Depressive symptoms as risk factor of cardiovascular mortality in older European men: the Finland, Italy and Netherlands Elderly (FINE) study.

BACKGROUND: Depressive symptoms have been suggested to increase the risk of cardiovascular diseases, but this may reflect reversed causality. We investigated to what extent depressive symptoms are a true risk factor for cardiovascular mortality in elderly men. DESIGN: The Finland, Italy and Netherlands Elderly (FINE) study is a prospective cohort study conducted in Finland, Italy and The Netherlands. METHODS: Depressive symptoms were measured with the Zung self-rating Depression Scale in 799 elderly men, aged 70-90 years, free from cardiovascular diseases. Using Cox models, hazard ratios (HRs) were calculated for specific cardiovascular mortality endpoints. The analyses were adjusted for potential confounders, stratified on country and repeated after exclusion of men who died from cardiovascular diseases up to 5 years after baseline. RESULTS: During 10-years of follow-up 224 (28%) men died from cardiovascular diseases. The adjusted hazard for a five-point increase in depressive symptoms was 1.15 [95% confidence interval (CI) 1.08-1.23] for cardiovascular mortality. This risk was stronger for mortality from stroke (HR 1.35; 95% CI 1.19-1.53) and heart failure (HR 1.16; 95% CI 1.00-1.35) in comparison with mortality from coronary heart disease (HR 1.08; 95% CI 0.97-1.20) and other degenerative heart diseases (HR 1.06; 95% CI 0.91-1.23). Exclusion of men who died from cardiovascular diseases within 5 years after baseline did not change the strength of the associations. There were no significant differences in HRs between northern and southern Europe. CONCLUSIONS: This study provides further and more convincing prospective evidence for depressive symptoms as a risk factor for cardiovascular mortality in elderly men.     

Symptoms of anxiety and depression in patients with stable coronary heart disease: prognostic value and consideration of pathogenetic links.

BACKGROUND: We evaluated the association of symptoms of anxiety and depression with fatal and non-fatal cardiovascular disease events among patients with coronary heart disease and considered several potential underlying pathogenetic links. DESIGN: This was a prospective cohort study. METHODS: In this study, including coronary heart disease patients undergoing an in-patient rehabilitation program, symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal cardiovascular disease events were determined during a 3-year follow-up. RESULTS: Of the 1052 patients with CHD 16.1% showed a borderline and 8.3% a manifest anxiety symptoms score, whereas 11.8 and 5.9% showed a borderline and manifest depressive symptoms score, respectively. During the 3-year follow-up fatal and non-fatal cardiovascular disease events were observed in 73 (6.9%) patients. After adjustment for covariates, patients having manifest anxiety symptoms had a statistically significant hazard ratio (HR) of 2.32 [95% confidence interval (CI) 1.14-4.74] for a cardiovascular disease event, and patients with depressive symptoms had an HR of 1.47 (95% CI 0.62-3.51) compared to other patients. In a model considering anxiety and depressive symptom scores simultaneously, the hazard ratio for a cardiovascular disease event associated with anxiety symptoms increased to 3.31 (95% CI 1.32-8.27), whereas the hazard ratio associated with depressive symptoms decreased (HR 0.62; 95% CI 0.20-1.87). We found a positive association of increased anxiety scores with body mass index and systolic blood pressure. CONCLUSIONS: The study suggests an important role especially for symptoms of anxiety for long-term prognosis of patients with known coronary heart disease. It furthermore suggests that several pathogenetic links may partly explain the increased risk.     

Autonomic dysfunction: a link between depression and cardiovascular mortality? The FINE Study.

BACKGROUND: Depression is associated with an increased risk of cardiovascular diseases (CVD) in vascular patients as well as in the general population. We investigated whether autonomic dysfunction could explain this relationship. DESIGN: The Finland, Italy and The Netherlands Elderly (FINE) Study is a prospective cohort study. METHODS: Depressive symptoms were measured with the Zung Self-rating Depression Scale in 870 men, aged 70-90 years, free of CVD and diabetes in 1990. Resting heart rate was determined from a 15-30-s resting electrocardiogram in The Netherlands and Italy and as pulse rate in Finland. In addition, in The Netherlands, heart-rate variability (HRV) and QTc interval were determined. RESULTS: At baseline, depressive symptoms were associated with an increase in resting heart rate, and nonsignificantly with low HRV and prolonged QTc interval. After 10 years of follow-up, 233 (27%) men died from CVD. Prospectively, an increase in resting heart rate with 1 SD was associated with an increased risk of cardiovascular mortality [hazard ratio (HR), 1.22; 95% confidence interval (CI), 1.08-1.38]. In addition, low HRV (HR, 0.78; 95% CI, 0.61-1.01) and prolonged QTc interval (HR, 1.28; 95% CI, 1.06-1.53) per SD were associated with cardiovascular mortality. The increased risk of depressive symptoms for cardiovascular mortality (HR, 1.38; 95% CI, 1.21-1.58) did not change after adjustments for several indicators of autonomic dysfunction. CONCLUSION: This study suggests that mild depressive symptoms are associated with autonomic dysfunction in elderly men. The increased risk of cardiovascular mortality with increasing magnitude of depressive symptoms could, however, not be explained by autonomic dysfunction.     

Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction

OBJECTIVES: We sought to compare symptoms of depression and anxiety as predictors of incomplete recovery after a first myocardial infarction (MI). BACKGROUND: Depressive symptoms have been related to post-MI mortality and health care consumption, but little is known about the effect of anxiety. We wanted to examine the effect of emotional distress on health care consumption and whether depressive symptomatology is a better predictor of prognosis than anxiety. METHODS: Subjects were 318 men (mean age 58 years) who completed the depression, anxiety, and hostility scales from the 90-item symptom check list after they survived a first MI. RESULTS: After an average follow-up of 3.4 years, there were 25 cardiac events (fatal or non-fatal MI). Symptoms of both depression (hazard ratio [HR] 2.32, 95% confidence interval [CI] 1.04 to 5.18; p = 0.039) and anxiety (HR 3.01, 95% CI 1.20 to 7.60; p = 0.019) were associated with cardiac events, adjusting for age, left ventricular ejection fraction, and use of antidepressants. However, a multivariate analysis including all three negative emotions indicated that symptoms of anxiety (HR 2.79, 95% CI 1.11 to 7.03; p = 0.029) explained away the relationship between depressive symptoms and cardiac events. Regarding health care consumption, anxiety (OR 2.00, 95% CI 1.24 to 3.22; p = 0.005), but not depression/hostility, was a predictor of cardiac rehospitalization and frequent visits at the cardiac outpatient clinic. CONCLUSIONS: Symptoms of depression and anxiety were associated with cardiac events. Anxiety was an independent predictor of both cardiac events and increased health care consumption and accounted for the relationship between depressive symptoms and prognosis. Symptoms of anxiety need to be considered in the risk stratification and treatment of post-MI patients.     

Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study

OBJECTIVE: To examine the risk of clinical coronary heart disease (CHD) in patients with rheumatoid arthritis (RA) compared with age- and sex-matched non-RA subjects, and to determine whether RA is a risk factor for CHD after accounting for traditional CHD risk factors. METHODS: We assembled a population-based incidence cohort of 603 Rochester, Minnesota residents ages >or=18 years who first fulfilled the American College of Rheumatology (ACR) 1987 criteria for RA between January 1, 1955 and January 1, 1995, and 603 age- and sex-matched non-RA subjects. All subjects were followed up through their complete inpatient and outpatient medical records, beginning at age 18 years until death, migration, or January 1, 2001. Data were collected on CHD events and traditional CHD risk factors (diabetes mellitus, hypertension, dyslipidemia, body mass index, smoking) using established diagnostic criteria. CHD events included hospitalized myocardial infarction (MI), unrecognized MI, coronary revascularization procedures, angina pectoris, and sudden CHD deaths. Conditional logistic regression and Cox regression models were used to estimate the risk of CHD associated with RA, both prior to and following RA diagnosis, after adjusting for CHD risk factors. RESULTS: During the 2-year period immediately prior to fulfillment of the ACR criteria, RA patients were significantly more likely to have been hospitalized for acute MI (odds ratio [OR] 3.17, 95% confidence interval [95% CI] 1.16-8.68) or to have experienced unrecognized MIs (OR 5.86, 95% CI 1.29-26.64), and less likely to have a history of angina pectoris (OR 0.58, 95% CI 0.34-0.99) compared with non-RA subjects. After the RA incidence date, RA patients were twice as likely to experience unrecognized MIs (hazard ratio [HR] 2.13, 95% CI 1.13-4.03) and sudden deaths (HR 1.94, 95% CI 1.06-3.55) and less likely to undergo coronary artery bypass grafting (HR 0.36, 95% CI 0.16-0.80) compared with non-RA subjects. Adjustment for the CHD risk factors did not substantially change the risk estimates. CONCLUSION: Patients with RA have a significantly higher risk of CHD when compared with non-RA subjects. RA patients are less likely to report symptoms of angina and more likely to experience unrecognized MI and sudden cardiac death. The risk of CHD in RA patients precedes the ACR criteria-based diagnosis of RA, and the risk cannot be explained by an increased incidence of traditional CHD risk factors in RA patients.     

Depression and cardiovascular morbidity and mortality: cause or consequence?

BACKGROUND: Depression after myocardial infarction has been associated with increased cardiovascular mortality. This study assessed whether depressive symptoms were associated with adverse outcomes in people with a history of an acute coronary syndrome, and evaluated possible explanations for such an association. METHODS AND RESULTS: Depressive symptoms were assessed using the General Health Questionnaire at least 5 months after hospital admission for acute myocardial infarction or unstable angina in 1130 participants of the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study, a multicentre, placebo-controlled, clinical trial of cholesterol-lowering treatment. Cardiovascular symptoms, self-rated general health, cardiovascular risk factors, employment status, social support and life events were also assessed at the baseline visit. Cardiovascular death (n=114), non-fatal myocardial infarction (n=108), non-fatal stroke (n=53) and unstable angina (n=274) were documented during a median follow-up period of 8.1 years. Individuals with depressive symptoms (General Health Questionnaire score >/=5; 22% of participants) were more likely to report angina, dyspnoea, claudication, poorer general health, not being in paid employment, few social contacts and/or adverse life events (P<0.05 for all). There was a modest association between depressive symptoms and cardiovascular events (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.13-1.77), but not cardiovascular death (HR 1.12. 95% CI 0.71-1.77). After adjustment for symptoms related to cardiovascular disease, the HR for cardiovascular events was 1.22 (95% CI 0.97-1.53). After further adjustment for employment status, social support and life events, the HR was 1.13 (95% confidence interval 0.87-1.47). CONCLUSIONS: There was no significant association between depressive symptoms and fatal or non-fatal cardiovascular events after adjustment for cardiovascular symptoms associated with poorer prognosis. Previously observed associations between depression and cardiovascular mortality may not be causal.     

Depression after stroke: a prospective epidemiological study

OBJECTIVES: To elucidate the relationship between stroke and depressive symptoms and to determine whether disability or cerebrovascular risk factors mediate that relationship. DESIGN: A prospective longitudinal epidemiological survey. SETTING: The mid-Monongahela Valley, a rural, nonfarm, low-socioeconomic-status community. PARTICIPANTS: Random sample of 1,134 subjects aged 65 and older. MEASUREMENTS: The dependent variable was clinically significant depressive symptoms, as defined by five or more symptoms on the modified Center for Epidemiological Studies Depression scale. The independent variables were demographics (age, sex, education), stroke, number of impaired instrumental activities of daily living (IADLs), diabetes mellitus, hypertension, atherosclerotic heart disease, and smoking. Logistic regression analyses were conducted for cross-sectional and longitudinal models examining whether stroke was associated with or predicted depressive symptoms, with other associated factors included as covariates. RESULTS: Clinically significant depressive symptoms were cross-sectionally associated with stroke (odds ratio (OR)=3.5, 95% confidence interval (CI)=1.4-8.3), diabetes mellitus (OR=2.8, 95% CI=1.7-4.6; P相似文献   

Genetically determined high serum levels of mannose-binding lectin and agalactosyl IgG are associated with ischemic heart disease in rheumatoid arthritis

OBJECTIVE: Patients with rheumatoid arthritis (RA) have excess morbidity and mortality due to ischemic heart disease. It has been suggested that high serum levels of mannose-binding lectin (MBL) and agalactosyl IgG (IgG-G0) are associated with increased inflammation in RA. MBL also enhances inflammation-mediated tissue injury during postischemic reperfusion. This study was undertaken to examine whether these factors are associated with increased risk of ischemic heart disease in RA. METHODS: MBL alleles were genotyped in 229 Danish patients with RA. In addition, serum levels of MBL and IgG-G0 were measured. Incidences of ischemic heart disease, myocardial infarction, and death due to ischemic heart disease after the diagnosis of RA were assessed in a prospective study. RESULTS: During a median followup of 9.5 years, ischemic heart disease was diagnosed in 8 of 27 patients with genetically determined high serum levels of MBL, as compared with 24 of the remaining 192 patients (data not available on 10 patients). After correction for other known risk factors, the hazard ratio (HR) was 3.6 (95% confidence interval [95% CI] 1.4-9.2). The corrected HR for myocardial infarction was 9.0 (95% CI 2.2-36.4). High serum levels of MBL also conferred an increased risk of death due to ischemic heart disease (age- and sex-adjusted HR 10.5, 95% CI 2.7-41.3). However, further analyses showed that these associations were present only in patients with high serum levels of IgG-G0. CONCLUSION: Genetically determined high serum levels of MBL and high serum levels of IgG-G0 are associated with increased risk of ischemic heart disease, myocardial infarction, and premature death in patients with RA.     

Synergistic effects of depressed mood and obesity on long-term cardiovascular risks in 1510 obese men and women: results from the MONICA-KORA Augsburg Cohort Study 1984-1998

OBJECTIVE: To examine the contribution of depressed mood in obese subjects on the prediction of a future coronary heart disease event (CHD). DESIGN: A prospective population-based cohort study of three independent cross-sectional surveys with 6239 subjects, 45-74 years of age and free of diagnosed CHD, stroke and cancer. During a mean follow-up of 7 years, 179 CHD events occurred among men and 50 events among women. SUBJECTS: A total of 737 (23%) male and 773 (26%) female subjects suffering from obesity (BMI >or=30 kg/m2). MEASUREMENTS: Body weight determined by trained medical staff following a standardized protocol; standardized questionnaires to assess subsyndromal depressive mood and other psychosocial features. RESULTS: The main effect of obesity to predict a future CHD (hazard ratio, HR=1.38, 95% CI 1.03-1.84; P=0.031) and the interaction term of obesity by depression (HR=1.73, 95% CI 0.98-3.05; P=0.060) were borderline significant, both covariate adjusted for multiple risk factors. Relative to the male subgroup with normal body weight and no depression, the male obese group with no depression was not at significantly increased risk for CHD events (HR=1.17, 95% CI 0.76-1.80; P=0.473) whereas CHD risk in males with both obesity and depressed mood was substantially increased (HR=2.32, 95% CI 1.45-3.72, P>0.0001). The findings for women were similar, however, not significant probably owing to lack of power associated with low event rates. Combining obesity and depressed mood resulted in a relative risk to suffer from a future CHD event of HR 1.84 (95% CI 0.79-4.26; P=0.158). CONCLUSIONS: Depressed mood substantially amplifies the CHD risk of middle-aged obese, but otherwise apparently healthy men. The impact of depression on the obesity risk in women is less pronounced.     

Depressive symptoms, inflammation, and ischemic stroke in older adults: a prospective analysis in the cardiovascular health study

OBJECTIVES: To investigate the mediator role of inflammation in any relationship between depressive symptoms and ischemic stroke.
DESIGN: Longitudinal prospective study.
SETTING: Review of medical records, death certificates, and the Medicare healthcare utilization database for hospitalizations.
PARTICIPANTS: Total of 5,525 elderly men and women aged 65 and older who were prospectively followed from 1989 to 2000 as participants in the Cardiovascular Health Study.
MEASUREMENTS: Depression symptom scores, inflammatory markers.
RESULTS: Greater depressive symptoms were associated with risk of ischemic stroke (unadjusted hazard ratio (HR)=1.32, 95% confidence interval (CI)=1.09–1.59; HR=1.26, 95% CI=1.03–1.54, adjusted for traditional risk factors). When a term for inflammation (C-reactive protein (CRP)) was introduced in the model, the HRs were not appreciably altered (unadjusted HR=1.31, 95% CI=1.08–1.58; adjusted HR=1.25, 95% CI=1.02–1.53), indicating that CRP at baseline was not a mediator in this relationship. In analyses stratified according to CRP levels, a J-shaped relationship between depressive symptoms and stroke was evident in the unadjusted analyses; in the fully adjusted model, only CRP in the highest tertile was associated with a higher risk for stroke in the presence of higher depressive symptoms scores.
CONCLUSION: The analyses from this prospective study provide evidence of a positive association between depressive symptoms and risk of incident stroke. Inflammation, as measured according to CRP at baseline, did not appear to mediate the relationship between depressive symptoms and stroke.     

Heart failure and risk of dementia and Alzheimer disease: a population-based cohort study

BACKGROUND: Heart failure has been linked to cognitive impairment in several previous studies, but to our knowledge, no investigations have explored the relationship between heart failure and the risk of dementia. We sought to examine the hypothesis that heart failure is a risk factor for dementia and Alzheimer disease. METHODS: A community-based cohort of 1301 individuals 75 years or older and without dementia in Stockholm, Sweden, was examined 3 times over a 9-year period to detect patients with dementia and Alzheimer disease using the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Heart failure was defined according to the guidelines of the Task Force on Heart Failure of the European Society of Cardiology by integrating clinical symptoms and signs with inpatient register entries and use of cardiac medications. Data were analyzed using Cox proportional hazards models with adjustment for major potential confounders. RESULTS: During the 6534 person-years of follow-up (mean, 5.02 years per person), 440 subjects were diagnosed as having dementia, including 333 with Alzheimer disease. At baseline, heart failure was identified in 205 subjects. Heart failure was associated with a multi-adjusted hazard ratio (HR) of 1.84 (95% confidence interval [CI], 1.35-2.51) for dementia and 1.80 (95% CI, 1.25-2.61) for Alzheimer disease. Use of antihypertensive drugs (83% of which are diuretics) seemed to reduce dementia risk due to heart failure (HR, 1.38; 95% CI, 0.99-1.94). Heart failure and low diastolic pressure (< 70 mm Hg) had an additive effect on the risk for dementia (HR, 3.07; 95% CI, 1.67-5.61). CONCLUSIONS: Heart failure is associated with an increased risk of dementia and Alzheimer disease in older adults. Antihypertensive drug therapy may partially counteract the risk effect of heart failure on dementia disorders.     

Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. The Stockholm Female Coronary Risk Study.

AIMS: Several studies have reported that women with coronary heart disease have a poorer prognosis than men. Psychosocial factors, including social isolation and depressive symptoms have been suggested as a possible cause. However, little is known about these factors and their independent predictive value in women. Therefore, we investigated the prognostic impact of depression, lack of social integration and their interaction in the Stockholm Female Coronary Risk Study. METHODS AND RESULTS: Two hundred and ninety-two women patients aged 30 to 65 years and admitted for an acute coronary event between 1991 and 1994, were followed for 5 years from baseline assessments, which were performed between 3 and 6 months after admission. Lack of social integration and depressive symptoms, assessed at baseline by standardized questionnaires, were associated with recurrent events, including cardiovascular mortality, acute myocardial infarction and revascularization procedures (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). Adjusting for age, diagnosis at index event, symptoms of heart failure, diabetes mellitus, high density lipoprotein (HDL) cholesterol, history of hypertension, systolic blood pressure, smoking, sedentary lifestyle, body mass index, and severity of angina pectoris symptoms, the hazard ratio associated with low (lowest quartile) as compared to high social integration (upper quartile) was 2.3 (95% CI 1.2-4.5) and the hazard ratio associated with two or more (upper three quartiles) as compared to one or no depressive symptoms was 1.9 (95% CI 1.02-3.6). CONCLUSIONS: The presence of two or more depressive symptoms and lack of social integration independently predicted recurrent cardiac events in women with coronary heart disease. Women who were free of both these risk factors, had the best prognosis.     

Depressive Tendency and the Risk of Death from Pneumonia: The JACC Study

Objective The burden of death from pneumonia is expected to increase with the aging of the population, as has been observed in Japan. Depressive tendency, a common psychosocial sign, may be a risk factor for pneumonia due to its possible association with some immune dysfunction. This study aimed to clarify the association between depressive tendency and the risk of death from pneumonia. Methods A population-based cohort that consisted of 75,174 Japanese men and women was followed for a median of 19.1 years. Four psychological and behavioral symptoms (depressive symptoms) were used to evaluate depressive tendency. Results A total of 1,329 deaths from pneumonia were observed. Depressive symptoms were positively and dose-dependently associated with the risk of death from pneumonia (p<0.001 for trend), and subjects with ≥2 depressive symptoms showed a significantly elevated risk compared to those without any symptoms [multivariable hazard ratio (HR), 1.66; 95% confidence interval (CI), 1.39-1.99]. This association was not significantly affected by sex or age at baseline. The elevated risk was still significant even when subjects were limited to those without any medical histories. The excess risk was observed not only for death occurring within the first 10 years of follow-up (multivariable HR, 2.05; 95% CI, 1.51-2.78) but also for that occurring in the longer follow-up period (multivariable HR, 1.48; 95% CI, 1.18-1.85). Conclusion Depressive tendency may be a risk factor for death from pneumonia. Further studies using a more reliable tool for the evaluation of depressive state are necessary to confirm this relationship.     

Diabetes mellitus and incidence of lower body disability among older Mexican Americans

BACKGROUND: Little is known about the effect of diabetes mellitus on subsequent lower body disability in older Mexican Americans, one of the fastest growing ethnic groups in the United States. The aim of this study is to examine the relationship between diabetes mellitus and incident lower body disability over a 7-year follow-up period. METHODS: Ours was a 7-year prospective cohort study of 1835 Mexican-American individuals > or = 65 years old, nondisabled at baseline, and residing in five Southwestern states. Measures included self-reported physician diagnosis of diabetes, stroke, heart attack, hip fracture, arthritis, or cancer. Disability measures included activities of daily living (ADLs), mobility tasks, and an 8-foot walk test. Body mass index, depressive symptoms, and vision function were also measured. RESULTS: At 7-year follow-up, 48.7% of diabetic participants nondisabled at baseline developed limitations in one or more measures of lower body function. Cox proportional regression analyses showed that diabetic participants were more likely to report any limitation in lower body ADL function (hazard ratio [HR] = 2.05, 95% confidence interval [CI], 1.58-2.67), mobility tasks (HR = 1.69, 95% CI, 1.39-2.04), and 8-foot walk (HR = 1.46, 95% CI, 1.15-1.85) compared with nondiabetic participants, after controlling for relevant factors. Older age and having one or more diabetic complications were significantly associated with increased risk of limitations in any lower body ADL and mobility task at follow-up. CONCLUSION: Older Mexican Americans with diabetes mellitus are at high risk for development of lower body disability over time. Awareness of disability as a potentially modifiable complication and use of interventions to reduce disability should become health priorities for older Mexican Americans with diabetes.     

Cognitive function and incidence of stroke in older Mexican Americans

BACKGROUND: Given the high prevalence of cognitive impairment in older Mexican Americans and limited longitudinal research examining cognitive function in this ethnic group, we conducted a study examining whether cognitive impairment is a risk factor for new onset of stroke among older Mexican Americans. METHODS: We performed a prospective cohort study of 2682 Mexican Americans aged 65 years and older living in the southwestern United States. For subjects with no prior history of stroke and who completed the Mini-Mental State Examination (MMSE) at baseline, stroke incidence was assessed after 2, 5, and 7 years of follow-up. RESULTS: In Cox proportional regression models, MMSE score at baseline predicted risk of incident stroke over a 7-year follow-up period. For the unadjusted model, subjects with an MMSE score of 21 or higher were half as likely to report stroke at follow-up (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.35-0.69; p <.001) compared with those with a score of less than 21. We found similar results after controlling for relevant risk factors for stroke including age, gender, smoking status, education, body mass index, diabetes, heart attack, systolic blood pressure, and depressive symptoms (HR, 0.54; 95% CI, 0.38-0.77; p =.001). Additionally, each 1-point increase in MMSE score was associated with a 5% reduction in risk (HR, 0.95; 95% CI, 0.92-0.99; p =.01). CONCLUSIONS: Increasing MMSE score is associated with a decreasing incidence of stroke in older Mexican Americans. This study highlights the need for a more aggressive focus on identifying and addressing cognitive decline in the Mexican American population.     

The negative prognostic synergism of anemia and heart disease in female nursing home residents

This study assessed functional and cognitive status, hemoglobin, serum creatinine, and heart disease from chart reviews in 441 female nursing home residents (mean age 86.8 +/- 7.5 years) and correlated the findings with 1-year survival. Independent predictors of outcome were older age (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.13 to 2.73), Barthel index (HR 0.31, 95% CI 0.15 to 0.62), and the combined presence of anemia (hemoglobin < or =11 g/dl) and heart disease (HR 3.50, 95% CI 1.50 to 7.47). Survival rates were 92% in the reference group with neither anemia nor heart disease, 91% in anemic subjects without heart disease, 87% in nonanemic patients with heart disease, and 72% in women with the 2 conditions (p <0.001). Anemia is highly prevalent in this population and when present in subjects with heart disease determines a threefold increase in mortality risk.     

The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years

OBJECTIVE: It is hypothesized that the systemic inflammation associated with rheumatoid arthritis (RA) promotes an increased risk of cardiovascular (CV) morbidity and mortality. We examined the risk and determinants of congestive heart failure (CHF) in patients with RA. METHODS: We assembled a population-based, retrospective incidence cohort from among all individuals living in Rochester, Minnesota, in whom RA (defined according to the American College of Rheumatology 1987 criteria) was first diagnosed between 1955 and 1995, and an age- and sex-matched non-RA cohort. After excluding patients in whom CHF occurred before the RA index date, all subjects were followed up until either death, incident CHF (defined according to the Framingham Heart Study criteria), migration from the county, or until January 1, 2001. Detailed information from the complete medical records (including all inpatient and outpatient care provided by all local providers) regarding RA, ischemic heart disease, and traditional CV risk factors was collected. Cox models were used to estimate the effect of RA on the development of CHF, adjusting for CV risk factors and/or ischemic heart disease. RESULTS: The study population included 575 patients with RA and 583 subjects without RA. The CHF incidence rates were 1.99 and 1.16 cases per 100 person-years in patients with RA and in non-RA subjects, respectively (rate ratio 1.7, 95% confidence interval [95% CI] 1.3-2.1). After 30 years of followup, the cumulative incidence of CHF was 34.0% in patients with RA and 25.2% in non-RA subjects (P< 0.001). RA conferred a significant excess risk of CHF (hazard ratio [HR] 1.87, 95% CI 1.47-2.39) after adjusting for demographics, ischemic heart disease, and CV risk factors. The risk was higher among patients with RA who were rheumatoid factor (RF) positive (HR 2.59, 95% CI 1.95-3.43) than among those who were RF negative (HR 1.28, 95% CI 0.93-1.78). CONCLUSION: Compared with persons without RA, patients with RA have twice the risk of developing CHF. This excess risk is not explained by traditional CV risk factors and/or clinical ischemic heart disease.     

Effectiveness of highly active antiretroviral therapy in Spanish cohorts of HIV seroconverters: differences by transmission category

OBJECTIVE: To evaluate the population effectiveness of highly active antiretroviral therapy (HAART) in HIV progression and determine the heterogeneity of the effect of HAART in GEMES (Spanish multicenter study of seroconverters). DESIGN: Multicenter cohort study. METHODS: Data from 1091 persons with well-documented HIV seroconversion dates from 1980s to January 2000 were analysed. Risk of AIDS and death in subjects with same duration of HIV infection were compared in different calendar periods; before 1992, 1992-1995 (reference), 1996-1997, 1998 and 1999 with Kaplan-Meier methods and Cox proportional hazards models, allowing for late entry, fitting calendar period as time-dependent covariate and adjusting for transmission category, age and gender. RESULTS: Statistically significant reductions in the risk of AIDS were first observed in 1998 [hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.35-1.01] becoming more pronounced in 1999 (HR, 0.45; 95% CI, 0.24-0.84). Reduction in the risk of death was seen in 1997, though only reached borderline significance in 1999 (HR, 0.53; 95% CI, 0.26-1.07). Progression to AIDS and death was slower in women (HR, 0.68; 95% CI, 0.46-0.99 and HR, 0.53; 95% CI, 0.33-0.87, respectively). Compared with men who have sex with men (MSM), intravenous drug users (IDU) had lower reductions in the risk of AIDS and death. CONCLUSIONS: Reductions in incidence of AIDS and death in GEMES are seen after 1998 and 1999, respectively, compared with 1992-1995, being more pronounced in MSM compared with IDU, the commonest category in Spain.     

Weight change and mortality among older Mexican Americans

BACKGROUND AND AIMS: Weight changes are predictors of health outcomes in older people. The purpose of this study is to examine the association between 2-year weight change and mortality in older Mexican Americans. METHODS: Seven year prospective cohort study of 1,749 non-institutionalized Mexican American men and women aged 65 and older residing in five Southwestern states. Measures include self-reports of medical conditions (heart attack, stroke, diabetes, hypertension, hip fracture or cancer), functional disability, high depressive symptoms, smoking status, a summary performance score of lower body function, hand grip muscle strength, and body mass index (BMI). Weight change was examined by comparing the baseline weight to the weight two years later to estimate the hazard of death within the following five-year period. RESULTS: Of the 1,749 subjects, 396 (22.6%) lost 5% or more weight, 984 (56.3%) had weight that remained stable, and 369 (21.1%) gained 5% or more weight between baseline and the 2-year follow-up period. Of the ones who lost 5% of weight, 28% died as compared to 19.7% and 15.2% of those whose weight remained stable and those who gained weight after 5 years, respectively. The hazard ratio (HR) of death for the group that lost 5% or more of their weight compared to the reference group (stable weight) was 1.35 (95% CI 1.06-1.70) after controlling for demographic variables, BMI, and waist circumference at baseline and 1.32 (95% CI 1.04-1.67) after controlling for all covariates. The HR of death for the group that gained 5% or more of weight was 0.78 (95% CI 0.58-1.05) after controlling for demographic variables, BMI, and waist circumference at baseline and 0.77 (95% CI 0.57-1.04) after controlling for all covariates. CONCLUSIONS: Weight loss is an independent predictor of mortality among older Mexican Americans, after controlling for relevant risk factors.     

Heart Failure and Incident Late‐Life Depression

OBJECTIVES: To assess whether heart failure (HF) increases the risk of developing depression and whether the use of loop diuretics in persons with HF alters this risk. DESIGN: Population‐based cohort study between 1993 and 2005. SETTING: Ommoord, a district of Rotterdam, the Netherlands. PARTICIPANTS: Five thousand ninety‐five older adults free of depression at baseline. MEASUREMENTS: Detailed information on HF and depression was collected during examination rounds and through continuous monitoring of medical and pharmaceutical records. HF was defined according to the criteria of the European Society of Cardiology. Depressive episodes were categorized as clinically relevant depressive symptoms and depressive syndromes, including major depressive disorders defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Hazard ratios (HRs) were calculated using multivariate Cox proportional hazard regression. RESULTS: HF was associated with greater risk of depressive symptoms and syndromes (HR=1.41, 95% CI=1.03–1.94) and depressive syndromes only (HR=1.66, 95% CI=1.09–2.52). In participants with HF, the use of loop diuretics was associated with a lower risk of depressive symptoms and syndromes (HR=0.46, 95% CI=0.22–0.96) and depressive syndromes only (HR=0.41, 95% CI=0.16–1.00). CONCLUSION: HF is an independent risk factor for incident depression in elderly persons. Patient with HF require careful follow‐up to monitor and prevent the onset of depression. Effective treatment of the debilitating symptoms of HF may prevent depression.