03864nas a2200373 4500008004100000022001400041245012500055210006900180260001300249300001200262490000700274520283300281653003103114653002103145653000903166653002203175653002803197653001103225653001103236653000903247653001503256653002103271653002603292100001503318700001903333700001503352700001503367700001503382700001303397700001403410700001603424700001403440856003603454 1993 eng d a0002-861400aAge-related trends in cardiovascular morbidity and physical functioning in the elderly: the Cardiovascular Health Study.0 aAgerelated trends in cardiovascular morbidity and physical funct c1993 Oct a1047-560 v413 a

OBJECTIVE: To describe relationships between age and sub-clinical cardiovascular disease, manifest chronic disease, and physical functioning and limitations among persons aged 65 years and older, with emphasis on the "oldest old," those 85 years and older.

DESIGN: Observational population-based study.

SETTING: Four U.S. communities: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania.

PARTICIPANTS: 5,201 men and women aged 65 years and older.

MEASUREMENTS: Demographic data; histories of cardiovascular disease (CVD), chronic lung disease, arthritis, diabetes, and hypertension; measures of subclinical disease including arm and ankle blood pressures, internal carotid wall thickness and stenosis, ejection fraction, left ventricular mass, fractional shortening, and diastolic function, electrocardiographic left ventricular hypertrophy and cardiac injury score, forced expiratory flow and volume; functional status including self-reported physical functioning, hearing and sight limitations and health status, and performance-based measures of function. These variables were examined among men and women in three age groups: 65-74 years, 75-84 years, and 85 + years. Subgroups of participants with and without manifest CVD were also examined.

MAIN RESULTS: In women, the prevalence of CVD and other chronic conditions increased with age, and the highest rates occurred among those 85 years and older. In men, prevalence rates increased between the two younger groups, but the oldest group had lower than expected rates for coronary heart disease, cerebrovascular disease, hypertension, and chronic lung disease. In contrast, there were strong age-related linear trends in most of the subclinical measures of blood pressure, atherosclerosis and pulmonary function and in virtually all measures of functional status in both gender groups across the age range. There was a particularly marked decline in functional status between the two older age groups. While subclinical disease was greater and functional status was poorer among those with manifest CVD, with few exceptions, age-related trends were not significantly different between the two groups.

CONCLUSIONS: Lower than expected prevalence rates of CVD among those aged 85 years and older, particularly among men, in this study of community-dwelling elderly may represent selection bias or a real plateauing in disease prevalence with age. However, subclinical disease appears to increase and functional status to decline across the age range in both men and women regardless of the presence of CVD. The apparent increase in subclinical disease with age indicates potential for CVD prevention after age 65.

10aActivities of Daily Living10aAge Distribution10aAged10aAged, 80 and over10aCardiovascular Diseases10aFemale10aHumans10aMale10aPrevalence10aSex Distribution10aSocioeconomic Factors1 aBild, D, E1 aFitzpatrick, A1 aFried, L P1 aWong, N, D1 aHaan, M, N1 aLyles, M1 aBovill, E1 aPolak, J, F1 aSchulz, R uhttps://chs-nhlbi.org/node/144202686nas a2200409 4500008004100000022001400041245008200055210006900137260001600206300001000222490000700232520161900239653000901858653002801867653001901895653002101914653001101935653001101946653001401957653002501971653000901996653002602005653001502031653002102046653001702067100001602084700001702100700001502117700001702132700001402149700001502163700001702178700001702195700001502212700001302227856003602240 1995 eng d a0009-732200aSubclinical disease as an independent risk factor for cardiovascular disease.0 aSubclinical disease as an independent risk factor for cardiovasc c1995 Aug 15 a720-60 v923 a

BACKGROUND: The primary aim of the present study was to determine the relation between measures of subclinical cardiovascular disease and the incidence of clinical cardiovascular disease among 5201 adults 65 years of age or older who were participating in the Cardiovascular Health Study.

METHODS AND RESULTS: A new method of classifying subclinical disease at baseline examination in the Cardiovascular Health Study included measures of ankle-brachial blood pressure, carotid artery stenosis and wall thickness, ECG and echocardiographic abnormalities, and positive response to the Rose Angina and Claudication Questionnaire. Participants were followed for an average of 2.39 years (maximum, 3 years). For participants without evidence of clinical cardiovascular disease at baseline, the presence of subclinical disease compared with no subclinical disease was associated with a significant increased risk of incident total coronary heart disease including CHD deaths and nonfatal MI and angina pectoris for both men and women. For individuals with subclinical disease, the increased risk of total coronary heart disease was 2.0 for men and 2.5 for women, and the increased risk of total mortality was 2.9 for men and 1.7 for women. The increased risk changed little after adjustment for other risk factors, including lipoprotein levels, blood pressure, smoking, and diabetes.

CONCLUSIONS: The measurement of subclinical disease provides an approach for identifying high-risk older individuals who may be candidates for more active intervention to prevent clinical disease.

10aAged10aCardiovascular Diseases10aCohort Studies10aCoronary Disease10aFemale10aHumans10aIncidence10aLongitudinal Studies10aMale10aMyocardial Infarction10aOdds Ratio10aReference Values10aRisk Factors1 aKuller, L H1 aShemanski, L1 aPsaty, B M1 aBorhani, N O1 aGardin, J1 aHaan, M, N1 aO'Leary, D H1 aSavage, P, J1 aTell, G, S1 aTracy, R uhttps://chs-nhlbi.org/node/141503451nas a2200349 4500008004100000022001400041245011600055210006900171260001600240300000900256490000800265520247500273653000902748653001002757653001202767653002202779653002802801653002402829653001902853653002202872653001302894653001102907653002702918653002402945653001702969100001502986700001703001700001703018700001703035700001403052856003503066 1999 eng d a0098-748400aThe role of APOE epsilon4 in modulating effects of other risk factors for cognitive decline in elderly persons.0 arole of APOE epsilon4 in modulating effects of other risk factor c1999 Jul 07 a40-60 v2823 a

CONTEXT: Cognitive decline in elderly persons is often an early predictor of dementia. Subclinical cardiovascular disease (CVD) and diabetes mellitus may contribute to substantial decline in cognitive function in the elderly. These risks may be modified by gene-environment interactions between apolipoprotein E (APOE) genotype and CVD risk factors or subclinical CVD.

OBJECTIVES: To examine the association between subclinical CVD and decline in cognitive functioning in the elderly and to examine effect modification by the APOE genotype of the association between subclinical disease and cognitive decline.

DESIGN: The Cardiovascular Health Study, a population-based, prospective cohort study.

SETTING AND POPULATION: A total of 5888 randomly selected Medicare-eligible participants from Sacramento County, California; Forsyth County, North Carolina; Washington County, Maryland; and Pittsburgh, Pa, aged 65 years or older, who were recruited in 1989-1990 (n = 5201) and in 1992-1993 (n = 687) and who were followed up for 7 and 5 years, respectively.

MAIN OUTCOME MEASURES: Change over time in scores on the Modified Mini-Mental State Examination and the Digit Symbol Substitution Test as a function of APOE genotype, subclinical CVD, and diabetes mellitus.

RESULTS: Seventy percent of participants had no significant decline on the Modified Mini-Mental State Examination. Systolic blood pressure, the ankle-arm brachial index, atherosclerosis of the internal carotid artery, diabetes mellitus, and several diagnoses of prevalent CVD were significantly associated with declines in scores on the Modified Mini-Mental State Examination and the Digit Symbol Substitution Test. The rate of cognitive decline associated with peripheral vascular disease, atherosclerosis of the common and internal carotid arteries, or diabetes mellitus was increased by the presence of any APOE epsilon4 allele.

CONCLUSIONS: Most healthy elderly people did not experience cognitive decline. Measures of subclinical CVD were modest predictors of cognitive decline. Those with any APOE epsilon4 allele in combination with atherosclerosis, peripheral vascular disease, or diabetes mellitus were at substantially higher risk of cognitive decline than those without the APOE epsilon4 allele or subclinical CVD. High levels of atherosclerosis increased cognitive decline independently of APOE genotype.

10aAged10aAging10aAlleles10aApolipoproteins E10aCardiovascular Diseases10aCognition Disorders10aCohort Studies10aDiabetes Mellitus10aGenotype10aHumans10aMental Status Schedule10aProspective Studies10aRisk Factors1 aHaan, M, N1 aShemanski, L1 aJagust, W, J1 aManolio, T A1 aKuller, L uhttps://chs-nhlbi.org/node/59702683nas a2200385 4500008004100000022001400041245009700055210006900152260000900221300001000230490000600240520166800246653002701914653000901941653002201950653001001972653002101982653001902003653002802022653000902050653002602059653001702085653002102102653001802123653001302141653001102154653001102165653000902176653001202185100001602197700001502213700002002228700001402248856003502262 2003 eng d a1279-770700aBody composition in the elderly: the influence of nutritional factors and physical activity.0 aBody composition in the elderly the influence of nutritional fac c2003 a130-90 v73 a

BACKGROUND: Controversy exists regarding the relative contribution of diet and exercise to body composition. Few studies have examined these associations in the elderly, where changes occur in the body fat to muscle ratio.

OBJECTIVE: The primary objective of this paper is to determine whether energy intake or physical activity are associated with body composition. Secondly, to investigate whether specific macronutrients are associated with fat or lean tissue.

DESIGN: Data (n= 1404) for this cross-sectional analysis were collected from a population-based sub-sample of elderly enrollees in the Cardiovascular Health Study (CHS). Dietary intake and physical activity were assessed by questionnaires. Body composition was measured by Dual Energy X-ray Absorptiometry (DEXA). Linear regression models were used to assess the associations of diet and activity with body composition.

RESULTS: Total energy intake was not associated with any of the body composition measures. Higher dietary saturated fat was associated with higher percent body mass as fat and trunk fat in both sexes (p<0.01), and in men other dietary fats were associated with body fat. In women, distance walked was inversely associated with fat masses even after adjustment for pace of walking. In both sexes, faster pace of walking was associated with lower body and fat mass (p<0.01). Lean muscle mass was not associated with physical activity or dietary intakes.

CONCLUSION: Physical activity and dietary fat intake in this the elderly population were more closely associated with body fat mass than was total energy intake.

10aAbsorptiometry, Photon10aAged10aAged, 80 and over10aAging10aBody Composition10aCohort Studies10aCross-Sectional Studies10aDiet10aDietary Carbohydrates10aDietary Fats10aDietary Proteins10aEnergy Intake10aExercise10aFemale10aHumans10aMale10aWalking1 aMitchell, D1 aHaan, M, N1 aSteinberg, F, M1 aVisser, M uhttps://chs-nhlbi.org/node/739