scholarly journals Incidence and predictors of asthma exacerbations in middle-aged and older adults: the Rotterdam Study

2021 ◽  
pp. 00126-2021
Author(s):  
Emmely W. de Roos ◽  
Lies Lahousse ◽  
Katia M.C. Verhamme ◽  
Gert-Jan Braunstahl ◽  
Johannes J.C.C.M. in ‘t Veen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Airflow Obstruction ◽  
Cox Proportional Hazards ◽  
Severe Exacerbation ◽  
Rotterdam Study ◽  
Exacerbation Rate ◽  
Asthma Exacerbations ◽  
Controller Medication ◽  
Respiratory Complaints

AimTo investigate occurrence and determinants of asthma exacerbations in an ageing general population.MethodsSubjects aged 45 years or above with physician-diagnosed asthma in the Rotterdam Study, a population-based prospective cohort from January 1991 to May 2018 were assessed for asthma exacerbations. Exacerbations were defined as acute episodes of worsening asthma treated with oral corticosteroids. Cox proportional hazards analysis was used to investigate risk factors for a future exacerbation.ResultsOut of 763 participants with asthma (mean age 61.3 years, 69.2% female), 427 (56.0%) experienced at least one exacerbation, in a mean follow-up time of 13.9 years. The mean annual exacerbation rate was 0.22. Most exacerbations occurred during winter months. Risk factors for exacerbations were a history of previous exacerbations (Hazard Ratio (HR) 4.25; CI 3.07–5.90, p<0.001)), respiratory complaints (HR 2.18; 1.48–3.21, p<0.001), airflow obstruction (HR 1.52; 1.07–2.15, p=0.019), obesity (HR 1.38; 1.01–1.87, p=0.040) and depressive symptoms (HR 1.55; 1.05–2.29, p=0.027). Compared to those not using respiratory medication, we observed higher HRs for those on short-acting beta2-agonists (SABA, i.e. rescue medication) only (HR 3.08, 95% CI 1.61–5.90, p=0.001) than those on controller medication (HR 2.50, 95% CI 1.59–3.92, p<0.001).ConclusionMany older adults with asthma suffer from at least one severe exacerbation. Previous exacerbations, use of SABA without concomitant controller medication, respiratory complaints, obesity, airway obstruction and depression are independent risk factors for exacerbations.

Abstract MP07: Metabolic Signature Improves Heart Failure Risk Prediction In Older Adults

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Guning Liu ◽  
Quynh Nguyen ◽  
Sunil K Agarwal ◽  
David Aguilar ◽  
Eric Boerwinkle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Ejection Fraction ◽  
Risk Prediction ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Atherosclerosis Risk In Communities ◽  
Reduced Ejection Fraction ◽  
Metabolic Signature ◽  
Cox Proportional Hazards Models

Introduction: Circulating metabolome profiling holds promise in predicting HF risk, but its prediction performance among older adults is not well established. Hypothesis: We hypothesize that metabolic signatures are associated with the risk of HF and its subtypes (HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)), and they can improve HF risk prediction beyond established risk factors. Methods: We measured 828 serum metabolites among 4,030 African and European Americans free of HF from the Atherosclerosis Risk in Communities (ARIC) study visit 5 (2011-2013). We regressed incident HF on each metabolite using Cox proportional hazards models. A metabolite risk score (MRS) was derived by summing individual metabolite levels weighted by beta coefficients estimated from least absolute shrinkage and selection operator (LASSO) regularized regressions. We regressed incident HF, HFpEF and HFrEF on the MRS. Harrell’s C-statistics were calculated to evaluate risk discrimination. We replicated the association between MRS and HF in 3,697 independent ARIC participants with metabolite measured at visit 1 (1987-1989). Results: Among 4,030 participants, the mean (SD) age was 76 (5) years. Adjusting for HF risk factors, 302 metabolites were associated with incident HF (false discovery rate < 0.05). One SD increase of the MRS, constructed from 51 metabolites selected by LASSO, was associated with two to three-fold high risk of HF, HFpEF and HFrEF in the fully adjusted models ( Table ). Five-year risk prediction analysis showed that C statistics improved from 0.850 to 0.884 by adding MRS over ARIC HF risk factors, kidney function and NT-proBNP (ΔC (95%CI) = 0.034 (0.017,0.052)). In the replication analysis, a more parsimonious MRS constructed using 15 metabolites, was associated with incident HF ( Table ). Conclusions: We identified a metabolic signature that was associated with the risk of HF and improved HF risk prediction. Our findings may shed light on pathways in HF development and at-risk populations.

Abstract P007: Ankle-brachial Index And Cardiovascular Outcomes In Older Adults: The Atherosclerosis Risk In Communities Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Frances M Wang ◽  
Chao Yang ◽  
Shoshana Ballew ◽  
Corey A Kalbaugh ◽  
Michelle L Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Primary Prevention ◽  
Proportional Hazards ◽  
Ankle Brachial Index ◽  
Cox Proportional Hazards ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Atherosclerosis Risk In Communities ◽  
Cox Proportional Hazards Models

Introduction: The ankle-brachial index (ABI) is a representative diagnostic indicator of peripheral artery disease (PAD) and recognized as a risk enhancer in the ACC/AHA guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, our understanding of the association between ABI and cardiovascular (CVD) risk in older adults is limited. Additionally, the prognostic value of ABI among individuals with prior ASCVD is not well understood. Hypothesis: In a contemporary cohort of older adults, low ABI is independently associated with higher risk of CVD events, regardless of prevalent ASCVD at baseline (coronary heart disease [CHD], stroke, and/or symptomatic PAD). Methods: At ARIC Visit 5 (2011-2013), we studied 5,005 participants (4,160 without prior ASCVD [median age 74 years, 38% male], and 843 with ASCVD [median age 76 years, 65% male]). We quantified the association between ABI categories and subsequent risk of heart failure (HF) and composite CHD/stroke using multivariable Cox proportional hazards models. Results: Over a median follow-up of 5.5 years, we observed 400 CHD/stroke and 338 HF cases (242 CHD/stroke and 199 HF cases in those without prior ASCVD). After adjustment for CVD risk factors, in those without ASCVD history, ABI ≤0.9 was associated with a higher risk of both CHD/stroke and HF ( Table ). In those with a history of ASCVD, low ABI was not significantly associated with CHD/stroke, but was associated with HF (hazard ratio 7.1, 95% CI: 2.5-20.5); ABI categories of 0.9-1.1 and >1.3 were also significantly associated with HF. Addition of ABI to traditional risk factors improved prediction of CHD/stroke risk in those without prior ASCVD and prediction of HF, regardless of baseline ASCVD ( Table ). Conclusions: Low ABI (≤0.9) was associated with incident CHD/stroke in those without prior ASCVD and HF regardless of baseline ASCVD status. These results support ABI as a risk enhancer for guiding primary prevention of ASCVD and suggest its potential value in HF risk assessment for older adults.

scholarly journals Incidence, risk factors and re‐exacerbation rate of severe asthma exacerbations in a multinational, multidatabase pediatric cohort study

2020 ◽  
Vol 31 (5) ◽  
pp. 496-505 ◽  
Author(s):  
Marjolein Engelkes ◽  
Esme J. Baan ◽  
Maria A. J. Ridder ◽  
Elisabeth Svensson ◽  
Daniel Prieto‐Alhambra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Severe Asthma ◽  
Exacerbation Rate ◽  
Asthma Exacerbations ◽  
Incidence Risk

scholarly journals Trends in the Incidence of Activities of Daily Living Disability Among Chinese Older Adults From 2002 to 2014

2019 ◽  
Vol 75 (11) ◽  
pp. 2113-2118 ◽  
Author(s):  
Zhi-Hao Li ◽  
Yue-Bin Lv ◽  
Virginia Byers Kraus ◽  
Zhao-Xue Yin ◽  
Si-Min Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Cardiovascular Risk ◽  
Older People ◽  
Activities Of Daily Living ◽  
Cardiovascular Risk Factors ◽  
Daily Living ◽  
Cox Proportional Hazards ◽  
Adl Disability ◽  
Chinese Older People

Abstract Background Evidence of the trend of the incidence of activities of daily living (ADL) disability among Chinese older people is limited. We aimed to investigate the time trends and potential risk factors for the incidence of ADL disability among Chinese older people (≥65 years). Methods We established two consecutive and nonoverlapping cohorts (6,857 participants in the 2002 cohort and 5,589 participants in the 2008 cohort) from the Chinese Longitudinal Healthy Longevity Survey. ADL disability was defined as the need for assistance with at least one essential activity (dressing, bathing, toileting, eating, indoor activities, and continence). Cox proportional hazards models were used to identify factors associated with the trend in the incidence of ADL disability from 2002 to 2014. Results The incidence (per 1,000 person-years) of ADL disability decreased significantly from 64.2 in the 2002 cohort to 46.6 in the 2008 cohort (p &lt; .001), and decreasing trends in the incidence of ADL disability were observed for all sex, age, and residence subgroups (all p &lt; .001), even after adjusting for multiple potential confounding factors. Moreover, we found that adjustment for sociodemographic, lifestyle information, and cardiovascular risk factors (hypertension, diabetes, heart disease, and stroke) explained less of the decline in ADL disability during the period from 2002 to 2014. Conclusion The incidence of ADL disability among the older adults in China appears to have decreased during the study period, and this finding cannot be explained by existing sociodemographic and lifestyle information and cardiovascular risk factors.

scholarly journals Homocysteine Predicts Incident Isolated Systolic Hypertension in Older Adults

Circulation ◽  
2001 ◽  
Vol 103 (suppl_1) ◽  
pp. 1347-1347
Author(s):  
Rachel P Wildman ◽  
Lewis H Kuller
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Older Adults ◽  
Systolic Hypertension ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Isolated Systolic Hypertension ◽  
Kaplan Meier ◽  
Blood Pressures ◽  
Amino Acid Methionine

0019 Untreated isolated systolic hypertension (ISH) indicates arterial stiffening and carries a risk for both stroke and cardiovascular disease. Elevated plasma homocysteine, a metabolite of the essential amino acid methionine, has been linked to vascular stiffness. 187 normotensive (defined as systolic blood pressure (SBP) < 160 mmHg and diastolic blood pressure < 90 mmHg) men and women (mean age 71.29 + 6.3 yrs) were followed for an average of 7 years for incident ISH. ISH was defined as a SBP ≥160 mmHg (while maintaining a DBP of < 90 mmHg) at least one time at 3 year follow-up visits, or the initiation of antihypertensive therapy. The mean baseline systolic and diastolic blood pressures (DBP) were 127 and 69 mmHg, respectively. Over the 7 year period, 59(31.5%) participants developed ISH, 76% qualified by antihypertensive use, and 24% by blood pressure values. The Kaplan Meier Estimate of 7 year survival free from ISH was 67% (95% CI: 61%, 74%). The relationship between incident ISH and the traditional cardiovascular risk factors, creatinine, homocysteine, and carotid artery intima-media wall thickness (IMT) was assessed by Cox proportional hazards regression. The strongest predictor of incident ISH was baseline SBP. For participants with baseline SBPs of < 130, 130-139, and 140+ mmHg, the corresponding 7 year survival free from ISH was 80% (95% CI: 73%, 88% ), 53% (95%CI: 38%, 67%), and 44% (95% CI: 26%, 62%). Factors independently associated with time to ISH were higher triglycerides (upper tertile,RR=2.0, p=0.012), homocysteine levels (> 12.0 μmol/l, RR=2.2, p=0.005), and baseline SBP (per 10 mmHg,RR=1.4, p=0.003). The results were similar when the analysis was restricted to the 157 participants with a baseline SBP of < 140 mmHg. Baseline IMT was found to be univariately related to time to ISH (RR per each 1.0 mm increment=3.0; p=0.016). In multivariate analysis, this association remained independent of triglycerides and homocysteine, but not baseline SBP (RR per each 1.0 mm increment=2.5; p=0.049). In conclusion, among normotensive older adults, 32% can be expected to develop ISH over a 7 year period, and higher triglyceride and homocysteine levels are risk factors.

scholarly journals Risk factors for emergency department visit in a prospective open cohort of asthmatic children

2021 ◽  
Author(s):  
Bruno Mahut ◽  
Flore Amat ◽  
Plamen Bokov ◽  
Christophe Delclaux
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Atopic Dermatitis ◽  
Confidence Interval ◽  
Emergency Department Visit ◽  
Severe Exacerbation ◽  
Exacerbation Rate ◽  
Asthmatic Children ◽  
Ed Visits ◽  
A Prospective Study

Abstract BackgroundRisk factors of emergency department (ED) visits have mainly been obtained from hospital cohorts.ObjectiveTo evaluate risk factors for ED visits in asthmatic children in an out-of-hospital cohort.MethodsWe led a prospective study in an open cohort of 933 asthmatic children followed-up by a specialized pediatrician. We measured the annualized rate of ED visits since age two and described their characteristics at last visit.ResultsMean age (± SD) at last visit was 11.1 ± 3.3 years, and the annualized rate of ED visit was 0.194 ± 0.356. Two groups were defined: one with no ED visits (n = 463), and the other with at least one ED visit (n = 470). The latter group included younger children, with multiple sensitizations and more frequent early atopic dermatitis, who reported having more inhaled corticosteroid (ICS) treatment and a more severe exacerbation rate in the three months prior to the last visit. Socioeconomic status did not influence the rate of ED visits. In a logistic regression, the absence of hospitalization before 2 years of age and of atopic dermatitis had odds ratios of 0.38 (95% confidence interval: 0.23–0.65) and of 0.57 (95% confidence interval: 0.42–0.79) respectively to predict at least one ED visit. When an asthmatic child had no early hospitalization and no atopic dermatitis, the relative risk of ED visit was decreased by 28%.ConclusionAsthmatic children with an absence of atopic dermatitis and hospitalization before two years of age are less prone to emergency department visit after age two.

Outdoor light at night and risk of coronary heart disease among older adults: a prospective cohort study

2020 ◽  
Author(s):  
Shengzhi Sun ◽  
Wangnan Cao ◽  
Yang Ge ◽  
Jinjun Ran ◽  
Feng Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Prospective Cohort ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Light At Night ◽  
Night Time ◽  
Cox Proportional Hazards Models

Abstract Aims We estimated the association between outdoor light at night at the residence and risk of coronary heart disease (CHD) within a prospective cohort of older adults in Hong Kong. Methods and results Over a median of 11 years of follow-up, we identified 3772 incident CHD hospitalizations and 1695 CHD deaths. Annual levels of outdoor light at night at participants’ residential addresses were estimated using time-varying satellite data for a composite of persistent night-time illumination at ∼1 km2 scale. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between outdoor light at night at the residence and risk of CHD. The association between light at night and incident CHD hospitalization and mortality exhibited a monotonic exposure-response function. An interquartile range (IQR) (60.0 nW/cm2/sr) increase in outdoor light at night was associated with an HR of 1.11 (95% CI: 1.03, 1.18) for CHD hospitalizations and 1.10 (95% CI: 1.00, 1.22) for CHD deaths after adjusting for both individual and area-level risk factors. The association did not vary across strata of hypothesized risk factors. Conclusion Among older adults, outdoor light at night at the residence was associated with a higher risk of CHD hospitalizations and deaths. We caution against causal interpretation of these novel findings. Future studies with more detailed information on exposure, individual adaptive behaviours, and potential mediators are warranted to further examine the relationship between light at night and CHD risk.

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