scholarly journals The Neutrophil to Lymphocyte Ratio Is Associated With the Risk of Subsequent Dementia in the Framingham Heart Study

2021 ◽  
Vol 13 ◽  
Author(s):  
Jaime Ramos-Cejudo ◽  
Andrew D. Johnson ◽  
Alexa Beiser ◽  
Sudha Seshadri ◽  
Joel Salinas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Predictive Value ◽  
Framingham Heart Study ◽  
Density Lipoprotein ◽  
Lymphocyte Ratio ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Heart Study ◽  
History Of

Objective: Active neutrophils are important contributors to Alzheimer’s disease (AD) pathology through the formation of capillary stalls that compromise cerebral blood flow (CBF) and through aberrant neutrophil signaling that advances disease progression. The neutrophil to lymphocyte ratio (NLR) is a proxy of neutrophil-mediated inflammation, and higher NLR is found in persons diagnosed with clinical AD. The objective of this study was to investigate whether increased NLR in older adults is independently associated with the risk of subsequent dementia.Methods: We examined associations of baseline NLR with incident dementia risk in the community-based Framingham Heart Study (FHS) longitudinal cohorts. The association between NLR and risk of dementia was evaluated using the cumulative incidence function (CIF) and inverse probability-weighted Cox proportional cause-specific hazards regression models, with adjustment for age, sex, body mass index (BMI), systolic and diastolic blood pressure, diabetes, current smoking status, low-density lipoprotein (LDH), high-density lipoprotein (LDL), total cholesterol, triglycerides, and history of cardiovascular disease (CVD). Random forest survival models were used to evaluate the relative predictive value of the model covariates on dementia risk.Results: The final study sample included 1,648 participants with FHS (average age, 69 years; 56% women). During follow-up (median, 5.9 years), we observed 51 cases of incident dementia, of which 41 were AD cases. Results from weighted models suggested that the NLR was independently associated with incident dementia, and it was preceded in predictive value only by age, history of CVD, and blood pressure at baseline.Conclusion: Our study shows that individuals with higher NLR are at a greater risk of subsequent dementia during a 5.9-year follow-up period. Further evaluating the role of neutrophil-mediated inflammation in AD progression may be warranted.

Haemostatic, Endothelial and Lipoprotein Parameters and Blood Pressure Levels in Women with a History of Preeclampsia

1999 ◽  
Vol 81 (04) ◽  
pp. 538-542 ◽  
Author(s):  
Shu He ◽  
Angela Silveira ◽  
Anders Hamsten ◽  
Margareta Blombäck ◽  
Katarina Bremme
Keyword(s):  
Blood Pressure ◽  
Low Density Lipoprotein ◽  
Lipoprotein Metabolism ◽  
Density Lipoprotein ◽  
Normal Pregnancy ◽  
Index Pregnancy ◽  
History Of ◽  
Von Willebrand ◽  
Willebrand Factor

SummaryTo determine whether perturbations of haemostatic function and lipoprotein metabolism prevail long after preeclampsia and increase the risk of future coronary heart disease (CHD), we conducted a follow-up study in women with (cases, n = 25) or without (controls, n = 24) a history of preeclampsia. Blood samples were taken in the follicular and in the luteal phases of a menstrual cycle. Levels of blood pressure (BP) and proteinuria measured during the index pregnancy were included in the evaluation. Compared to control women who had undergone a normal pregnancy, the formerly preeclamptic patients had higher systolic (p <0.01) and diastolic (p <0.05) BPs and increased plasma levels of von Willebrand factor (vWF), fibrinogen, cholesterol, triglycerides and very low density lipoprotein (VLDL) (all p <0.05). The lipid, vWF, and fibrinogen levels were positively related to the degree of BP elevation but not to the degree of proteinuria during the index pregnancy. Except for the increase in vWF level, all biochemical perturbations were only present in the luteal but not in the follicular phase samples. In conclusion, persistent endothelial dysfunction with ensuing dysregulation of blood pressure, haemostatic perturbation and dyslipoproteinemia after preeclampsia may indicate a proneness to future CHD.

scholarly journals Bi-directional association between epilepsy and dementia

Neurology ◽  
2020 ◽  
Vol 95 (24) ◽  
pp. e3241-e3247 ◽  
Author(s):  
Maria Stefanidou ◽  
Alexa S. Beiser ◽  
Jayandra Jung Himali ◽  
Teng J. Peng ◽  
Orrin Devinsky ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Heart Study ◽  
Allele Status ◽  
Ε4 Allele ◽  
Nested Case Control

ObjectiveTo assess the risk of incident epilepsy among participants with prevalent dementia and the risk of incident dementia among participants with prevalent epilepsy in the Framingham Heart Study (FHS).MethodsWe analyzed prospectively collected data in the Original and Offspring FHS cohorts. To determine the risk of developing epilepsy among participants with dementia and the risk of developing dementia among participants with epilepsy, we used separate, nested, case–control designs and matched each case to 3 age-, sex- and FHS cohort–matched controls. We used Cox proportional hazards regression analysis, adjusting for sex and age. In secondary analysis, we investigated the role of education level and APOE ε4 allele status in modifying the association between epilepsy and dementia.ResultsA total of 4,906 participants had information on epilepsy and dementia and dementia follow-up after age 65. Among 660 participants with dementia and 1,980 dementia-free controls, there were 58 incident epilepsy cases during follow-up. Analysis comparing epilepsy risk among dementia cases vs controls yielded a hazard ratio (HR) of 1.82 (95% confidence interval 1.05–3.16, p = 0.034). Among 43 participants with epilepsy and 129 epilepsy-free controls, there were 51 incident dementia cases. Analysis comparing dementia risk among epilepsy cases vs controls yielded a HR of 1.99 (1.11–3.57, p = 0.021). In this group, among participants with any post–high school education, prevalent epilepsy was associated with a nearly 5-fold risk for developing dementia (HR 4.67 [1.82–12.01], p = 0.001) compared to controls of the same educational attainment.ConclusionsThere is a bi-directional association between epilepsy and dementia. with either condition carrying a nearly 2-fold risk of developing the other when compared to controls.

scholarly journals Serum Potassium is not Associated with Blood Pressure Tracking in the Framingham Heart Study

Circulation ◽  
2001 ◽  
Vol 103 (suppl_1) ◽  
pp. 1360-1360
Author(s):  
Craig R Walsh ◽  
Martin G Larson ◽  
Vasan S Ramachandran ◽  
Danial Levy
Keyword(s):  
Blood Pressure ◽  
Serum Potassium ◽  
Framingham Heart Study ◽  
Logistic Regression Model ◽  
Community Based ◽  
Heart Study ◽  
Risk Of Progression ◽  
Adjusted Logistic Regression ◽  
Low K

P52 Introduction Secondary and inherited, monogenic forms of hypertension (HTN) are often associated with low serum potassium (K). We hypothesized that low K may identify individuals at risk for progression of blood pressure (BP) stage. Methods 2358 participants (1066 men 1292 women) in the Framingham Heart Study free of HTN and not taking drugs affecting K who had K measured in 1979-83 were followed for progression of BP stage and development of HTN. Progression of BP stage was defined as increment of ≥1 JNC-VI BP category between baseline and follow-up exams. Results There were no differences in baseline systolic or diastolic BPs across K quartiles. Over 4 years of follow up, 36% progressed by ≥1 JNC-VI BP category. In a multivariable-adjusted logistic regression model, there was no significant association between K quartile and risk of BP progression ( table). During follow up, 14% progressed to HTN. After adjustment for multiple confounders, there was no significant association between K quartile and risk of progression to HTN ( table). Conclusions In our community-based sample, K was not associated with current BP, longitudinal BP tracking, or progression to HTN. Table 1.

Value of Childhood Blood Pressure Measurements and Family History in Predicting Future Blood Pressure Status: Results From 8 Years of Follow-up in the Bogalusa Heart Study

PEDIATRICS ◽  
1986 ◽  
Vol 77 (6) ◽  
pp. 862-869 ◽  
Author(s):  
Charles L. Shear ◽  
Gregory L. Burke ◽  
David S. Freedman ◽  
Gerald S. Berenson
Keyword(s):  
Blood Pressure ◽  
Family History ◽  
Age Groups ◽  
Correlation Coefficients ◽  
Pressure Measurements ◽  
Bogalusa Heart Study ◽  
Heart Study ◽  
History Of ◽  
Family History Of Hypertension

The value of BP measurements and family history of cardiovascular disease in predicting future BP status was studied in 1,501 children, initially 2 to 14 years of age, who were examined four times during an 8-year period in the Bogalusa Heart Study. Correlation coefficients between year 1 and year 9 BPs were as follows for systolic and diastolic BPs, respectively: 0.41 and 0.35 (P &lt; .0001). These correlations were significant in all age groups. For children in the upper quartile of BP at any one prior examination, the percentage remaining in the year 9 upper quartile ranged from 41% to 52% for systolic BP and 35% to 44% for diastolic BP. Three serial BP measurements in the upper quartile increased the percentages remaining in the upper quartile to 68% for systolic BP and 62% for diastolic BP. Conversely, of those children not in the upper quartile of systolic BP at year 9, 96.8% did not have all three prior measurements in the upper quartile. Family history of hypertension was shown to independently predict year 9 systolic BP status. These results confirm the importance of serial BP measurements and family history of hypertension for the practicing physician.

Diuretic medication use reduces incident dementia risk: A meta-analysis of prospective studies

2016 ◽  
Vol 33 (S1) ◽  
pp. S86-S86
Author(s):  
P. Tully ◽  
O. Hanon ◽  
S. Cosh ◽  
C. Tzourio
Keyword(s):  
Alzheimer’S Disease ◽  
Blood Pressure ◽  
Alzheimer's Disease ◽  
Fixed Effects ◽  
Disease Risk ◽  
Medication Use ◽  
Placebo Control ◽  
Dementia Risk ◽  
Incident Dementia

IntroductionNumerous observational studies suggest that blood pressure management with antihypertensive drugs may be effective in reducing dementia risk.ObjectiveTo quantify dementia risk in relation to diuretic medication use.MethodsElectronic databases were searched until June 2015. Eligibility criteria: population, adults without dementia at baseline from primary care, community cohort, residential/institutionalized or randomized controlled trial (RCT); exposure, diuretic medication; comparison, no diuretic medication, other or no antihypertensive medication, placebo-control; outcome, incident dementia in accordance with standardized criteria. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were pooled in fixed-effects models with RevMan 5.3. The overall quality and strength of evidence was rated with GRADE criteria.ResultsFifteen articles were eligible comprising a pooled sample of 52,599 persons and 3444 incident dementia cases (median age 76.1 years, 40% male) with a median follow-up of 6.1 years. Diuretic use was associated with 17% reduction in dementia risk (HR 0.83; 95% CI 0.75 to 0.90) and a 21% reduction in Alzheimer's disease risk (HR 0.79; 95% CI 0.68 to 0.93). GRADE was rated as moderate. Risk estimates were consistent comparing monotherapy versus combination therapy, study design and follow-up. Meta-regression did not suggest that age, gender, systolic blood pressure, attrition, mortality rate, education, cognitive function, stroke, Apolipoprotein E allele, heart failure or diabetes altered the primary results.ConclusionsDiuretic medication was associated with a consistent reduction in dementia and Alzheimer's disease risk and the absence of heterogeneity points to the generalizability of these findings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Longitudinal association of dairy consumption with the changes in blood pressure and the risk of incident hypertension: the Framingham Heart Study

2015 ◽  
Vol 114 (11) ◽  
pp. 1887-1899 ◽  
Author(s):  
Huifen Wang ◽  
Caroline S. Fox ◽  
Lisa M. Troy ◽  
Nicola M. Mckeown ◽  
Paul F. Jacques
Keyword(s):  
Blood Pressure ◽  
Framingham Heart Study ◽  
Medication Use ◽  
Low Fat ◽  
Incident Hypertension ◽  
Dairy Foods ◽  
Dairy Consumption ◽  
Heart Study ◽  
Longitudinal Association

AbstractWe aimed to examine the longitudinal association of dairy consumption with the changes in blood pressure (BP) and the risk of incident hypertension (HTN) among adults. This study included 2636 Framingham Heart Study Offspring Cohort members who participated in the 5th through 8th examinations (1991–2008) and were free of HTN at their first examination during the follow-up. Data collected at each examination included dietary intake (by a validated FFQ), BP (following standardised procedures) and anti-hypertensive medication use (by physician-elicited self-report). HTN was defined as systolic BP (SBP)≥140 mmHg, or diastolic BP (DBP)≥90 mmHg or anti-hypertensive medication use. We used repeated-measure and discrete-time hazard regressions to examine the associations of dairy consumption with the annualised BP change (n2075) and incident HTN (n2340; cases=1026), respectively. Covariates included demographic, lifestyle, overall diet quality, metabolic factors and medication use. Greater intakes of total dairy foods, total low-fat/fat-free dairy foods, low-fat/skimmed milk and yoghurt were associated with smaller annualised increments in SBP and a lower risk of projected HTN incidence. However, with the exception of total dairy foods and yoghurt, these inverse associations with HTN risk were attenuated as the follow-up time increased. For yoghurt, each additional serving was associated with 6 (95 % CI 1, 10) % reduced risk of incident HTN. Total dairy and total low-fat/fat-free dairy intakes were found to be inversely related to changes in DBP. Dairy consumption, as part of a nutritious and energy-balanced diet pattern, may benefit BP control and prevent or delay the onset of HTN.

Association between widespread pain and dementia, Alzheimer’s disease and stroke: a cohort study from the Framingham Heart Study

2021 ◽  
pp. rapm-2021-102733
Author(s):  
Kanran Wang ◽  
Hong Liu
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Chronic Pain ◽  
Cohort Study ◽  
Framingham Heart Study ◽  
Widespread Pain ◽  
Dementia Risk ◽  
Heart Study ◽  
Alzheimer’S Disease Dementia

Background and objectiveChronic pain may be an early indicator of cognitive decline, but previous studies have not systematically examined the population-level associations between widespread pain and adverse cognitive outcomes and stroke. This study was designed to determine the association between widespread pain, a common subtype of chronic pain, and subsequent dementia, Alzheimer’s disease dementia and stroke.MethodsThis retrospective cohort study used data from the US community-based Framingham Heart Study. Pain status was assessed at a single time point between 1990 and 1994. Widespread pain was determined based on the Framingham Heart Study pain homunculus. Dementia follow-up occurred across a median of 10 years (IQR, 6–13 years) for persons who were dementia free at baseline. Proportional hazard models examined associations between widespread pain and incident dementia, Alzheimer’s disease dementia and stroke.ResultsA total of 347 (14.1%) subjects fulfilled the criteria for widespread pain, whereas 2117 (85.9%) subjects did not. Of 188 cases of incident all-cause dementia, 128 were Alzheimer’s disease dementia. In addition, 139 patients suffered stroke during the follow-up period. After multivariate adjustment including age and sex, widespread pain was associated with 43% increase in all-cause dementia risk (HR: 1.43; 95% CI 1.06 to 1.92), 47% increase in Alzheimer’s disease dementia risk (HR: 1.47; 95% CI 1.13 to 2.20) and 29% increase in stroke risk (HR: 1.29; 95% CI 1.08 to 2.54). Comparable results were shown in the subgroup of individuals over 65 years old.ConclusionWidespread pain was associated with an increased incidence of all-cause dementia, Alzheimer’s disease dementia and stroke.Trial registration numberNCT00005121.

Abstract 74: Relationship Between Preeclampsia and Subsequent Stroke: A Secondary Analysis of the Framingham Heart Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Alen Delic ◽  
Lauren Theilen ◽  
Heidi Hanson ◽  
Karen Schliep ◽  
...  
Keyword(s):  
Framingham Heart Study ◽  
Structural Model ◽  
Later Life ◽  
Outcome Data ◽  
Time Dependent ◽  
Marginal Structural Model ◽  
Heart Study ◽  
Increased Risk ◽  
History Of

Introduction: Although prior studies have examined the later-life risk of stroke in women with a history of preeclampsia, they have relied on claims data or epidemiological studies with poorly detailed risk factor or outcome data. The Framingham Heart Study (FHS) is a landmark epidemiological study that began in 1948 and followed participants aged 30-59 at baseline until death. The study enrolled 5,209 residents of Framingham, Massachusetts, almost half of which were female. The adjudicated outcome of stroke was ascertained during follow-up visits until 2015, death, or loss to follow-up. Methods: We examined a cohort of 2,136 women from FHS for an association of preeclampsia with stroke occurrence. With each subject having their own unique history of exposures and treatments that vary over time, standard approaches of adjusting for confounding are biased when time-dependent confounders exist. Using a marginal structural model, the effects of possible time-dependent confounders were controlled for using inverse-probability-of-treatment weighted estimators. At each of the study visits, potential confounders were evaluated. Variables controlled for, across the study visits, included age, blood pressure, cholesterol, weight, glucose, treatment for hypertension, treatment for hyperlipidemia, and smoking. Results: Two hundred women (9.4%) had preeclampsia and 380 women (17.8%) had strokes. As compared with the 1,936 women who did not have a history with preeclampsia, the 200 women with a history of preeclampsia had a significantly higher risk of stroke (adjusted Hazard Ratio, 2.29; 95% CI, 1.13 - 4.63) when controlling for time-dependent confounders. Conclusion: A history of preeclampsia is associated with a significantly increased risk of a future stroke. Prior approaches to analyses of this nature have not fully emphasized the importance of controlling for time-dependent confounders with methods such as marginal structural modeling. We plan on analyzing the mediators of the observed association to determine which risk factors might prove beneficial for disease-modifying treatment in midlife.

Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Huang ◽  
C Liu
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: &lt;120mmHg, ≥120mmHg and &lt;130mmHg, ≥130mmHg and &lt;140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of &lt;120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of &lt;120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

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