03027nas a2200361 4500008004100000022001400041245011300055210006900168260001300237300001100250490000700261520198700268653002202255653000902277653002802286653004002314653001102354653002202365653001102387653001102398653000902409653001802418653003002436653001702466653002602483653001802509100002202527700002202549700001502571700002302586700002102609856003502630 2004 eng d a0143-005X00aNeighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study.0 aNeighbourhood environments and mortality in an elderly cohort re c2004 Nov a917-230 v583 a

BACKGROUND: It has been postulated that neighbourhood conditions are related to the health of the elderly population but longitudinal studies are rare and confounding by individual level variables remains a possibility.

METHODS: Data were obtained from the cardiovascular health study, a population based study of adults aged 65 years and older. Census block groups were used as proxies for neighbourhoods. A summary score was used to characterise the neighbourhood socioeconomic environment. Information on personal socioeconomic indicators, cardiovascular disease prevalence, and cardiovascular risk factors was obtained from the baseline examination. Proportional hazards regression and propensity score matching were used to control for individual level variables.

RESULTS: Over the eight year follow up there were 1346 deaths among the 5074 participants, of which 43% were attributable to cardiovascular disease. Among white participants, living in the most disadvantaged neighbourhood group was associated with higher rates of cardiovascular death, after adjustment for income, education, and occupation (hazard ratio (HR) 1.5, 95% confidence intervals (CI) 1.2 to 1.9). No neighbourhood differences were observed for non-cardiovascular deaths. Estimates for black participants were 1.3 (95% CI 0.7 to 2.3) for cardiovascular deaths and 1.4 (95% CI 0.8 to 2.4) for non-cardiovascular deaths, but sample size was small. In white participants, associations of neighbourhood characteristics with cardiovascular mortality persisted after adjustment for prevalent baseline disease and cardiovascular risk factors. The use of propensity score matching led to similar results (HR for the lowest compared with the highest neighbourhood score group: 1.6 95% CI 1.1 to 2.5, controlling for personal socioeconomic indicators).

CONCLUSION: Neighbourhood disadvantage is related to rates of cardiovascular death in elderly white adults.

10aAfrican Americans10aAged10aCardiovascular Diseases10aEuropean Continental Ancestry Group10aFemale10aFollow-Up Studies10aHumans10aIncome10aMale10aPoverty Areas10aResidence Characteristics10aRisk Factors10aSocioeconomic Factors10aUnited States1 aRoux, Ana, V Diez1 aBorrell, Luisa, N1 aHaan, Mary1 aJackson, Sharon, A1 aSchultz, Richard uhttps://chs-nhlbi.org/node/80903809nas a2200433 4500008004100000022001400041245010000055210006900155260001300224300001200237490000700249520259500256653002202851653001602873653000902889653002202898653001802920653002802938653001902966653004002985653001203025653001103037653001103048653001403059653000903073653002303082653001703105653001603122100002403138700001603162700002303178700002303201700002603224700002403250700002203274700002103296700002303317856003503340 2006 eng d a0002-861400aMetabolic syndrome and cardiovascular disease in older people: The cardiovascular health study.0 aMetabolic syndrome and cardiovascular disease in older people Th c2006 Sep a1317-240 v543 a

OBJECTIVES: To assess the prospective association between metabolic syndrome (MetS) and cardiovascular disease (CVD) in older people and to evaluate the effect of lowering the threshold for impaired fasting glucose (IFG) on the prevalence of IFG and MetS and the risk of CVD.

DESIGN: Prospective cohort study.

SETTING: Four field centers in U.S. communities.

PARTICIPANTS: Three thousand five hundred eighty-five subjects in the Cardiovascular Health Study free of diabetes mellitus and CVD at baseline (mean age 72, 62% female, 14% black).

MEASUREMENTS: Baseline measures of MetS components and adjudicated incident CVD events. MetS (2001) was defined first using the original criteria from the Third Adult Treatment Panel Report of the National Cholesterol Education Program (> or =3 of the following: large waist circumference (women >88 cm, men >102 cm), elevated triglycerides (> or =1.70 mmol/L), low high-density lipoprotein cholesterol (men <1.04 mmol/L, women <1.30 mmol/L), elevated fasting glucose (6.1-6.9 mmol/L), and high blood pressure (> or =130/85 mmHg or self-reported use of medications for hypertension). Subjects were also classified according to the revised definition of the MetS (2005) that applies the lower threshold for fasting glucose (5.6-6.9 mmol/L).

RESULTS: During follow-up (median 11 years), 818 coronary heart disease (CHD), 401 stroke, and 554 congestive heart failure (CHF) events occurred. Age- and race-adjusted hazard ratios (HRs) for CHD, stroke, and CHF were 1.30 (95% confidence interval (CI) = 1.07-1.57), 0.94 (95% CI = 0.73-1.21), and 1.40 (95% CI = 1.12-1.76) for women and 1.35 (95% CI = 1.10-1.66), 1.51 (95% CI = 1.08-2.12), and 1.47 (95% CI = 1.14-1.90) for men, respectively. Overall, women and men with MetS (2005) were 20% to 30% more likely to experience any CVD event than subjects without MetS (2005). Using the lower cut-point for IFG resulted in a near tripling in IFG prevalence (16% to 46%) and an additional 9% classified with MetS (2005) but HRs similar to those estimated from the original MetS (2001) criteria. High blood pressure was the component most strongly associated with incident CHD.

CONCLUSION: Results from this study of an elderly, population-based cohort provide support for earlier investigations in primarily middle-aged populations that link the presence of MetS with the development of CVD and further underscore the importance of recognizing and treating its individual components, particularly high blood pressure.

10aAfrican Americans10aAge Factors10aAged10aAged, 80 and over10aBlood Glucose10aCardiovascular Diseases10aCohort Studies10aEuropean Continental Ancestry Group10aFasting10aFemale10aHumans10aIncidence10aMale10aMetabolic Syndrome10aRisk Factors10aSex Factors1 aMcNeill, Ann, Marie1 aKatz, Ronit1 aGirman, Cynthia, J1 aRosamond, Wayne, D1 aWagenknecht, Lynne, E1 aBarzilay, Joshua, I1 aTracy, Russell, P1 aSavage, Peter, J1 aJackson, Sharon, A uhttps://chs-nhlbi.org/node/918