@article {1447, title = {Properties of the random zero sphygmomanometer.}, journal = {Hypertension}, volume = {21}, year = {1993}, month = {1993 May}, pages = {632-7}, abstract = {

The random zero sphygmomanometer is widely used in studies involving blood pressure measurement because it is believed to eliminate digit preference and reduce measurement error. We performed blood pressure measurements sequentially using random zero and standard sphygmomanometers in random order in 1,356 participants in the Cardiovascular Health Study. Despite adherence to the manufacturer{\textquoteright}s instructions, we observed a substantially nonuniform distribution of zero levels generated by the random zero sphygmomanometer and a disturbing correlation between the zero level and blood pressures taken with the standard sphygmomanometer. With the random zero device, the pooled estimated slopes for the regression of standard systolic and diastolic pressures on the zero level were -0.71 and -0.17, respectively (both p < 0.0001). The only plausible explanation for this relation between the random zero device and the standard device is that by some unknown mechanism the subject{\textquoteright}s blood pressure is influencing the zero level. Systolic and diastolic blood pressures measured with the random zero device were, respectively, 1.65 and 1.84 mm Hg lower (both p < 0.0001) than standard blood pressures. Digit preference was detectable in the uncorrected blood pressure and zero level measured with the random zero device but was eliminated after calculation of the corrected blood pressure. For most epidemiological studies, the random zero sphygmomanometer offers no significant advantage over the standard sphygmomanometer. It may still be useful in those epidemiological studies and clinical trials where blinding is important.

}, keywords = {Aged, Blood Pressure, Blood Pressure Determination, Cohort Studies, Diastole, Humans, Regression Analysis, Systole}, issn = {0194-911X}, author = {Kronmal, R A and Rutan, G H and Manolio, T A and Borhani, N O} } @article {1427, title = {Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study).}, journal = {Am J Cardiol}, volume = {74}, year = {1994}, month = {1994 Aug 01}, pages = {236-41}, abstract = {

Atrial fibrillation (AF) is a common arrhythmia in elderly persons and a common cause of embolic stroke. Most studies of the prevalence and correlates of AF have used selected, hospital-based populations. The Cardiovascular Health Study is a population-based, longitudinal study of risk factors for coronary artery disease and stroke in 5,201 men and women aged > or = 65 years. AF was diagnosed in 4.8\% of women and in 6.2\% of men at the baseline examination, and prevalence was strongly associated with advanced age in women. Prevalence of AF was 9.1\% in men and women with clinical cardiovascular disease, 4.6\% in patients with evidence of subclinical but no clinical cardiovascular disease, and only 1.6\% in subjects with neither clinical nor subclinical cardiovascular disease. A history of congestive heart failure, valvular heart disease and stroke, echocardiographic evidence of enlarged left atrial dimension, abnormal mitral or aortic valve function, treated systemic hypertension, and advanced age were independently associated with the prevalence of AF. The low prevalence of AF in the absence of clinical and subclinical cardiovascular disease calls into question the existence and clinical usefulness of the concept of so-called "lone atrial fibrillation" in the elderly.

}, keywords = {Aged, Aged, 80 and over, Anti-Arrhythmia Agents, Anticoagulants, Atrial Fibrillation, Blood Glucose, Cardiovascular Diseases, Chi-Square Distribution, Coronary Disease, Electrocardiography, Female, Humans, Male, Prevalence, Regression Analysis, Sampling Studies}, issn = {0002-9149}, author = {Furberg, C D and Psaty, B M and Manolio, T A and Gardin, J M and Smith, V E and Rautaharju, P M} } @article {1467, title = {Prevalence and correlates of snoring and observed apneas in 5,201 older adults.}, journal = {Sleep}, volume = {19}, year = {1996}, month = {1996 Sep}, pages = {531-8}, abstract = {

The objectives of this study were to describe the prevalence of snoring, observed apneas, and daytime sleepiness in older men and women, and to describe the relationships of these sleep disturbances to health status and cardiovascular diseases (CVD). A cross-sectional design was employed to study sleep problems, CVD, general health, psychosocial factors, and medication use. The subjects were participants in the Cardiovascular Health Study, which included 5,201 adults, aged 65 and older, who were recruited from a random sample of Medicare enrollees in four U.S. communities. Study measures employed were sleep questions, echocardiography, carotid ultrasound, resting electrocardiogram, cognitive function, cardiopulmonary symptoms and diseases, depression, independent activities of daily living (IADLs), and benzodiazepine use. Thirty-three percent of the men and 19\% of the women reported loud snoring, which was less frequent in those over age 75. Snoring was positively associated with younger age, marital status, and alcohol use in men, and obesity, diabetes, and arthritis in women. Snoring was not associated, however, with cardiovascular risk factors or clinical CVD in men or women. Observed apneas were reported much less frequently (13\% of men and 4\% women) than snoring, and they were associated with alcohol use, chronic bronchitis, and marital status in men. Observed apneas were associated with depression and diabetes in women. In both men and women, daytime sleepiness was associated with poor health, advanced age, and IADL limitations. The conclusions of the study were that loud snoring, observed apneas, and daytime sleepiness are not associated cross-sectionally with hypertension or prevalent CVD in elderly persons.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Cardiovascular Diseases, Comorbidity, Female, Humans, Incidence, Lung Diseases, Male, Narcolepsy, Prevalence, Random Allocation, Sex Factors, Sleep Apnea Syndromes, Snoring}, issn = {0161-8105}, author = {Enright, P L and Newman, A B and Wahl, P W and Manolio, T A and Haponik, E F and Boyle, P J} } @article {1524, title = {Prevalence and associations of MRI-demonstrated brain infarcts in elderly subjects with a history of transient ischemic attack. The Cardiovascular Health Study.}, journal = {Stroke}, volume = {30}, year = {1999}, month = {1999 Feb}, pages = {383-8}, abstract = {

BACKGROUND AND PURPOSE: MRI is more sensitive than CT, but the significance of brain abnormalities seen on MR images obtained in older subjects with transient ischemic attack (TIA) is not clear. We studied the prevalence and risk factors associated with MRI-demonstrated infarcts in elderly subjects with a history of TIA.

METHODS: Participants of the Cardiovascular Health Study, aged 65 years or more and without prior stroke, were studied with brain MRI (n=3456). The prevalence of brain infarcts (>/=3 mm) on MRI was determined in subjects with and without TIA. The cardiovascular risk factors and clinical and subclinical cardiovascular disease associated with MRI infarcts were studied in subjects with TIA.

RESULTS: Subjects with TIA (n=100) had a higher prevalence of MRI infarcts than subjects without TIA (46\% versus 28\%; P<0.001). The unadjusted odds ratio for having MRI infarcts in subjects with TIA was 2.20 (95\% CI, 1.47 to 3.30) and remained significantly elevated after adjustments for risk factors and cerebrovascular disease (odds ratio, 1.86; 95\% CI, 1.23 to 2.83). In subjects with TIA, diastolic blood pressure (P=0.01) and internal carotid artery intima-media thickness (P=0.01) were the only factors predictive of the presence of MRI infarcts by stepwise logistic regression analysis.

CONCLUSIONS: MRI infarcts are imaging manifestations of clinically important cerebrovascular disease in subjects with a history of TIA, given their increased prevalence and positive association with increased diastolic blood pressure and internal carotid artery intima-media thickness.

}, keywords = {Aged, Brain, Cardiovascular Diseases, Cerebral Infarction, Cross-Sectional Studies, Female, Humans, Ischemic Attack, Transient, Magnetic Resonance Imaging, Male, Odds Ratio, Population Surveillance, Predictive Value of Tests, Prevalence, Prospective Studies, Risk Factors, United States}, issn = {0039-2499}, author = {Bhadelia, R A and Anderson, M and Polak, J F and Manolio, T A and Beauchamp, N and Knepper, L and O{\textquoteright}Leary, D H} } @article {607, title = {Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly.}, journal = {J Am Coll Cardiol}, volume = {35}, year = {2000}, month = {2000 Jan}, pages = {119-26}, abstract = {

OBJECTIVES: This study was designed to determine the prevalence of unrecognized myocardial infarction (UMI), as well as risk factors, and to compare prognosis after detection of previously UMI to that after recognized myocardial infarction (RMI).

BACKGROUND: Past studies revealed that a significant proportion of MIs escape recognition, and that prognosis after such events is poor, but the epidemiology of UMI has not been reassessed in the contemporary era.

METHODS: The Cardiovascular Health Study (CHS) database, composed of individuals > or =65, was queried for participants who, at entry, demonstrated electrocardiographic evidence of a prior Q-wave MI, but who lacked a history of this diagnosis. The features and outcomes of this group were compared to those of individuals with prevalent RMI.

RESULTS: Of 5,888 participants, 901 evidenced a past MI, and 201 (22.3\%) were previously unrecognized. The independent predictors of UMI were the absence of angina and the absence of congestive heart failure (CHF). Six-year mortality did not significantly differ between the two groups.

CONCLUSIONS: 1) In the elderly, UMI continues to represent a significant proportion of all MIs; 2) associations with angina and CHF may reflect complex neurological issues, but they also may represent diagnosis bias; 3) these individuals can otherwise not be distinguished from those with recognized infarctions; and 4) mortality rates after UMI and RMI are similar. Future studies should address screening for UMI, risk stratification after detection of previously UMI, and the role of standard post-MI therapies.

}, keywords = {Aged, Cause of Death, Coronary Disease, Cross-Sectional Studies, Databases, Factual, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Myocardial Infarction, Prognosis, Risk Factors, Stroke, Survival Rate}, issn = {0735-1097}, doi = {10.1016/s0735-1097(99)00524-0}, author = {Sheifer, S E and Gersh, B J and Yanez, N D and Ades, P A and Burke, G L and Manolio, T A} } @article {669, title = {Patterns on cranial magnetic resonance imaging in elderly people and vascular disease outcomes.}, journal = {Arch Neurol}, volume = {58}, year = {2001}, month = {2001 Dec}, pages = {2074}, keywords = {Aged, Brain, Cardiovascular Diseases, Cluster Analysis, Humans, Magnetic Resonance Imaging}, issn = {0003-9942}, doi = {10.1001/archneur.58.12.2074}, author = {Longstreth, W T and Diehr, P and Beauchamp, N J and Manolio, T A} } @article {637, title = {Predictors of loss of lung function in the elderly: the Cardiovascular Health Study.}, journal = {Am J Respir Crit Care Med}, volume = {163}, year = {2001}, month = {2001 Jan}, pages = {61-8}, abstract = {

Pulmonary function, as measured by spirometry (FEV1 or FVC), is an important independent predictor of morbidity and mortality in elderly persons. In this study we examined the predictors of longitudinal decline in lung function for participants of the Cardiovascular Health Study (CHS). The CHS was started in 1990 as a population-based observational study of cardiovascular disease in elderly persons. Spirometry testing was conducted at baseline, 4 and 7 yr later. The data were analyzed using a random effects model (REM) including an AR(1) error structure. There were 5,242 subjects (57.6\% female, mean age 73 yr, 87.5\% white and 12.5\% African-American) with eligible FEV1 measures representing 89\% of the baseline cohort. The REM results showed that African-Americans had significantly lower spirometry levels than whites but that their rate of decline with age was significantly less. Subjects reporting congestive heart failure (CHF), high systolic blood pressure (> 160 mm Hg), or taking beta-blockers had significantly lower spirometry levels; however, the effects of high blood pressure and taking beta-blockers diminished with increasing age. Chronic bronchitis, pneumonia, emphysema, and asthma were associated with reduced spirometry levels. The most notable finding of these analyses was that current smoking (especially for men) was associated with more rapid rates of decline in FVC and FEV1. African-Americans (especially women) had slower rates of decline in FEV1 than did whites. Although participants with current asthma had a mean 0.5 L lower FEV1 at their baseline examination, they did not subsequently experience more rapid declines in FEV1.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cardiovascular Diseases, Female, Forced Expiratory Volume, Humans, Longitudinal Studies, Lung, Lung Volume Measurements, Male}, issn = {1073-449X}, doi = {10.1164/ajrccm.163.1.9906089}, author = {Griffith, K A and Sherrill, D L and Siegel, E M and Manolio, T A and Bonekat, H W and Enright, P L} }