03137nas a2200445 4500008004100000022001400041245016600055210006900221260001300290300001200303490000700315520182100322653000902143653002102152653001502173653001902188653001502207653002202222653001102244653001402255653002502269653003102294653001302325653002602338653002902364653001902393653001502412653001702427653003002444653001702474100002002491700002102511700002102532700002202553700002502575700002002600700001502620700002102635856003502656 2002 eng d a1524-462800aIncidence, manifestations, and predictors of brain infarcts defined by serial cranial magnetic resonance imaging in the elderly: the Cardiovascular Health Study.0 aIncidence manifestations and predictors of brain infarcts define c2002 Oct a2376-820 v333 a
BACKGROUND AND PURPOSE: MRI-defined infarcts are common in the elderly. We sought to explore incidence, manifestations, and predictors of such infarcts.
METHODS: The Cardiovascular Health Study (CHS) is a population-based, longitudinal study of 5888 people aged > or =65 years. Participants have had extensive baseline and follow-up evaluations; 1433 participants underwent 2 MRI scans separated by 5 years and had no infarcts on initial MRI.
RESULTS: On follow-up MRI, 254 participants (17.7%) had 1 or more infarcts. Most were single (75.6%), subcortical (79.9%), and small (3 to 20 mm in 87.0%). Only 11.4% of those with infarcts experienced a documented transient ischemic attack or stroke between the scans. Although participants were similar at initial MRI, those with MRI-defined infarcts on follow-up experienced greater decline than those without infarcts on the Modified Mini-Mental State Examination and Digit-Symbol Substitution test (both P<0.01). Severity of white matter changes on initial MRI was the strongest predictor of incident infarcts. When it was excluded from stepwise multivariable models, predictors were serum creatinine, age, and ankle-arm index.
CONCLUSIONS: Incident MRI-defined infarcts commonly affect the elderly. Most are small, subcortical, and not associated with acute symptoms recognized as a transient ischemic attack or stroke. Nonetheless, they cannot be considered silent because of their association with subtle cognitive deficits. These covert infarcts are associated with white matter changes, which may share a common pathophysiology. Whether control of vascular risk factors, such as blood pressure, would reduce the risk of developing these infarcts and associated cognitive decline deserves further investigation.
10aAged10aBrain Infarction10aCalifornia10aCohort Studies10aCreatinine10aFollow-Up Studies10aHumans10aIncidence10aLongitudinal Studies10aMagnetic Resonance Imaging10aMaryland10aMultivariate Analysis10aNeuropsychological Tests10aNorth Carolina10aOdds Ratio10aPennsylvania10aPredictive Value of Tests10aRisk Factors1 aLongstreth, W T1 aDulberg, Corinne1 aManolio, Teri, A1 aLewis, Michael, R1 aBeauchamp, Norman, J1 aO'Leary, Daniel1 aCarr, Jeff1 aFurberg, Curt, D uhttps://chs-nhlbi.org/node/70302775nas a2200445 4500008004100000022001400041245012900055210006900184260001600253300001100269490000700280520149700287653000901784653002201793653001501815653002801830653002101858653001901879653002801898653001501926653001101941653001101952653000901963653001501972653001701987653003202004653001602036653003102052653001802083653001702101100002002118700002402138700002402162700002402186700002002210700002102230700002202251700002102273856003502294 2002 eng d a1524-463600aRelationship between coronary artery calcification and other measures of subclinical cardiovascular disease in older adults.0 aRelationship between coronary artery calcification and other mea c2002 Oct 01 a1674-90 v223 aBACKGROUND: In the Cardiovascular Health Study, subclinical cardiovascular disease (CVD) predicted CVD events in older adults. The extent to which this measure or its components reflect calcified coronary disease is unknown.
METHODS AND RESULTS: Coronary artery calcium (CAC) was assessed with electron beam tomography in 414 participants without clinical CVD and examined using cut points (CAC> or =400 and CAC> or =800) and the log(CAC); 274 had subclinical CVD by ankle-arm index, ECG, or carotid ultrasound. Cut points for subclinical disease as previously defined in the Cardiovascular Health Study were examined as well as continuous measures to produce receiver operating characteristic curve curves. A low ankle-arm index was highly specific for a high CAC score. The internal carotid artery intima-media thickness was most strongly correlated with CAC (r=0.30) and was significantly related to both CAC cut points and to the log(CAC) score independently of all other measures.
CONCLUSIONS: In these community-dwelling older adults without clinical CVD, internal carotid artery intima-media thickness was most closely related to CAC. However, 17.5% of those with a CAC> or =400 would be missed in the ascertainment of subclinical atherosclerosis using the previously published composite of subclinical atherosclerosis. Prospective follow-up will determine whether the CAC score improves prediction of CVD events over other noninvasive measures.
10aAged10aAged, 80 and over10aCalcinosis10aCardiovascular Diseases10aCarotid Stenosis10aCohort Studies10aCoronary Artery Disease10aDemography10aFemale10aHumans10aMale10aPrevalence10aRisk Factors10aSensitivity and Specificity10aSex Factors10aTomography, X-Ray Computed10aTunica Intima10aTunica Media1 aNewman, Anne, B1 aNaydeck, Barbara, L1 aSutton-Tyrrell, Kim1 aEdmundowicz, Daniel1 aO'Leary, Daniel1 aKronmal, Richard1 aBurke, Gregory, L1 aKuller, Lewis, H uhttps://chs-nhlbi.org/node/70403011nas a2200421 4500008004100000022001400041245007000055210006600125260001600191300001200207490000800219520184900227653000902076653002202085653001002107653002302117653002802140653001102168653001802179653001102197653002502208653000902233653002002242653002402262653001702286100002002303700002102323700002402344700002002368700002202388700001802410700002102428700001902449700002002468700001902488710004702507856003502554 2003 eng d a0003-992600a"Successful aging": effect of subclinical cardiovascular disease.0 aSuccessful aging effect of subclinical cardiovascular disease c2003 Oct 27 a2315-220 v1633 aBACKGROUND: Cardiovascular diseases are the primary cause of death in older adults. Among those without clinical disease, high levels of subclinical disease are associated with poor survival. The effect of the extent of subclinical cardiovascular disease on the quality of the remaining years has not been defined.
METHODS: In a longitudinal cohort study, 2932 men and women aged 65 years and older were followed up for 8 years to determine the likelihood of maintaining intact health and functioning. Successful aging was defined as remaining free of cardiovascular disease, cancer, and chronic obstructive pulmonary disease and with intact physical and cognitive functioning.
RESULTS: Younger age at study entry and a lower extent of subclinical cardiovascular disease were independently associated with the likelihood of maintaining successful aging. In age-stratified summaries, those with subclinical disease had a trajectory of decline similar to subjects 5 years older without subclinical vascular disease. Regression analyses showed that the decline associated with subclinical disease was equivalent to 6.5 (95% confidence interval, 6.4-6.6) years of aging for women and 5.6 (95% confidence interval, 5.4-5.8) years of aging for men. Individual measures of the extent of cardiovascular disease, diabetes mellitus, smoking, and higher C-reactive protein level were also independently predictive of fewer years of successful aging, but none of these factors substantially attenuated the effect of age itself.
CONCLUSIONS: There is a graded relationship between the extent of vascular disease measured noninvasively and the likelihood of maintaining intact health and function. Prevention of subclinical vascular disease may increase the quality and the quantity of years in late life.
10aAged10aAged, 80 and over10aAging10aC-Reactive Protein10aCardiovascular Diseases10aFemale10aHealth Status10aHumans10aLongitudinal Studies10aMale10aQuality of Life10aRegression Analysis10aRisk Factors1 aNewman, Anne, B1 aArnold, Alice, M1 aNaydeck, Barbara, L1 aFried, Linda, P1 aBurke, Gregory, L1 aEnright, Paul1 aGottdiener, John1 aHirsch, Calvin1 aO'Leary, Daniel1 aTracy, Russell1 aCardiovascular Health Study Research Group uhttps://chs-nhlbi.org/node/757