Depression as a Mediator of the Association Between Wealth Status and Risk of Cognitive Impairment and Dementia: A Longitudinal Population-Based Cohort Study

2021 ◽  
pp. 1-11
Author(s):  
Rui Zhou ◽  
Hua-Min Liu ◽  
Fu-Rong Li ◽  
Hai-Lian Yang ◽  
Jia-Zhen Zheng ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Population Based ◽  
Cognitive Status ◽  
Wealth Status ◽  
Cox Models ◽  
Mediating Role ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Time Dependent Covariates

Background: Wealth and income are potential modifiable risk factors for dementia, but whether wealth status, which is composed of a combination of debt and poverty, and assessed by wealth and income, is associated with cognitive impairment among elderly adults remains unknown. Objective: To examine the associations of different combinations of debt and poverty with the incidence of dementia and cognitive impairment without dementia (CIND) and to evaluate the mediating role of depression in these relationships. Methods: We included 15,565 participants aged 51 years or older from the Health and Retirement Study (1992–2012) who were free of CIND and dementia at baseline. Dementia and CIND were assessed using either the modified Telephone Interview for Cognitive Status (mTICS) or a proxy assessment. Cox models with time-dependent covariates and mediation analysis were used. Results: During a median of 14.4 years of follow-up, 4,484 participants experienced CIND and 1,774 were diagnosed with dementia. Both debt and poverty were independently associated with increased dementia and CIND risks, and the risks were augmented when both debt and poverty were present together (the hazard ratios [95% confidence intervals] were 1.35 [1.08–1.70] and 1.96 [1.48–2.60] for CIND and dementia, respectively). The associations between different wealth statuses and cognition were partially (mediation ratio range: 11.8–29.7%) mediated by depression. Conclusion: Debt and poverty were associated with an increased risk of dementia and CIND, and these associations were partially mediated by depression. Alleviating poverty and debt may be effective for improving mental health and therefore curbing the risk of cognitive impairment and dementia.

scholarly journals Mortality Risk and The Progression of The Electronic Frailty Index and Hospital Frailty Risk Score Over Time

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Joe Hollinghurst ◽  
Alan Watkins
Keyword(s):  
Risk Score ◽  
Frailty Index ◽  
Time Frame ◽  
Time Dependent ◽  
Cox Models ◽  
Hazard Ratios ◽  
Increased Risk ◽  
The Matrix ◽  
Time Dependent Covariates ◽  
Over Time

IntroductionThe electronic Frailty Index (eFI) and the Hospital Frailty Risk Score (HFRS) have been developed in primary and secondary care respectively. Objectives and ApproachOur objective was to investigate how frailty progresses over time, and to include the progression of frailty in a survival analysis.To do this, we performed a retrospective cohort study using linked data from the Secure Anonymised Information Linkage Databank, comprising 445,771 people aged 65-95 living in Wales (United Kingdom) on 1st January 2010. We calculated frailty, using both the eFI and HFRS, for individuals at quarterly intervals for 8 years with a total of 11,702,242 observations. ResultsWe created a transition matrix for frailty states determined by the eFI (states: fit, mild, moderate, severe) and HFRS (states: no score, low, intermediate, high), with death as an absorbing state. The matrix revealed that frailty progressed over time, but that on a quarterly basis it was most likely that an individual remained in the same state. We calculated Hazard Ratios (HRs) using time dependent Cox models for mortality, with adjustments for age, gender and deprivation. Independent eFI and HFRS models showed increased risk of mortality as frailty severity increased. A combined eFI and HFRS revealed the highest risk was primarily determined by the HFRS and revealed further subgroups of individuals at increased risk of an adverse outcome. For example, the HRs (95% Confidence Interval) for individuals with an eFI as fit, mild, moderate and severe with a high HFRS were 18.11 [17.25,19.02], 20.58 [19.93,21.24], 21.45 [20.85,22.07] and 23.04 [22.34,23.76] respectively with eFI fit and no HFRS score as the reference category. ConclusionFrailty was found to vary over time, with progression likely in the 8-year time-frame analysed. We refined HR estimates of the eFI and HFRS for mortality by including time dependent covariates.

scholarly journals Autoantibodies and the Risk of Cardiovascular Events

2009 ◽  
Vol 36 (11) ◽  
pp. 2462-2469 ◽  
Author(s):  
KIMBERLY P. LIANG ◽  
HILAL MARADIT-KREMERS ◽  
CYNTHIA S. CROWSON ◽  
MELISSA R. SNYDER ◽  
TERRY M. THERNEAU ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Population Based ◽  
Cox Models ◽  
Diagnostic Indices ◽  
Increased Risk ◽  
Peptide Antibody ◽  
Cv Disease ◽  
Citrullinated Peptide ◽  
Overall Mortality

Objective.Inflammation and autoimmunity are associated with increased cardiovascular (CV) risk in patients with rheumatoid arthritis. This association may also be present in those without rheumatic diseases. Our purpose was to determine whether rheumatoid factor (RF), antinuclear antibody (ANA), and cyclic citrullinated peptide antibody (CCP) positivity are associated with increased risk of CV events and overall mortality in those with and without rheumatic diseases.Methods.We performed a population-based cohort study of all subjects who had a RF and/or ANA test performed between January 1, 1990, and January 1, 2000, and/or CCP test performed between September 1, 2003, and January 1, 2005, with followup until April 1, 2007. Outcomes were ascertained using diagnostic indices from complete medical records, including CV events [myocardial infarction (MI), heart failure (HF), and peripheral vascular disease (PVD)] and mortality. Cox models were used to analyze the data.Results.There were 6783 subjects with RF, 7852 with ANA, and 299 with CCP testing. Of these, 10.4%, 23.9%, and 14.7% were positive for RF, ANA, and CCP, respectively. Adjusting for age, sex, calendar year, comorbidity, and rheumatic disease, RF and ANA positivity were significant predictors of CV events [hazard ratio (HR) 1.24 and 1.26] and death (HR 1.43 and 1.18). Adjusting for age, CCP positivity was associated with CV events, but this association was not statistically significant (HR 3.1; 95% CI 0.8, 12.3).Conclusion.RF and ANA positivity are significant predictors of CV events and mortality in both those with and those without rheumatic diseases. These results support the role of immune dysregulation in the etiology of CV disease.

scholarly journals Fragility Fractures Are Associated with an Increased Risk for Cardiovascular Events in Women and Men with Rheumatoid Arthritis: A Population-based Study

2017 ◽  
Vol 44 (5) ◽  
pp. 558-564 ◽  
Author(s):  
Orla Ni Mhuircheartaigh ◽  
Cynthia S. Crowson ◽  
Sherine E. Gabriel ◽  
Veronique L. Roger ◽  
L. Joseph Melton ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Fragility Fracture ◽  
Fragility Fractures ◽  
Population Based ◽  
Cvd Risk ◽  
Cox Models ◽  
Excess Morbidity ◽  
Increased Risk ◽  
Time Dependent Covariates

Objective.Women and men with rheumatoid arthritis (RA) have an increased risk for fragility fractures and cardiovascular disease (CVD), each of which has been reported to contribute to excess morbidity and mortality in these patients. Fragility fractures share similar risk factors for CVD but may occur at relatively younger ages in patients with RA. We aimed to determine whether a fragility fracture predicts the development of CVD in women and men with RA.Methods.We studied a population-based cohort with incident RA from 1955 to 2007 and compared it with age- and sex-matched non-RA subjects. We identified fragility fractures and CVD events following the RA incidence/index date, along with relevant risk factors. We used Cox models to examine the association between fractures and the development of CVD, in which fractures and CVD risk factors were modeled as time-dependent covariates.Results.There were 1171 subjects (822 women; 349 men) in each of the RA and non-RA cohorts. Over followup, there were 406 and 346 fragility fractures and 286 and 225 CVD events, respectively. The overall CVD risk was increased significantly for RA subjects following a fragility fracture (HR 1.81, 95% CI 1.38–2.37) but not for non-RA subjects (HR 1.18, 95% CI 0.85–1.63). Results were similar for women and men with RA.Conclusion.Fragility fractures in both women and men with RA are associated with an increased risk for CVD events and should raise an alert to clinicians to target these individuals for further screening and preventive strategies for CVD.

Are patients with rheumatoid arthritis still at an increased risk of tuberculosis and what is the role of biological treatments?

2014 ◽  
Vol 74 (6) ◽  
pp. 1212-1217 ◽  
Author(s):  
Elizabeth V Arkema ◽  
Jerker Jonsson ◽  
Eva Baecklund ◽  
Judith Bruchfeld ◽  
Nils Feltelius ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
General Population ◽  
Population Based ◽  
Calendar Time ◽  
Cox Models ◽  
Increased Risk ◽  
National Cohort ◽  
Biologics Register

ObjectiveTo estimate the risk of tuberculosis (TB) in patients with rheumatoid arthritis (RA) both with and without exposure to biological therapy and to directly compare the risks between therapies.MethodsData from the Swedish National Population Registers, Tuberculosis Register and the Swedish Biologics Register were used to conduct a prospective population-based national cohort study (2002–2011). We estimated the rate of incident TB in the general population and in a cohort of biological-naïve and biological-exposed patients diagnosed with RA. Cox models were used to estimate HRs with particular attention to risks by calendar and follow-up time and individual biologics.ResultsCompared to the general population, RA patients not exposed to biologicals had a fourfold increased risk of TB (HR 4.2; 95% CI 2.7 to 6.7), which did not decline over calendar time. In contrast, the risk of TB in the biological-exposed RA population decreased since 2002 compared with biological-naïve; from HR=7.9 (95% CI 3.3 to 18.9) in 2002–2006 to HR=2.4 (95% CI 0.9 to 6.1) in 2007–2011. The HRs for most recent exposure to adalimumab and infliximab compared with etanercept were 3.1 (95% CI 0.8 to 12.5) and 2.7 (95% CI 0.7 to 10.9), respectively, and the HR for etanercept compared with biological-naïve RA was 1.7 (95% CI 0.6 to 4.6).ConclusionsIn the past decade, the risk of TB has decreased among biological-exposed RA patients but remains higher than in biological-naïve RA patients. Most cases of TB in RA occur in biological-naïve RA patients, underscoring the elevated risk also in these patients.

Abstract P132: Potato Consumption And Risk Of Diabetes And Cardiovascular Mortality In The Alpha Omega Cohort

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Esther Cruijsen ◽  
Anne W Simon ◽  
Indira M Indyk ◽  
Maria C Busstra ◽  
Johanna M Geleijnse
Keyword(s):  
Population Based ◽  
French Fries ◽  
Cox Models ◽  
Preparation Methods ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Alpha Omega ◽  
All Cause Mortality ◽  
Potato Consumption

Introduction: Higher potatoes intake, especially French fries, was unfavorably associated with cardiometabolic endpoints in population-based studies. Little is known about this in coronary heart disease (CHD) patients. Hypothesis: Boiled potatoes and French fries intake might increase the risk of type 2 diabetes (T2D), cardiovascular disease (CVD) mortality and all-cause mortality after myocardial infarction (MI). Methods: We analyzed 3401 Dutch patients (60-80 y, 78% male) from the Alpha Omega Cohort, free from T2D, with an MI ≤ 10 y before enrolment. Diet was assessed at baseline (2002-2006) using a 203-item validated food frequency questionnaire, including potato preparation methods. T2D incidence (self-reported physician diagnosis and/or prescribed anti-diabetes medication) was monitored during the first 40 months of follow-up and cause-specific mortality through December 2018. Multivariable Cox models were used to obtain Hazard Ratios (HRs) for incident T2D and fatal endpoints in potato categories. Results: Patients had a median potato intake (mainly boiled) of 111 g/d (3.8 weekly servings of 200 g), with 6% consuming <1 serving per week. French fries were consumed by 48% of the patients (median: 6 g/d). Total potato intake was non-linearly associated with T2D risk during early follow-up (186 cases). Compared to 0-2 servings, HRs were 1.52 (0.97, 2.39) for 3-4 servings and 1.78 (1.10, 2.89) for ≥5 servings per week. During >12 y of follow-up (38,987 person-years) 1618 deaths occurred, of which 697 from CVD, 431 from CHD and 128 from stroke. HRs for fatal endpoints were non-significant in categories of total and boiled potatoes (Table). For French fries (consumers vs. non-consumers), HRs were 1.23 (0.89, 1.69) for T2D, 1.03 (0.87, 1.22) for fatal CVD and 0.93 (0.83, 1.04) for all-cause mortality. Conclusion: In Dutch post-MI patients, potatoes (mainly boiled) were neutrally associated with CVD and all-cause mortality. An increased risk of T2D was found for French fries, which warrants further study in CHD patient cohorts.

scholarly journals Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study

2020 ◽  
Author(s):  
Hui Liu ◽  
Ning Hsieh ◽  
Zhenmei Zhang ◽  
Yan Zhang ◽  
Kenneth M Langa
Keyword(s):  
Cognitive Impairment ◽  
The United States ◽  
Population Based ◽  
Cognitive Status ◽  
Health And Retirement Study ◽  
Sex Partners ◽  
Physical And Mental Health ◽  
Same Sex ◽  
Same Sex Couples ◽  
Retirement Study

Abstract Objectives We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States. Methods We analyzed data from the Health and Retirement Study (2000–2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment. Results The estimated odds of cognitive impairment were 78% (p &lt; .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (odds ratio = 1.53, p &lt; .001). Discussion The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.

P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O L Rueda Ochoa ◽  
L R Bons ◽  
S Rohde ◽  
K E L Ghoud ◽  
R Budde ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Mortality ◽  
Total Mortality ◽  
Population Based ◽  
Cardiovascular Outcomes ◽  
Increased Risk ◽  
Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

scholarly journals Plasma Branched-Chain Amino Acids and Incident Cardiovascular Disease in the PREDIMED Trial

2016 ◽  
Vol 62 (4) ◽  
pp. 582-592 ◽  
Author(s):  
Miguel Ruiz-Canela ◽  
Estefania Toledo ◽  
Clary B Clish ◽  
Adela Hruby ◽  
Liming Liang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Amino Acids ◽  
Cardiovascular Death ◽  
Branched Chain Amino Acids ◽  
Control Group ◽  
Cvd Risk ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Branched Chain

Abstract BACKGROUND The role of branched-chain amino acids (BCAAs) in cardiovascular disease (CVD) remains poorly understood. We hypothesized that baseline BCAA concentrations predict future risk of CVD and that a Mediterranean diet (MedDiet) intervention may counteract this effect. METHODS We developed a case-cohort study within the Prevención con Dieta Mediterránea (PREDIMED), with 226 incident CVD cases and 744 noncases. We used LC-MS/MS to measure plasma BCAAs (leucine, isoleucine, and valine), both at baseline and after 1 year of follow-up. The primary outcome was a composite of incident stroke, myocardial infarction, or cardiovascular death. RESULTS After adjustment for potential confounders, baseline leucine and isoleucine concentrations were associated with higher CVD risk: the hazard ratios (HRs) for the highest vs lowest quartile were 1.70 (95% CI, 1.05–2.76) and 2.09 (1.27–3.44), respectively. Stronger associations were found for stroke. For both CVD and stroke, we found higher HRs across successive quartiles of BCAAs in the control group than in the MedDiet groups. With stroke as the outcome, a significant interaction (P = 0.009) between baseline BCAA score and intervention with MedDiet was observed. No significant effect of the intervention on 1-year changes in BCAAs or any association between 1-year changes in BCAAs and CVD were observed. CONCLUSIONS Higher concentrations of baseline BCAAs were associated with increased risk of CVD, especially stroke, in a high cardiovascular risk population. A Mediterranean-style diet had a negligible effect on 1-year changes in BCAAs, but it may counteract the harmful effects of BCAAs on stroke.

The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

2014 ◽  
Vol 24 (3) ◽  
pp. 219-227 ◽  
Author(s):  
Francisco J Tarazona-Santabalbina ◽  
Juan R Doménech-Pascual ◽  
Ángel Belenguer-Varea A ◽  
Eduardo Rovira Daudi
Keyword(s):  
Cognitive Impairment ◽  
Hip Fracture ◽  
Functional Recovery ◽  
Functional Outcomes ◽  
Older Patients ◽  
Future Research ◽  
Research Perspectives ◽  
Increased Risk ◽  
Risk Of Falls

SummaryHip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.

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