03823nas a2200361 4500008004100000022001400041245010900055210006900164260001600233300001200249490000800261520277400269653001703043653000903060653002203069653003003091653001103121653001103132653001403143653001503157653000903172653005303181653002403234653001703258653001803275100002503293700002003318700002403338700001803362700002403380700002103404856003603425 2009 eng d a1538-367900aLifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study.0 aLifestyle risk factors and newonset diabetes mellitus in older a c2009 Apr 27 a798-8070 v1693 a

BACKGROUND: The combined impact of lifestyle factors on incidence of diabetes mellitus later in life is not well established. The objective of this study was to determine how lifestyle factors, assessed in combination, relate to new-onset diabetes in a broad and relatively unselected population of older adults.

METHODS: We prospectively examined associations of lifestyle factors, measured using repeated assessments later in life, with incident diabetes mellitus during a 10-year period (1989-1998) among 4883 men and women 65 years or older (mean [SD] age at baseline, 73 [6] years) enrolled in the Cardiovascular Health Study. Low-risk lifestyle groups were defined by physical activity level (leisure-time activity and walking pace) above the median; dietary score (higher fiber intake and polyunsaturated to saturated fat ratio, lower trans-fat intake and lower mean glycemic index) in the top 2 quintiles; never smoked or former smoker more than 20 years ago or for fewer than 5 pack-years; alcohol use (predominantly light or moderate); body mass index less than 25 (calculated as weight in kilograms divided by height in meters squared); and waist circumference of 88 cm for women or 92 cm for men. The main outcome measure was incident diabetes defined annually by new use of insulin or oral hypoglycemic medications. We also evaluated fasting and 2-hour postchallenge glucose levels.

RESULTS: During 34,539 person-years, 337 new cases of drug-treated diabetes mellitus occurred (9.8 per 1000 person-years). After adjustment for age, sex, race, educational level, and annual income, each lifestyle factor was independently associated with incident diabetes. Overall, the rate of incident diabetes was 35% lower (relative risk, 0.65; 95% confidence interval, 0.59-0.71) for each 1 additional lifestyle factor in the low-risk group. Participants whose physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes (relative risk, 0.18; 95% confidence interval, 0.06-0.56) compared with all other participants. When absence of adiposity (either body mass index <25 or waist circumference < or =88/92 cm for women/men) was added to the other 4 low-risk lifestyle factors, incidence of diabetes was 89% lower (relative risk, 0.11; 95% confidence interval, 0.01-0.76). Overall, 9 of 10 new cases of diabetes appeared to be attributable to these 5 lifestyle factors. Associations were slightly attenuated, but still highly significant, for incident diabetes defined by medication use or glucose level.

CONCLUSION: Even later in life, combined lifestyle factors are associated with a markedly lower incidence of new-onset diabetes mellitus.

10aAge of Onset10aAged10aAged, 80 and over10aDiabetes Mellitus, Type 210aFemale10aHumans10aIncidence10aLife Style10aMale10aNational Heart, Lung, and Blood Institute (U.S.)10aProspective Studies10aRisk Factors10aUnited States1 aMozaffarian, Dariush1 aKamineni, Aruna1 aCarnethon, Mercedes1 aDjoussé, Luc1 aMukamal, Kenneth, J1 aSiscovick, David uhttps://chs-nhlbi.org/node/109502810nas a2200421 4500008004100000022001400041245006500055210006400120260001300184300001000197490000700207520167700214653000901891653001801900653002501918653003001943653000901973653001701982653000901999653002102008653001102029653001102040653001202051653002302063653000902086653003202095653002402127653001702151653003102168100001802199700002002217700002102237700002402258700002502282700002102307700002402328856003602352 2010 eng d a1938-320700aEgg consumption and risk of type 2 diabetes in older adults.0 aEgg consumption and risk of type 2 diabetes in older adults c2010 Aug a422-70 v923 a

BACKGROUND: Type 2 diabetes (T2D) remains an important public health issue in the United States. There are limited and inconsistent data on the association between egg consumption and fasting glucose or incident diabetes.

OBJECTIVES: We assessed the association between egg intake and incident diabetes in older adults.

DESIGN: In this prospective study of 3898 men and women from the Cardiovascular Health Study (1989-2007), we assessed egg consumption by using a picture-sorted food questionnaire and ascertained incident T2D annually by using information on hypoglycemic agents and plasma glucose. We used Cox proportional hazards models to estimate adjusted relative risks.

RESULTS: During a mean follow-up of 11.3 y, 313 new cases of T2D occurred. Crude incidence rates of T2D were 7.39, 6.83, 7.00, 6.72, and 12.20 per 1000 person-years in people who reported egg consumption of never, <1 egg/mo, 1-3 eggs/mo, 1-4 eggs/wk, and almost daily, respectively. In multivariable-adjusted models, there was no association between egg consumption and increased risk of T2D in either sex and overall. In a secondary analysis, dietary cholesterol was not associated with incident diabetes (P for trend = 0.47). In addition, egg consumption was not associated with clinically meaningful differences in fasting glucose, fasting insulin, or measures of insulin resistance despite small absolute analytic differences that were significant.

CONCLUSION: In this cohort of older adults with limited egg intake, there was no association between egg consumption or dietary cholesterol and increased risk of incident T2D.

10aAged10aBlood Glucose10aCholesterol, Dietary10aDiabetes Mellitus, Type 210aDiet10aDiet Surveys10aEggs10aFeeding Behavior10aFemale10aHumans10aInsulin10aInsulin Resistance10aMale10aProportional Hazards Models10aProspective Studies10aRisk Factors10aSurveys and Questionnaires1 aDjoussé, Luc1 aKamineni, Aruna1 aNelson, Tracy, L1 aCarnethon, Mercedes1 aMozaffarian, Dariush1 aSiscovick, David1 aMukamal, Kenneth, J uhttps://chs-nhlbi.org/node/120303266nas a2200421 4500008004100000022001400041245022000055210006900275260001600344300000900360490000800369520191700377653003902294653001602333653000902349653002202358653002002380653002802400653001902428653003402447653001802481653004002499653001102539653002202550653001102572653002502583653000902608653001602617653003002633653001702663100002302680700001802703700001702721700001902738700002402757700002702781856003602808 2012 eng d a1524-453900aRacial differences in risks for first cardiovascular events and noncardiovascular death: the Atherosclerosis Risk in Communities study, the Cardiovascular Health Study, and the Multi-Ethnic Study of Atherosclerosis.0 aRacial differences in risks for first cardiovascular events and  c2012 Jul 03 a50-90 v1263 a

BACKGROUND: No studies have compared first cardiovascular disease (CVD) events and non-CVD death between races in a competing risks framework, which examines risks for numerous events simultaneously.

METHODS AND RESULTS: We used competing Cox models to estimate hazards for first CVD events and non-CVD death within and between races in 3 multicenter, National Heart, Lung, and Blood Institute-sponsored cohorts. Of 14 569 Atherosclerosis Risk in Communities (ARIC) study participants aged 45 to 64 years with mean follow-up of 10.5 years, 11.6% had CVD and 5.0% had non-CVD death as first events; among 4237 Cardiovascular Health Study (CHS) study participants aged 65 to 84 years and followed for 8.5 years, these figures were 43.2% and 15.7%, respectively. Middle-aged blacks were significantly more likely than whites to experience any CVD as a first event; this disparity disappeared by older adulthood and after adjustment for CVD risk factors. The pattern of results was similar for Multi-Ethnic Study of Atherosclerosis (MESA) participants. Traditional Cox and competing risks models yielded different results for coronary heart disease risk. Black men appeared somewhat more likely than white men to experience coronary heart disease with use of a standard Cox model (hazard ratio 1.06; 95% CI 0.90, 1.26), whereas they appeared less likely than white men to have a first coronary heart disease event with use of a competing risks model (hazard ratio, 0.77; 95% CI, 0.60, 1.00).

CONCLUSIONS: CVD affects blacks at an earlier age than whites; this may be attributable in part to elevated CVD risk factor levels among blacks. Racial disparities in first CVD incidence disappear by older adulthood. Competing risks analyses may yield somewhat different results than traditional Cox models and provide a complementary approach to examining risks for first CVD events.

10aAfrican Continental Ancestry Group10aAge Factors10aAged10aAged, 80 and over10aAtherosclerosis10aCardiovascular Diseases10aCohort Studies10aContinental Population Groups10aEthnic Groups10aEuropean Continental Ancestry Group10aFemale10aFollow-Up Studies10aHumans10aLongitudinal Studies10aMale10aMiddle Aged10aResidence Characteristics10aRisk Factors1 aFeinstein, Matthew1 aNing, Hongyan1 aKang, Joseph1 aBertoni, Alain1 aCarnethon, Mercedes1 aLloyd-Jones, Donald, M uhttps://chs-nhlbi.org/node/139003623nas a2200481 4500008004100000022001400041245008800055210006900143260001300212300001100225490000600236520232300242653000902565653001102574653001602585653001802601653002102619653001102640653001402651653001202665653002302677653000902700653001602709653002602725653001502751653003202766653002402798100002302822700001902845700001802864700002102882700001902903700002102922700001802943700002002961700001802981700001902999700001803018700002403036700002103060700002403081856003603105 2013 eng d a1941-329700aInsulin resistance and risk of incident heart failure: Cardiovascular Health Study.0 aInsulin resistance and risk of incident heart failure Cardiovasc c2013 May a364-700 v63 a

BACKGROUND: Patients with heart failure (HF) have higher fasting insulin levels and a higher prevalence of insulin resistance as compared with matched controls. Insulin resistance leads to structural abnormalities in the heart, such as increased left atrial size, left ventricular mass, and alterations in transmitral velocity that can precede the diagnosis of HF. It is not known whether insulin resistance precedes the development of HF or whether the relationship between insulin resistance and HF is present among adults with HF caused by nonischemic heart disease.

METHODS AND RESULTS: We examined 4425 participants (60% women) from the Cardiovascular Health Study after excluding those with HF, myocardial infarction, or treated diabetes mellitus at baseline. We used Cox proportional hazards models to estimate the relative risk of incident HF associated with fasting insulin measured at study entry. There were 1216 cases of incident HF (1103 without antecedent myocardial infarction) during a median follow-up of 12 years (maximum, 19 years). Fasting insulin levels were positively associated with the risk of incident HF (hazard ratio, 1.10; 95% confidence interval, 1.05-1.15, per SD change) when adjusted for age, sex, race, field center, physical activity, smoking, alcohol intake, high-density lipoprotein-cholesterol, total cholesterol, systolic blood pressure, and waist circumference. The association between fasting insulin levels and incident HF was similar for HF without antecedent myocardial infarction (hazard ratio, 1.10; 95% confidence interval, 1.05-1.15). Measures of left atrial size, left ventricular mass, and peak A velocity at baseline were associated both with fasting insulin levels and with HF; however, additional statistical adjustment for these parameters did not completely attenuate the insulin-HF estimate (hazard ratio, 1.08; 95% confidence interval, 1.03-1.14 per 1-SD increase in fasting insulin).

CONCLUSIONS: Fasting insulin was positively associated with adverse echocardiographic features and risk of subsequent HF in Cardiovascular Health Study participants, including those without an antecedent myocardial infarction.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.

10aAged10aFemale10aHeart Atria10aHeart Failure10aHeart Ventricles10aHumans10aIncidence10aInsulin10aInsulin Resistance10aMale10aMiddle Aged10aMyocardial Infarction10aOrgan Size10aProportional Hazards Models10aProspective Studies1 aBanerjee, Dipanjan1 aBiggs, Mary, L1 aMercer, Laina1 aMukamal, Kenneth1 aKaplan, Robert1 aBarzilay, Joshua1 aKuller, Lewis1 aKizer, Jorge, R1 aDjoussé, Luc1 aTracy, Russell1 aZieman, Susan1 aLloyd-Jones, Donald1 aSiscovick, David1 aCarnethon, Mercedes uhttps://chs-nhlbi.org/node/584502942nas a2200445 4500008004100000022001400041245010400055210006900159260001300228300001000241490000700251520170200258653000901960653002501969653002301994653001102017653001502028653002202043653001102065653001402076653002502090653000902115653002302124653003202147653001502179653001702194653001502211100002102226700001902247700002402266700001902290700002302309700002402332700001802356700002402374700002002398700001802418700002402436856003602460 2014 eng d a1524-456300aMetabolic syndrome and risk of incident peripheral artery disease: the cardiovascular health study.0 aMetabolic syndrome and risk of incident peripheral artery diseas c2014 Feb a413-90 v633 a

Prior studies evaluating metabolic syndrome (MetS) and incident peripheral artery disease (PAD) have been limited by use of modified MetS criteria and restriction to clinical PAD end points. We investigated MetS and risk of developing a low ankle-brachial index (ABI) and clinical PAD in the Cardiovascular Health Study, a population-based cohort of adults aged ≥65 years. Participants with MetS met at least 3 of 5 Adult Treatment Panel III criteria. Baseline C-reactive protein-MetS or fibrinogen-MetS were defined as presence of 3 of 6 components, with elevated C-reactive protein (>3 mg/L) or fibrinogen (>341 mg/dL) as a sixth component. Incident low ABI, defined as ABI <0.9 and decline of ≥0.15, was assessed among a subset of 1899 individuals with 2 ABI measurements 6 years apart. Over a median follow-up of 13.7 years, 4632 individuals were followed up for clinical PAD, defined as revascularization or diagnosed claudication. Adult Treatment Panel III MetS was associated with both incident low ABI (risk ratio, 1.26; 95% confidence interval [CI], 1.00-1.58) and clinical PAD (hazard ratio, 1.47; 95% CI, 1.11-1.94). Incorporating C-reactive protein or fibrinogen into Adult Treatment Panel III criteria identified an additional 16% to 20% of individuals as having MetS, and both C-reactive protein-MetS and fibrinogen-MetS were associated with incident low ABI (risk ratio, 1.36; 95% CI, 1.07-1.72 and risk ratio, 1.43; 95% CI, 1.13-1.81, respectively) and clinical PAD (hazard ratio, 1.56; 95% CI, 1.17-2.08 and hazard ratio, 1.55; 95% CI, 1.17-2.07, respectively). Among Adult Treatment Panel III MetS criteria, risk of PAD was most strongly associated with hypertension.

10aAged10aAnkle Brachial Index10aC-Reactive Protein10aFemale10aFibrinogen10aFollow-Up Studies10aHumans10aIncidence10aLongitudinal Studies10aMale10aMetabolic Syndrome10aPeripheral Arterial Disease10aPrevalence10aRisk Factors10aVasculitis1 aGarg, Parveen, K1 aBiggs, Mary, L1 aCarnethon, Mercedes1 aIx, Joachim, H1 aCriqui, Michael, H1 aBritton, Kathryn, A1 aDjoussé, Luc1 aSutton-Tyrrell, Kim1 aNewman, Anne, B1 aCushman, Mary1 aMukamal, Kenneth, J uhttps://chs-nhlbi.org/node/614803413nas a2200445 4500008004100000022001400041245010800055210006900163260001300232300001200245490000600257520216400263653000902427653002202436653002802458653001602486653002202502653001102524653002102535653001102556653003402567653002002601653000902621653002502630653001402655653003202669653002402701653002002725653001702745653001702762653001802779100001702797700001702814700002202831700002402853700001702877700001702894700002002911856003602931 2015 eng d a1876-759100aLV Mass as a Predictor of CVD Events in Older Adults With and Without Metabolic Syndrome and Diabetes.0 aLV Mass as a Predictor of CVD Events in Older Adults With and Wi c2015 Sep a1007-150 v83 a

OBJECTIVES: The purpose of this study was to examine the prognostic significance of left ventricular (LV) mass for cardiovascular disease (CVD) events in older adults with and without metabolic syndrome (MetS) and diabetes mellitus (DM).

BACKGROUND: MetS and DM are associated with increased CVD risk, but it is unclear in these groups whether subclinical CVD as shown by increased LV mass improves risk prediction compared to standard risk factors in older individuals.

METHODS: We studied 3,724 adults (mean 72.4 ± 5.4 years of age, 61.0% female, 4.4% African-American) from the Cardiovascular Health Study who had MetS but not DM or had DM alone or had neither condition. Cox regression was used to examine the association of LV mass, (alone and indexed by height and body surface area [BSA]) as determined by echocardiography, with CVD events, including coronary heart disease (CHD), stroke, heart failure (HF), and CVD death, as well as total mortality. We also assessed the added prediction, discriminative value, and net reclassification improvement (NRI) for clinical utility of LV mass compared to standard risk factors.

RESULTS: Over a mean follow-up of 14.2 ± 6.3 years, 2,180 subjects experienced CVD events, including 986 CVD deaths. After adjustment for age, sex and standard risk factors, LV mass was positively associated with CVD events in those with MetS (hazard ratio [HR]: 1.4, p < 0.001) and without MetS (HR: 1.4, p < 0.001), but not DM (HR: 1.0, p = 0.62), with similar findings for LV mass indexed for height or BSA. Adding LV mass to standard risk factors moderately improved the prediction accuracy in the overall sample and MetS group from changes in C-statistics (p < 0.05). Categorical-free net reclassification improvement increased significantly by 17% to 19% in those with MetS. Findings were comparable for CHD, CVD mortality, and total mortality.

CONCLUSIONS: LV mass is associated with increased CVD risk and provides modest added prediction and clinical utility compared to standard risk factors in older persons with and without MetS but not with DM.

10aAged10aAged, 80 and over10aCardiovascular Diseases10aComorbidity10aDiabetes Mellitus10aFemale10aHeart Ventricles10aHumans10aHypertrophy, Left Ventricular10aLogistic Models10aMale10aMetabolic Syndrome X10aPrognosis10aProportional Hazards Models10aProspective Studies10aRisk Assessment10aRisk Factors10aTime Factors10aUnited States1 aHoang, Khiet1 aZhao, Yanglu1 aGardin, Julius, M1 aCarnethon, Mercedes1 aMukamal, Ken1 aYanez, David1 aWong, Nathan, D uhttps://chs-nhlbi.org/node/682603610nas a2200493 4500008004100000022001400041245009600055210006900151260001300220300001100233490000700244520223400251653001002485653000902495653001802504653002602522653002802548653003002576653001202606653001102618653002702629653001102656653001402667653001202681653002302693653000902716653001602725653002602741653004702767653001202814653001802826100002402844700002402868700002102892700001802913700002202931700002402953700002102977700001902998700002103017700001803038700002403056856003603080 2015 eng d a1935-554800aSleep Disturbances and Glucose Metabolism in Older Adults: The Cardiovascular Health Study.0 aSleep Disturbances and Glucose Metabolism in Older Adults The Ca c2015 Nov a2050-80 v383 a

OBJECTIVE: We examined the associations of symptoms of sleep-disordered breathing (SDB), which was defined as loud snoring, stopping breathing for a while during sleep, and daytime sleepiness, and insomnia with glucose metabolism and incident type 2 diabetes in older adults.

RESEARCH DESIGN AND METHODS: Between 1989 and 1993, the Cardiovascular Health Study recruited 5,888 participants ≥65 years of age from four U.S. communities. Participants reported SDB and insomnia symptoms yearly through 1989-1994. In 1989-1990, participants underwent an oral glucose tolerance test, from which insulin secretion and insulin sensitivity were estimated. Fasting glucose levels were measured in 1989-1990 and again in 1992-1993, 1994-1995, 1996-1997, and 1998-1999, and medication use was ascertained yearly. We determined the cross-sectional associations of sleep symptoms with fasting glucose levels, 2-h glucose levels, insulin sensitivity, and insulin secretion using generalized estimated equations and linear regression models. We determined the associations of updated and averaged sleep symptoms with incident diabetes in Cox proportional hazards models. We adjusted for sociodemographics, lifestyle factors, and medical history.

RESULTS: Observed apnea, snoring, and daytime sleepiness were associated with higher fasting glucose levels, higher 2-h glucose levels, lower insulin sensitivity, and higher insulin secretion. The risk of the development of type 2 diabetes was positively associated with observed apnea (hazard ratio [HR] 1.84 [95% CI 1.19-2.86]), snoring (HR 1.27 [95% CI 0.95-1.71]), and daytime sleepiness (HR 1.54 [95% CI 1.13-2.12]). In contrast, we did not find consistent associations between insomnia symptoms and glucose metabolism or incident type 2 diabetes.

CONCLUSIONS: Easily collected symptoms of SDB are strongly associated with insulin resistance and the incidence of type 2 diabetes in older adults. Monitoring glucose metabolism in such patients may prove useful in identifying candidates for lifestyle or pharmacological therapy. Further studies are needed to determine whether insomnia symptoms affect the risk of diabetes in younger adults.

10aAdult10aAged10aBlood Glucose10aCardiovascular System10aCross-Sectional Studies10aDiabetes Mellitus, Type 210aFasting10aFemale10aGlucose Tolerance Test10aHumans10aIncidence10aInsulin10aInsulin Resistance10aMale10aMiddle Aged10aSleep Apnea Syndromes10aSleep Initiation and Maintenance Disorders10aSnoring10aUnited States1 aStrand, Linn, Beate1 aCarnethon, Mercedes1 aBiggs, Mary, Lou1 aDjoussé, Luc1 aKaplan, Robert, C1 aSiscovick, David, S1 aRobbins, John, A1 aRedline, Susan1 aPatel, Sanjay, R1 aJanszky, Imre1 aMukamal, Kenneth, J uhttps://chs-nhlbi.org/node/685403009nas a2200265 4500008004100000022001400041245008800055210006900143260001600212300001400228490000700242520222800249100002102477700002102498700001702519700001702536700002002553700002202573700002202595700002302617700002402640700002202664700002102686856003602707 2017 eng d a1558-359700aRelationship Between Physical Activity, Body Mass Index, and Risk of Heart Failure.0 aRelationship Between Physical Activity Body Mass Index and Risk  c2017 Mar 07 a1129-11420 v693 a

BACKGROUND: Lower leisure-time physical activity (LTPA) and higher body mass index (BMI) are independently associated with risk of heart failure (HF). However, it is unclear if this relationship is consistent for both heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).

OBJECTIVES: This study sought to quantify dose-response associations between LTPA, BMI, and the risk of different HF subtypes.

METHODS: Individual-level data from 3 cohort studies (WHI [Women's Health Initiative], MESA [Multi-Ethnic Study of Atherosclerosis], and CHS [Cardiovascular Health Study]) were pooled and participants were stratified into guideline-recommended categories of LTPA and BMI. Associations between LTPA, BMI, and risk of overall HF, HFpEF (ejection fraction ≥45%), and HFrEF (ejection fraction <45%) were assessed by using multivariable adjusted Cox models and restricted cubic splines.

RESULTS: The study included 51,451 participants with 3,180 HF events (1,252 HFpEF, 914 HFrEF, and 1,014 unclassified HF). In the adjusted analysis, there was a dose-dependent association between higher LTPA levels, lower BMI, and overall HF risk. Among HF subtypes, LTPA in any dose range was not associated with HFrEF risk. In contrast, lower levels of LTPA (<500 MET-min/week) were not associated with HFpEF risk, and dose-dependent associations with lower HFpEF risk were observed at higher levels. Compared with no LTPA, higher than twice the guideline-recommended minimum LTPA levels (>1,000 MET-min/week) were associated with an 19% lower risk of HFpEF (hazard ratio: 0.81; 95% confidence interval: 0.68 to 0.97). The dose-response relationship for BMI with HFpEF risk was also more consistent than with HFrEF risk, such that increasing BMI above the normal range (≥25 kg/m(2)) was associated with a greater increase in risk of HFpEF than HFrEF.

CONCLUSIONS: Our study findings show strong, dose-dependent associations between LTPA levels, BMI, and risk of overall HF. Among HF subtypes, higher LTPA levels and lower BMI were more consistently associated with lower risk of HFpEF compared with HFrEF.

1 aPandey, Ambarish1 aLaMonte, Michael1 aKlein, Liviu1 aAyers, Colby1 aPsaty, Bruce, M1 aEaton, Charles, B1 aAllen, Norrina, B1 ade Lemos, James, A1 aCarnethon, Mercedes1 aGreenland, Philip1 aBerry, Jarett, D uhttps://chs-nhlbi.org/node/735602317nas a2200217 4500008004100000022001400041245012400055210006900179260001300248300001200261490000700273520165100280100001701931700001701948700002001965700001701985700002402002700001702026700002002043856003602063 2018 eng d a1932-873700aImpact of lung-function measures on cardiovascular disease events in older adults with metabolic syndrome and diabetes.0 aImpact of lungfunction measures on cardiovascular disease events c2018 Jul a959-9650 v413 a

BACKGROUND: Individuals with metabolic syndrome (MetS) and diabetes (DM) are more likely to have decreased lung function and are at greater risk of cardiovascular disease (CVD).

HYPOTHESIS: Lung-function measures can predict CVD events in older persons with MetS, DM, and neither condition.

METHODS: We followed 4114 participants age ≥ 65 years with and without MetS or DM in the Cardiovascular Health Study. Cox regression examined the association of forced vital capacity (FVC) and 1-second forced expiratory volume (FEV ; percent of predicted values) with incident coronary heart disease and CVD events over 12.9 years.

RESULTS: DM was present in 537 (13.1%) and MetS in 1277 (31.0%) participants. Comparing fourth vs first quartiles for FVC, risk of CVD events was 16% (HR: 0.84, 95% CI: 0.59-1.18), 23% (HR: 0.77, 95% CI: 0.60-0.99), and 30% (HR: 0.70, 95% CI: 0.58-0.84) lower in DM, MetS, and neither disease groups, respectively. For FEV , CVD risk was lower by 2% (HR: 0.98, 95% CI: 0.70-1.37), 26% (HR: 0.74, 95% CI: 0.59-0.93), and 31% (HR: 0.69, 95% CI: 0.57-0.82) in DM. Findings were strongest for predicting congestive heart failure (CHF) in all disease groups. C-statistics increased significantly with addition of FEV or FVC over risk factors for CVD and CHF among those with neither MetS nor DM.

CONCLUSIONS: FEV and FVC are inversely related to CVD in older adults with and without MetS, but not DM (except for CHF); however, their value in incremental risk prediction beyond standard risk factors is limited mainly to metabolically healthier persons.

1 aLee, Hwa, Mu1 aZhao, Yanglu1 aLiu, Michael, A1 aYanez, David1 aCarnethon, Mercedes1 aBarr, Graham1 aWong, Nathan, D uhttps://chs-nhlbi.org/node/779902117nas a2200217 4500008004100000022001400041245012100055210006900176260001300245300001000258490000700268520143400275100002001709700001901729700002501748700002201773700002401795700002101819700002301840856003601863 2020 eng d a1873-258500aThe association of prediagnosis social support with survival after heart failure in the Cardiovascular Health Study.0 aassociation of prediagnosis social support with survival after h c2020 Feb a73-770 v423 a

PURPOSE: Although social support has been shown to be associated with survival among persons with cardiovascular disease, little research has focused on whether social support, measured before the onset of heart failure, can enhance survival after diagnosis. The objective of this study was to assess the association between prediagnosis social support and postdiagnosis survival among older adults with heart failure.

METHODS: We obtained the data from the Cardiovascular Health Study, which included noninstitutionalized adults aged 65 years or older from four sites in the United States with primary enrollment in 1989-1990. We used two measures of social support, the Lubben Social Network Scale and the Interpersonal Support Evaluation List. The analytic data set included 529 participants with a social support measure within two years before diagnosis of heart failure.

RESULTS: After adjustment for demographic covariates, cardiovascular risk factors, and general health status, mortality rates were lower among participants in the highest tertile of social network scores (HR 0.74, 95% CI: 0.59, 0.93) and the middle tertile (HR 0.73 [0.58, 0.90]), compared with the lowest tertile. Results with interpersonal support were null.

CONCLUSIONS: These findings suggest that prediagnosis structural social support may modestly buffer heart failure patients from mortality.

1 aKaiser, Paulina1 aAllen, Norrina1 aDelaney, Joseph, A C1 aHirsch, Calvin, H1 aCarnethon, Mercedes1 aArnold, Alice, M1 aOdden, Michelle, C uhttps://chs-nhlbi.org/node/828502773nas a2200349 4500008004100000022001400041245011200055210006900167260001600236300000800252490000700260520176200267653000902029653002802038653001102066653001202077653001102089653002302100653000902123653003402132653003102166100002102197700001902218700002002237700002002257700001702277700002402294700002402318700002102342700002402363856003602387 2022 eng d a1475-284000aGlucose dysregulation and subclinical cardiac dysfunction in older adults: The Cardiovascular Health Study.0 aGlucose dysregulation and subclinical cardiac dysfunction in old c2022 Jun 20 a1120 v213 a

OBJECTIVE: We evaluated whether measures of glucose dysregulation are associated with subclinical cardiac dysfunction, as assessed by speckle-tracking echocardiography, in an older population.

METHODS: Participants were men and women in the Cardiovascular Health Study, age 65+ years and without coronary heart disease, atrial fibrillation, or heart failure at baseline. We evaluated fasting insulin resistance (IR) with the homeostatic model of insulin resistance (HOMA-IR) and estimated the Matsuda insulin sensitivity index (ISI) and insulin secretion with an oral glucose tolerance test. Systolic and diastolic cardiac mechanics were measured with speckle-tracking analysis of echocardiograms. Multi-variable adjusted linear regression models were used to investigate associations of insulin measures and cardiac mechanics.

RESULTS: Mean age for the 2433 included participants was 72.0 years, 33.6% were male, and 3.7% were black. After adjustment for age, sex, race, site, speckle-tracking analyst, echo image and quality score, higher HOMA-IR, lower Matsuda ISI, and higher insulin secretion were each associated with worse left ventricular (LV) longitudinal strain and LV early diastolic strain rate (p-value < 0.005); however, associations were significantly attenuated after adjustment for waist circumference, with the exception of Matsuda ISI and LV longitudinal strain (increase in strain per standard deviation increment in Matsuda ISI = 0.18; 95% confidence interval = 0.03-0.33).

CONCLUSION: In this cross-sectional study of older adults, associations of glucose dysregulation with subclinical cardiac dysfunction were largely attenuated after adjusting for central adiposity.

10aAged10aCross-Sectional Studies10aFemale10aGlucose10aHumans10aInsulin Resistance10aMale10aVentricular Dysfunction, Left10aVentricular Function, Left1 aGarg, Parveen, K1 aBiggs, Mary, L1 aKizer, Jorge, R1 aShah, Sanjiv, J1 aPsaty, Bruce1 aCarnethon, Mercedes1 aGottdiener, John, S1 aSiscovick, David1 aMukamal, Kenneth, J uhttps://chs-nhlbi.org/node/909203979nas a2200613 4500008004100000022001400041245015200055210007100207260001600278300001200294490000800306520218600314653001502500653001902515653002802534653001602562653002502578653001102603653003602614653001002650100002202660700001902682700002302701700002302724700002002747700002302767700001902790700002502809700002302834700002202857700002102879700002502900700002002925700002002945700001902965700002102984700002403005700002403029700001803053700002403071700001503095700002403110700002003134700001803154700001703172700001503189700002003204700001903224700001603243700002103259700002403280700002503304856003603329 2022 eng d a1938-320700aPUFA ω-3 and ω-6 biomarkers and sleep: a pooled analysis of cohort studies on behalf of the Fatty Acids and Outcomes Research Consortium (FORCE).0 aPUFA ω3 and ω6 biomarkers and sleep a pooled analysis of cohort  c2022 Mar 04 a864-8760 v1153 a

BACKGROUND: n-3 and n-6 PUFAs have physiologic roles in sleep processes, but little is known regarding circulating n-3 and n-6 PUFA and sleep parameters.

OBJECTIVES: We sought to assess associations between biomarkers of n-3 and n-6 PUFA intake with self-reported sleep duration and difficulty falling sleeping in the Fatty Acids and Outcome Research Consortium.

METHODS: Harmonized, de novo, individual-level analyses were performed and pooled across 12 cohorts. Participants were 35-96 y old and from 5 nations. Circulating measures included α-linolenic acid (ALA), EPA, docosapentaenoic acid (DPA), DHA, EPA + DPA + DHA, linoleic acid, and arachidonic acid. Sleep duration (10 cohorts, n = 18,791) was categorized as short (≤6 h), 7-8 h (reference), or long (≥9 h). Difficulty falling asleep (8 cohorts, n = 12,500) was categorized as yes or no. Associations between PUFAs, sleep duration, and difficulty falling sleeping were assessed by cross-sectional multinomial logistic regression using standardized protocols and covariates. Cohort-specific multivariable-adjusted ORs per quintile of PUFAs were pooled with inverse-variance weighted meta-analysis.

RESULTS: In pooled analysis adjusted for sociodemographic characteristics and health status, participants with higher very long-chain n-3 PUFAs were less likely to have long sleep duration. In the top compared with the bottom quintiles, the multivariable-adjusted ORs (95% CIs) for long sleep were 0.78 (95% CI: 0.65, 0.95) for DHA and 0.76 (95% CI: 0.63, 0.93) for EPA + DPA + DHA. Significant associations for ALA and n-6 PUFA with short sleep duration or difficulty falling sleeping were not identified.

CONCLUSIONS: Participants with higher concentrations of very long-chain n-3 PUFAs were less likely to have long sleep duration. While objective biomarkers reduce recall bias and misclassification, the cross-sectional design limits assessment of the temporal nature of this relation. These novel findings across 12 cohorts highlight the need for experimental and biological assessments of very long-chain n-3 PUFAs and sleep duration.

10aBiomarkers10aCohort Studies10aCross-Sectional Studies10aFatty Acids10aFatty Acids, Omega-310aHumans10aOutcome Assessment, Health Care10aSleep1 aMurphy, Rachel, A1 aTintle, Nathan1 aHarris, William, S1 aDarvishian, Maryam1 aMarklund, Matti1 aVirtanen, Jyrki, K1 aHantunen, Sari1 ade Mello, Vanessa, D1 aTuomilehto, Jaakko1 aLindström, Jaana1 aBolt, Matthew, A1 aBrouwer, Ingeborg, A1 aWood, Alexis, C1 aSenn, Mackenzie1 aRedline, Susan1 aTsai, Michael, Y1 aGudnason, Vilmundur1 aEiriksdottir, Gudny1 aLindberg, Eva1 aShadyab, Aladdin, H1 aLiu, Buyun1 aCarnethon, Mercedes1 aUusitupa, Matti1 aDjoussé, Luc1 aRiserus, Ulf1 aLind, Lars1 avan Dam, Rob, M1 aKoh, Woon-Puay1 aShi, Peilin1 aSiscovick, David1 aLemaitre, Rozenn, N1 aMozaffarian, Dariush uhttps://chs-nhlbi.org/node/9455