scholarly journals Physical Activity and Long-Term Mortality Risk in Older Adults with and without Cardiovascular Disease: A Nationwide Cohort Study

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Or Shaked ◽  
Gali Cohen ◽  
Abigail Goshen ◽  
Tal Shimony ◽  
Tamar Shohat ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Older Adults ◽  
Propensity Score ◽  
Mortality Risk ◽  
Mortality Data ◽  
Cox Models ◽  
Long Term Mortality

<b><i>Aims:</i></b> To evaluate the association between physical activity (PA) levels and mortality among older adults, to determine whether it differs according to cardiovascular disease (CVD) status, and to assess the optimal weekly duration of PA associated with subsequent survival. <b><i>Methods:</i></b> Participants (<i>n</i> = 1,799) were drawn from a national survey conducted from 2005 to 2006, constituting Israeli adults aged ≥65 years. Sociodemographic, clinical, behavioral, and psychosocial data were collected via interview at study entry. Based on a detailed PA questionnaire and according to published guidelines, participants were classified as sufficiently active, insufficiently active, and inactive. CVD status was self-reported. Mortality data (last follow-up, December 2016) were obtained from the Israeli Ministry of Health. Using Cox models, inverse probability weighted hazard ratios (HRs) for mortality, based on propensity score, were estimated for PA categories. <b><i>Results:</i></b> Among the participants at baseline (mean age, 74.6 years), 559 (31.1%) were sufficiently active, 506 (28.1%) were insufficiently active, and 734 (40.8%) were inactive. During follow-up (mean, 9.0 years), 684 participants (38.0%) died. PA was inversely associated with mortality, with propensity score-adjusted HRs (95% confidence intervals) of 0.84 (0.71–1.01) in insufficiently and 0.73 (0.61–0.88) in sufficiently active participants (<i>p</i><sub>trend</sub> &#x3c; 0.001). No PA-by-CVD interaction was detected on multiplicative scale (<i>p</i> = 0.36) or additive scale (<i>p</i> = 0.58). A monotonic survival benefit was observed until ∼150 min of PA per week, beyond which no further gain was apparent. <b><i>Conclusions:</i></b> In a nationwide cohort of older adults, nearly 70% did not meet the guideline for PA. PA engagement was inversely associated with long-term mortality risk, similarly in individuals with and without CVD. A maximum survival advantage was achieved at around 150 min of exercise per week.

1445Physical activity and long-term mortality risk in Israeli older adults with and without cardiovascular disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Gerber ◽  
O Shaked ◽  
G Cohen ◽  
A Goshen ◽  
T Shimony ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Older Adults ◽  
Older Adult ◽  
Mortality Risk ◽  
Protective Factor ◽  
Adult Population ◽  
Mortality Data ◽  
Nutrition Survey

Abstract Background Physical activity (PA) is a known protective factor among both general population and cardiovascular disease (CVD) patients. Yet, only a few cohort studies assessed the role of PA among older adult populations, characterized by high CVD prevalence rates. Objectives To evaluate the association between PA levels and all-cause mortality among Israeli older adults, and to assess whether it differs by baseline CVD status. Methods Participants were drawn from the National Health and Nutrition Survey of Older Adults Aged 65+ (“Mabat-Zahav”), conducted by the Israel Center for Disease Control between July 2005 and December 2006. Clinical, behavioral, and psychosocial data were collected via interview at study entry; a detailed PA questionnaire was also administered, through which participants were classified as sufficiently-active, insufficiently-active, and inactive, according to the American College of Sports Medicine classification. Mortality data (last follow-up, December 2016) were obtained from the Israeli Ministry of Health. Inverse probability weighted Cox proportional hazards models, based on propensity score, were constructed to assess the adjusted association between PA categories and mortality. Results Of the 1799 participants (mean [SD] age, 74.6 [6.2] years; 647 [36%] with a history of CVD), 559 (31%) were sufficiently-active, 506 (28%) were insufficiently-active and 734 (41%) were inactive. During a mean follow-up period of 9.0 years, 684 participants (38%) died. PA and mortality demonstrated an inverse dose-response relationship in both CVD and non-CVD groups, with no CVD-by-PA interaction detected on multiplicative-scale (P=0.70) or additive-scale (P=0.58). Notably, inactive non-CVD subjects had comparable risk to CVD patients who were sufficiently active (Figure). Physical activity and mortality Conclusions In a nationally-based cohort of subjects aged 65 years and over, PA was inversely associated with mortality risk. CVD patients who preformed sufficient PA had a comparable mortality risk to inactive subjects free of CVD. These findings illustrate the importance of PA in the older adult population.

scholarly journals Physical activity and long-term mortality risk in older adults: A prospective population based study (NEDICES)

2016 ◽  
Vol 4 ◽  
pp. 546-550 ◽  
Author(s):  
Sara Llamas-Velasco ◽  
Alberto Villarejo-Galende ◽  
Israel Contador ◽  
David Lora Pablos ◽  
Jesús Hernández-Gallego ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Mortality Risk ◽  
Population Based ◽  
Population Based Study ◽  
Long Term Mortality

Abstract P075: Influence of Systemic Interleukin-6 on the Inverse Association between Your-Choice American Heart Diet and a 41-Year Mortality Risk from Coronary Heart Disease among Men

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Jun Dai ◽  
Anthony J Acton ◽  
Robert V Considine ◽  
Ruth E Krasnow ◽  
Terry Reed
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Systemic Inflammation ◽  
Mortality Risk ◽  
Interleukin 6 ◽  
Reactive Protein ◽  
Chd Risk ◽  
Long Term Mortality

Introduction: Whole diet evaluated using dietary pattern is associated with systemic inflammation and coronary heart disease (CHD). Systemic inflammation also contributes to CHD risk. Genetic factors explain variations in whole diet, systemic inflammation, and CHD. However, it is unknown whether systemic inflammation is a mechanism linking whole diet to the long-term mortality risk from coronary heart disease independent of genes. Hypothesis: Systemic inflammation measured as plasma interleukin-6 levels medicates the association between whole diet and long-term mortality risk from coronary heart disease independent of genes. Methods: From the National Heart, Lung, and Blood Institute Twin Study, we included 554 white, middle-aged, veteran male twins (105 monozygotic and 109 dizygotic twin pairs; 65 monozygotic and 61 dizygotic unpaired twins). The twins were not on antihypertensive medication and had diastolic blood pressure below 105 mmHg at baseline (1969-1973) and did not have suspected acute inflammation [plasma levels of interleukin-6 (IL-6) above 10 pg/mL or C-reactive protein above 30 mg/L)]. Usual dietary data at baseline were collected through nutritionist-administered dietary history interview. Your-Choice American Heart Diet (YCARD) score was devised to quantitatively evaluate whole diet. Plasma interleukin-6 and C-reactive protein levels were measured with ELISA. Data on vital status and death causes were collected through death certificates until Dec 31, 2010. A frailty survival model was used to estimate various associations: overall (equivalent to the association in the general population), within-pair (independent of genes and environment common to co-twins), and between-pair (indicating influence of the common factors). We controlled for total caloric intake and known CHD risk factors including body mass index and modified Framingham Risk Score. Results: There were 75 CHD deaths during a 41-year follow-up (median follow-up of 34 years). The adjusted overall association between YCARD score and the CHD mortality risk was negative [partial coefficient for a 10-unit increment in the YCARD score: βo (95% confidence interval (CI)): -0.13 (-0.24, -0.02); hazard ratio (95% CI): 0.88 (0.78, 0.98)]. The partial regression coefficient was -0.02 [95% CI (-0.23, 0.19)] for the within-pair effect of YCARD (βw) and -0.12 [95% CI (-0.26, 0)] for the between-pair effect of YCARD (βb) in relation to CHD mortality risk. Additional adjustment for IL-6 led to a 15.4% reduction in the βo, a 100% increment in the βw, and a 16.7% reduction in the βb. Conclusions: Systemic inflammation measured as interleukin-6 mediates the association between whole diet and long-term coronary heart mortality risk, which is largely through genetic and environmental factors shared between co-twins.

scholarly journals Cardiovascular Health and Stroke in Older British Men

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3286-3294
Author(s):  
Ayesha Ahmed ◽  
Snehal M. Pinto Pereira ◽  
Lucy Lennon ◽  
Olia Papacosta ◽  
Peter Whincup ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Cardiovascular Health ◽  
Population Attributable Fraction ◽  
Cox Models ◽  
Population Attributable Fractions ◽  
Hazard Ratios ◽  
Attributable Fractions ◽  
Time Point

Background and Purpose: Research exploring the utility of cardiovascular health (CVH) and its Life’s Simple 7 (LS7) components (body mass index, blood pressure [BP], glucose, cholesterol, physical activity, smoking, and diet) for prevention of stroke in older adults is limited. In the British Regional Heart Study, we explored (1) prospective associations of LS7 metrics and composite CVH scores with, and their impact on, stroke in middle and older age; and (2) if change in CVH was associated with subsequent stroke. Methods: Men without cardiovascular disease were followed from baseline recruitment (1978–1980), and again from re-examination 20 years later, for stroke over a median period of 20 years and 16 years, respectively. LS7 were measured at each time point except baseline diet. Cox models estimated hazard ratios (95% CI) of stroke for (1) ideal and intermediate versus poor levels of LS7; (2) composite CVH scores; and (3) 4 CVH trajectory groups (low-low, low-high, high-low, high-high) derived by dichotomising CVH scores from each time point across the median value. Population attributable fractions measured impact of LS7. Results: At baseline (n=7274, mean age 50 years), healthier levels of BP, physical activity, and smoking were associated with reduced stroke risk. At 20-year follow-up (n=3798, mean age 69 years) only BP displayed an association. Hazard ratios for intermediate and ideal (versus poor) levels of BP 0.65 (0.52–0.81) and 0.40 (0.24–0.65) at baseline; and 0.84 (0.67–1.05) and 0.57 (0.36–0.90) at 20-year follow-up. With reference to low-low trajectory, the low-high trajectory was associated with 40% reduced risk, hazard ratio 0.60 (0.44–0.83). Associations of CVH scores weakened, and population attributable fractions of LS7 reduced, from middle to old age; population attributable fraction of nonideal BP from 53% to 39%. Conclusions: Except for BP, CVH is weakly associated with stroke at older ages. Prevention strategies for older adults should prioritize BP control but also enhance focus beyond traditional risk factors.

scholarly journals Increased mortality risk in patients with primary and secondary adrenal insufficiency

2021 ◽  
Author(s):  
Kanchana Ngaosuwan ◽  
Desmond G Johnston ◽  
Ian F Godsland ◽  
Jeremy Cox ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Adrenal Insufficiency ◽  
Mortality Risk ◽  
Reference Population ◽  
Mortality Data ◽  
Adrenal Crisis ◽  
Malignant Neoplasms ◽  
Geographical Differences ◽  
All Cause Mortality

Abstract Context Mortality data in patients with adrenal insufficiency are inconsistent, possibly due to temporal and geographical differences between patients and their reference populations. Objective To compare mortality risk and causes of death in adrenal insufficiency with an individually-matched reference population. Design Retrospective cohort study. Setting UK general practitioner database (CPRD). Participants 6821 patients with adrenal insufficiency (primary, 2052; secondary, 3948) and 67564 individually-matched controls (primary, 20366; secondary, 39134). Main outcome measures All-cause and cause-specific mortality; hospital admission from adrenal crisis. Results With follow-up of 40799 and 406899 person-years for patients and controls respectively, the hazard ratio (HR; [95%CI]) for all-cause mortality was 1.68 [1.58 - 1.77]. HRs were greater in primary (1.83 [1.66 - 2.02]) than in secondary (1.52 [1.40 - 1.64]) disease; (HR; primary versus secondary disease, 1.16 [1.03 - 1.30]). The leading cause of death was cardiovascular disease (HR 1.54 [1.32-1.80]), along with malignant neoplasms and respiratory disease. Deaths from infection were also relatively high (HR 4.00 [2.15 - 7.46]). Adrenal crisis contributed to 10% of all deaths. In the first two years following diagnosis, the patients’ mortality rate and hospitalisation from adrenal crisis were higher than in later years. Conclusion Mortality was increased in adrenal insufficiency, especially primary, even with individual matching and was observed early in the disease course. Cardiovascular disease was the major cause but mortality from infection was also high. Adrenal crisis was a common contributor. Early education for prompt treatment of infections and avoidance of adrenal crisis hold potential to reduce mortality.

scholarly journals Long-Term Adherence to Physical Activity Among Older Veterans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 859-859
Author(s):  
Candace Brown
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Body Mass Index ◽  
Self Efficacy ◽  
Moderate Intensity ◽  
Social Barriers ◽  
Initiation Phase ◽  
Α Level

Abstract The benefits of physical activity (PA) are well-established and it is recommended that older adults achieve at least 150 to 300 minutes of moderate intensity PA and strengthening activities weekly. However, only 54.0% and 23.2% of older adults achieve these recommendations for endurance and strengthening (respectively), and 48% dropout within the first 6-months. Most PA research focuses on the 6-month initiation phase leaving a gap regarding long-term adherence. We explored predictors of long-term adherence (&gt;2-years) to PA from 97participants at 6-month follow-up and yearly surveys. Variables examined included age, race, gender, body mass index (BMI), and self-reported comorbidities, symptoms, physical function, and barrier-specific self-efficacy scale (α-level 0.05). Lower BMI (29.1±5.1 versus 31.6±6.5, p=0.047) and higher self-efficacy to overcome environmental barriers (p=0.016) and social isolation (p=0.05) were associated with long-term adherence. Self-efficacy to overcome environmental and social barriers should be addressed to promote long-term adherence to exercise among older adults

Cardiovascular Disease as a Long-Term Complication of Treatment for Testicular Cancer

2003 ◽  
Vol 21 (8) ◽  
pp. 1513-1523 ◽  
Author(s):  
R.A. Huddart ◽  
A. Norman ◽  
M. Shahidi ◽  
A. Horwich ◽  
D. Coward ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Testicular Cancer ◽  
Cardiac Risk ◽  
Mortality Data ◽  
Resident Male ◽  
Cardiac Risk Factors ◽  
Long Term Survivors

Purpose: To assess the risk of cardiovascular morbidity and cardiac risk factors in long-term survivors of testicular cancer according to treatment received. Patients and Methods: All resident male patients registered in the United Kingdom between 1982 and 1992 attending for follow-up were eligible for recruitment. Patients completed a current health questionnaire and underwent clinical review, along with hematologic, biochemical, and hormonal profiles. For patients not under routine review, follow-up information was sought from their general practitioner and mortality data were sought from the Office of National Statistics. Descriptive analysis was performed on all variables and comparisons were made among patients treated by orchidectomy and follow-up only, chemotherapy alone (C), radiotherapy alone (RT), and radiotherapy and chemotherapy (C/RT). Results: Data on cardiovascular events were available on 992 patients. After a median follow-up of 10.2 years, 68 events had been reported, including 18 deaths. After adjusting for age, increased risk for cardiac events was seen after C (relative risk [RR] = 2.59; 95% confidence interval [CI], 1.15 to 5.84; P = .022), RT (RR = 2.40; 95% CI, 1.04 to 5.45; P = .036), and C/RT (RR = 2.78; 95% CI, 1.09 to 7.07; P = .032). There were no significant differences in cardiac risk factors. On multivariate analysis, age, treatment group, free thyroxine, protein, and magnesium levels were associated with cardiovascular disease. Conclusion: In long-term survivors of testicular cancer, we observed a two-fold or greater risk of developing cardiovascular disease. This was not due to increases in cardiac risk factors, which suggests a direct or indirect treatment effect. These data support the continued research into the minimization of treatment in good-prognosis testicular cancer.

scholarly journals ‘You started something … then I continued by myself’: a qualitative study of physical activity maintenance

2017 ◽  
Vol 18 (06) ◽  
pp. 574-590 ◽  
Author(s):  
Charlotte Wahlich ◽  
Carole Beighton ◽  
Christina Victor ◽  
Rebecca Normansell ◽  
Derek Cook ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Good Health ◽  
Text Messages ◽  
Telephone Interviews ◽  
Walking Intervention ◽  
Effective Interventions ◽  
Bad Weather

Background Most mid-life and older adults are not achieving recommended physical activity (PA) targets and effective interventions are needed to increase and maintain PA long-term for health benefits. The Pedometer And Consultation Evaluation (PACE-UP) trial, a three-armed primary care pedometer-based walking intervention in those aged 45–75 years, demonstrated increased PA levels at 12 months. A three-year follow-up was conducted to evaluate long-term PA maintenance, including a qualitative component. Aim To examine facilitators and barriers to PA maintenance in mid-life and older adults previously involved in a PA trial. Method Semi-structured telephone interviews were conducted with 60 PACE-UP participants across all study arms. Interviews were audio-recorded, transcribed verbatim and coded independently by researchers, prior to thematic analysis. Findings Two-thirds of participants felt since the PACE-UP trial they had an awareness of PA, with the pedometer reported as ‘kick-starting’ regular activity, and then helped them to maintain regular activity. PA facilitators included: maintaining good health, self-motivation, social support and good weather. Lack of time was the most frequently cited barrier. Other barriers were often the inverse of the facilitators; for example, poor health and bad weather. Participants described the type of ‘top-up’ intervention they would find beneficial to aid PA maintenance (eg, text messages, online resources and walking groups). Conclusion A challenge for future PA interventions is to transform barriers into facilitators; for example, educating trial participants about the value of PA for many chronic health conditions to change this from inhibiting to promoting PA. Participants provided ideas for encouraging PA maintenance which could be incorporated into future interventions.

scholarly journals Repeated Measurements of Cardiac Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide to Assess Long-Term Mortality Risk in Subjects with Osteoarthritis

Biomolecules ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 230
Author(s):  
Martin Rehm ◽  
Gisela Büchele ◽  
Rolf Erwin Brenner ◽  
Klaus-Peter Günther ◽  
Hermann Brenner ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin T ◽  
Repeated Measurements ◽  
Cardiac Troponin T ◽  
One Year ◽  
Long Term Mortality

Osteoarthritis (OA) is associated with higher cardiovascular mortality risk. High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are well-characterized prognostic cardiac markers. We aimed to describe the changes in biomarkers measured one year apart in a cohort of 347 subjects with OA who underwent hip or knee replacement surgery in 1995/1996 and to analyze the prognostic value of repeated measurements for long-term mortality. During a median follow-up of 19 years, 209 (60.2%) subjects died. Substantial changes in cardiac biomarkers, especially for NT-proBNP, and an independent prognostic value of NT-proBNP for long-term mortality were found for both baseline measurement concentration (hazard ratio (HR) 1.32, 95% confidence interval (CI) (1.13–1.55)) and follow-up measurement concentration (HR 1.39, 95% CI 1.18–1.64) (all HR per standard deviation increase after natural log-transformation). Baseline concentrations were correlated with follow-up concentrations of NT-proBNP and no longer showed prognostic value when included simultaneously in a single model (HR 1.08, 95% CI 0.86–1.37), whereas the estimate for the one-year measurement remained robust (HR 1.31, 95% CI 1.04–1.66). Therefore, no significant additional benefit of repeated NT-proBNP measurements was found in this cohort, facilitating the use of a single NT-proBNP measurement as a stable prognostic marker.

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