03196nas a2200457 4500008004100000022001400041245008100055210006900136260001300205300001100218490000800229520191200237653003102149653000902180653002202189653002802211653001902239653002102258653002802279653003002307653001802337653001102355653001102366653003102377653001802408653000902426653001902435653003202454653001102486653001802497653001202515100002102527700002402548700001802572700002202590700002102612700001802633700002002651710003202671856003502703 2003 eng d a0012-369200aThe 6-min walk test: a quick measure of functional status in elderly adults.0 a6min walk test a quick measure of functional status in elderly a c2003 Feb a387-980 v1233 a
OBJECTIVES: To determine the correlates of the total 6-min walk distance (6MWD) in a population sample of adults > or = 68 years old.
METHODS: The standardized 6-min walk test (6MWT) was administered to the Cardiovascular Health Study cohort during their seventh annual examination.
RESULTS: Of the 3,333 participants with a clinic visit, 2,281 subjects (68%) performed the 6MWT. There were no untoward events. The mean 6MWD was 344 m (SD, 88 m). Independent general correlates of a shorter 6MWD in linear regression models in women and men included the following: older age, higher weight, larger waist, weaker grip strength, symptoms of depression, and decreased mental status. Independent disease or risk factor correlates of a shorter 6MWD included the following: a low ankle BP, use of angiotensin-converting enzyme inhibitors, and arthritis in men and women; higher C-reactive protein, diastolic hypertension, and lower FEV(1) in women; and the use of digitalis in men. Approximately 30% of the variance in 6MWD was explained by the linear regression models. Newly described bivariate associations of a shorter 6MWD included impaired activities of daily living; self-reported poor health; less education; nonwhite race; a history of coronary heart disease, transient ischemic attacks, stroke, or diabetes; and higher levels of C-reactive protein, fibrinogen, or WBC count.
CONCLUSIONS: Most community-dwelling elderly persons can quickly and safely perform this functional status test in the outpatient clinic setting. The test may be used clinically to measure the impact of multiple comorbidities, including cardiovascular disease, lung disease, arthritis, diabetes, and cognitive dysfunction and depression, on exercise capacity and endurance in older adults. Expected values should be adjusted for the patient's age, gender, height, and weight.
10aActivities of Daily Living10aAged10aAged, 80 and over10aCardiovascular Diseases10aCohort Studies10aCoronary Disease10aCross-Sectional Studies10aDiabetes Mellitus, Type 210aExercise Test10aFemale10aHumans10aIschemic Attack, Transient10aLinear Models10aMale10aMass Screening10aSensitivity and Specificity10aStroke10aUnited States10aWalking1 aEnright, Paul, L1 aMcBurnie, Mary, Ann1 aBittner, Vera1 aTracy, Russell, P1 aMcNamara, Robert1 aArnold, Alice1 aNewman, Anne, B1 aCardiovascular Health Study uhttps://chs-nhlbi.org/node/72502819nas a2200409 4500008004100000022001400041245014000055210006900195260001300264300001100277490000800288520165500296653000901951653002801960653001901988653001502007653001102022653001802033653001102051653001402062653002002076653000902096653001502105653001502120653001702135653001602152653004702168653003102215100002002246700001602266700001602282700002102298700002102319700001702340700001702357856003502374 2005 eng d a0002-962900aFactors associated with incidence and persistence of symptoms of disturbed sleep in an elderly cohort: the Cardiovascular Health Study.0 aFactors associated with incidence and persistence of symptoms of c2005 Apr a163-720 v3293 aBACKGROUND: There are limited data pertaining to the factors influencing the incidence and persistence of sleep symptoms in the elderly. The purpose of this study was to determine the incidence and nonremission rates of the following sleep symptoms: trouble falling asleep (TFA), frequent awakenings (FA), and excessive daytime sleepiness (EDS) in the Cardiovascular Health Study (CHS), a prospective multicenter study of cardiovascular disease in a large cohort of elderly adults. Factors influencing these rates were assessed as well.
METHODS: 4467 participants in CHS were surveyed for the presence of TFA, FA, and EDS as well as other health problems at their baseline examination and at a follow-up examination 1 to 4 years later.
RESULTS: Annualized incidence and nonremission rates were the following: TFA (2.8% and 15.4%), FA (12.3% and 22.7%), and EDS (4.4% and 13.4%). Women were more likely to have incident and persistent TFA. Depression was the primary factor predicting the incidence of all three sleep symptoms. However, other health conditions, including respiratory symptoms and cardiovascular disease, and limitation in activities of daily living were important as well. Depression also was the most important factor associated with persistence of these sleep symptoms. The role of other health conditions in determining nonremission was much more limited.
CONCLUSIONS: Incidence of sleep disturbances in the elderly is related to depression, health conditions, and physical functioning. However, persistence of sleep disturbances is best predicted by the presence of depression.
10aAged10aCardiovascular Diseases10aCohort Studies10aDepression10aFemale10aHealth Status10aHumans10aIncidence10aLogistic Models10aMale10aOdds Ratio10aPrevalence10aRisk Factors10aSex Factors10aSleep Initiation and Maintenance Disorders10aSurveys and Questionnaires1 aQuan, Stuart, F1 aKatz, Ronit1 aOlson, Jean1 aBonekat, William1 aEnright, Paul, L1 aYoung, Terry1 aNewman, Anne uhttps://chs-nhlbi.org/node/83303343nas a2200457 4500008004100000022001400041245012900055210006900184260001300253300001200266490000700278520198400285653003102269653000902300653002802309653001902337653001602356653002602372653001102398653000902409653002502418653001102443653002002454653000902474653002402483653003302507653003202540653002002572653001702592653001802609100002302627700001702650700002402667700002402691700002102715700002502736700002102761700002002782710004702802856003602849 2008 eng d a1532-541500aIncident physical disability in people with lower extremity peripheral arterial disease: the role of cardiovascular disease.0 aIncident physical disability in people with lower extremity peri c2008 Jun a1037-440 v563 aOBJECTIVES: To evaluate the risk of incident physical disability and the decline in gait speed over a 6-year follow-up associated with a low ankle-arm index (AAI) in older adults.
DESIGN: Observational cohort study.
SETTING: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania.
PARTICIPANTS: Four thousand seven hundred five older adults, 58% women and 17.6% black, participating in the Cardiovascular Health Study.
MEASUREMENTS: AAI was measured in 1992/93 (baseline). Self-reported mobility, activity of daily living (ADL), and instrumental activity of daily living (IADL) disability and gait speed were recorded at baseline and at 1-year intervals over 6 years of follow-up. Mobility disability was defined as any difficulty walking half a mile and ADL and IADL disability was defined as any difficulty with 11 specific ADL and IADL tasks. Individuals with mobility, ADL, or IADL disability at baseline were excluded from the respective incident disability analyses.
RESULTS: Lower baseline AAI values were associated with increased risk of mobility disability and ADL/IADL disability. Clinical cardiovascular disease (CVD), diabetes mellitus, and interim CVD events partially explained these associations for mobility disability and clinical CVD and diabetes mellitus partially explained these associations for ADL and IADL disability. Individuals with an AAI less than 0.9 had on average a mean decrease in gait speed of 0.02 m/s per year, or a decline of 0.12 m/s over the 6-year follow-up. Prevalent CVD partly explained this decrease but interim CVD events did not further attenuate it.
CONCLUSION: Low AAI serves as marker of future disability risk. Reduction of disability risk in patients with a low AAI should consider cardiovascular comorbidity and the prevention of additional disabling CVD events.
10aActivities of Daily Living10aAged10aCardiovascular Diseases10aCohort Studies10aComorbidity10aDisability Evaluation10aFemale10aGait10aGeriatric Assessment10aHumans10aLower Extremity10aMale10aMobility Limitation10aPeripheral Vascular Diseases10aProportional Hazards Models10aRisk Assessment10aRisk Factors10aUnited States1 aBrach, Jennifer, S1 aSolomon, Cam1 aNaydeck, Barbara, L1 aSutton-Tyrrell, Kim1 aEnright, Paul, L1 aJenny, Nancy, Swords1 aChaves, Paulo, M1 aNewman, Anne, B1 aCardiovascular Health Study Research Group uhttps://chs-nhlbi.org/node/102402756nas a2200433 4500008004100000022001400041245008000055210006900135260001600204300001100220490000800231520152100239653000901760653002301769653002801792653001101820653001501831653002901846653002501875653001101900653002001911653002501931653002901956653000901985653003301994653004302027653001502070100001502085700002202100700002102122700002002143700002402163700001802187700002202205700001802227700002402245700001702269856003602286 2008 eng d a1476-625600aInflammatory markers and longitudinal lung function decline in the elderly.0 aInflammatory markers and longitudinal lung function decline in t c2008 Sep 15 a602-100 v1683 aLongitudinal studies examining associations of the inflammatory markers fibrinogen and C-reactive protein (CRP) with lung function decline are sparse. The authors examined whether elevated fibrinogen and CRP levels were associated with greater longitudinal lung function decline in the elderly. The Cardiovascular Health Study measured fibrinogen and CRP in 5,790 Whites and African Americans from four US communities aged 65 years or older in 1989-1990 or 1992-1993. Spirometry was performed in 1989-1990 and 4, 7, and 16 years later. Fibrinogen and CRP were inversely associated with lung function at baseline after adjustment for multiple potential confounders. In mixed models, the rate of decline in forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) ratio with increasing age was faster among those with higher baseline fibrinogen (-0.032%/year per standard deviation higher fibrinogen (95% confidence interval: -0.057, -0.0074)) but not among those with higher CRP (-0.0037%/year per standard deviation higher CRP (95% confidence interval: -0.013, 0.0056)). Longitudinal analyses for FEV(1) and FVC yielded results in the direction opposite of that hypothesized, possibly because of the high mortality rate and strong inverse association of FEV(1) and FVC but not FEV(1)/FVC with mortality. An alternative approach to missing data yielded similar results. In conclusion, higher levels of fibrinogen, but not CRP, independently predicted greater FEV(1)/FVC decline in the elderly.
10aAged10aC-Reactive Protein10aCross-Sectional Studies10aFemale10aFibrinogen10aForced Expiratory Volume10aGeriatric Assessment10aHumans10aLogistic Models10aLongitudinal Studies10aLung Volume Measurements10aMale10aMulticenter Studies as Topic10aPulmonary Disease, Chronic Obstructive10aSpirometry1 aJiang, Rui1 aBurke, Gregory, L1 aEnright, Paul, L1 aNewman, Anne, B1 aMargolis, Helene, G1 aCushman, Mary1 aTracy, Russell, P1 aWang, Yuanjia1 aKronmal, Richard, A1 aBarr, Graham uhttps://chs-nhlbi.org/node/104802822nas a2200637 4500008004100000022001400041245011200055210006900167260001300236300001000249490000700259520095900266653002301225653001101248653002901259653003801288653001801326653003401344653001101378653000901389653001801398653000901416653002701425653003601452653001501488653001901503100002101522700002201543700001901565700002001584700002001604700002601624700002301650700003001673700001901703700001701722700002501739700002101764700002201785700002001807700002301827700002201850700002801872700001901900700002301919700002601942700002401968700002101992700001902013700002302032700001902055700002502074700002402099700002502123856003602148 2010 eng d a1546-171800aMeta-analyses of genome-wide association studies identify multiple loci associated with pulmonary function.0 aMetaanalyses of genomewide association studies identify multiple c2010 Jan a45-520 v423 aSpirometric measures of lung function are heritable traits that reflect respiratory health and predict morbidity and mortality. We meta-analyzed genome-wide association studies for two clinically important lung-function measures: forced expiratory volume in the first second (FEV(1)) and its ratio to forced vital capacity (FEV(1)/FVC), an indicator of airflow obstruction. This meta-analysis included 20,890 participants of European ancestry from four CHARGE Consortium studies: Atherosclerosis Risk in Communities, Cardiovascular Health Study, Framingham Heart Study and Rotterdam Study. We identified eight loci associated with FEV(1)/FVC (HHIP, GPR126, ADAM19, AGER-PPT2, FAM13A, PTCH1, PID1 and HTR4) and one locus associated with FEV(1) (INTS12-GSTCD-NPNT) at or near genome-wide significance (P < 5 x 10(-8)) in the CHARGE Consortium dataset. Our findings may offer insights into pulmonary function and pathogenesis of chronic lung disease.
10aDatabases, Genetic10aFemale10aForced Expiratory Volume10aGenetic Predisposition to Disease10aGenome, Human10aGenome-Wide Association Study10aHumans10aLung10aLung Diseases10aMale10aMeta-Analysis as Topic10aPolymorphism, Single Nucleotide10aSpirometry10aVital Capacity1 aHancock, Dana, B1 aEijgelsheim, Mark1 aWilk, Jemma, B1 aGharib, Sina, A1 aLoehr, Laura, R1 aMarciante, Kristin, D1 aFranceschini, Nora1 avan Durme, Yannick, M T A1 aChen, Ting-Hsu1 aBarr, Graham1 aSchabath, Matthew, B1 aCouper, David, J1 aBrusselle, Guy, G1 aPsaty, Bruce, M1 aDuijn, Cornelia, M1 aRotter, Jerome, I1 aUitterlinden, André, G1 aHofman, Albert1 aPunjabi, Naresh, M1 aRivadeneira, Fernando1 aMorrison, Alanna, C1 aEnright, Paul, L1 aNorth, Kari, E1 aHeckbert, Susan, R1 aLumley, Thomas1 aStricker, Bruno, H C1 aO'Connor, George, T1 aLondon, Stephanie, J uhttps://chs-nhlbi.org/node/115001829nas a2200229 4500008004100000022001400041245014800055210006900203260001300272300001200285490000700297520109200304100001901396700002101415700002101436700002401457700002101481700002301502700001801525700002001543856003601563 2014 eng d a1552-688700aAssociation Between 6-Minute Walk Test and All-Cause Mortality, Coronary Heart Disease-Specific Mortality, and Incident Coronary Heart Disease.0 aAssociation Between 6Minute Walk Test and AllCause Mortality Cor c2014 Jun a583-5990 v263 aOBJECTIVE: To examine the association between 6-min walk test (6 MWT) performance and all-cause mortality, coronary heart disease mortality, and incident coronary heart disease in older adults.
METHOD: We conducted a time-to-event analysis of 1,665 Cardiovascular Health Study participants without prevalent cardiovascular disease with a 6 MWT.
RESULTS: During a mean follow-up of 8 years, there were 305 incident coronary heart disease events, and 504 deaths of which 100 were coronary heart disease-related deaths. The 6 MWT performance in the shortest two distance quintiles was associated with increased risk of all-cause mortality (290-338 m: hazard ratio [HR] = 1.7; 95% confidence interval [CI] = [1.2, 2.5]; <290 m: HR = 2.1; 95% CI = [1.4, 3.0]). The adjusted risk of coronary heart disease mortality incident events among those with a 6 MWT < 290 m was not significant.
DISCUSSION: Performance on the 6 MWT is independently associated with all-cause mortality and is of prognostic utility in community-dwelling older adults.
1 aYazdanyar, Ali1 aAziz, Michael, M1 aEnright, Paul, L1 aEdmundowicz, Daniel1 aBoudreau, Robert1 aSutton-Tyrell, Kim1 aKuller, Lewis1 aNewman, Anne, B uhttps://chs-nhlbi.org/node/634102780nas a2200445 4500008004100000022001400041245010600055210006900161260001600230300001400246490000800260520149600268100002601764700002201790700002501812700001801837700002101855700002101876700002001897700002101917700001701938700001901955700002101974700001801995700002002013700002502033700002202058700002002080700002402100700002402124700002002148700001402168700001602182700002102198700002402219700002002243700001802263700001702281856003602298 2018 eng d a1476-625600aHarmonization of Respiratory Data From 9 US Population-Based Cohorts: The NHLBI Pooled Cohorts Study.0 aHarmonization of Respiratory Data From 9 US PopulationBased Coho c2018 Nov 01 a2265-22780 v1873 aChronic lower respiratory diseases (CLRDs) are the fourth leading cause of death in the United States. To support investigations into CLRD risk determinants and new approaches to primary prevention, we aimed to harmonize and pool respiratory data from US general population-based cohorts. Data were obtained from prospective cohorts that performed prebronchodilator spirometry and were harmonized following 2005 ATS/ERS standards. In cohorts conducting follow-up for noncardiovascular events, CLRD events were defined as hospitalizations/deaths adjudicated as CLRD-related or assigned relevant administrative codes. Coding and variable names were applied uniformly. The pooled sample included 65,251 adults in 9 cohorts followed-up for CLRD-related mortality over 653,380 person-years during 1983-2016. Average baseline age was 52 years; 56% were female; 49% were never-smokers; and racial/ethnic composition was 44% white, 22% black, 28% Hispanic/Latino, and 5% American Indian. Over 96% had complete data on smoking, clinical CLRD diagnoses, and dyspnea. After excluding invalid spirometry examinations (13%), there were 105,696 valid examinations (median, 2 per participant). Of 29,351 participants followed for CLRD hospitalizations, median follow-up was 14 years; only 5% were lost to follow-up at 10 years. The NHLBI Pooled Cohorts Study provides a harmonization standard applied to a large, US population-based sample that may be used to advance epidemiologic research on CLRD.
1 aOelsner, Elizabeth, C1 aBalte, Pallavi, P1 aCassano, Patricia, A1 aCouper, David1 aEnright, Paul, L1 aFolsom, Aaron, R1 aHankinson, John1 aJacobs, David, R1 aKalhan, Ravi1 aKaplan, Robert1 aKronmal, Richard1 aLange, Leslie1 aLoehr, Laura, R1 aLondon, Stephanie, J1 aAcien, Ana, Navas1 aNewman, Anne, B1 aO'Connor, George, T1 aSchwartz, Joseph, E1 aSmith, Lewis, J1 aYeh, Fawn1 aZhang, Yiyi1 aMoran, Andrew, E1 aMwasongwe, Stanford1 aWhite, Wendy, B1 aYende, Sachin1 aBarr, Graham uhttps://chs-nhlbi.org/node/8042