Cardiovascular Disease Is Associated with Greater Incident Dehydroepiandrosterone Sulfate Decline in the Oldest Old: The Cardiovascular Health Study All Stars Study

OBJECTIVES: To describe cross‐sectional and longitudinal associations with dehydroepiandrosterone sulfate (DHEAS) and change in DHEAS with age. DESIGN: Longitudinal cohort study. SETTING: Pittsburgh, Pennsylvania. PARTICIPANTS: Cardiovascular Health Study All Stars study participants assessed in 2005/06 (N=989, mean age 85.2, 63.5% women, 16.5% African American). MEASUREMENTS: Health characteristics were assessed in 2005/06 according to DHEAS level, mean DHEAS and DHEAS change across age categories were tested, and linear and logistic regression was used to identify factors present in 1996/97 associated with continuous and categorical DHEAS change. RESULTS: Mean ± standard deviation DHEAS was 0.555 ± 0.414 μg/mL in 1996/97 and 0.482 ± 0.449 μg/mL in 2005/06 for women and 0.845 ± 0.520 μg/mL in 1996/97 and 0.658 ± 0.516 μg/mL in 2005/06 for men. In 2005/06, DHEAS was lower in women and subjects with cardiovascular disease (CVD) and chronic pulmonary disease and higher for African Americans and subjects with hypertension and high cholesterol. Mean DHEAS change was greater in men (?0.200 μg/mL) than in women (?0.078 μg/mL) (P<.001). Each 1‐year increase in age attenuated the effect of male sex by 0.01 μg/mL (P=.009), abolishing the sex difference in DHEAS change by age 79. Presence of CVD before the study period was associated with greater absolute DHEAS change (β=?0.04 μg/mL, P=.04) and with the fourth quartile of DHEAS change versus the first to third quartiles (odds ratio=1.46, 95% confidence interval=1.03–2.05). CONCLUSION: DHEAS change continues into very old age, is not homogenous, is affected by sex, and is associated with prevalent CVD. Future studies should investigate factors that might accelerate DHEAS decline.     

Dementia and Alzheimer's disease incidence in relationship to cardiovascular disease in the Cardiovascular Health Study cohort

OBJECTIVES: To determine whether coronary artery disease, peripheral arterial disease (PAD), or noninvasive markers of cardiovascular disease (CVD) predict the onset of dementia and Alzheimer's disease (AD). DESIGN: Longitudinal cohort study. SETTING: Four U.S. communities. PARTICIPANTS: Men and women (N=3,602) with a brain magnetic resonance imaging (MRI) scan but no dementia were followed for 5.4 years. Participants with stroke were excluded. MEASUREMENTS: Neurologists and psychiatrists classified incident cases of dementia and subtype using neuropsychological tests, examination, medical records and informant interviews. CVD was defined at the time of the MRI scan. Noninvasive tests of CVD were assessed within 1 year of the MRI. Apolipoprotein E allele status, age, race, sex, education, Mini-Mental State Examination score, and income were assessed as potential confounders. RESULTS: The incidence of dementia was higher in those with prevalent CVD, particularly in the subgroup with PAD. The rate of AD was 34.4 per 1,000 person-years for those with a history of CVD, versus 22.2 per 1,000 person-years without a history of CVD (adjusted hazard ratio (HR)=1.3, 95% confidence interval (CI)=1.0-1.7). Rates of AD were highest in those with PAD (57.4 vs 23.7 per 100 person-years, adjusted HR=2.4, 95% CI=1.4-4.2). Results were similar with further exclusion of those with vascular dementia from the AD group. A gradient of increasing risk was noted with the extent of vascular disease. CONCLUSION: Older adults with CVD other than stroke had a higher risk of dementia and AD than did those without CVD. The risk was highest in people with PAD, suggesting that extensive peripheral atherosclerosis is a risk factor for AD.     

Age-associated Cardiovascular Changes in Health: Impact on Cardiovascular Disease in Older Persons

In the United States, cardiovascular disease, e.g., atherosclerosis and hypertension, that lead to heart failure and stroke, is the leading cause of mortality, accounting for over 40 percent of deaths in those aged 65 years and above. Over 80 percent of all cardio-vascular deaths occur in the same age group. Thus, age, per se, is the major risk factor for cardiovascular disease. Clinical manifestations and prognosis of these cardiovascular diseases likely become altered in older persons with advanced age because interactions occur between age-associated cardiovascular changes in health and specific pathophysiologic mechanisms that underlie a disease. A fundamental understanding of age-associated changes in cardiovascular structure and function ranging in scope from humans to molecules is required for effective and efficient prevention and treatment of cardiovascular disease in older persons. A sustained effort over the past two decades has been applied to characterize the multiple effects of aging in health on cardiovascular structure and function in a single study population, the Baltimore Longitudinal Study on Aging. In these studies, community dwelling, volunteer participants are rigorously screened to detect both clinical and occult cardiovascular disease and characterized with respect to lifestyle, e.g. exercise habits, in an attempt to deconvolute interactions among lifestyle, cardiovascular disease and the aging process in health. This review highlights some specific changes in resting cardiovascular structure and function and cardiovascular reserve capacity that occur with advancing age in healthy humans. Observations from relevant experiments in animal models have been integrated with those in humans to provide possible mechanistic insight.     

Telomeric G-Tail Length and Hospitalization for Cardiovascular Events in Hemodialysis Patients

Background and objectives

Telomeric G-tails play a pivotal role in maintaining the intramolecular loop structure of telomeres. Previous in vitro studies have suggested that the erosion of telomeric G-tails triggers cellular senescence, leading to organ dysfunction and atherosclerosis. The authors recently established a method to measure telomeric G-tail length using a hybridization protection assay. Using this method, this study investigated whether telomeric G-tail length could be used as a novel predictor for future cardiovascular events in hemodialysis patients.

Design, setting, participants, & measurements

A prospective observational study was performed involving a cohort of 203 Japanese hemodialysis patients to examine the lengths of telomeric G-tails and total telomeres and subsequent cardiovascular events during a median follow-up period of 48 months. The lengths of telomeric G-tails and total telomeres were also measured in 203 participants who did not have CKD and who were age- and sex-matched to hemodialysis patients.

Results

The lengths of telomeric G-tails and total telomeres were significantly shorter in hemodialysis patients than in control subjects. Telomeric G-tails, but not total telomeres, were independently and negatively associated with clinical history of cardiovascular disease. During follow-up, 80 cardiovascular events occurred. Total telomere length did not predict cardiovascular events. However, the length of telomeric G-tails was associated with new-onset cardiovascular events (hazard ratio per log luminescence signals, 0.12; 95% confidence interval, 0.12 to 0.50) that persisted after adjustment for age, sex, diabetes mellitus, clinical history of cardiovascular disease, inflammation, use of vitamin D, and serum levels of phosphate and intact parathyroid hormone.

Conclusions

Longer telomeric G-tail length is associated with a lower risk of future cardiovascular events in hemodialysis patients.     

Long‐Term Retention of Older Adults in the Cardiovascular Health Study: Implications for Studies of the Oldest Old

OBJECTIVES: To describe retention according to age and visit type (clinic, home, telephone) and to determine characteristics associated with visit types for a longitudinal epidemiological study in older adults. DESIGN: Longitudinal cohort study. SETTING: Four U.S. clinical sites. PARTICIPANTS: Five thousand eight hundred eighty‐eight Cardiovascular Health Study (CHS) participants aged 65 to 100 at 1989/90 or 1992/93 enrollment (58.6% female; 15.7% black). CHS participants were contacted every 6 months, with annual assessments through 1999 and in 2005/06 for the All Stars Study visit of the CHS cohort (aged 77–102; 66.5% female; 16.6% black). MEASUREMENTS: All annual contacts through 1999 (n=43,772) and for the 2005/06 visit (n=1,942). RESULTS: CHS had 43,772 total participant contacts from 1989 to 1999: 34,582 clinic visits (79.0%), 2,238 refusals (5.1%), 4,401 telephone visits (10.1%), 1,811 home visits (4.1%), and 740 other types (1.7%). In 2005/06, the All Stars participants of the CHS cohort had 36.6% clinic, 22.3% home, and 41.1% telephone visits. Compared with participants aged 65 to 69, odds ratios of not attending a CHS clinic visit were 1.82 (95% confidence interval (CI)=1.54–2.13), 2.94 (95% CI=2.45–3.57), 4.55 (95% CI=3.70–5.56), and 9.09 (95% CI=7.69–11.11) for those aged 70 to 74, 75 to 79, 80 to 84, and 85 and older, respectively, in sex‐adjusted regression. In multivariable regression, participants with a 2005/06 clinic visit were younger, more likely to be male and in good health, and had had better cognitive and physical function 7 years earlier than participants with other visit types. Participants with home, telephone, and missing visits were similar on characteristics measured 7 years earlier. CONCLUSION: Offering home, telephone, and proxy visits are essential to optimizing follow‐up of aging cohorts. Home visits increased in‐person retention from 36.5% to 58.8% and diversified the cohort with respect to age, health, and physical functioning.     

The Framingham Study, Diabetes Mellitus and Cardiovascular Disease: Turning Back the Clock

The global population of individuals with diabetes is important and rapidly growing. Because of the link between diabetes and cardiovascular disease (CVD), it is expected that diabetes will be an important driver of the future burden of CVD around the world. A connection between diabetes and CVD was suspected as earlier as in the mid 19th century. However, CVD in diabetes received less attention until the advent in the 20th century of treatments that allowed people with diabetes to live long enough to experience CVD. Since then the relationship between diabetes and CVD has been extensively investigated and characterised. The present article outlines the important contribution the Framingham Heart Study has made to the recognition of diabetes as a cardiovascular risk factor and the way in which the study has informed the association between other risk factors and CVD in the presence of diabetes, the changing pattern of the risk with time, and the quantification of CVD risk in the presence of diabetes. Through this contribution, Framingham has largely influenced our understanding of CVD in people with diabetes. Lines of investigation regarding cardiovascular health in this population are still wide open, and the Framingham Study continues to be part of this journey.     

Distribution and correlates of lipoprotein-associated phospholipase A2 in an elderly cohort: the Cardiovascular Health Study

OBJECTIVES: To determine whether high levels of lipoprotein‐associated phospholipase A₂ (Lp‐PLA₂) are associated with prevalent cardiovascular disease (CVD) and to evaluate factors most influencing Lp‐PLA₂ levels in a community‐based cohort of older adults. DESIGN: Cross‐sectional. SETTING: The Cardiovascular Health Study (CHS), a population‐based cohort study of men and women aged 65 and older. PARTICIPANTS: Five thousand five hundred thirty‐one CHS participants. MEASUREMENTS: Levels of Lp‐PLA₂ activity were determined using stored blood samples from the baseline examination. RESULTS: Mean Lp‐PLA₂ was higher in participants with electrocardiographically determined ventricular conduction defect and major Q‐wave abnormality and was positively correlated with left ventricular (LV) mass. It was high in those with echocardiographically determined abnormal LV ejection fraction, which persisted after adjustment. Mean Lp‐PLA₂ was also higher in participants with mild renal insufficiency and kidney disease. After multivariable adjustment, there was a modest but significant 27% greater risk of prevalent CHF per standard deviation increment of Lp‐PLA₂ and a modest but significant 12% greater risk of prevalent myocardial infarction. Lp‐PLA₂ was weakly but mainly most strongly correlated with cholesterol and lipoproteins, but those correlations were not especially strong. Lp‐PLA₂ was weakly positively correlated with soluble intercellular adhesion molecule‐1 but not interleukin‐6. In total, all factors considered could explain only 29% of Lp‐PLA₂ activity. CONCLUSION: Novel findings in the study are the associations, in those aged 65 and older, between Lp‐PLA₂ activity and LV dysfunction, CHF, and renal disease. CVD risk factors only minimally explain levels of Lp‐PLA₂.     

The effect of cardiovascular and osteoarticular diseases on disability in older Italian men and women: rationale,design, and sample characteristics of the Progetto Veneto Anziani (PRO.V.A.) study

OBJECTIVES: Describe the methodology and preliminary results of the Progetto Veneto Anziani (PRO.V.A.) Study, an observational study of the Italian population aged 65 and older DESIGN: Cross-sectional cohort observation. SETTING: Northern Italy. PARTICIPANTS: Italians aged 65 and older, living in both the community and nursing homes. MEASUREMENTS: At baseline, participants were interviewed at their homes and subsequently examined by nurses and physicians at the two study clinics using an extensive battery of clinical, instrumental, biochemical, and physical performance tests. Hand, knee, hip, and chest x-rays and bone densitometry were performed in 92% of the participants, and 99% of the participants consented to blood drawing and deoxyribonucleic acid analyses. The physician who performed the physical examination determined disease presence based on several components of the interview and examination. A further, comprehensive determination was performed with standardized algorithms using all the information collected on each participant, including hospital records surveillance, standardized x-ray readings, and blood assays. In one of the study sites, a brain magnetic resonance imaging was performed in a subsample of the participants (820 persons). RESULTS: Overall response rate to the baseline clinic visit was 77% for men and 64% for women. Co-presence of at least one cardiovascular disease (CVD) and at least one osteoarticular disease (OAD) was identified in 10%, 22%, and 29% of men and 9%, 24%, and 40% of women aged 65 to 74, 75 to 84, and 85 and older, respectively. Overall, the mean number of coexisting chronic conditions was 1.8 for men and 2.4 for women. CONCLUSIONS: The PRO.V.A. study has the potential to provide an original contribution to clarify the mechanisms whereby diseases cause disability in older men and women; the particular focus on CVD and OADs will make it possible to comprehensively evaluate the development of disability as it relates to these two important conditions.     

Cardiovascular mortality and morbidity in chronic obstructive pulmonary disease: the impact of bronchodilator treatment

Chronic obstructive pulmonary disease (COPD) is a substantial health burden. Cardiovascular disease (CVD), the leading cause of death, frequently coexists with COPD, an effect attributed to high individual disease prevalences and shared risk factors. It has long been recognized that COPD, whether stable or during acute exacerbations, is associated with an excess of cardiac arrhythmias. Bronchodilator medications have been implicated in the excess CVD seen in COPD, either as an intrinsic medication effect or related to side‐effects. Despite the theory behind increased pro‐arrhythmic effects in COPD, the reported results of trials investigating this for inhaled formulations at therapeutic doses are few. Methodological flaws, retrospective analysis and inadequate adjustment for concomitant medications, including short‐acting ‘relief’ bronchodilators and non‐respiratory medications with known arrhythmia propensity, mar many of these studies. For most bronchodilators at therapeutic levels in stable COPD, we can be reassured of their safety from current studies. The exception to this is ipratropium bromide, where the current data indicate an association with increased cardiovascular adverse effects. Moreover, there is no proven benefit from combining short‐acting beta‐agonists with short‐acting anticholinergics at high doses in the acute setting, and although this practice is widespread, it is associated with increased cardiovascular risk.     

关注重症病毒性肺炎患者的心脏损伤:唇亡齿寒

重症病毒性肺炎常导致一系列的心脏损伤,引发心律失常、心肌梗死及心力衰竭等心脏并发症,使病情迅速恶化。目前,涉及的相关机制尚不完全清楚。本文将对重症病毒性肺炎引起的心脏损伤的可能机制进行探讨,为临床治疗提供思路。     

Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults

OBJECTIVES: To evaluate the association between serum 25‐hydroxyvitamin D (25(OH)D) levels and mortality in a representative U.S. sample of older adults. DESIGN: Prospective cohort from the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality files. SETTING: Noninstitutionalized U.S. civilian population. PARTICIPANTS: Three thousand four hundred eight NHANES III participants aged 65 and older enrolled from 1988 to 1994 and followed for mortality through 2000. MEASUREMENTS: Primary exposure was serum 25(OH)D level at enrollment. Primary and secondary outcomes were all‐cause and cardiovascular disease (CVD) mortality, respectively. RESULTS: During the median 7.3 years of follow‐up, there were 1,493 (44%) deaths, including 767 CVD‐related deaths. Median 25(OH)D level was 66 nmol/L. Adjusting for demographics, season, and cardiovascular risk factors, baseline 25(OH)D levels were inversely associated with all‐cause mortality risk (adjusted hazard ratio (HR)=0.95, 95% confidence interval (CI)=0.92–0.98, per 10 nmol/L 25[OH]D). Compared with subjects with 25(OH)D levels of 100 nmol/L or higher, the adjusted HR for subjects with levels less than 25.0 nmol/L was 1.83 (95% CI=1.14–2.94) and for levels of 25.0 to 49.9 nmol/L was 1.47 (95% CI=1.09–1.97). The association appeared stronger for CVD mortality (adjusted HR=2.36, 95% CI=1.17–4.75, for subjects with 25[OH]D levels<25.0 nmol/L vs those ≥100.0 nmol/L) than for non‐CVD mortality (adjusted HR=1.42, 95% CI=0.73–2.79, for subjects with 25[OH]D levels<25.0 nmol/L vs those ≥100.0 nmol/L). CONCLUSION: In noninstitutionalized older adults, a group at high risk for all‐cause mortality, serum 25(OH)D levels had an independent, inverse association with CVD and all‐cause mortality. Randomized controlled trials of vitamin D supplementation in older adults are warranted to determine whether this association is causal and reversible.     

The Effect of CKD on Associations between Lifestyle Factors and All-cause,Cancer, and Cardiovascular Mortality: A Population-based Cohort Study

Objective Results from previous studies on the dose-dependent effect of adhering to multiple lifestyle factors on all-cause mortality in patients with chronic kidney disease (CKD) are inconsistent, despite the reported dose-dependent effect in the general population. This study aimed to examine whether CKD modifies the dose-dependent effect of adhering to multiple lifestyle factors on mortality. Methods This population-based prospective cohort study targeted 262,011 men and women aged 40-74 years at baseline. Of these, 18.5% had CKD, which was defined as GFR <60 mL/min/1.73 m², ≥1+ proteinuria on urinalysis, or both. The following lifestyle behaviors were considered healthy: no smoking, body mass index <25 kg/m², moderate or lower alcohol consumption, regular exercise, and healthy eating habits. Healthy lifestyle scores were calculated by adding the total number of lifestyle factors for which each participant was at low risk. Cox proportional hazards models were used to examine associations between healthy lifestyle scores and all-cause, cancer, and cardiovascular mortality, and whether CKD modified these associations. Results During a median follow-up of 4.7 years, 3,471 participants died. The risks of all-cause and cancer mortality decreased as the number of five healthy lifestyle factors that were adhered to increased, irrespective of the CKD status. The risk of cardiovascular mortality, however, was modified by CKD (interaction p=0.07), and an unhealthy lifestyle and CKD synergistically increased cardiovascular mortality. Conclusion A healthy lifestyle can reduce the risk of all-cause and cancer death in patients with or without CKD, while the prevention of CKD is essential for reducing the risk of cardiovascular death.     

Epidemiology of Cardiovascular Diseases in Morocco: A Systematic Review

OBJECTIVETo provide a systematic review of studies on cardiovascular diseases (CVD) and their risk factors in the Moroccan population.METHODSA systematic analysis was performed based on PRISMA guidelines by retrieving data bases (Medline, Embase, and other) using technical keywords in addition to manual research on official websites. Published studies in the English or French language, conducted in Morocco or concerning the Moroccan population within the last two decades, were identified.RESULTSThis is the first systematic review of CVD in Morocco. Data from 159 studies were retrieved and analyzed. Most studies were written in the English language (75.89%) and published between 2010 and 2019 (85.47%). The mortality rate caused by CVD in Morocco has reached 38%, with ischemic heart disease and stroke as the main events causing death (31.0% and 22.5% respectively). The risk factors present in the population studied were headed by tobacco smoking (45-50%), followed by physical inactivity (21.1%), elevated rate of hypertension (25.3%), and depression (5.47%). Impacted by a high rate of illiteracy and poverty and an unprepared health care system in Morocco, these numbers are expected to increase over the next decade.CONCLUSIONSBased on these alarming incidences, investment in scientific research and epidemiological studies should be increased to determine the needs of the local population. The available evidence shows that the risk of cardiovascular disease and the associated mortality is very high in Morocco and will rise in the next years prospectively, which calls for urgent multi-sectorial approaches and treatment strategies.     

Direct comparisons of three alternative plasma fibrinogen assays with the von Clauss assay in prediction of cardiovascular disease and all‐causes mortality: the Scottish Heart Health Extended Cohort

There is strong evidence from meta‐analyses of prospective epidemiological studies that increasing plasma fibrinogen levels are associated with an increasing risk of cardiovascular disease (CVD) and all‐cause mortality. However, there are few published direct comparisons of the several different available fibrinogen assays in association with CVD or mortality. We therefore prospectively compared the standardized von Clauss assay of clottable fibrinogen with three other assays: prothrombin time (PT)‐derived clottable fibrinogen, immunonephelometric fibrinogen, and heat precipitable fibrinogen in the Scottish Heart Health Extended Cohort. Hazard ratios (HRs) for a standard deviation increase in fibrinogen for risk of CVD, adjusted for age and sex, were 1·17 (95% confidence interval [CI] 1·14; 1·21) for the von Clauss assay; 1·19 (1·06; 1·33) for the heat precipitation assay; 1·16 (1·01; 1·35) for the PT‐derived assay; and 1·28 (1·10; 1·51) for the immunonephelometric assay. HRs for all‐cause mortality were 1·21 (1·18; 1·24); 1·13 (1·01; 1·26), 1·17 (1·00; 1·37) and 1·17 (0·99; 1·39), respectively. No significant differences were observed between the assays in such comparisons. We therefore conclude that the choice between plasma fibrinogen assays in routine clinical haematology and biochemistry laboratories should depend on practical factors, and not on expected differences in the strength of associations.