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

2016 ◽  
Vol 6 (3) ◽  
pp. 129-139 ◽  
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.

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

Circulation ◽  
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.

Abstract 2568: Cerebral Infarcts in Blacks vs Whites: the Southall and Brent REvisited (SABRE) Multi-ethnic Cohort Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Dean Shibata ◽  
Therese Tillin ◽  
Norman Beauchamp ◽  
John Heasman ◽  
Wadyslaw Gedroyc ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Health ◽  
African Descent ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Stroke Mortality ◽  
Black African ◽  
Cerebral Mri ◽  
Mri Scans

Introduction: Stroke mortality is doubled in people of Black African descent compared with Whites, but factors responsible for this excess are unclear. We wished to compare infarct like lesions (ILL) on MRI by ethnicity and the role of risk factors. Methods: SABRE is a UK community based multi-ethnic cohort of men and women aged 40-69 years at baseline (1988-1990), and 58-86 years at follow up (2008-2011). At follow up, a questionnaire was completed and investigations performed including resting and ambulatory BP, anthropometry, and bloods for glucose and lipids. Cerebral MRI scans were scored for infarcts independently by two readers according to the Cardiovascular Health Study protocol. Results: Of 2346 Whites, 684 attended follow up, and 590 completed cerebral MRI. Of 801 Blacks (first generation migrants of Black African descent to the UK), 232 attended clinic and 207 completed MRI. Mortality loss was greater in Whites (605, 25%) than Blacks (121, 15%)(p<0.0001), although stroke was more likely the underlying cause in Blacks (23, 19%), than Whites (43, 7%)(p<0.0001) . Baseline systolic/diastolic BP was similarly higher in Blacks than Whites in attendees (8/5 mmHg), non-responders (7/6 mm Hg), and those who died (8/5 mmHg). At follow up stroke risk factors were adverse in Blacks, apart from smoking ( table ). Prevalence of ILL was similar by ethnicity, not differing when those <65 years were analysed separately, or when those with stroke/TIA history were excluded. Associations between ILL and risk factors did not differ by ethnicity. But prescribed treatment in those with elevated clinic BP (≥140 mmHg systolic, or ≥90 mmHg diastolic) was 83% in Blacks, 63% in Whites (p<0.0001). Further, in those with an ILL, 95% of Blacks, and 69% (p<0.0001) of Whites were on treatment. Conclusion: Equivalence of ILL rates in Blacks and Whites was unanticipated, given the greater stroke mortality in Blacks. Mitigating against selective mortality as the explanation of our findings is the similar ethnic differential in baseline BP in survivors and non-survivors, the lower overall mortality in Blacks, and overall small numbers of stroke deaths. A more likely explanation is that better targeted more aggressive treatment is now occurring in Blacks than Whites, reducing their potential burden of ILL.

Abstract TP164: Blood Pressure and Heart Rate Measures and Risk of Covert Brain Infarction and Worsening White Matter in Older Adults

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lester Y Leung ◽  
Traci M Bartz ◽  
Kenneth Rice ◽  
James Floyd ◽  
Bruce Psaty ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Heart Rate ◽  
White Matter ◽  
Cardiovascular Health ◽  
Brain Infarction ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Mri Findings ◽  
Increased Risk

Introduction: Covert brain infarction (CBI) and worsening white matter grade (WMG) on serial MRI are associated with increased risk for ischemic stroke and dementia. Hypothesis: We sought to evaluate the association of various measures of blood pressure and heart rate with these MRI findings. Methods: In the Cardiovascular Health Study, a longitudinal cohort study of cardiovascular disease in older adults, we used relative risk regression to assess the risk of incident CBI and worsening WMG associated with mean, variability, and trend in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) measured at four or more annual clinic visits between two brain MRIs. We included participants who underwent both brain MRIs and had no change in antihypertensive medication status, no CBI on the initial MRI, and no stroke before the follow-up MRI. Results: Among 897 eligible participants, incident CBI occurred in 15% and worsening WMG in 27%. Mean SBP mean was strongly associated with increased risk for incident CBI (RR per 10 mmHg 1.29; 95% CI, 1.13-1.47), and DBP mean was strongly associated with increased risk for worsening WMG (RR per 10 mmHg 1.43; 95% CI, 1.23-1.67). DBP variability may be associated with incident CBI (RR per 10 mmHg 1.71; 95% CI, 1.10-2.65), The HR measures were not associated with these MRI findings. Conclusions: Elevated mean levels of blood pressure contribute to covert cerebrovascular diseases. Control of mean blood pressure levels, even in older adults, remains a high priority for prevention of vascular brain injury.

scholarly journals Hospitalization Rates in Older Adults With Albuminuria: The Cardiovascular Health Study

2020 ◽  
Vol 75 (12) ◽  
pp. 2426-2433 ◽  
Author(s):  
Joshua I Barzilay ◽  
Petra Buzkova ◽  
Michael G Shlipak ◽  
Nisha Bansal ◽  
Pranav Garimella ◽  
...  
Keyword(s):  
Older Adults ◽  
Rate Ratio ◽  
Regression Models ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Hospitalization Rates ◽  
Incident Rate Ratio ◽  
Increased Risk ◽  
Incident Rate

Abstract Background Albuminuria is highly prevalent among older adults, especially those with diabetes. It is associated with several chronic diseases, but its overall impact on the health of older adults, as measured by hospitalization, has not been quantified. Method We followed up 3,110 adults, mean age 78 years, for a median 9.75 years, of whom 654 (21%) had albuminuria (≥30 mg albumin/gram creatinine) at baseline. Poisson regression models, adjusted for cardiovascular, renal, and demographic factors, were used to evaluate the association of albuminuria with all-cause and cause-specific hospitalizations, as defined by ICD, version 9, categories. Results The rates of hospitalization per 100 patient-years were 65.85 for participants with albuminuria and 37.55 for participants without albuminuria. After adjustment for covariates, participants with albuminuria were more likely to be hospitalized for any cause than participants without albuminuria (incident rate ratio, 1.39 [95% confidence intervals, 1.27. 1.53]) and to experience more days in hospital (incident rate ratio 1.56 [1.37, 1.76]). The association of albuminuria with hospitalization was similar among participants with and without diabetes (adjusted incident rate ratio for albuminuria versus no albuminuria: diabetes 1.37 [1.11, 1.70], no diabetes 1.40 [1.26, 1.55]; p interaction nonsignificant). Albuminuria was significantly associated with hospitalization for circulatory, endocrine, genitourinary, respiratory, and injury categories. Conclusions Albuminuria in older adults is associated with an increased risk of hospitalization for a broad range of illnesses. Albuminuria in the presence or absence of diabetes appears to mark a generalized vulnerability to diseases of aging among older adults.

scholarly journals Cardiovascular health outcomes of mobbing at work: results of the population-based, five-year follow-up of the Gutenberg health study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Karla Romero Starke ◽  
Janice Hegewald ◽  
Andreas Schulz ◽  
Susan Garthus-Niegel ◽  
Matthias Nübling ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Cardiovascular Health ◽  
Population Based ◽  
Health Study ◽  
Single Item ◽  
Men And Women ◽  
Gutenberg Health Study ◽  
Increased Risk ◽  
Study Population

Abstract Background The aim of this study was to determine if there is an increased risk of incident cardiovascular disease (CVD) resulting from workplace mobbing measured with two mobbing instruments in the Gutenberg Health Study. Methods In this prospective study, we examined working persons younger than 65 years for the presence of mobbing at baseline and at a 5-year follow-up using a single-item and a 5-item instrument. We used multivariate models to investigate the association between mobbing and incident CVD, hypertension, and change in arterial stiffness and further stratified the models by sex. Results After adjustment for confounders, mobbed workers appeared to have a higher risk of incident CVD than those not mobbed (single-item HR = 1.28, 95% CI 0.73–2.24; 5-item HR = 1.57, 95% CI 0.96–2.54). With the 5-item instrument, men who reported mobbing had a higher risk of incident CVD (HR = 1.77, 95% CI 1.01–3.09), while no association was observed for women (HR = 1.05, 95% CI 0.38–2.91). There was no difference in risks between men and women with the single-item instrument. No association between mobbing and incident hypertension and arterial stiffness was seen. Conclusions Our results show an indication of an increased risk of incident CVD for those mobbed at baseline when using the whole study population. Differences in risks between men and women when using the five-item instrument may be due to the instrument itself. Still, it is essential to detect or prevent workplace mobbing, and if present, to apply an intervention to halt it in order to minimize its adverse effects on CVD.

Carotid artery measures are strongly associated with left ventricular mass in older adults (A report from the cardiovascular health study)

1996 ◽  
Vol 77 (8) ◽  
pp. 628-633 ◽  
Author(s):  
Richard A. Kronmal ◽  
Vivienne-Elizabeth Smith ◽  
Daniel H. O'Leary ◽  
Joseph F. Polak ◽  
Julius M. Gardin ◽  
...  
Keyword(s):  
Older Adults ◽  
Carotid Artery ◽  
Left Ventricular Mass ◽  
Cardiovascular Health ◽  
Left Ventricular ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Ventricular Mass

scholarly journals Cardiovascular Risk Factors and Incident Acute Renal Failure in Older Adults: The Cardiovascular Health Study

2008 ◽  
Vol 3 (2) ◽  
pp. 450-456 ◽  
Author(s):  
Anuja Mittalhenkle ◽  
Catherine O. Stehman-Breen ◽  
Michael G. Shlipak ◽  
Linda F. Fried ◽  
Ronit Katz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study

scholarly journals Serum Fasting Non-esterified Fatty Acids and Carotid Artery Intima-Media Thickness in Older Adults: The Cardiovascular Health Study

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1043-1043
Author(s):  
Neil Huang ◽  
Petra Bůžková ◽  
Nirupa Matthan ◽  
Luc Djoussé ◽  
Jorge Kizer ◽  
...  
Keyword(s):  
Older Adults ◽  
Carotid Artery ◽  
Cardiovascular Health ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Fasting Serum ◽  
Media Thickness ◽  
Linoelaidic Acid

Abstract Objectives Carotid artery intima-media thickness (CIMT) has been used as an early indicator of subclinical atherosclerosis. Multiple studies have identified significant associations between plasma total non-esterified fatty acid (NEFA) concentrations and risk factors associated with subclinical atherosclerosis. However, the relationship between CIMT and serum NEFA is less clear. We hypothesized fasting serum total, individual saturated, and trans NEFA are positively associated with, and individual monounsaturated, n-6 polyunsaturated (PUFA) and n-3 PUFA NEFA are inversely associated with, CIMT. Methods We investigated the associations between fasting serum NEFA, and CIMT assessed in 1998–1999 among Cardiovascular Health Study (CHS) participants (N = 1,569) not taking anti-diabetic medication. A total of 35 individual NEFAs were measured in stored specimens from 1996–1997 using gas chromatography. CIMT was determined using ultrasound images, and was defined as the sum of the maximum common CIMT at the far wall divided by its standard deviation (SD) and the maximum internal CIMT at the far wall divided by its SD. At baseline, mean age was 77.3 ± 4.2, body mass index (BMI) was 26.8 ± 4.3 and 64% were female. Associations were assessed by linear regression, with adjustments for other individual NEFAs, age, sex, race, field center, education, smoking, BMI, physical activity, alcohol consumption, eGFR, serum albumin, hyperglycemia, hypertension, use of anti-hypertensive, statin, and other lipid-lowering drugs. Results In adjusted models per SD increment, linoelaidic acid (trans18:2) was positively associated with CIMT [β (95% confidence interval): 10.4 (0.99, 19.8), P = 0.03], and α-linolenic acid (18:3n-3) was marginally associated with lower CIMT [−21.2 (−42.6, 0.2), P = 0.05]. No significant associations were observed between total NEFAs or any other individual NEFAs (SFA, MUFA, and n-6 PUFA) and CIMT. Conclusions In this large community-based cohort of older adults, higher concentration of linoelaidic acid was positively associated with CIMT, suggesting the importance of partially hydrogenated fat in the development of subclinical atherosclerosis in older adults. Overall, however, serum fasting NEFAs were largely unrelated to subclinical atherosclerosis in CHS participants. Funding Sources NIH, NHLBI, USDA.

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