@article {7673, title = {Spirometric impairments, cardiovascular outcomes, and noncardiovascular death in older persons.}, journal = {Respir Med}, volume = {137}, year = {2018}, month = {2018 Apr}, pages = {40-47}, abstract = {

BACKGROUND: In prior work involving older persons, the reported associations of spirometric impairments with cardiovascular outcomes may have been confounded by age-related changes in lung function. Hence, using more age-appropriate spirometric criteria from the Global Lung Function Initiative (GLI), we have evaluated the associations of spirometric impairments, specifically restrictive-pattern and airflow-obstruction, with cardiovascular death (CV-death) and hospitalization (CV-hospitalization). In these analyses, we also evaluated the competing outcome of noncardiovascular death (nonCV-death) and calculated measures of relative and absolute risk.

METHODS: Our study sample was drawn from the Cardiovascular Health Study (CHS), including 4232 community-dwelling white persons aged >=65 years. Multivariable regression models included the following baseline predictors: GLI-defined restrictive-pattern and airflow-obstruction, age, male gender, obesity, waist circumference, current smoker status, >=10 pack-years of smoking, hypertension, dyslipidemia, diabetes, and cardiovascular and cerebrovascular disease. Outcomes included adjudicated CV-death, CV-hospitalization, and nonCV-death, ascertained over 10 years of follow-up. Measures of association included hazard ratios (HRs), rate ratios (RRs), and average attributable fraction (AAF), each with 95\% confidence intervals.

RESULTS: Restrictive-pattern and airflow-obstruction were associated with CV-death (adjusted HRs: 1.57 [1.18, 2.09] and 1.29 [1.04, 1.60]) and with nonCV-death (adjusted HRs: 2.10 [1.63, 2.69] and 1.79 [1.51, 2.12]), respectively. Airflow-obstruction, but not restrictive-pattern, was also associated with CV-hospitalization (adjusted RRs: 1.18 [1.02, 1.36] and 1.20 [0.96, 1.50], respectively). The adjusted AAFs of restrictive-pattern and airflow-obstruction were 1.68\% (0.46, 3.06) and 2.35\% (0.22, 4.72) for CV-death, and 3.44\% (1.97, 5.08) and 7.77\% (5.15, 10.60) for nonCV-death, respectively.

CONCLUSION: Assessment of GLI-defined spirometric impairments contributes to broad geriatric risk stratifications for both cardiovascular and non-cardiovascular outcomes.

}, issn = {1532-3064}, doi = {10.1016/j.rmed.2018.02.018}, author = {Vaz Fragoso, Carlos A and Van Ness, Peter H and Murphy, Terrence E and McAvay, Gail J} } @article {7772, title = {Time-varying social support and time to death in the cardiovascular health study.}, journal = {Health Psychol}, year = {2018}, month = {2018 Sep 10}, abstract = {

OBJECTIVES: There is a consensus that social connectedness is integral for a long, healthy life. However, studies of social support and survival have primarily relied on baseline social support measures, potentially missing the effects of fluctuations of perceived support over time. This is especially important for older adults who experience increased changes in disability. This study examined whether among older adults time-varying perceived social support was associated with time to death (main effect model of support) and whether time-varying disability was a modifier (stress-buffering model of support). Gender and marital status were also examined as modifiers.

METHODS: Older adults in the Cardiovascular Health Study ( = 5,201) completed self- report measures of demographics and psychological health and clinical risk factors for mortality at baseline (1989-1990). Perceived social support and disability were measured from baseline through Wave 11 (1998-1999). Cox regression of time to death with time-varying covariates was performed.

RESULTS: Time-varying as well as baseline-only perceived social support was associated with greater survival in the unadjusted models but not after adjustment. Gender, marital status, and time-varying disability were not significant modifiers.

CONCLUSIONS: In contrast with the previously reported association between baseline individual differences in perceived social support and time to death, older adults{\textquoteright} baseline-only and fluctuating perceptions of perceived support over time were not associated with time to death after adjustment for other clinical physical and psychological risk factors. Research is needed to identify other relationship factors that may be more informative as time-varying predictors of health and longevity in large longitudinal data sets. (PsycINFO Database Record

}, issn = {1930-7810}, doi = {10.1037/hea0000660}, author = {MacNeil-Vroomen, Janet and Schulz, Richard and Doyle, Margaret and Murphy, Terrence E and Ives, Diane G and Monin, Joan K} }