@article {677, title = {Correlates of aortic stiffness in elderly individuals: a subgroup of the Cardiovascular Health Study.}, journal = {Am J Hypertens}, volume = {15}, year = {2002}, month = {2002 Jan}, pages = {16-23}, abstract = {

BACKGROUND: Arterial stiffness has been associated with aging, hypertension, and diabetes; however, little data has been published examining risk factors associated with arterial stiffness in elderly individuals.

METHODS: Longitudinal associations were made between aortic stiffness and risk factors measured approximately 4 years earlier. Aortic pulse wave velocity (PWV), an established index of arterial stiffness, was measured in 356 participants (53.4\% women, 25.3\% African American), aged 70 to 96 years, from the Pittsburgh site of the Cardiovascular Health Study during 1996 to 1998.

RESULTS: Mean aortic pulse wave velocity (850 cm/sec, range 365 to 1863) did not differ by ethnicity or sex. Increased aortic stiffness was positively associated with higher systolic blood pressure (SBP), age, fasting and 2-h postload glucose, fasting and 2-h insulin, triglycerides, waist circumference, body mass index, truncal fat, decreased physical activity, heart rate, and common carotid artery wall thickness (P < .05). After controlling for age and SBP, the strongest predictors of aortic stiffness in men were heart rate (P = .001) and 2-h glucose (P = .063). In women, PWV was positively associated with heart rate (P = .018), use of antihypertensive medication (P = .035), waist circumference (P = .030), and triglycerides (P = .081), and was negatively associated with physical activity (P = .111). Results were similar when the analysis was repeated in nondiabetic individuals and in those free of clinical or subclinical cardiovascular disease in 1992 to 1993.

CONCLUSIONS: In these elderly participants, aortic stiffness was positively associated with risk factors associated with the insulin resistance syndrome, increased common carotid intima-media thickness, heart rate, and decreased physical activity measured several years earlier.

}, keywords = {Aged, Aged, 80 and over, Aging, Aorta, Female, Heart Rate, Humans, Hypertension, Insulin Resistance, Longitudinal Studies, Male, Pulsatile Flow, Risk Factors, Sex Distribution}, issn = {0895-7061}, doi = {10.1016/s0895-7061(01)02228-2}, author = {Mackey, Rachel H and Sutton-Tyrrell, Kim and Vaitkevicius, Peter V and Sakkinen, Pamela A and Lyles, Mary F and Spurgeon, Harold A and Lakatta, Edward G and Kuller, Lewis H} } @article {797, title = {Fish intake and risk of incident atrial fibrillation.}, journal = {Circulation}, volume = {110}, year = {2004}, month = {2004 Jul 27}, pages = {368-73}, abstract = {

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is particularly common in the elderly. Although effects of fish intake, including potential antiarrhythmic effects, may favorably influence risk of AF, relationships between fish intake and AF incidence have not been evaluated.

METHODS AND RESULTS: In a prospective, population-based cohort of 4815 adults > or =age 65 years, usual dietary intake was assessed at baseline in 1989 and 1990. Consumption of tuna and other broiled or baked fish correlated with plasma phospholipid long-chain n-3 fatty acids, whereas consumption of fried fish or fish sandwiches (fish burgers) did not. AF incidence was prospectively ascertained on the basis of hospital discharge records and annual electrocardiograms. During 12 years{\textquoteright} follow-up, 980 cases of incident AF were diagnosed. In multivariate analyses, consumption of tuna or other broiled or baked fish was inversely associated with incidence of AF, with 28\% lower risk with intake 1 to 4 times per week (HR=0.72, 95\% CI=0.58 to 0.91, P=0.005), and 31\% lower risk with intake > or =5 times per week (HR=0.69, 95\% CI=0.52 to 0.91, P=0.008), compared with <1 time per month (P trend=0.004). Results were not materially different after adjustment for preceding myocardial infarction or congestive heart failure. In similar analyses, fried fish/fish sandwich consumption was not associated with lower risk of AF.

CONCLUSIONS: Among elderly adults, consumption of tuna or other broiled or baked fish, but not fried fish or fish sandwiches, is associated with lower incidence of AF. Fish intake may influence risk of this common cardiac arrhythmia.

}, keywords = {Aged, Animals, Atrial Fibrillation, Cardiotonic Agents, Cohort Studies, Cooking, Diet, Dietary Fats, Fatty Acids, Omega-3, Fish Oils, Fishes, Follow-Up Studies, Humans, Incidence, Massachusetts, Proportional Hazards Models, Prospective Studies, Risk, Seafood, Tuna}, issn = {1524-4539}, doi = {10.1161/01.CIR.0000138154.00779.A5}, author = {Mozaffarian, Dariush and Psaty, Bruce M and Rimm, Eric B and Lemaitre, Rozenn N and Burke, Gregory L and Lyles, Mary F and Lefkowitz, David and Siscovick, David S} } @article {853, title = {Hospitalization for pneumonia in the Cardiovascular Health Study: incidence, mortality, and influence on longer-term survival.}, journal = {J Am Geriatr Soc}, volume = {53}, year = {2005}, month = {2005 Jul}, pages = {1108-16}, abstract = {

OBJECTIVES: To estimate the rate of hospitalization for pneumonia in community-dwelling older adults and to assess its risk factors and contribution to mortality.

DESIGN: Prospective observational study.

SETTING: The Cardiovascular Health Study (CHS) in four U.S. communities.

PARTICIPANTS: Five thousand eight hundred eighty-eight men and women aged 65 and older who were followed for a median 10.7 years.

MEASUREMENTS: Participants were interviewed about medical history and demographics; evaluated for lung, physical, and cognitive function; and followed for hospitalizations, cardiovascular disease, and death.

RESULTS: Nearly 10\% of the cohort was hospitalized for pneumonia, for a rate of 11.1 per 1,000 person-years (95\% confidence interval (CI)=10.2-12.0). Risk factors included older age, male sex, current and past smoking, poor physical and lung function, and history of cardiovascular disease and chronic obstructive pulmonary disease. Ten percent of participants died during their incident pneumonia hospitalization, and death rates were high in those who survived to discharge. Compared with participants who had not been hospitalized for pneumonia, the relative risk of total mortality was 4.9 (95\% CI=4.1-6.0) during the first year after hospitalization and 2.6 (95\% CI=2.2-3.1) thereafter, adjusted for age, sex, and race. The respective relative risks were 3.9 (95\% CI=3.1-4.8) and 2.0 (95\% CI=1.6-2.4) after further adjustment for baseline history of cardiovascular disease; diabetes mellitus; smoking; and measures of lung, physical, and cognitive function.

CONCLUSION: In older people, hospitalization for pneumonia is common and is associated with an elevated risk of death, as shown in this population-based, prospective cohort.

}, keywords = {Aged, Aged, 80 and over, Cognition, Comorbidity, Diabetes Complications, Female, Hospitalization, Humans, Male, Mortality, Pneumonia, Prospective Studies, Respiratory Physiological Phenomena, Risk Factors, Smoking}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2005.53352.x}, author = {O{\textquoteright}Meara, Ellen S and White, Mark and Siscovick, David S and Lyles, Mary F and Kuller, Lewis H} } @article {868, title = {Weight loss, muscle strength, and angiotensin-converting enzyme inhibitors in older adults with congestive heart failure or hypertension.}, journal = {J Am Geriatr Soc}, volume = {53}, year = {2005}, month = {2005 Nov}, pages = {1996-2000}, abstract = {

OBJECTIVES: To determine whether angiotensin-converting enzyme (ACE) inhibitor use may be associated with weight maintenance and sustained muscle strength (measured by grip strength) in older adults.

DESIGN: Data from the Cardiovascular Health Study (CHS), a community-based prospective cohort study of 5,888 older adults, were used.

SETTING: Subjects were recruited from four U.S. sites beginning in 1989; this analysis included data through 2001.

PARTICIPANTS: CHS participants with congestive heart failure (CHF) or treated hypertension.

MEASUREMENTS: The exposure, current ACE inhibitor use, was ascertained by medication inventory at annual clinic visits; the outcomes were weight change and grip-strength change during the following year. Multivariate linear regression was used, accounting for correlations between observations on the same participant over time.

RESULTS: The average annual weight change was -0.38 kg in 2,834 participants (14,443 person-years) with treated hypertension and -0.62 kg in 342 participants (980 person-years) with CHF. ACE inhibitor use was associated with less annual weight loss after adjustment for potential confounders: a difference of 0.17 kg (95\% confidence interval (CI)=0.05-0.29) in those with treated hypertension and 0.29 kg (95\% CI=-0.25-0.83) in those with CHF. There was no evidence of association between ACE inhibitor use and grip-strength change.

CONCLUSION: ACE inhibitor use may be associated with weight maintenance, but not maintenance of muscle strength, in older adults with treated hypertension.

}, keywords = {Aged, Aged, 80 and over, Angiotensin-Converting Enzyme Inhibitors, Female, Hand Strength, Heart Failure, Humans, Hypertension, Male, Multivariate Analysis, Outcome Assessment, Health Care, Prospective Studies, Statistics as Topic, United States, Weight Loss}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2005.53568.x}, author = {Schellenbaum, Gina D and Smith, Nicholas L and Heckbert, Susan R and Lumley, Thomas and Rea, Thomas D and Furberg, Curt D and Lyles, Mary F and Psaty, Bruce M} } @article {1212, title = {Cognition and the risk of hospitalization for serious falls in the elderly: results from the Cardiovascular Health Study.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {65}, year = {2010}, month = {2010 Nov}, pages = {1242-9}, abstract = {

BACKGROUND: Many elderly adults fall every year, sometimes resulting in serious injury and hospitalization. Although impaired cognition is a risk factor for injurious falls, little is known about cognitive decline above the threshold of impairment and risk of serious falls in community-dwelling seniors.

METHODS: In total, 702 of 5,356 older adults participating in the Cardiovascular Health Study experienced an injurious fall between 1990 and 2005, as indicated by hospitalization records. General cognition was measured annually with the Modified Mini-Mental State Examination and processing speed with the Digit Symbol Substitution Test. The Cox regression model was used to calculate hazard ratio and 95\% confidence interval with and without time-dependent covariates and adjusted for known risk factors.

RESULTS: Participants with slightly decreased Digit Symbol Substitution Test scores were at increased risk for a serious fall (hazard ratio = 1.58, 95\% confidence interval = 1.15-2.17). The risk continued to increase with each quartile decrease in Digit Symbol Substitution Test score. Participants without prevalent cardiovascular disease at baseline and decreased Modified Mini-Mental State Examination scores (80-89) had a 45\% increased risk for a serious fall and those at high risk for dementia (<80) were at twice the risk as participants scoring above 90 (hazard ratio = 2.16, 95\% confidence interval = 1.60-2.91).

CONCLUSIONS: Both decreased general cognition and decreased processing speed appear to be potential risk factors for serious falls in the elderly. When assessing the risk of serious falls in elderly patients, clinicians should consider usual factors like gait instability and sensory impairment as well as less obvious ones such as cardiovascular disease and cognitive function in nondemented adults.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Chi-Square Distribution, Cognition Disorders, Female, Follow-Up Studies, Geriatric Assessment, Hospitalization, Humans, Male, Mental Status Schedule, Physical Examination, Proportional Hazards Models, Risk Assessment, Risk Factors, Surveys and Questionnaires}, issn = {1758-535X}, doi = {10.1093/gerona/glq115}, author = {Welmerink, Diana B and Longstreth, W T and Lyles, Mary F and Fitzpatrick, Annette L} } @article {6669, title = {Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease.}, journal = {JAMA}, volume = {313}, year = {2015}, month = {2015 Jan 20}, pages = {264-74}, abstract = {

IMPORTANCE: The risk of cardiovascular disease (CVD) after infection is poorly understood.

OBJECTIVE: To determine whether hospitalization for pneumonia is associated with an increased short-term and long-term risk of CVD.

DESIGN, SETTINGS, AND PARTICIPANTS: We examined 2 community-based cohorts: the Cardiovascular Health Study (CHS, n = 5888; enrollment age, >=65 years; enrollment period, 1989-1994) and the Atherosclerosis Risk in Communities study (ARIC, n = 15,792; enrollment age, 45-64 years; enrollment period, 1987-1989). Participants were followed up through December 31, 2010. We matched each participant hospitalized with pneumonia to 2 controls. Pneumonia cases and controls were followed for occurrence of CVD over 10 years after matching. We estimated hazard ratios (HRs) for CVD at different time intervals, adjusting for demographics, CVD risk factors, subclinical CVD, comorbidities, and functional status.

EXPOSURES: Hospitalization for pneumonia.

MAIN OUTCOMES AND MEASURES: Incident CVD (myocardial infarction, stroke, and fatal coronary heart disease).

RESULTS: Of 591 pneumonia cases in CHS, 206 had CVD events over 10 years after pneumonia hospitalization. CVD risk after pneumonia was highest in the first year. CVD occurred in 54 cases and 6 controls in the first 30 days (HR, 4.07; 95\% CI, 2.86-5.27); 11 cases and 9 controls between 31 and 90 days (HR, 2.94; 95\% CI, 2.18-3.70); and 22 cases and 55 controls between 91 days and 1 year (HR, 2.10; 95\% CI, 1.59-2.60). Additional CVD risk remained elevated into the tenth year, when 4 cases and 12 controls developed CVD (HR, 1.86; 95\% CI, 1.18-2.55). In ARIC, of 680 pneumonia cases, 112 had CVD over 10 years after hospitalization. CVD occurred in 4 cases and 3 controls in the first 30 days (HR, 2.38; 95\% CI, 1.12-3.63); 4 cases and 0 controls between 31 and 90 days (HR, 2.40; 95\% CI, 1.23-3.47); 11 cases and 8 controls between 91 days and 1 year (HR, 2.19; 95\% CI, 1.20-3.19); and 8 cases and 7 controls during the second year (HR, 1.88; 95\% CI, 1.10-2.66). After the second year, the HRs were no longer statistically significant.

CONCLUSIONS AND RELEVANCE: Hospitalization for pneumonia was associated with increased short-term and long-term risk of CVD, suggesting that pneumonia may be a risk factor for CVD.

}, keywords = {Aged, Atherosclerosis, Cardiovascular Diseases, Cohort Studies, Comorbidity, Female, Hospitalization, Humans, Male, Middle Aged, Pneumonia, Risk Factors}, issn = {1538-3598}, doi = {10.1001/jama.2014.18229}, author = {Corrales-Medina, Vicente F and Alvarez, Karina N and Weissfeld, Lisa A and Angus, Derek C and Chirinos, Julio A and Chang, Chung-Chou H and Newman, Anne and Loehr, Laura and Folsom, Aaron R and Elkind, Mitchell S and Lyles, Mary F and Kronmal, Richard A and Yende, Sachin} } @article {6808, title = {Intermediate and long-term risk of new-onset heart failure after hospitalization for pneumonia in elderly adults.}, journal = {Am Heart J}, volume = {170}, year = {2015}, month = {2015 Aug}, pages = {306-12}, abstract = {

BACKGROUND: Pneumonia is associated with high risk of heart failure (HF) in the short term (30 days) postinfection. Whether this association persists beyond this period is unknown.

METHODS: We studied 5,613 elderly (>=65 years) adults enrolled in the Cardiovascular Health Study between 1989 and 1994 at 4 US communities. Participants had no clinical diagnosis of HF at enrollment, and they were followed up through December 2010. Hospitalizations for pneumonia were identified using validated International Classification of Disease Ninth Revision codes. A centralized committee adjudicated new-onset HF events. Using Cox regression, we estimated adjusted hazard ratios (HRs) of new-onset HF at different time intervals after hospitalization for pneumonia.

RESULTS: A total of 652 participants hospitalized for pneumonia during follow-up were still alive and free of clinical diagnosis of HF by day 30 posthospitalization. Relative to the time of their hospitalization, new-onset HF occurred in 22 cases between 31 and 90 days (HR 6.9, 95\% CI 4.46-10.63, P < .001), 14 cases between 91 days and 6 months (HR 3.2, 95\% CI 1.88-5.50, P < .001), 20 cases between 6 months and 1 year (HR 2.6, 95\% CI 1.64-4.04, P < .001), 76 cases between 1 and 5 years (HR 1.7, 95\% CI 1.30-2.12, P < .001), and 71 cases after 5 years (HR 2.0, 95\% CI 1.56-2.58, P < .001). Results were robust to sensitivity analyses using stringent definitions of pneumonia and extreme assumptions for potential informative censoring.

CONCLUSION: Hospitalization for pneumonia is associated with increased risk of new-onset HF in the intermediate and long term. Studies should characterize the mechanisms of this association in order to prevent HF in elderly pneumonia survivors.

}, keywords = {Aged, Disease Progression, Female, Follow-Up Studies, Forecasting, Heart Failure, Hospitalization, Humans, Incidence, Inpatients, Male, Patient Readmission, Pneumonia, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors}, issn = {1097-6744}, doi = {10.1016/j.ahj.2015.04.028}, author = {Corrales-Medina, Vicente F and Taljaard, Monica and Yende, Sachin and Kronmal, Richard and Dwivedi, Girish and Newman, Anne B and Elkind, Mitchell S V and Lyles, Mary F and Chirinos, Julio A} }