03000nas a2200409 4500008004100000022001400041245008400055210006900139260001600208300001200224490000700236520195300243653001902196653000902215653001802224653002202242653002102264653002502285653001102310653001102321653001402332653001202346653000902358653002402367653000902391653001802400653001202418100001702430700001702447700001602464700001602480700001502496700001502511700001202526700001702538856003502555 1999 eng d a0027-887400aIncreased blood glucose and insulin, body size, and incident colorectal cancer.0 aIncreased blood glucose and insulin body size and incident color c1999 Jul 07 a1147-540 v913 a

BACKGROUND: Abdominal obesity--an elevated level of visceral adipose tissue--has been linked to colorectal cancer. Furthermore, elevated levels of visceral adipose tissue have been associated with hyperinsulinemia, and insulin is a growth factor in the colon. We assessed whether waist circumference, a surrogate measure of visceral adipose tissue, and metabolic parameters associated with visceral adipose tissue were related to colorectal cancer.

METHODS: In the Cardiovascular Health Study cohort, we examined the relationship of baseline measurements of body size, glucose, insulin, and lipoproteins to incident colorectal cancer. All P values are two-sided.

RESULTS: Among 5849 participants, 102 incident cases of colorectal cancer were identified. Individuals in the highest quartile of fasting glucose had a nearly twofold increased risk of colorectal cancer (relative risk [RR] = 1.8; 95% confidence interval [CI] = 1.0-3.1), and the linear trend RR (LT RR = 1.2; 95% CI = 1.0-1.5) for fasting glucose level was statistically significant (P =. 02). Glucose and insulin levels 2 hours after oral glucose challenge also exhibited statistically significant associations with colorectal cancer (2-hour glucose levels: RR = 2.4 [95% CI = 1.2-4. 7]/LT RR = 1.3 [95% CI = 1.0-1.6; P =.02]; 2-hour insulin levels: RR = 2.0 [95% CI = 1.0-3.8]/LT RR = 1.2 [95% CI = 1.0-1.5; P =.04]). Analysis of fasting insulin levels suggested a threshold effect, with values above the median associated with colorectal cancer (RR = 1.6; 95% CI = 1.1-2.4; P =.02). Higher levels of waist circumference were also statistically significantly associated with colorectal cancer (RR = 1.9; 95% CI = 1.1-3.3; P =.02).

CONCLUSIONS: These data provide, to our knowledge, the first direct evidence of an association between elevated visceral adipose tissue level, its associated metabolic effects, and colorectal cancer.

10aAdipose Tissue10aAged10aBlood Glucose10aBody Constitution10aCholesterol, HDL10aColorectal Neoplasms10aFemale10aHumans10aIncidence10aInsulin10aMale10aProspective Studies10aRisk10aTriglycerides10aViscera1 aSchoen, R, E1 aTangen, C, M1 aKuller, L H1 aBurke, G, L1 aCushman, M1 aTracy, R P1 aDobs, A1 aSavage, P, J uhttps://chs-nhlbi.org/node/59402728nas a2200349 4500008004100000022001400041245015400055210006900209260001600278300001100294490000800305520174600313653000902059653002202068653001902090653002102109653001502130653001102145653001102156653000902167653002402176653001702200653001802217100001602235700001202251700001702263700001902280700001502299700001202314700001702326856003502343 2000 eng d a1524-453900aDepressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Cardiovascular Health Study Collaborative Research Group.0 aDepressive symptoms and risks of coronary heart disease and mort c2000 Oct 10 a1773-90 v1023 a

BACKGROUND: Several epidemiological studies have associated depressive symptoms with cardiovascular disease. We investigated whether depressive symptoms constituted a risk for coronary heart disease (CHD) and total mortality among an apparently healthy elderly cohort.

METHODS AND RESULTS: In a prospective cohort of 5888 elderly Americans (>/=65 years) who were enrolled in the Cardiovascular Health Study, 4493 participants who were free of cardiovascular disease at baseline provided annual information on their depressive status, which was assessed using the Depression Scale of the Center for Epidemiological Studies. These 4493 subjects were followed for 6 years for the development of CHD and mortality. The cumulative mean depression score was assessed for each participant up to the time of event (maximum 6-year follow-up). Using time-dependent, proportional-hazards models, the unadjusted hazard ratio associated with every 5-unit increase in mean depression score for the development of CHD was 1.15 (P:=0.006); the ratio for all-cause mortality was 1.29 (P:<0.0001). In multivariate analyses adjusted for age, race, sex, education, diabetes, hypertension, cigarette smoking, total cholesterol, triglyceride level, congestive heart failure, and physical inactivity, the hazard ratio for CHD was 1.15 (P:=0.006) and that for all-cause mortality was 1.16 (P:=0.006). Among participants with the highest cumulative mean depression scores, the risk of CHD increased by 40% and risk of death by 60% compared with those who had the lowest mean scores.

CONCLUSIONS: Among elderly Americans, depressive symptoms constitute an independent risk factor for the development of CHD and total mortality.

10aAged10aAged, 80 and over10aCohort Studies10aCoronary Disease10aDepression10aFemale10aHumans10aMale10aProspective Studies10aRisk Factors10aUnited States1 aAriyo, A, A1 aHaan, M1 aTangen, C, M1 aRutledge, J, C1 aCushman, M1 aDobs, A1 aFurberg, C D uhttps://chs-nhlbi.org/node/62204256nas a2200469 4500008004100000022001400041245005500055210005300110260001300163300001200176490000700188520307600195653000903271653002203280653001903302653002103321653001203342653001103354653001803365653001103383653001403394653000903408653002003417653001403437653001503451653002103466653001803487653001603505100001503521700001703536700001503553700001703568700001403585700001803599700001403617700001303631700001403644700001303658700001903671710006103690856003503751 2001 eng d a1079-500600aFrailty in older adults: evidence for a phenotype.0 aFrailty in older adults evidence for a phenotype c2001 Mar aM146-560 v563 a

BACKGROUND: Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established.

METHODS: To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality.

RESULTS: Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline).

CONCLUSIONS: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.

10aAged10aAged, 80 and over10aCohort Studies10aDisabled Persons10aFatigue10aFemale10aFrail Elderly10aHumans10aIncidence10aMale10aMuscle Weakness10aPhenotype10aPrevalence10aSex Distribution10aUnited States10aWeight Loss1 aFried, L P1 aTangen, C, M1 aWalston, J1 aNewman, A, B1 aHirsch, C1 aGottdiener, J1 aSeeman, T1 aTracy, R1 aKop, W, J1 aBurke, G1 aMcBurnie, M, A1 aCardiovascular Health Study Collaborative Research Group uhttps://chs-nhlbi.org/node/639