@article {796, title = {Mesenteric artery disease in the elderly.}, journal = {J Vasc Surg}, volume = {40}, year = {2004}, month = {2004 Jul}, pages = {45-52}, abstract = {

PURPOSE: The purpose of this study was to estimate the population-based prevalence of mesenteric artery stenosis (MAS) and occlusion among independent elderly Americans.

METHOD: As part of an ancillary investigation to the Cardiovascular Health Study (CHS), participants in the Forsyth County, NC cohort had visceral duplex sonography of the celiac arteries and superior mesenteric arteries (SMAs). Critical MAS was defined by celiac peak systolic velocity >or=2.0 m/s and/or SMA peak systolic velocity >or=2.7 m/s. Occlusion of either vessel was defined by lack of a Doppler-shifted signal within the imaged artery. Demographic data, blood pressures, and blood lipid levels were collected as part of the baseline CHS examination. Participants{\textquoteright} weights were measured at baseline and before the duplex exam. Univariate tests of association were performed with two-way contingency tables, Student t tests, and Fisher exact tests. Multivariate associations were examined with logistic regression analysis.

RESULTS: A total of 553 CHS participants had visceral duplex sonography technically adequate to define the presence or absence of MAS. The study group had a mean age of 77.2 +/- 4.9 years and comprised 63\% women and 37\% men. Participant race was 76\% white and 23\% African-American. Ninety-seven participants (17.5\%) had MAS. There was no significant difference in age, race, gender, body mass index, blood pressure, cholesterol, or low-density lipoproteins for participants with or without MAS. Forward stepwise variable selection found renal artery stenosis (P =.008; odds ratio [OR], 2.85; 95\% confidence interval [CI], 1.31, 6.21) and high-density lipoprotein >40 (P =.02; OR, 3.03; 95\% CI, 1.17, 7.81) significantly associated with MAS in a multivariate logistic regression model. Eighty-three of the 97 participants with MAS (15.0\% of the cohort) had isolated celiac stenosis. Seven participants (1.3\% of the cohort) had combined celiac and SMA stenosis. Five participants (0.9\% of the cohort) had isolated SMA stenosis. Two participants (0.4\% of the cohort) had celiac occlusion. Considering all participants with MAS, there was no association with weight change. However, SMA stenosis and celiac occlusion demonstrated an independent association with annualized weight loss (P =.028; OR, 1.54; 95\% CI, 1.05, 2.26) and with renal artery stenosis (P =.001; OR, 9.48; 95\% CI, 2.62, 34.47).

CONCLUSION: This investigation provides the first population-based estimate of the prevalence of MAS among independent elderly Americans. MAS existed in 17.5\% of the study cohort. The majority had isolated celiac disease. SMA stenosis and celiac artery occlusion demonstrated a significant and independent association with weight loss and concurrent renal artery disease.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Arteriosclerosis, Celiac Artery, Cohort Studies, Female, Humans, Male, Mesenteric Arteries, Mesenteric Artery, Superior, Mesenteric Vascular Occlusion, Prevalence, Ultrasonography, Doppler, Duplex, Weight Loss}, issn = {0741-5214}, doi = {10.1016/j.jvs.2004.03.022}, author = {Hansen, Kimberley J and Wilson, David B and Craven, Timothy E and Pearce, Jeffrey D and English, William P and Edwards, Matthew S and Ayerdi, Juan and Burke, Gregory L} } @article {923, title = {Mortality in pharmacologically treated older adults with diabetes: the Cardiovascular Health Study, 1989-2001.}, journal = {PLoS Med}, volume = {3}, year = {2006}, month = {2006 Oct}, pages = {e400}, abstract = {

BACKGROUND: Diabetes mellitus (DM) confers an increased risk of mortality in young and middle-aged individuals and in women. It is uncertain, however, whether excess DM mortality continues beyond age 75 years, is related to type of hypoglycemic therapy, and whether women continue to be disproportionately affected by DM into older age.

METHODS AND FINDINGS: From the Cardiovascular Health Study, a prospective study of 5,888 adults, we examined 5,372 participants aged 65 y or above without DM (91.2\%), 322 with DM treated with oral hypoglycemic agents (OHGAs) (5.5\%), and 194 with DM treated with insulin (3.3\%). Participants were followed (1989-2001) for total, cardiovascular disease (CVD), coronary heart disease (CHD), and non-CVD/noncancer mortality. Compared with non-DM participants, those treated with OHGAs or insulin had adjusted hazard ratios (HRs) for total mortality of 1.33 (95\% confidence interval [CI], 1.10 to 1.62) and 2.04 (95\% CI, 1.62 to 2.57); CVD mortality, 1.99 (95\% CI, 1.54 to 2.57) and 2.16 (95\% CI, 1.54 to 3.03); CHD mortality, 2.47 (95\% CI, 1.89 to 3.24) and 2.75 (95\% CI, 1.95 to 3.87); and infectious and renal mortality, 1.35 (95\% CI, 0.70 to 2.59) and 6.55 (95\% CI, 4.18 to 10.26), respectively. The interaction of age (65-74 y versus > or =75 y) with DM was not significant. Women treated with OHGAs had a similar HR for total mortality to men, but a higher HR when treated with insulin.

CONCLUSIONS: DM mortality risk remains high among older adults in the current era of medical care. Mortality risk and type of mortality differ between OHGA and insulin treatment. Women treated with insulin therapy have an especially high mortality risk. Given the high absolute CVD mortality in older people, those with DM warrant aggressive CVD risk factor reduction.

}, keywords = {Administration, Oral, Aged, Cardiovascular Diseases, Coronary Disease, Diabetes Mellitus, Female, Humans, Hypoglycemic Agents, Insulin, Male, Proportional Hazards Models, Prospective Studies, Risk Assessment, Sex Distribution}, issn = {1549-1676}, doi = {10.1371/journal.pmed.0030400}, author = {Kronmal, Richard A and Barzilay, Joshua I and Smith, Nicholas L and Psaty, Bruce M and Kuller, Lewis H and Burke, Gregory L and Furberg, Curt} }