Abstract MP56: Progression of Hyperglycemia in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Mary R Rooney ◽  
Andreea Rawlings ◽  
James S Pankow ◽  
Justin Echouffo Tcheugui ◽  
Josef Coresh ◽  
...  
Keyword(s):  
Older Adults ◽  
Multinomial Logistic Regression ◽  
Older Age ◽  
Self Report ◽  
Atherosclerosis Risk In Communities ◽  
High Prevalence ◽  
Risk Of Progression ◽  
Using Data ◽  
Aric Study

Introduction: Despite the high prevalence of prediabetes and diabetes in old age, the progression of hyperglycemia in older adults is not well-characterized. Objective: To characterize prevalence and predictors of hyperglycemia progression during 5 years of follow-up among 2894 older adults without diabetes (mean age 76, 60% female, 18% black). Methods: Using data from the ARIC Study, we report according to hyperglycemia (normal or prediabetes) status at baseline (visit 5, 2011-13) the incidence of visit 6 (2016-17) outcomes (normoglycemia, prediabetes, diabetes, or mortality). Multinomial logistic regression was used to identify predictors of these outcomes stratified by baseline hyperglycemia status. In a sensitivity analysis, we applied inverse probability of attrition weights (IPAW) to account for informative missingness. Results: Most participants (64%) with normal HbA1c at baseline had normal HbA1c at the follow-up visit, 19% progressed to prediabetes, 16% died, and 1% developed diabetes (HbA1c ≥6.5% or diabetes medication use or self-report diagnosis). Among participants with prediabetes at baseline, most remained prediabetic 5 years later (61%), 18% died, 14% reverted to normoglycemia, and 7% developed diabetes. Black participants, men, and those with hypercholesterolemia had a higher risk of hyperglycemia progression ( Table ). Physical activity was inversely associated with risk of progression. Body mass index (BMI) in older age was not associated with hyperglycemia progression and BMI was inversely associated with mortality. Results were similar when we used IPAW. Conclusions: In this community-based population of older adults, progression from prediabetes to diabetes was relatively uncommon over the 5 year period. Risk factors for hyperglycemia progression and mortality, such as BMI, may differ when measured in older adulthood. We also identified subgroups with higher risk of hyperglycemia progression in older age and who may benefit from targeted diabetes prevention efforts.

scholarly journals Changes in hypertension control in a community-based population of older adults, 2011-2013 to 2016-2017

2020 ◽  
Author(s):  
Kathryn Foti ◽  
Kunihiro Matsushita ◽  
Silvia Koton ◽  
Keenan A Walker ◽  
Josef Coresh ◽  
...  
Keyword(s):  
Older Adults ◽  
Baseline Risk ◽  
Treatment Goals ◽  
Hypertension Control ◽  
Community Based ◽  
Study Objective ◽  
Atherosclerosis Risk In Communities ◽  
Black And White ◽  
Aric Study

Abstract Background The 2014 hypertension guideline raised treatment goals in older adults. The study objective was to examine changes in blood pressure (BP) control (<140/90 mmHg) from 2011-2013 to 2016-2017 among Black and white older adults with treated hypertension. Methods Participants were 1600 white and 650 Black adults aged 71-90 years in the Atherosclerosis Risk in Communities (ARIC) Study with treated hypertension in 2011-2013 (baseline) who had BP measured in 2016-2017 (follow up). Factors associated with changes in BP control were examined by race. Results BP was controlled among 75.3% of white and 65.7% of Black participants at baseline and 59.0% of white and 56.5% of Black participants at follow up. Among those with controlled BP at baseline, risk factors for incident uncontrolled BP included age (RR 1.15 per 5 years, 95% CI 1.07-1.25), female sex (RR 1.36, 95% CI 1.16-1.60), and chronic kidney disease (CKD) (RR 1.19, 95% CI 1.01-1.40) among white participants, and hypertension duration (RR 1.14 per 5 years, 95% CI 1.03-1.27) and diabetes (RR 1.48, 95% CI 1.15-1.91) among Black participants. Among those with uncontrolled BP at baseline, white females vs males (RR 0.60, 95% CI 0.46-0.78) and Black participants with CKD vs without (RR 0.58, 95% CI 0.36-0.93) were less likely to have incident controlled BP. Conclusions BP control decreased among white and Black older adults. Black individuals with diabetes or CKD were less likely to have controlled BP at follow up. Higher treatment goals may have contributed to these findings and unintended differences by race.

Abstract MP76: Severe Hypoglycemia and Prevalence of Cognitive Impairment in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Alexandra K Lee ◽  
Andreea M Rawlings ◽  
Andrea L Schneider ◽  
A R Sharrett ◽  
Elbert S Huang ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Severe Hypoglycemia ◽  
Emergency Department Visits ◽  
Cross Sectional ◽  
Atherosclerosis Risk In Communities ◽  
Using Data ◽  
Diagnosed Diabetes ◽  
Aric Study

Introduction: Hypoglycemia and cognitive impairment are major problems in older adults with diabetes. It is unknown whether persons with prior hypoglycemia have distinct patterns of cognitive impairment compared to persons without hypoglycemia. Hypothesis: Compared to older adults with diabetes and no history of hypoglycemia, persons with prior hypoglycemia will have worse cognitive performance across all domains, but particularly in the executive function domain. Methods: We conducted a cross-sectional analysis of older adults with diagnosed diabetes using data from the ARIC study (2011-2013). Participants completed eight cognitive tests that measured three domains: memory, language, and executive function. Cognitive impairment in each domain was defined as having at least one test score lower than 1.5 standard deviations below age-, race-, and education-specific norms. We identified prior severe hypoglycemic events through 2012 with ICD-9 codes from hospitalizations and emergency department visits. We used Poisson regression with robust standard errors to generate prevalence ratios (PR) adjusted for demographic and clinical characteristics. Results: Among 1,867 adults with diagnosed diabetes: mean age 76 years, 56% female, 32% black, and 3% with prior hypoglycemia. In persons with prior hypoglycemia, 50% had cognitive impairment in at least one domain, compared to 43% in persons without prior hypoglycemia (p=0.24). After adjustment, persons with prior hypoglycemia were more likely to have worse performance in executive function (PR=1.73; 95% CI: 1.14-2.64) and language (PR=1.78; 95% CI: 1.08-2.93) but not memory (PR=1.19; 95% CI: 0.81-1.76) (Figure). Conclusions: Persons with prior severe hypoglycemia are a unique subset of older adults with diabetes with greater cognitive deficits in the domains of executive function and language. Their cognitive impairment presents challenges for the management of their diabetes and the prevention of additional hypoglycemic episodes and cognitive decline.

1398-P: Mortality Implications of Comorbid Health Status in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1398-P
Author(s):  
MARY R. ROONEY ◽  
OLIVE TANG ◽  
B. GWEN WINDHAM ◽  
JUSTIN B. ECHOUFFO TCHEUGUI ◽  
PAMELA LUTSEY ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Status ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Aric Study

scholarly journals Prevalence of Multiple Sensory Deficits in Older Adults in BLSA and ARIC Studies

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 804-805
Author(s):  
Nicole Armstrong ◽  
Jennifer Deal ◽  
Hang Wang ◽  
Jennifer Schrack ◽  
Qu Tian ◽  
...  
Keyword(s):  
Older Adults ◽  
Vision Loss ◽  
Age Groups ◽  
Adverse Outcomes ◽  
Atherosclerosis Risk In Communities ◽  
Sensory Deficits ◽  
Olfactory Loss ◽  
Atherosclerosis Risk ◽  
Baltimore Longitudinal Study ◽  
Using Data

Abstract Individual sensory deficits have been associated with adverse outcomes, including dementia, in older adults. Using data from the Baltimore Longitudinal Study of Aging (BLSA) (N=259) and Atherosclerosis Risk in Communities Study (ARIC) (N=962), we examined the prevalence of one, two, or three sensory deficits (hearing, vision, and olfaction) among older adults ≥70 years. Any hearing loss was the most prevalent sensory deficit (70-79 year-olds: 41.3% [BLSA] and 51.2% [ARIC]; ≥80 year-olds: 82.6% [BLSA] and 74.2% [ARIC]), followed by vision loss and olfactory loss. Hearing and vision impairments were more prevalent than hearing and olfactory losses as well as vision and olfactory losses in both age groups and studies There were few people with deficits in all three senses (70-79 year-olds: 3.3% [BLSA] and 2.0% [ARIC]; ≥80 year-olds: 5.8% [BLSA] and 7.4% [ARIC]). Further research should investigate the potential impact of multisensory impairments on older adults.

Abstract P116: Trait Anger Increases Short-term and Long-term Risk for Recurrent CHD: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Janice E Williams ◽  
Sharon B Wyatt ◽  
Kathryn M Rose ◽  
David J Couper ◽  
Anna Kucharska-Newton
Keyword(s):  
Cigarette Smoking ◽  
Trait Anger ◽  
Middle Aged ◽  
Short Term ◽  
Men And Women ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Aric Study

Though several large epidemiologic studies have demonstrated the positive association of anger with coronary heart disease (CHD) onset, a dearth of population-based evidence exists regarding the relationship of anger to the clinical course of CHD among people with established disease. Trait anger is conceptualized as a stable personality trait and defined as the tendency to experience frequent and intense anger. Therefore, it is plausible that the effects of trait anger on CHD are long standing. We assessed the hypothesis that trait anger predicts short-term and long-term risk for recurrent CHD among middle-aged men and women. Participants were 611 black or white men and women, ages 48 - 67, who had a history of CHD at the second clinical examination (1990-1992) of the Atherosclerosis Risk in Communities (ARIC) Study. They were followed for the recurrence of CHD (myocardial infarction or fatal CHD) from 1990 through three different time intervals: 1995, 2003, and 2009 (maximum follow-up = 19.0 years). Trait anger (measured at Visit 2) was assessed using the Spielberger Trait Anger Scale, with scores categorized as high, moderate, and low. Cox proportional hazards regression analyses were adjusted for age, sex, race-center, educational level, waist-to-hip ratio, plasma LDL-and HDL-cholesterol levels, hypertension, diabetes, cigarette smoking status, and pack-years of cigarette smoking. After 3 - 5 years of follow-up, the risk for recurrent CHD among participants with high trait anger was more than twice that of their counterparts with low trait anger (2.24 [95% C.I: 1.14 to 4.40]). After 11 - 13 years, the risk was 80% greater (1.80 [95% C.I: 1.17 to 2.78]) and after 17 - 19 years, it was 70% greater (1.70 [95% C.I: 1.15 to 2.52]). The risk for recurrent CHD was strongest in the first time interval but remained strong and statistically significant through 19 years of follow-up. In conclusion, the experience of frequent and intense anger increases short-term and long-term risk for recurrent CHD in middle-aged men and women.

Abstract 12385: Past Alcohol Consumption and Incident Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shalini Dixit ◽  
Alvaro Alonso ◽  
Elsayed Z Soliman ◽  
Lin Y Chen ◽  
Gregory M Marcus
Keyword(s):  
Atrial Fibrillation ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Population Based ◽  
Self Report ◽  
Atherosclerosis Risk In Communities ◽  
Increased Risk ◽  
Before And After ◽  
Dietary Intake Assessment ◽  
Aric Study

Introduction: Although current alcohol consumption appears to be a risk factor for incident atrial fibrillation (AF), limitations related to self-reported alcohol use and confounding in observational studies limit the certainty of conclusions regarding causality. Whether cessation of alcohol consumption can protect against incident AF remains unknown. Methods: We examined all participants in the Atherosclerosis Risk in Communities (ARIC) study, a population-based cohort of 15,792 men and women aged 45-65, without prevalent AF. Past alcohol consumption was assessed via self-report during the baseline dietary intake assessment. Cases of incident AF were ascertained via study ECGs, hospital discharge ICD-9 codes, and death certificates. Results: Among 15,262 participants with complete survey data, 2,898 (19.0%) were former drinkers. During an average follow-up of 17.4 years, there were 380 cases of incident AF in former consumers. Both before and after adjustment for potential confounders, a longer duration of alcohol abstinence was associated with a lower risk of developing AF; previously consuming alcohol for a longer duration and consuming a greater quantity of alcohol were each associated with a higher risk of developing AF (Table). Conclusions: Among former drinkers, the number of years of drinking and the amount of alcohol consumed may each confer an increased risk of AF. Given that a longer duration of abstinence was associated with a decreased risk of AF, modification of alcohol use could potentially play a role in AF prevention.

Abstract 15380: Association of Change in Body Mass Index With Premature Atrial Contractions Frequency and Atrial Fibrillation in Older Age: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Joseph Decker ◽  
Wendy Wang ◽  
Faye L Norby ◽  
Romil Parikh ◽  
Jorge L Reyes ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
The Elderly ◽  
Atherosclerosis Risk In Communities ◽  
Aging Adults ◽  
Aric Study ◽  
Multivariable Adjustment ◽  
Adjustment Table

Introduction: The proportions of obese and aging adults are rapidly growing. While obesity and advancing age are associated with atrial fibrillation (AF), data are limited on weight change in the elderly as a risk factor for premature atrial contractions (PACs)—which are known to precede AF—or AF. Hypothesis: Compared to a stable body mass index (BMI) over time, increasing BMI will be associated with a higher PAC frequency and AF in elderly participants in ARIC. Methods: We included N=2,070 ARIC participants [age mean ± SD 79 ± 4.5 years, 59% female] without known AF who attended visit 6 and wore an ambulatory ECG-monitoring device (Zio XT® Patch, iRhythm Technologies Inc.) for ≥48 hours. BMI change was defined as change between V5 (2011-13) and V6 (2016-17) and was categorized into 4 groups: >10% decrease, 2 to 10% decrease, -2 to 2% change (stable BMI) and > 2% increase. PAC frequency was defined as percent of beats that are PACs. Linear regression was used to evaluate the association between BMI change and % PAC. Incident AF was ascertained after V6 through 2018 from hospital discharge codes and death certificates. Logistic regression was used to evaluate the association between BMI change and incident AF. Results: Median PACs per hour were 8.84. Participants with >2% BMI increase had 0.35% (95% CI: 0.06%-0.64%) higher frequency of PACs compared to those with stable BMI after multivariable adjustment (Table). After a mean (SD) follow-up of 19 (7) months, there were 82 incident AF cases. Compared to stable BMI, both >2% BMI increase and 2 to 10% decrease were nonsignificantly associated with higher odds of AF compared with stable BMI after multivariable adjustment (Table). Conclusion: Increasing BMI in the elderly is associated with higher PAC frequency and is nonsignificantly associated with higher odds of AF compared to stable BMI. This finding suggests that weight management, which is currently emphasized in middle age, may also apply in late-life to prevent atrial arrhythmias.

scholarly journals Hemodynamic Correlates of Blood Pressure in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

2016 ◽  
Vol 18 (12) ◽  
pp. 1222-1227 ◽  
Author(s):  
Hirofumi Tanaka ◽  
Gerardo Heiss ◽  
Elizabeth L. McCabe ◽  
Michelle L. Meyer ◽  
Amil M. Shah ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Aric Study

Abstract 14482: Apparent Resistant Hypertension is a Marker of Risk: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Magnus O Wijkman ◽  
Marcus Malachias ◽  
Brian Claggett ◽  
Susan Cheng ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Antihypertensive Drug ◽  
Resistant Hypertension ◽  
Composite Endpoint ◽  
Atherosclerosis Risk In Communities ◽  
Drug Classes ◽  
Atherosclerosis Risk ◽  
Aric Study

Introduction: Apparent resistant hypertension (ARH) is a common marker of risk in patients with established cardiovascular disease. We ascertained the prevalence and prognostic significance of ARH in patients without prior cardiovascular disease. Methods: This prospective observational cohort study included 9669 community-based participants without a history of heart failure, myocardial infarction, or stroke, who completed the Atherosclerosis Risk in Communities (ARIC) study visit 4 between 1996-1998. The definition of ARH was blood pressure (BP) above goal (traditional goal <140/90mmHg, more stringent goal <130/80mmHg) despite use of ≥3 antihypertensive drug classes, or any BP with ≥4 antihypertensive drug classes. Participants with controlled hypertension (CH), defined as BP at goal with use of 1-3 antihypertensive drug classes, constituted the reference group. The outcome was a composite endpoint of heart failure, myocardial infarction, stroke, or death. Cox regression models were adjusted for age, sex, race, BMI, heart rate, smoking, eGFR, LDL, HDL, triglycerides, glucose, and diabetes. Results: Applying the traditional BP goal, 154/9669 participants (1.6%) had ARH, and there were 2311 participants with CH (23.9%). Using the more stringent BP goal, 218/9669 participants (2.3%) had ARH, and 1523 participants (15.8 %) had CH. The median follow-up time was 19 years. Apparent resistant hypertension was associated with an increased risk for the composite endpoint (adjusted hazard ratio 1.58 [95% CI 1.32-1.90] with the traditional BP goal, and adjusted hazard ratio 1.51 [95% CI 1.28-1.79] with the more stringent BP goal). Conclusions: Apparent resistant hypertension had a low prevalence but was independently associated with adverse outcome during long term follow-up, compared to controlled hypertension and even compared to uncontrolled hypertension. This was observed for both traditional and more stringent BP goals.

scholarly journals Associations of Cardiac, Kidney, and Diabetes Biomarkers With Peripheral Neuropathy among Older Adults in the Atherosclerosis Risk in Communities (ARIC) Study

2020 ◽  
Vol 66 (5) ◽  
pp. 686-696 ◽  
Author(s):  
Caitlin W Hicks ◽  
Dan Wang ◽  
Natalie R Daya ◽  
B Gwen Windham ◽  
Christie M Ballantyne ◽  
...  
Keyword(s):  
Older Adults ◽  
Peripheral Neuropathy ◽  
Glycated Albumin ◽  
Creatinine Ratio ◽  
Atherosclerosis Risk In Communities ◽  
Hb A1c ◽  
Urine Albumin ◽  
Diabetes Status ◽  
Atherosclerosis Risk ◽  
Aric Study

Abstract Background The aim of this study was to assess the association of high-sensitivity cardiac troponin (hs-cTnT) and other cardiac, kidney, hyperglycemia, and inflammatory biomarkers with peripheral neuropathy (PN) in a community-based population. Methods We conducted a cross-sectional analysis of 3056 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent standardized monofilament PN testing and had measures of cardiac function (hs-cTnT, N-terminal pro–B-type natriuretic peptide [NT-proBNP], and growth differentiation factor 15 [GDF15]), kidney function (serum creatinine, cystatin C, β-2 microglobulin, urine albumin-to-creatinine ratio), hyperglycemia (fasting glucose, hemoglobin A1c [Hb A1c], fructosamine, glycated albumin, 1,5-anhydroglucitol), and inflammation (C-reactive protein) assessed at visit 6 (2016–2017; age 71–94 years). We used logistic regression to assess the associations of these biomarkers (modeled in diabetes-specific tertiles) with PN in older adults with and without diabetes after adjusting for traditional risk factors. Results In total, 33.5% of participants had PN (37.3% with diabetes and 31.9% without diabetes). There was an independent association of hs-cTnT with PN regardless of diabetes status (diabetes T3 vs. T1: odds ratio [OR], 2.15 [95% CI, 1.44–3.22]; no diabetes: OR, 2.31 [95%CI, 1.76–3.03]; P = 0.72 for interaction). Among participants without diabetes, there were also significant associations of NT-proBNP (OR, 1.40 [95% CI, 1.08–1.81]) and urine albumin-to-creatinine ratio (OR, 1.55 [95% CI, 1.22–1.97]) with PN. Associations of hyperglycemia biomarkers including Hb A1c (OR, 1.76 [95% CI, 1.22–2.54]), fructosamine (OR, 1.71 [95% CI, 1.19–2.46]), and glycated albumin (OR, 1.45 [95% CI, 1.03–2.03]) with PN were significant only among participants with diabetes. Conclusions Overall, hs-cTnT appears to be a global marker of end organ damage, including PN. Laboratory biomarkers may be able to help us identify those individuals with PN.

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