Mini-Mental State Examination score and B-type natriuretic peptide as predictors of cardiovascular and total mortality in an elderly general population

INTRODUCTION. The aim of the present study was to examine the power of B-type natriuretic peptide (BNP) and mild cognitive impairment as independent predictors of total and cardiovascular mortality in combination with established cardiovascular risk markers in an elderly general population without severe cognitive impairment. METHODS. A total of 499 individuals, aged more than 75 years, were examined and followed up for a median of 7.9 years in a prospective population-based stratified cohort study carried out in eastern Finland. The Cox proportional hazards regression model was used to determine the impact of multiple factors on total and cardiovascular mortality. RESULTS. In a multivariable model including established cardiovascular risk factors and conditions, both continuous BNP (adjusted hazard ratio (HR) 1.44 for a 1-SD change; 95% confidence interval (CI) 1.22-1.77; P < 0.001) and continuous MMSE score (HR 0.81 for a 1-SD change; 95% CI 0.70-0.94; P = 0.007) were independently associated with all-cause mortality. In a multivariable model, BNP remained a significant predictor of cardiovascular mortality, while MMSE score lost its significance. CONCLUSIONS. BNP, a measure of cardiovascular burden, and MMSE score 18-23, an indicator of mild cognitive impairment, are both independent predictors of total mortality. BNP and MMSE score may potentially be useful in screening elderly patients for elevated risk of mortality.     

Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment

Purpose:?To assess the association between cognitive status and functional gain during a rehabilitation programme for elderly patients with hip fracture.

Method:?Prospective study in a hospital geriatric rehabilitation unit. Sixty-one consecutive patients were studied: 28 with cognitive impairment (age 87.6?±?7.2 years, Mini Mental State Examination (MMSE) score 11.25?±?5.9), 23 with possible cognitive impairment (age 83.9?±?6.8 years, MMSE 22.65?±?1.6) and 10 without cognitive impairment (age 77.6?±?7.4 years, MMSE 29.5?±?0.9). Cognitive status was assessed with the MMSE and admission and discharge functional status with the Functional Independence Measure (FIM). Functional gain was calculated by absolute FIM gain (admission FIM minus discharge FIM), relative (to maximum potential) FIM gain with the Montebello Rehabilitation Factor Score (MRFS) and analysis of covariance of the FIM (ANCOVA).

Results:?Patients without cognitive impairment had significantly higher admission FIM and discharge FIM. Cognitive status was not significantly associated with absolute functional gain. The adjusted (age, gender, sensory impairment, nutritional status, comorbidity and treatment) MRFS score of cognitively impaired patients was significantly lower (p?<?0.03). However, the functional gain related to baseline functional status (ANCOVA) was not significantly different between the groups.

Conclusions:?In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes.     

American heart association’s cardiovascular health metrics and risk of cardiovascular disease mortality among a middle-aged male Scandinavian population

Abstract

Background: The burden of cardiovascular disease (CVD) prompted the American Heart Association to develop a cardiovascular health (CVH) metric as a measure to assess the cardiovascular status of the population. We aimed to assess the association between CVH scores and the risk of CVD mortality among a middle-aged Finnish population.

Methods: We employed the prospective population-based Kuopio Ischemic Heart Disease cohort study comprising of middle-aged men (42–60 years). CVH scores were computed among 2607 participants at baseline and categorized as optimum (0–4), average (5–9), or inadequate (10–14) CVH. Multivariate cox regression models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) of CVH score for cardiovascular mortality.

Results: During a median follow-up period of 25.8 years, 609 CVD mortality cases were recorded. The risk of CVD mortality increased gradually with increasing CVH score across the range 3–14 (p-value for non-linearity =.77). Men with optimum CVH score had HR (95% CI) for CVD mortality of 0.30 (CI 0.21 – 0.42, p?<?.0001) compared to those with inadequate CVH score after adjustment for conventional cardiovascular risk factors.

Conclusions: CVH score was strongly and continuously associated with the risk of CVD mortality among middle-aged Finnish population and this was independent of other conventional risk factors.

• Key messages

• Achieving optimum cardiovascular health score reduces the risk of cardiovascular mortality.

• Adopting the American Heart Association’s cardiovascular health metrics is a welcome approach for public health awareness and monitoring of cardiovascular health among Scandinavian population.

     

≥75岁急诊心房颤动患者的预后分析——中国急诊心房颤动研究的亚组分析

目的:了解老年（年龄≥75岁）急诊心房颤动（房颤）患者的预后情况,分析不良预后的危险因素。方法:2009年至2011年在全国20家医院连续入选急诊就诊、年龄≥75岁房颤患者为本研究对象,收集患者基线资料和治疗情况,并进行1年随访,主要终点事件为全因死亡,次要终点事件为心血管死亡、卒中、大出血事件及主要不良事件。应用单因素和多因素Cox回归模型分析上述事件的独立危险因素。结果:共入选766例老年急诊房颤患者,年龄(80.76±4.66)岁,女性占56.9%。1年的全因病死率为24.3%,心血管病死率为12.8%,卒中发生率为10.6%,主要不良事件发生率33.6%,再入院率32%。多因素Cox回归模型分析显示年龄（ HR1.073,95% CI 1.042~1.105）、心率（ HR 1.008,95% CI 1.002~1.013）、痴呆/认知障碍史（ HR 1.849,95% CI 1.016~3.365）、既往慢性阻塞性肺疾病史（ HR 1.824,95% CI 1.303~2.551）为老年房颤患者1年死亡的独立危险因素。女性（ HR 1.664,95% CI 1.036~2.675）、高血压病史（ HR 2.035,95% CI 1.080~3.836）、痴呆/认知障碍史（ HR 2.773,95% CI 1.220~6.302）、为老年房颤患者1年卒中的独立危险因素。 结论:老年急诊房颤患者的预后较差,年龄、心率、痴呆/认知障碍史、慢性阻塞性肺疾病史是老年急诊房颤患者1年全因死亡和主要不良事件的独立危险因素;女性、高血压病史、痴呆/认知障碍史为老年急诊房颤患者1年卒中的独立危险因素。     

Evaluation of Cognitive Functioning in the Context of Rehabilitation for Visual Impairment in Older Adults: A Case Series

Aims: As the risk of visual impairment increases with age, so does the risk of developing cognitive impairment. Detection of cognitive deficits in people with visual impairments is a challenge and it remains unclear to what extent cognitive issues impact daily habits and the rehabilitation process. The present study aimed to (1) verify the consistency between the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) (“Blind” versions) and the therapist's observations of elderly individuals in low-vision rehabilitation (LVR), and (2) document how cognitive difficulties may influence LVR and the satisfactory carrying-out of life habits. Methods: Six elderly individuals who received LVR completed the MMSE and MoCA (“Blind” versions) and Assessment of Life Habits (LIFE-H). The therapist rated the achievement of rehabilitation objectives, clients' cognitive functioning and its impact on the rehabilitation process. Results: All participants obtained scores within the normative score range for both tests except for one participant on the MoCA. The therapist perceived that four out of six participants had cognitive difficulties significant enough to hinder the rehabilitation process and these persons required more adaptations to therapy. All participants were satisfied with their life habits despite remaining functional limitations and the need for assistance. Conclusions: In this sample, standardized cognitive tests had limited utility to predict the complexity of LVR. Even if present, cognitive difficulties do not preclude rehabilitation for even severe visual impairment in elderly persons and does not imply significantly longer or more intense rehabilitation.     

Abdominal aortic calcification detected by dual X-ray absorptiometry: A strong predictor for cardiovascular events

Abstract

Background. Vertebral fracture assessment (VFA) using dual-energy X-ray absorptiometry can visualize abdominal aortic calcification (AAC). AAC correlates with total atherosclerosis burden. We questioned whether VFA-detected AAC could be used for cardiovascular risk assessment.

Methods. VFA images of 2,500 subjects were evaluated to detect and score AAC (n = 164). A random age- and gender-matched set of subjects (n = 325) without AAC served as control group. Patients with prior cardiovascular disease or procedures were excluded. Base-line cardiovascular risk factors and further cardiovascular events were checked. Design-based Cox regression analysis was used to examine the prognostic value of AAC for cardiovascular outcomes.

Results. AAC-positive subjects were divided into two groups: low-AAC (score 1–3), and high-AAC group (score > 3). Mean age in the groups was 68, 68, and 71 years, percentage of females was 64.4%, 61%, and 66.1%, and the proportion of cardiovascular events within groups was 1.5%, 6.7%, and 11.9% in control, low-AAC, and high-AAC groups, respectively. Age- and gender-adjusted as well as multivariable analysis showed a significant, higher risk for cardiovascular events incidence in AAC-positive, low-AAC, and high-AAC when compared to the control group.

Interpretation. AAC assessed with routine VFA was shown to be a strong predictor for cardiovascular events.     

高血压与老年人认知功能障碍的相关性

目的探讨老年人高血压与认知功能障碍的相关性方法选择2011年1月~2013年12月在我院就诊的原发性老年高血压患者（病程5年以上）326例作为观察组,并选取老年健康人群320例作对照。对选择对象采用中文版简易智能量表评定认知功能,对两组人群采用对照分析的方法。结果（1）高血压组患者的简易智能量表得分均明显低于正常对照组（P<0.01）;高血压组患者的轻度认知功能障碍比例明显高于正常对照组（P<0.01）;（2）随着血压分级的升高,简易智能量表得分呈下降趋势,轻度认知功能障碍的患病率也随之增高,差异均有显著性意义（P<0.01）;（3）轻度认知功能障碍患病率与高血压分级、LDL-c、OGTT2 h血糖呈显著正相关。结论（1）高血压疾病与老年人认知障碍的发生关系密切,并且高血压程度越高,认知障碍越严重;（2）老年人认知障碍与高血压分级、低密度脂蛋白、OGTT2 h血糖等危险因素相关。     

Comorbidities and risk of mortality in patients with sleep apnea

Background: A variety of disorders, most notably cardiovascular diseases, was linked to sleep apnea (SA), but their impact on mortality of SA patients had not been systematically investigated. We aimed to develop a composite index based on the comorbidity burden to predict mortality risk.

Methods: Using Taiwan National Health Insurance Research Database, 9853 adult SA patients were enrolled and their comorbidity profile at baseline was recorded. The subjects were followed from 1995 till death or the end of 2011. A Cox regression model was used for multivariable adjustment to identify independent predictors for mortality.

Results: During an average follow-up period of 5.3?±?3.1 years, 311 (3.2%) subjects died. SA patients with any comorbidity had a higher risk for death compared to those without comorbidity (HR: 11.01, 95% CI 4.00–30.33, p?6 were 1 (reference), 3.29 (95% CI, 2.04–5.28, p?Conclusions: Based on the comorbidity burden, we developed an easy-to-use tool to evaluate mortality risk in SA.

• Key messages:

• Sleep apnea (SA) is linked to a variety of disorders, particularly cardiovascular diseases. SA patients with any comorbidity may experience a higher risk of death in comparison to those without comorbidity.

• Comorbidities related to increased mortality are identified and converted into a simple risk indicator, the CoSA (Comorbidities of Sleep Apnea) index scores, which may help to stratify risk of death in daily practice.

     

Family history of myocardial infarction is an independent risk factor for venous thromboembolism: the Tromsø study

Summary. Background: Recent studies indicate that arterial cardiovascular diseases and venous thromboembolism (VTE) share common risk factors. A family history of myocardial infarction (MI) is a strong and independent risk factor for future MI. Objectives: The purpose of the present study was to determine the impact of cardiovascular risk factors, including family history of MI, on the incidence of VTE in a prospective, population‐based study. Patients and methods: Traditional cardiovascular risk factors and family history of MI were registered in 21 330 subjects, aged 25–96 years, enrolled in the Tromsø study in 1994–95. First‐lifetime VTE events during follow‐up were registered up to 1 September 2007. Results: There were 327 VTE events (1.40 per 1000 person‐years), 138 (42%) unprovoked, during a mean of 10.9 years of follow‐up. In age‐ and gender‐adjusted analysis, age [hazard ratio (HR) per decade, 1.97; 95% confidence interval (CI), 1.82–2.12], gender (men vs. women; HR, 1.25; 95% CI, 1.01–1.55), body mass index (BMI; HR per 3 kg m^?2, 1.21; 95% CI, 1.13–1.31), and family history of MI (HR, 1.31; 95% CI, 1.04–1.65) were significantly associated with VTE. Family history of MI remained a significant risk factor for total VTE (HR, 1.27; 95% CI, 1.01–1.60) and unprovoked VTE (HR, 1.46; 95% CI, 1.03–2.07) in multivariable analysis. Blood pressure, total cholesterol, HDL‐cholesterol, triglycerides, and smoking were not independently associated with total VTE. Conclusions: Family history of MI is a risk factor for both MI and VTE, and provides further evidence of a link between venous and arterial thrombosis.     

Verification of the Correlation between Cognitive Function and Lower Limb Muscle Strength for the Community-dwelling Elderly

[Purpose] The purpose of this study was to evaluate the lower limb muscle strength of the community-dwelling elderly, with or without cognitive decline, using isometric knee extension strength (IKES) and the 30-second chair stand test (CS-30). [Subjects] A total of 306 community-dwelling elderly participated in this study. Assessment items were the CS-30, IKES, Mini-Mental State Examination (MMSE), and Trail-Making Test Part A (TMT-A). [Methods] Participants were divided into three groups according to their MMSE score: cognitive impairment (MMSE ≤ 24), cognitive decline (MMSE 25 to 27), and normal (MMSE ≥ 28). We compared IKES and CS-30 among the three groups. [Results] IKES was not significantly different among the three groups. However, the CS-30 was significantly different among the three groups. Upon further analysis the CS-30 score of each group, when adjusted for age and TMT-A, did not indicate a significant difference. [Conclusion] These results suggest that the lower limb muscle strength of the elderly does not differ with cognitive decline. Moreover, we suggest that when using the CS-30 score as an indicator of lower limb muscle strength attentional function should be taken into account.Key words: Isometric knee extension strength, CS-30, Attentional function     

Place orientation and visual construction subdomains of the Mini Mental State Examination test as predictors of rehabilitation outcome of post-acute hip-fractured patients

Purpose: The study aimed at assessing the relationship between various Mini Mental State Examination (MMSE) subdomains and rehabilitation achievements in post-acute hip-fractured patients.

Method: Six hundred and five hip-fractured patients admitted during 2010–2013 to a post-acute geriatric rehabilitation center were included in the study. Main outcome measures were the Functional Independence Measure (FIM) instrument, the motor FIM (mFIM), the Montebello Rehabilitation Factor Score (MRFS) on the mFIM and length of stay (LOS). A logistic regression analysis tested the predictive value of MMSE subdomains for achieving a satisfactory functional gain (mFIM MRFS >30%) on operated patients admitted from community.

Results: Of all the six MMSE subdomains, place orientation and visual construction demonstrated significant predictive values for rehabilitation outcome. Patients who did not err on place orientation and visual construction MMSE domains had better probabilities [(OR 1.28, 95%CI, 1.05–1.58; p?=?0.017); (OR 2.15, 95%CI, 1.28–3.59; p?=?0.004), respectively] of achieving better rehabilitation achievements. Similar results were obtained for cognitively impaired patient groups [(OR 1.40 95%CI, 1.11–1.77; p?=?0.005); (OR 2.47, 95%CI, 1.15–5.30; p?=?0.021), respectively]. For the cognitively intact patient group, the variables with significant predictive value were time orientation and visual construction MMSE subdomains [(OR 2.26, 95%CI, 1.18–4.33; p?=?0.014); (OR 2.87, 95%CI, 1.16–7.09; p?=?0.022), respectively].

Conclusions: Post-acute hip-fractured patients scoring normally on place orientation and visual construction MMSE subdomains have a better chance of achieving favorable rehabilitation outcome.

• Implications for Rehabilitation

• Post-acute hip-fractured patients have a better chance to achieve a favorable rehabilitation outcome when scoring normally on place orientation and visual construction MMSE subdomains.

• Patients having difficulties in orientation and visual construction may need more rehabilitation time as they lack planning and organizational capacity to follow instructions.

• Assessing MMSE subdomains may reveal subtle cognitive impairment in patients scored within the normal range on the MMSE test.

• Identifying subtle cognitive impairment may assist in coordinating the patients and their caregivers' expectations, efficiently allocating resources and help in advanced care planning.

     

Survival in patients with hypertension treated in primary care A population-based follow-up study in the Skaraborg Hypertension and Diabetes Project

Objective – To explore risk factors for all-cause mortality in patients with hypertension.

Design – Community-based cohort study.

Setting – Hypertension outpatient clinic in primary health care.

Subjects – Hypertensive men and women who consecutively underwent an annual follow-up during 1992–1993 (n=894).

Methods – Vital status was ascertained up to December 1999 by record linkage with national registers. Gender-specific predictors for mortality from baseline examination were analysed by Cox regression.

Main outcome measure – All-cause mortality.

Results – In both sexes all-cause mortality was predicted by fasting blood glucose (RR by 1 mmol L^?1: 1.2, CI: 1.1–1.3 in men; 1.2, 1.1–1.4 in women), and known type 2 diabetes (RR: 1.9, CI: 1.3–2.9 in men; 2.5, 1.7–3.9 in women). In men, furthermore, mortality was predicted by previous cardiovascular disease, left ventricular hypertrophy and microalbuminuria, whilst in women mortality was predicted by high blood pressure and dyslipidemia. In patients without known diabetes male gender was a strong predictor of mortality (RR: 2.0, CI: 1.4–2.9), whereas in patients with hypertension and type 2 diabetes combined, male gender was not associated with increased mortality (RR: 1.4, CI: 0.9–2.2).

Conclusion – Type 2 diabetes in hypertensive patients treated in primary care predicts mortality and dilutes gender difference in survival. For hypertensive patients general practitioners should be observant regarding disturbed glucose metabolism and regarding the associated major risk increase in women.     

Health 2000 score – development and validation of a novel cardiovascular risk score

Background: Previous risk scores for predicting myocardial infarctions and strokes have mainly been based on conventional risk factors. We aimed to develop a novel improved risk score that would incorporate other widely available clinical variables for predicting the broadest range of endpoints, including revascularizations.

Methods: A nationwide sample of 5843 Finns underwent a clinical examination in 2000–2001. The participants were followed for a median of 11.2 years for incident cardiovascular events. Model discrimination and calibration were assessed and internal validation was performed.

Results: Sex, age, systolic blood pressure, total cholesterol, HDL cholesterol, smoking status, parental death from cardiovascular disease, left ventricular hypertrophy, hemoglobin A1c, and educational level remained significant predictors of cardiovascular events (p?≤?0.005 for all). The share of participants with ≥10% estimated cardiovascular risk was 28.9%, 18.5%, 36.9% and 23.8% with the Health 2000, Finrisk, Framingham and Reynolds risk scores. The Health 2000 score (c-statistic: 0.850) showed superior discrimination to the Framingham (c-statistic improvement: 0.021) and Reynolds (c-statistic improvement: 0.007) scores (p?c-statistic improvement: 0.006, p?=?0.003).

Conclusions: The Health 2000score improves cardiovascular risk prediction in the current study population.

• KEY MESSAGES

• Previous risk scores for predicting myocardial infarctions and strokes have mainly been based on conventional risk factors.

• We aimed to develop a novel improved risk score that would incorporate other widely available clinical variables (including left ventricular hypertrophy, hemoglobin A1c, and education level) for predicting the broadest range of endpoints, including revascularizations.

• The Health 2000 score improved cardiovascular risk prediction in the current study population compared with traditional cardiovascular risk prediction scores.

     

东小口社区老年人认知障碍的影响因素分析

目的分析东小口社区老年人认知障碍的影响因素。方法将东小口社区366例参加老年人健康体检者按照记忆障碍自评量表(AD8)评分是否≥2分分为观察组(≥2分,认知障碍患者,116例)与对照组(<2分,健康体检者,250例)。分析认知障碍发生的影响因素。结果两组的社会活动能力评分、SDS评分、ADL评分、受教育年限、高血压、卒中史比较,差异均具有统计学意义(P<0.05);多因素Logistic回归分析结果显示,社会活动能力评分、SDS评分及卒中史均为影响老年人认知障碍的独立危险因素(P<0.05)。结论社会活动能力、SDS评分及卒中史均为影响东小口社区老年人认知障碍的危险因素,临床需针对以上因素进行对症干预,以降低其罹患认知障碍的风险。     

Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality

Objectives: We investigated whether there was a higher prevalence of cognitive impairment (CI) and/or physical frailty (PF) in persons with diabetes compared to their non-diabetic counterparts, and the individual and combined impact of CI and PF on functional and mortality outcomes among diabetic older persons.

Method: Community-living diabetic and non-diabetic participants (N = 2696) aged 55 and above were assessed on CI (MMSE) and PF (CHS criteria) status. Among 486 diabetic persons, we estimated the odds ratio and 95% confidence intervals (OR, 95% CI) of association of CI and/or PF with prevalent IADL and ADL disability and mortality from 11 years of follow up.

Results: Diabetes was associated with significantly higher prevalence of CI and/or PF. Adjusted for sex, age, education, smoking, alcohol intake, physical activity, and BMI, diabetes was associated with higher prevalence of PF alone (OR = 2.24, 1.16–4.34) and PF with CI (OR = 2.01, 1.12–3.60), but not with CI alone (OR = 1.02, 0.73–1.44). In multivariable analyses of 486 diabetic older adults, compared to non-frail (NF) and cognitive normal (CN), CI alone was not significantly associated with IADL (OR = 1.06, 0.53–2.10), but PF alone was associated with considerably higher prevalence of IADL (OR = 6.72, 1.84–24.5). PF with CI was associated with the highest prevalence of IADL (OR = 17.8, 3.66–8.68) and ADL disability (OR = 93.8, 23.6–372.4). Whether singly or in combination, PF and/or CI were associated with worse hazard (HR) ratio for mortality outcomes: CI alone (HR = 2.72, 1.48–5.01), PF alone (HR = 4.30, 1.88–9.82) and CI with PF (HR = 8.41, 3.95–17.9).

Conclusion: Cognitive impairment and/or physical frailty are powerful prognostic factors identifying people with diabetes at high risk of mortality.     

Efficient screening of cognitive dysfunction in stroke patients: Comparison between the CAMCOG and the R-CAMCOG,Mini Mental State Examination and Functional Independence Measure-cognition score

Background. The CAMCOG is a valid screening instrument for cognitive dysfunction in stroke patients but too time-consuming to be used by physicians in acute or post-acute care settings. The aim of this study was to identify a shorter cognitive screening test or combination of tests that yields the same results as the CAMCOG.

Methods. A total of 169 stroke patients completed the CAMCOG and the abbreviated Rotterdam-CAMCOG (R-CAMCOG), Mini Mental State Examination (MMSE) and the cognitive part of the Functional Independence Measure (FIM cognition) after admission to clinical rehabilitation and 1 year after stroke. The CAMCOG score was used as criterion standard for validity.

Results. Spearman correlations with the CAMCOG were very strong for the R-CAMCOG (both 0.92), strong for the MMSE (0.66 and 0.69) and moderate to weak for the FIM cognition (0.35 and 0.27). Stepwise linear regression analyses showed that, at admission, the R-CAMCOG explained 83% of the variance in the CAMCOG. The MMSE and R-CAMCOG together explained 87%. At 1 year after stroke the correlations and explained variances were similar.

Conclusion. The recently constructed R-CAMCOG appears an efficient alternative for the CAMCOG as a screening tool for cognitive dysfunction of stroke patients.     

Visual Impairment Related to Cognition and Loneliness in Old Age

Reported problems in visual acuity were examined as determinants of loneliness experienced by community dwelling people with either impaired or unimpaired cognition. The Mini-Mental State Examination (MMSE) was used as a screening instrument to form a cognitively-impaired (MMSE 20–23/30) and a cognitively-intact group (MMSE 28–30/30). A total of 147 subjects took part in the study and were examined by an optometrist. Subjects with intact cognition tended to report visual problems more often than subjects with cognitive deficits. One out of two subjects had slight visual impairment, in both cognitive groups. After acuity had been optimally corrected, six to seven out of ten subjects' visual acuity did improve. In a multiple regression analysis, higher MMSE score and visual improvement were significantly related to lower levels of self-reported loneliness among the elderly with their cognition intact, but not among the subjects with impaired cognition.     

The clinical use of N-terminal-pro brain natriuretic peptide in elderly patients with mental illness

BackgroundSerum N-terminal-pro brain natriuretic peptide (NT-proBNP) is regarded as a marker of vascular disease and has previously been shown to exhibit an increased frequency of pathological values in elderly patients with mental illness with vascular disease compared to patients without vascular disease. Vascular disease plays an important role in cognitive impairment in elderly patients with mental illness.MethodWe have investigated the relation between NT-proBNP, vascular disease and cognition in consecutively enrolled elderly patients with mental illness.ResultsNT-proBNP level is increased in patients with vascular disease compared to patients without vascular disease, and a logistic regression analysis showed that NT-proBNP was a significant predictor of vascular disease. However, NT-proBNP level did not predict cognition as assessed by MMSE score. NT-proBNP level also showed a highly significant relation to mortality in all patients.ConclusionDeterminations of NT-proBNP could be used in elderly patients with mental illness to detect patients in need of control and treatment of vascular risk factors. The levels of NT-proBNP may also provide prognostic information.     

Changes in cardiovascular autonomic regulation among elderly subjects: Follow‐up of sixteen years

BACKGROUND. Previous cross‐sectional studies have suggested that cardiac autonomic regulation, measured as heart rate (HR) variability, is altered upon ageing, and that altered HR variability may predict mortality. However, there are no longitudinal follow‐up reports of the changes of HR dynamics in elderly subjects.

AIM & METHOD. This study was designed to examine the longitudinal changes in the spectral, fractal, and complexity measures of HR variability in a random sample of 41 elderly subjects (mean age 69±4 years), who underwent repeated 24‐hour Holter recordings at the baseline and after 16 years' follow‐up. Several cardiovascular risk factors were determined at the baseline.

RESULTS. A time‐domain index, standard deviation of N‐N intervals (SDNN) (142±34?msec versus 133±50?msec, not significant (NS)), and the high frequency spectral component of HR variability (219±222?msec² versus 268±287?msec², NS) did not change during the follow‐up. The low frequency power (LF) of HR variability decreased from 678±654?msec² to 436±651?msec² (P<0.01). Among the fractal HR variability indexes, the power‐law slope (β) (?1.31±0.20 versus ?1.47±0.21, P<0.001) and the short‐term fractal exponent α₁ (1.16±0.19 versus 1.06±0.18, P<0.01) decreased significantly. Approximate entropy remained unchanged.

CONCLUSIONS. The magnitude of total HR variability and the respiratory vagal modulation of HR do not change over time in the elderly. However, the spectral and fractal characteristics of HR behavior still undergo alterations upon ageing.     

Triglyceride glucose and haemoglobin glycation index for predicting outcomes in diabetes patients with new-onset,stable coronary artery disease: a nested case-control study

Abstract

Aim: Previous studies have shown that both triglyceride glucose (TyG) and haemoglobin glycation indexes (HGI) are predictors of cardiovascular risk. However, the prognostic value of TyG index and HGI in patients with type 2 diabetes mellitus (T2DM) and stable coronary artery disease (CAD) is not determined.

Methods: We conducted a nested case-control study among 1282 T2DM patients with stable CAD. Patients were followed up for 3846 person-years. A total of 160 patients with events (12.5%) were identified and matched individually on age, gender, previous use of lipid lowering agents and duration of follow-up with 640 controls.

Results: In Kaplan–Meier analysis, the upper tertiles of TyG index and HGI had a significant lower event-free survival (p?=?.002; p?=?.036, respectively). Of the note, both TyG index and HGI were associated with increased risk of MACCEs after adjusting for confounding risk factors [adjusted HR (95% CI): 1.693 (1.238–2.316); 1.215 (1.046–1.411), respectively]. Moreover, adding TyG index to the Cox model increased the C-statistic to 0.638 (95%CI: 0.595–0.683, p?=?.002) while the C-statistic was not statistically improved when HGI was included (p?=?.240).

Conclusions: Both TyG index and HGI could predict cardiovascular outcomes in T2DM patients with new-onset, stable CAD while TyG index might be better.

• Key messages

• Both TyG and HGI are predictors of cardiovascular risk.

• The prognostic value of TyG index and HGI in T2DM patients with stable coronary artery disease is not determined.

• Our study firstly indicates that TyG index might have better prognostic value than HGI in T2DM patients with new-onset, stable CAD.