@article {1426, title = {Relation of smoking with carotid artery wall thickness and stenosis in older adults. The Cardiovascular Health Study. The Cardiovascular Health Study (CHS) Collaborative Research Group.}, journal = {Circulation}, volume = {90}, year = {1994}, month = {1994 Dec}, pages = {2905-8}, abstract = {

BACKGROUND: Cigarette smoking has been associated with increased risk of atherosclerotic diseases in hospital-based studies and in studies of middle-aged populations but not in population-based studies of older adults with and without clinical cardiovascular disease.

METHODS AND RESULTS: We investigated the relation of smoking to carotid artery atherosclerotic disease, expressed as intimal-medial wall thickness and arterial lumen narrowing (stenosis) measured by ultrasound. Subjects were 5116 older adults participating in the baseline examination of the Cardiovascular Health Study, a community-based study of cardiovascular diseases in older age. With increased smoking there was significantly greater internal and common carotid wall thickening and internal carotid stenosis: current smokers > former smokers > never-smokers; for instance, the unadjusted percent stenosis was 24\%, 20\%, and 16\%, respectively (P < .0001). A significant dose-response relation was seen with pack-years of smoking. These findings persisted after adjusting for other cardiovascular risk factors and were also confirmed when analyses were restricted to those without prevalent cardiovascular disease. The difference in internal carotid wall thickness between current smokers and nonsmokers was greater than the difference associated with 10 years of age among never-smoking participants (0.39 mm versus 0.31 mm). Among all participants, the prevalence of clinically significant (> or = 50\%) internal carotid stenosis increased from 4.4\% in never-smokers to 7.3\% in former smokers to 9.5\% in current smokers (P < .0001).

CONCLUSIONS: These findings extend previous reports of a positive relation between smoking and carotid artery disease to a population-based sample of older adults using several different indicators of atherosclerotic disease.

}, keywords = {Aged, Aged, 80 and over, Carotid Arteries, Carotid Stenosis, Cohort Studies, Female, Humans, Male, Smoking, Ultrasonography}, issn = {0009-7322}, author = {Tell, G S and Polak, J F and Ward, B J and Kittner, S J and Savage, P J and Robbins, J} } @article {1455, title = {Asthma and its association with cardiovascular disease in the elderly. The Cardiovascular Health Study Research Group.}, journal = {J Asthma}, volume = {33}, year = {1996}, month = {1996}, pages = {45-53}, abstract = {

Cardiovascular disease (CVD) is more prevalent in elderly than in middle-aged patients. Symptoms such as intermittent wheezing with dyspnea may then be due to either CVD or asthma. The objective of this study was to determine the prevalence and correlates of asthma in the elderly and their associations with CVD and CVD risk factors. A community sample of 5201 elderly persons from the Cardiovascular Health Study was asked if they had a physician diagnosis of asthma, and multiple cardiovascular risk and disease variables were measured. Six percent of the participants (309) recalled a history of asthma, and half of these were never smokers. Thirty percent of those with asthma were currently taking a bronchodilator, 14\% inhaled steroids, and 10\% oral prednisone. Men and women with asthma who were cigarette smokers were more likely to report a concurrent diagnosis of congestive heart failure than smokers without asthma (p = .04). However, when we determined the independent CVD correlates of asthma in this cohort, controlling for smoking status, age, gender, and diagnoses of chronic bronchitis and emphysema, only higher levels of high-density lipoprotein cholesterol (HDL-C) and higher plasma fibrinogen levels were significantly associated with asthma. It was concluded that asthma is as prevalent in the elderly as in middle-aged persons and is associated with higher HDL-C and higher fibrinogen levels, but not with prevalent cardiovascular disease.

}, keywords = {Aged, Aged, 80 and over, Asthma, Cardiovascular Diseases, Cohort Studies, Female, Humans, Lung, Male, Multivariate Analysis, Prevalence, Risk Factors, Sex Distribution, Smoking}, issn = {0277-0903}, author = {Enright, P L and Ward, B J and Tracy, R P and Lasser, E C} } @article {1462, title = {Lipoprotein levels in elderly patients with asthma. Cardiovascular Health Study Research Group.}, journal = {J Allergy Clin Immunol}, volume = {98}, year = {1996}, month = {1996 Aug}, pages = {467-9}, keywords = {Aged, Aging, Arteriosclerosis, Asthma, Female, Humans, Lipoproteins, Male, Prospective Studies, Risk Factors, Sex Factors}, issn = {0091-6749}, author = {Enright, P L and Lasser, E C and Ward, B J and Tracy, R P} } @article {1475, title = {Diabetes mellitus and echocardiographic left ventricular function in free-living elderly men and women: The Cardiovascular Health Study.}, journal = {Am Heart J}, volume = {133}, year = {1997}, month = {1997 Jan}, pages = {36-43}, abstract = {

This report describes the relation among diabetes, blood pressure, and prevalent cardiovascular disease, and echocardiographically measured left ventricular mass and filling (transmitral valve flow) velocities in the Cardiovascular Health Study, a cohort of 5201 men and women > or = 65 years of age. Ventricular septal and left posterior wall thicknesses were greater in diabetic than in nondiabetic subjects, showing a significant linear trend (p = 0.025 for ventricular septal thickness in both sexes combined, p = 0.002 for posterior wall thickness) with increased duration of diabetes. Increased wall thickness of the ventricular septum or the left posterior wall was not associated with prevalent coronary heart disease (CHD) in the cohort. Increased left ventricular mass was associated with diabetic persons not reporting CHD and with all subjects with CHD regardless of glucose tolerance status. After adjusting for body weight, blood pressure, heart rate, and prevalent coronary or cerebrovascular disease, diabetes (as measured by glucose level, insulin use, oral hypoglycemic use, and a positive history of diabetes before baseline examination) remained an independent predictor of increased left ventricular mass among men and women (174.2 gm in diabetic men vs 169.8 gm in normal men, 138.2 gm in diabetic women vs 134.0 gm in normal women, p = 0.043 for both sexes combined). Both early and late diastolic transmitral peak flow velocities were higher with increased duration of diabetes, but the calculated ratio of the early peak flow velocity to the late velocity (E/A ratio) did not differ significantly between subjects with historical diabetes and those with normal fasting glucose (both genders combined, p = 0.190). Glucose level, insulin use, oral hypoglycemic use, and a positive history of diabetes before baseline examination were significant independent predictors of the late transmitral peak flow velocity and its integrated flow-velocity curve but not for the integral of the early peak flow velocity or the E/A ratio. Diabetes is associated with abnormal left ventricular structure and function in elderly persons. This association persists after adjustment for body weight, blood pressure, heart rate, and reported coronary or cerebrovascular disease.

}, keywords = {Aged, Blood Flow Velocity, Blood Pressure, Diabetes Mellitus, Echocardiography, Female, Glucose Tolerance Test, Humans, Male, Mitral Valve, Residence Characteristics, Ventricular Function, Left}, issn = {0002-8703}, author = {Lee, M and Gardin, J M and Lynch, J C and Smith, V E and Tracy, R P and Savage, P J and Szklo, M and Ward, B J} }