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 Blood Pressure and Heart Rate Measures Associated With Increased Risk of Covert Brain Infarction and Worsening Leukoaraiosis in Older Adults

2017 ◽  
Vol 37 (8) ◽  
pp. 1579-1586 ◽  
Author(s):  
Lester Y. Leung ◽  
Traci M. Bartz ◽  
Kenneth Rice ◽  
James Floyd ◽  
Bruce Psaty ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Heart Rate ◽  
Brain Infarction ◽  
Increased Risk

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 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.

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 Heart Rate Response to a Timed Walk and Cardiovascular Outcomes in Older Adults: The Cardiovascular Health Study

Cardiology ◽  
2012 ◽  
Vol 122 (2) ◽  
pp. 69-75 ◽  
Author(s):  
Saket Girotra ◽  
Dalane W. Kitzman ◽  
Willem J. Kop ◽  
Phyllis K. Stein ◽  
John S. Gottdiener ◽  
...  
Keyword(s):  
Older Adults ◽  
Heart Rate ◽  
Cardiovascular Health ◽  
Heart Rate Response ◽  
Cardiovascular Outcomes ◽  
Health Study ◽  
Cardiovascular Health Study

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.

scholarly journals Persistent Subclinical Hypothyroidism and Cardiovascular Risk in the Elderly: The Cardiovascular Health Study

2013 ◽  
Vol 98 (2) ◽  
pp. 533-540 ◽  
Author(s):  
Kristen A. Hyland ◽  
Alice M. Arnold ◽  
Jennifer S. Lee ◽  
Anne R. Cappola
Keyword(s):  
Older Adults ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Cardiovascular Health ◽  
The Elderly ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Increased Risk

Abstract Context: Use of a single set of thyroid function tests to define subclinical hypothyroidism may lead to misclassification over time and could influence findings from longitudinal studies. Objective: We assessed the risks of coronary heart disease (CHD), heart failure (HF), and cardiovascular (CV) death in older adults with persistent subclinical hypothyroidism. Design, Setting, and Participants: The study included 679 subclinically hypothyroid and 4184 euthyroid U.S. individuals at least 65 yr old enrolled in the Cardiovascular Health Study and not taking thyroid preparations. Main Outcome Measure: We measured the 10-yr risk of incident CHD, HF, and CV death from persistent subclinical hypothyroidism, overall and stratified by degree of TSH elevation (4.5–6.9, 7.0–9.9, and 10.0–19.9 mU/liter). Results: There was no association between persistent subclinical hypothyroidism and incident CHD [hazard ratio (HR), 1.12; 95% confidence interval (CI), 0.93–1.36], HF (HR, 1.05; 95% CI, 0.97–1.27), or CV death (HR, 1.07; 95% CI, 0.87–1.31) in adjusted analyses in which subclinical hypothyroidism was modeled as a time-varying exposure using up to four serial thyroid function tests. When subclinical hypothyroidism was stratified by degree of TSH elevation, no significant associations were found in any stratum. Findings were similar in fixed exposure analyses in which only participants with testing 2 yr apart were considered, with no association between persistent or transient subclinical hypothyroidism and incident CHD, HF, or CV death. Conclusions: Our data do not support increased risk of CHD, HF, or CV death in older adults with persistent subclinical hypothyroidism.

scholarly journals Blood Pressure Components and Decline in Kidney Function in Community-Living Older Adults: The Cardiovascular Health Study

2013 ◽  
Vol 26 (8) ◽  
pp. 1037-1044 ◽  
Author(s):  
D. E. Rifkin ◽  
R. Katz ◽  
M. Chonchol ◽  
M. G. Shlipak ◽  
M. J. Sarnak ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Kidney Function ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Community Living
Sign in / Sign up

Export Citation Format

Share Document