insulin resistance and ischemic stroke risk, and data are sparse for older adults. We investigated whether fasting and post-glucose load measures of insulin resistance were related to incident ischemic stroke in nondiabetic, older adults. Methods— Participants were men and women in the Cardiovascular Health Study, age 65+ years and without prevalent diabetes or stroke at baseline, followed for 17 years for incident ischemic stroke. The Gutt insulin sensitivity index was calculated from baseline body weight and from fasting and 2-hour postload insulin and glucose; a lower Gutt index indicates higher insulin resistance. Results— Analyses included 3442 participants (42% men) with a mean age of 73 years. Incidence of ischemic stroke was 9.8 strokes per 1000 person-years. The relative risk (RR) for lowest quartile versus highest quartile of Gutt index was 1.64 (95% CI, 1.24–2.16), adjusted for demographics and prevalent cardiovascular and kidney disease. Similarly, the adjusted RR for highest quartile versus lowest quartile of 2-hour glucose was 1.84 (95% CI, 1.39–2.42). In contrast, the adjusted RR for highest quartile versus lowest quartile of fasting insulin was 1.10 (95% CI, 0.84–1.46). Conclusions— In nondiabetic, older adults, insulin resistance measured by Gutt index or 2-hour glucose, but not by fasting insulin, was associated with risk of incident ischemic stroke.

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Abstract P560: Serum Non-esterified Fatty Acids and Risk of Incident Stroke in Older Adults: The Cardiovascular Health Study

Circulation ◽

10.1161/circ.141.suppl_1.p560 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Neil K Huang ◽

Nirupa R Matthan ◽

Mary L Biggs ◽

W T Longstreth ◽

David S Siscovick ◽

...

Keyword(s):

Older Adults ◽

Fatty Acids ◽

Ischemic Stroke ◽

Lower Risk ◽

Palmitoleic Acid ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Fasting Serum ◽

Esterified Fatty Acids

Introduction: Serum non-esterified fatty acids (NEFAs) have been linked to both local and systemic inflammation and are higher in individuals with obesity, diabetes, cardiovascular disease, and ischemic stroke risk. Significant associations between total plasma NEFA concentrations and incident ischemic stroke have been reported in some but not all prospective studies. Given the functional and structural diversity among circulating NEFA, the associations of individual or clusters of circulating NEFAs may provide additional insight into their relationship with incident stroke. Hypothesis: Fasting serum n-3 NEFAs are inversely associated, and saturated and trans NEFAs are positively associated with incident stroke. Methods: We analyzed the incidence of stroke among Cardiovascular Health Study (CHS) participants who were free of stroke in 1996-1997 and underwent fasting NEFA profile measurement. At baseline, mean age was 77.8±4.5, body mass index was 26.7±4.4 and 61% were female. A total of 38 individual NEFAs in 5 classes (saturated, monounsaturated, polyunsaturated n-6, polyunsaturated n-3 and trans NEFAs) were measured using gas chromatography. Cox regression was used to evaluate the association of individual NEFA species with incident stroke, adjusting for: age, sex, race, and field center (model 1); model 1 covariates plus smoking, education, physical activity, alcohol consumption, eGFR, BMI, aspirin use, waist circumference, hypertension, prevalent diabetes, and cholesterol (model 2). Results: A total of 338 cases of incident stroke occurred during median follow-up of 10.5 years. In the fully adjusted model, trans -palmitoleic acid was inversely associated with incident stroke (HR per 1 mol% of NEFA composition: 0.03 [95% CI: 0.00 to 0.77], P <0.03). Serum docosahexaenoic acid levels were associated with lower risk of incident stroke (HR: 0.63 [95% CI: 0.40 to 1.00], P <0.05). Total n-3 fatty acids (HR: 0.78 [95% CI: 0.63 to 0.97]) and docosapentaenoic acid (HR: 0.12 [95% CI: 0.02 to 0.88]) were each associated with lower risk of incident stroke only in model 1. No significant association of saturated NEFAs with incidence of stroke was observed. Conclusion: Among fasting serum NEFA, docosahexaenoic acid and trans -palmitoleic acid were inversely associated with incident stroke, suggesting that these fatty acids may protect older adults from stroke.

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