Abstract 3744: Cystatin C Is Associated With Mitral Annular Calcification In Elderly Adults: Results From The Cardiovascular Health Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Folkert W Asselbergs ◽  
Dariush Mozaffarian ◽  
Ronit Katz ◽  
Bryan Kestenbaum ◽  
Linda F Fried ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Disease ◽  
Cystatin C ◽  
Cardiovascular Health ◽  
Hdl Cholesterol ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Mitral Annular Calcification ◽  
Waist To Hip Ratio ◽  
Annular Calcification

Background : A high prevalence of cardiac calcification has been observed in patients with end-stage kidney disease. The association between cardiac calcification and milder kidney disease has been less thoroughly characterized. We hypothesize that renal function is associated with mitral annular calcification (MAC), aortic annular calcification (AAC), and aortic valve sclerosis (AVS) in elderly. Methods and results : From the Cardiovascular Health Study (CHS), we analyzed 3,929 subjects (74 ± 5 years, 60% women), who underwent a 2-dimensional echocardiogram between 1994 –1995. Measures of kidney function were creatinine-based estimated glomerular filtration rate (eGFR) as calculated by the MDRD equation and cystatin C levels. MAC was present in 42 %, AAC in 44%, and AVS in 54% of the subjects. Subjects with MAC, AAC, and AVS were significantly older and significantly more subjects used anti-hypertensive medication and had prevalent cardiovascular disease (p<0.05). Participants with MAC had higher blood pressure levels, LDL-cholesterol levels, waist to hip ratio, fibrinogen levels and a higher prevalence of diabetes (p<0.05). Participants with AVS were more likely to be male, had higher systolic blood pressure, lower HDL-cholesterol, and higher waist to hip ratio (p<0.05). Levels of cystatin C were significantly higher in subjects with MAC in comparison to subjects without MAC (mean ± standard deviation 1.12 ± 0.33 versus 1.07 ± 0.25 mg/L, p<0.001). We found similar differences in those with and without AAC (1.11 ± 0.33 versus 1.07 ± 0.25 mg/L, p<0.001). Using logistic regression analysis, there was a significant and graded association between quartiles of Cystatin C levels and MAC (adjusted odds ratios and 95% confidence intervals) 1.0, 1.09 (0.91 to 1.32), 1.16 (0.96 to 1.40), and 1.27 (1.04 to 1.55) for quartiles 1 through 4 respectively (p for trend 0.017). In addition, Cystatin C levels were significantly associated with AAC (p<0.001), but this association became non-significant after adjustment for co-variates (p<0.174). No associations were present between Cystatin C and aortic sclerosis, and eGFR and cardiac calcifications. Conclusion : Cystatin C was significantly associated with the presence of MAC in a population-based cohort of elderly.

Abstract 039: A Comparison of Novel and Traditional Risk Factors for Cardiovascular Disease Across the Spectrum of Older Age: The Cardiovascular Health Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Michelle C Odden ◽  
Michael Shlipak ◽  
Heather Whitson ◽  
Ronit Katz ◽  
Patricia Kearney ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Oldest Old ◽  
Hdl Cholesterol ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Novel Risk Factors ◽  
Traditional Risk Factors

Introduction: There is evidence that some traditional cardiovascular risk factors have weaker associations with outcomes in elderly adults; whereas, some novel risk factors appear important in old age. Whether the risk factors for cardiovascular disease differ in the oldest old compared with younger elders is uncertain. Hypothesis: The associations of traditional risk factors - systolic blood pressure, LDL-cholesterol, HDL-cholesterol, obesity, and diabetes - will be attenuated with age, whereas the associations of novel risk factors - kidney disease, inflammation, and cardiac stiffness - will be robust across older age. Methods: Participants in the Cardiovascular Health Study ≥65 years (n=4,853), were stratified into three age cohorts: 65-74, 75-84, 85+ years based on the age at the time of risk factor measure (baseline, 3, 7, or 16 years of follow-up). Proportional hazards models were used to assess the associations of the risk factors assessed at the most recent visit and a composite outcome of incident stroke, myocardial infarction, and cardiovascular death over 5 years. Results: There were 1,481 events. In adults 65-84 years, systolic blood pressure, HDL-cholesterol, diabetes, kidney disease, inflammation, and cardiac stiffness were associated with the composite outcome, after adjustment for demographic factors. In adults 85+ years, only the novel risk factors were associated with the outcome in demographic-adjusted analyses (Figure). In fully adjusted models, only inflammation was associated with the outcome across the age spectrum. HDL-cholesterol was independently associated with the outcome in adults <75 years; systolic blood pressure, diabetes, cardiac stiffness, and kidney disease were associated with the outcome in adults <85 years. Conclusions: The associations of traditional risk factors with cardiovascular outcomes appear attenuated in adults ≥85 years; this could impact optimal prevention strategies in the oldest old. Inflammation is a robust risk factor across the spectrum of old age.

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 Heterogeneous Exposure Associations in Observational Cohort Studies: The Example of Blood Pressure in Older Adults

2019 ◽  
Vol 189 (1) ◽  
pp. 55-67
Author(s):  
Michelle C Odden ◽  
Andreea M Rawlings ◽  
Abtin Khodadadi ◽  
Xiaoli Fern ◽  
Michael G Shlipak ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Creatinine Concentration ◽  
Body Composition Study ◽  
Health Aging

Abstract Heterogeneous exposure associations (HEAs) can be defined as differences in the association of an exposure with an outcome among subgroups that differ by a set of characteristics. In this article, we intend to foster discussion of HEAs in the epidemiologic literature and present a variant of the random forest algorithm that can be used to identify HEAs. We demonstrate the use of this algorithm in the setting of the association between systolic blood pressure and death in older adults. The training set included pooled data from the baseline examination of the Cardiovascular Health Study (1989–1993), the Health, Aging, and Body Composition Study (1997–1998), and the Sacramento Area Latino Study on Aging (1998–1999). The test set included data from the National Health and Nutrition Examination Survey (1999–2002). The hazard ratios ranged from 1.25 (95% confidence interval: 1.13, 1.37) per 10-mm Hg increase in systolic blood pressure among men aged ≤67 years with diastolic blood pressure greater than 80 mm Hg to 1.00 (95% confidence interval: 0.96, 1.03) among women with creatinine concentration ≤0.7 mg/dL and a history of hypertension. HEAs have the potential to improve our understanding of disease mechanisms in diverse populations and guide the design of randomized controlled trials to control exposures in heterogeneous populations.

scholarly journals Trends in Blood Pressure and High-Sensitivity Cardiac Troponin-T With Cardiovascular Disease: The Cardiovascular Health Study

2019 ◽  
Vol 32 (10) ◽  
pp. 1013-1020 ◽  
Author(s):  
David M Tehrani ◽  
Wenjun Fan ◽  
Vijay Nambi ◽  
Julius Gardin ◽  
Calvin H Hirsch ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Troponin ◽  
Cardiovascular Health ◽  
Troponin T ◽  
High Sensitivity ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Cvd Risk ◽  
Over Time

AbstractBackgroundHigh-sensitivity cardiac troponin T (hs-cTnT) is individually associated with incident hypertension (HTN) and cardiovascular disease (CVD) events. We hypothesize that the increases in hs-cTnT with increases in blood pressure will be related to higher incidence of CVD.METHODSThe Cardiovascular Health Study is a longitudinal cohort of older adults. Those with hs-cTnT data and CVD risk factors at baseline and follow-up (2–3 years later) were stratified based on systolic blood pressure (SBP; optimal: <120 mm Hg, intermediate: 120–139 mm Hg, elevated: ≥140 mm Hg) and hs-cTnT (undetectable: <5 ng/l, detectable: 5–13 ng/l, elevated: ≥14 ng/l) categories. SBP and hs-cTnT were classified as increased or decreased if they changed categories between exams, and stable if they did not. Cox regression evaluated incident CVD events over an average 9-year follow-up.RESULTSAmong 2,219 adults, 510 (23.0 %) had decreased hs-cTnT, 1,279 (57.6 %) had stable hs-cTnT, and 430 (19.4 %) had increased hs-cTnT. Those with increased hs-cTnT had a higher CVD risk with stable SBP (hazard ratio [HR]: 1.28 [1.04–1.57], P = 0.02) or decreased SBP (HR: 1.57 [1.08–2.28], P = 0.02) compared to those within the same SBP group but a stable hs-cTnT. In those with lower SBP at follow-up, there was an inverse relation between diastolic blood pressure (DBP) and risk of CVD events in those with increased hs-cTnT (HR: 0.44 per 10 mm Hg increase, P < 0.01).CONCLUSIONAn increase in hs-cTnT over time is associated with a higher risk of CVD even when the blood pressure is stable or decreases over time.

scholarly journals Blood Pressure Variability and the Risk of All-Cause Mortality, Incident Myocardial Infarction, and Incident Stroke in the Cardiovascular Health Study

2013 ◽  
Vol 26 (10) ◽  
pp. 1210-1217 ◽  
Author(s):  
Astrid M. Suchy-Dicey ◽  
Erin R. Wallace ◽  
Mitchell S. Elkind ◽  
Maria Aguilar ◽  
Rebecca F. Gottesman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
All Cause Mortality

Hemoglobin Decline and Health Outcomes in the Elderly: the Cardiovascular Health Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3448-3448
Author(s):  
Neil A Zakai ◽  
Benjamin French ◽  
Alice Arnold ◽  
Anne Newman ◽  
Linda F. Fried ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Cardiovascular Health ◽  
The Elderly ◽  
Baseline Risk ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Logistic Regression Models ◽  
Concurrent Development ◽  
Adjusted Logistic Regression

Abstract Introduction: Anemia is associated with increased morbidity and mortality in the elderly, though the risk factors for and the consequences of hemoglobin (HGB) decline are poorly characterized. Methods: We studied 5201 men and women ≥65 participating in the Cardiovascular Health Study. The cohort was followed biannually and had baseline and repeat hemograms 3 years later. HGB decline was defined as >1g/dL HGB drop, or incident anemia at 3 years by WHO criteria. Results: 4006 participants survived to 3 years and had two HGB measures. The median HGB change was −0.2g/dL (IQR-0.8, 0.1). 961 (24%) participants had a >1g/dL HGB drop and 335 (8%) developed incident anemia. The left side of the table presents adjusted logistic regression models of baseline risk factors for HGB decline. Those with baseline cardiovascular disease (CVD), diabetes and kidney disease were more likely to develop >1g/dL HGB drop while only baseline kidney disease was associated with incident anemia. The table also shows the adjusted risk of HGB decline with concurrent development of co-morbid conditions. A >1g/dL drop in HGB was more likely in those who concurrently developed incident CVD, hypertension or inflammation. Incident anemia was more likely in participants with concurrent development of kidney disease or inflammation. Both incident anemia and a HGB drop >1g/dL were associated with subsequent 9-year mortality adjusting for age, race, gender, year 3 HGB, hypertension, CVD, diabetes, and renal disease; HRs (95% CI) 1.4 (1.2, 1.6) and 1.2 (1.1, 1.4) respectively. Discussion: Among studied factors, baseline CVD, diabetes and kidney disease were risk factors for >1g/dL HGB drop while only baseline kidney disease was a risk factor for incident anemia. Incident CVD and hypertension were associated concurrently with >1g/dL HGB drop while kidney disease was associated with concurrent incident anemia. Inflammation development was the strongest risk factor accompanying HGB decline. HGB decline, especially a 1g/dL drop, was associated with subsequent mortality irrespective of HGB concentration. These data suggest that small HGB changes not captured by the WHO anemia criteria are associated with poor health outcomes and that inflammation is a major correlate of HGB decline in the elderly. Table: Risk Factors for HGB Decline in Age-, Race-, Gender, and Baseline HGB-Adjusted Logistic Regression Models Baseline Risk Factors for HGB Decline Risk of HGB Decline with Concurrent Conditions HGB Drop >1g/dL Incident Anemia HGB Drop >1g/dL Incident Anemia CVD 1.2 (1.1, 1.4) 1.0 (0.8, 1.3) 1.3 (1.1, 1.6) 1.0 (0.7, 1.3) Hypertension 1.1 (0.99, 1.3) 1.1 (0.8, 1.2) 1.4 (1.1, 1.7) 1.1 (0.8, 1.5) Diabetes 1.3 (1.1, 1.5) 1.1 (0.8, 1.4) 0.9 (0.6, 1.4) 0.8 (0.4, 1.7) Kidney Disease (GFR <60ml/min/1.73m2) 1.2 (1.0, 1.3) 1.3 (1.1, 1.7) 1.1 (0.8, 1.4) 1.5 (1.0, 2.1) Inflammation CRP ≥10mg/dL or WBC≥15×109/mm3 1.0 (0.8, 1.3) 1.3 (0.99 1.8) 2.3 (1.8, 2.8) 2.3 (1.8, 3.0)

The Association Between Time Since Last Meal and Blood Pressure in Older Adults: The Cardiovascular Health Study

2003 ◽  
Vol 51 (6) ◽  
pp. 824-828 ◽  
Author(s):  
Nicholas L. Smith ◽  
Bruce M. Psaty ◽  
Gale H. Rutan ◽  
Thomas Lumley ◽  
David Yanez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study

scholarly journals Longitudinal Measures of Trimethylamine N-oxide and Incident Atherosclerotic Cardiovascular Disease Events in Older Adults: The Cardiovascular Health Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1434-1434
Author(s):  
Yujin Lee ◽  
Zeneng Wang ◽  
Heidi Lai ◽  
Marcia de Oliveira Otto ◽  
Rozenn Lemaitre ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Renal Function ◽  
Cystatin C ◽  
Impaired Renal Function ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Atherosclerotic Cardiovascular Disease ◽  
Community Based

Abstract Objectives Trimethylamine N-oxide (TMAO) is a gut microbiota-dependent metabolite of dietary choline, L-carnitine and phosphatidylcholine-rich animal foods. Based on experimental studies and cohorts with prevalent disease, elevated TMAO may increase risk of atherosclerotic cardiovascular disease (ASCVD). TMAO is also renally cleared and may interact with and causally contribute to renal dysfunction and elevated cystatin-C. Yet, the associations of serial TMAO levels with incident ASCVD in a community-based prospective cohort, and the potential mediating and modifying role of renal function, are not established. Methods We investigated the associations of serial measures of plasma TMAO, assessed at baseline and 7 years post baseline, with incident ASCVD among 4144 older adults in the Cardiovascular Health Study (CHS). TMAO was measured using stable isotope dilution LC/MS/MS (lab CV &lt;6%). Incident ASCVD (myocardial infarction, fatal coronary heart disease, stroke, sudden cardiac death, or other atherosclerotic death) was centrally adjudicated using medical records. Risk was assessed by multivariable Cox proportional hazards regression including time-varying demographics, lifestyle factors, medical history, and laboratory and dietary variables. We assessed potential mediating effects and interaction by renal function estimated by cystatin-C. Results During a median 15 years follow-up, 1757 ASCVD events occurred. After multivariable adjustment, TMAO was associated with a higher risk of ASCVD, with an extreme quintile HR (95% CI) of 1.22 (1.04, 1.44), P-trend = 0.01. This relationship appeared further mediated or confounded by estimated glomerular filtration rate (eGFR): adjusting for cystatin-C-based eGFR, the HR (95% CI) was 1.06 (0.98–1.25). Significant interaction was also observed by renal function (P-interaction &lt; 0.001), with TMAO associated with higher risk of ASCVD among individuals with impaired renal function (eGFR ≤ 60) [1.63 (1.03–2.59)], but not normal baseline renal function (eGFR &gt; 60) [1.15 (0.96–1.37)], even with further adjustment for continuous eGFR. Conclusions In this large community-based cohort of older US adults, higher serial measures of TMAO were associated with an elevated risk of ASCVD, in particular among those with impaired renal function. Funding Sources NIH, NHLBI.

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