02896nas a2200361 4500008004100000022001400041245010300055210006900158260001300227300001200240490000700252520185800259653000902117653002802126653002402154653001702178653001102195653002102206653002902227653002102256653002002277653001702297100001902314700002002333700001702353700002402370700001802394700002202412700002002434700002202454700002202476856003602498 2011 eng d a1524-462800aRetinal microvascular signs and functional loss in older persons: the cardiovascular health study.0 aRetinal microvascular signs and functional loss in older persons c2011 Jun a1589-950 v423 a

BACKGROUND AND PURPOSE: We hypothesized that retinal microvascular signs are associated with executive dysfunction, slow gait, and depressive mood, which are characteristic features of microvascular disease affecting frontal subcortical regions of the brain.

METHODS: In the Cardiovascular Health Study, 1744 participants (mean age, 78) free of stroke had retinal photographs and carotid ultrasound during the 1997 to 1998 visit. We examined the cross-sectional association of retinal signs with the digit-symbol substitution test (DSST) score, gait speed, the Center for Epidemiologic Studies-Depression score, and depressive mood, defined as Center for Epidemiologic Studies-Depression score >9 or antidepressant use.

RESULTS: After adjusting for potential confounders, retinal signs were associated with lower DSST score (generalized arteriolar narrowing and arteriovenous nicking), slower gait (retinopathy), and depressive mood (generalized arteriolar narrowing). A higher number of retinal signs was associated with lower DSST score (-0.76 and -2.79 points for 1 sign and ≥2 signs versus none; P<0.001) and slower gait (-0.009 and -0.083 m/s; P=0.047), but not with the square root of Center for Epidemiologic Studies-Depression score (0.079 and -0.208; P=0.072). In addition, coexistence of retinal signs (generalized arteriolar narrowing and arteriovenous nicking) and carotid atherosclerosis was associated with lower DSST score compared with either process alone (P for interaction <0.01). Notably, further adjustment for ventricular size, white matter disease, and infarcts on MRI did not attenuate the association.

CONCLUSIONS: Retinal signs are associated with executive dysfunction and slow gait, and possibly with depressive mood, suggesting a common process involving small vessels.

10aAged10aCardiovascular Diseases10aDepressive Disorder10aFrontal Lobe10aHumans10aMicrocirculation10aNeuropsychological Tests10aRetinal Diseases10aRetinal Vessels10aRisk Factors1 aKim, Dae, Hyun1 aNewman, Anne, B1 aHajjar, Ihab1 aStrotmeyer, Elsa, S1 aKlein, Ronald1 aNewton, Elizabeth1 aSarnak, Mark, J1 aBurke, Gregory, L1 aLipsitz, Lewis, A uhttps://chs-nhlbi.org/node/128303128nas a2200469 4500008004100000022001400041245008300055210006900138260001300207300001000220490000800230520178800238653003102026653000902057653002802066653002402094653004402118653002602162653002202188653001102210653001702221653001402238653002602252653002102278653003002299653001502329653001402344653002402358653002102382653001702403653001202420100001902432700002302451700002002474700001802494700002002512700002202532700002402554700002202578700002202600856003602622 2012 eng d a1538-360100aRetinal microvascular signs and disability in the Cardiovascular Health Study.0 aRetinal microvascular signs and disability in the Cardiovascular c2012 Mar a350-60 v1303 a

OBJECTIVE: To study the associations of retinal microvascular changes, which are associated with systemic conditions and cognitive decline, with disability in performing activities of daily living (ADL).

DESIGN: Prospective cohort study of 1487 community-dwelling participants in the Cardiovascular Health Study (mean age, 78 years) who were free of ADL disability and had available data on retinal signs and carotid intima-media thickness at the 1998-1999 visit. Main outcome measures were incident ADL disability, defined as self-reported difficulty in performing any ADL, by the presence of retinal signs and advanced carotid atherosclerosis, defined by carotid intima-media thickness in the 80th percentile or more or 25% or more stenosis, and potential mediation by cerebral microvascular disease on brain imaging or by executive dysfunction, slow gait, and depressive mood, which are symptoms of frontal subcortical dysfunction.

RESULTS: During the median follow-up of 3.1 years (maximum, 7.8 years), participants with 2 or more retinal signs had a higher rate of disability than those with fewer than 2 retinal signs (10.1% vs 7.1%; adjusted hazard ratio, 1.45; 95% confidence interval, 1.24-1.69; P < .001). There was no evidence of interaction by advanced carotid atherosclerosis (P > .10). The association seemed to be partially mediated by executive dysfunction, slow gait, and depressive symptoms but not by cerebral microvascular disease on brain imaging.

CONCLUSIONS: These results provide further support for the pathophysiologic and prognostic significance of microvascular disease in age-related disability. However, it remains to be determined how to best use retinal photography in clinical risk prediction.

10aActivities of Daily Living10aAged10aCarotid Artery Diseases10aCognition Disorders10aDiagnostic Techniques, Ophthalmological10aDisability Evaluation10aFollow-Up Studies10aHumans10aHypertension10aIncidence10aKaplan-Meier Estimate10aMicrocirculation10aPredictive Value of Tests10aPrevalence10aPrognosis10aProspective Studies10aRetinal Diseases10aRisk Factors10aSmoking1 aKim, Dae, Hyun1 aChaves, Paulo, H M1 aNewman, Anne, B1 aKlein, Ronald1 aSarnak, Mark, J1 aNewton, Elizabeth1 aStrotmeyer, Elsa, S1 aBurke, Gregory, L1 aLipsitz, Lewis, A uhttps://chs-nhlbi.org/node/135103265nas a2200457 4500008004100000022001400041245012300055210006900178260001300247300001300260490000700273520196100280653000902241653002202250653001002272653002502282653002602307653002402333653001102357653002202368653001602390653001102406653002002417653003102437653000902468653002102477653001402498653002402512653001702536653002702553100001902580700002402599700002002623700002302643700002302666700001802689700002002707700002202727700002202749856003602771 2014 eng d a1758-535X00aPrognostic implications of microvascular and macrovascular abnormalities in older adults: cardiovascular health study.0 aPrognostic implications of microvascular and macrovascular abnor c2014 Dec a1495-5020 v693 a

BACKGROUND: Microvascular and macrovascular abnormalities are frequently found on noninvasive tests performed in older adults. Their prognostic implications on disability and life expectancy have not been collectively assessed.

METHODS: This prospective study included 2,452 adults (mean age: 79.5 years) with available measures of microvascular (brain, retina, kidney) and macrovascular abnormalities (brain, carotid, coronary, peripheral artery) in the Cardiovascular Health Study. The burden of microvascular and macrovascular abnormalities was examined in relation to total, activity-of-daily-living disability-free, and severe disability-free life expectancies in the next 10 years (1999-2009).

RESULTS: At 75 years, individuals with low burden of both abnormalities lived, on average, 8.71 years (95% confidence interval: 8.29, 9.12) of which 7.67 years (7.16, 8.17) were without disability. In comparison, individuals with high burden of both abnormalities had shortest total life expectancy (6.95 years [6.52, 7.37]; p < .001) and disability-free life expectancy (5.60 years [5.10, 6.11]; p < .001). Although total life expectancy was similarly reduced for those with high burden of either type of abnormalities (microvascular: 7.96 years [7.50, 8.42] vs macrovascular: 8.25 years [7.80, 8.70]; p = .10), microvascular abnormalities seemed to have larger impact than macrovascular abnormalities on disability-free life expectancy (6.45 years [5.90, 6.99] vs 6.96 years [6.43, 7.48]; p = .016). These results were consistent for severe disability-free life expectancy and in individuals without clinical cardiovascular disease.

CONCLUSIONS: Considering both microvascular and macrovascular abnormalities from multiple noninvasive tests may provide additional prognostic information on how older adults spend their remaining life. Optimal clinical use of this information remains to be determined.

10aAged10aAged, 80 and over10aAging10aAnkle Brachial Index10aDisability Evaluation10aElectrocardiography10aFemale10aFollow-Up Studies10aForecasting10aHumans10aLife Expectancy10aMagnetic Resonance Imaging10aMale10aMicrocirculation10aPrognosis10aProspective Studies10aRisk Factors10aVascular Malformations1 aKim, Dae, Hyun1 aGrodstein, Francine1 aNewman, Anne, B1 aChaves, Paulo, H M1 aOdden, Michelle, C1 aKlein, Ronald1 aSarnak, Mark, J1 aPatel, Kushang, V1 aLipsitz, Lewis, A uhttps://chs-nhlbi.org/node/636303103nas a2200337 4500008004100000022001400041245013200055210006900187260001300256300001200269490000700281520211200288653000902400653002202409653001402431653002802445653001102473653001102484653000902495653002902504653002702533100001902560700002402579700002002603700002302623700002302646700001802669700002002687700002202707856003602729 2015 eng d a1532-541500aMicrovascular and Macrovascular Abnormalities and Cognitive and Physical Function in Older Adults: Cardiovascular Health Study.0 aMicrovascular and Macrovascular Abnormalities and Cognitive and  c2015 Sep a1886-930 v633 a

OBJECTIVES: To evaluate and compare the associations between microvascular and macrovascular abnormalities and cognitive and physical function

DESIGN: Cross-sectional analysis of the Cardiovascular Health Study (1998-1999).

SETTING: Community.

PARTICIPANTS: Individuals with available data on three or more of five microvascular abnormalities (brain, retina, kidney) and three or more of six macrovascular abnormalities (brain, carotid artery, heart, peripheral artery) (N = 2,452; mean age 79.5).

MEASUREMENTS: Standardized composite scores derived from three cognitive tests (Modified Mini-Mental State Examination, Digit-Symbol Substitution Test, Trail-Making Test (TMT)) and three physical tests (gait speed, grip strength, 5-time sit to stand)

RESULTS: Participants with high microvascular and macrovascular burden had worse cognitive (mean score difference = -0.30, 95% confidence interval (CI) = -0.37 to -0.24) and physical (mean score difference = -0.32, 95% CI = -0.38 to -0.26) function than those with low microvascular and macrovascular burden. Individuals with high microvascular burden alone had similarly lower scores than those with high macrovascular burden alone (cognitive function: -0.16, 95% CI = -0.24 to -0.08 vs -0.13, 95% CI = -0.20 to -0.06; physical function: -0.15, 95% CI = -0.22 to -0.08 vs -0.12, 95% CI = -0.18 to -0.06). Psychomotor speed and working memory, assessed using the TMT, were only impaired in the presence of high microvascular burden. Of the 11 vascular abnormalities considered, white matter hyperintensity, cystatin C-based glomerular filtration rate, large brain infarct, and ankle-arm index were independently associated with cognitive and physical function.

CONCLUSION: Microvascular and macrovascular abnormalities assessed using noninvasive tests of the brain, kidney, and peripheral artery were independently associated with poor cognitive and physical function in older adults. Future research should evaluate the usefulness of these tests in prognostication.

10aAged10aAged, 80 and over10aCognition10aCross-Sectional Studies10aFemale10aHumans10aMale10aNeuropsychological Tests10aVascular Malformations1 aKim, Dae, Hyun1 aGrodstein, Francine1 aNewman, Anne, B1 aChaves, Paulo, H M1 aOdden, Michelle, C1 aKlein, Ronald1 aSarnak, Mark, J1 aLipsitz, Lewis, A uhttps://chs-nhlbi.org/node/685202534nas a2200181 4500008004100000022001400041245015900055210006900214260001600283300001200299490000600311520191100317100002302228700002302251700002302274700001902297856003602316 2020 eng d a2047-998000aPredicting Risk of Atherosclerotic Cardiovascular Disease Using Pooled Cohort Equations in Older Adults With Frailty, Multimorbidity, and Competing Risks.0 aPredicting Risk of Atherosclerotic Cardiovascular Disease Using  c2020 Sep 15 ae0160030 v93 a

Background Assessment of atherosclerotic cardiovascular disease (ASCVD) risk is crucial for prevention and management, but the performance of the pooled cohort equations in older adults with frailty and multimorbidity is unknown. We evaluated the pooled cohort equations in these subgroups and the impact of competing risks. Methods and Results In 4249 community-dwelling adults, aged ≥65 years, from the CHS (Cardiovascular Health Study), we calculated 10-year risk of hard ASCVD. Frailty was determined using the Fried phenotype. Latent class analysis was used to identify individuals with multimorbidity patterns using chronic conditions. We assessed discrimination using the C-statistic and calibration by comparing predicted ASCVD risks with estimated risk using cause-specific and cumulative incidence models, by multimorbidity patterns and frailty status. A total of 917 (21.6%) participants had an ASCVD event, and 706 (16.6%) had a competing event of death. C-statistic was 0.68 in men and 0.69 in women; calibration was good when compared with cause-specific and cumulative incidence estimated risks (males, -0.1% and 3.3%; females, 0.6% and 1.4%). Latent class analysis identified 4 patterns: minimal disease, cardiometabolic, low cognition, musculoskeletal-lung depression. In the cardiometabolic pattern, ASCVD risk was overpredicted compared with cumulative incidence risk in men (7.4%) and women (6.8%). Risk was underpredicted in men (-10.7%) and women (-8.2%) with frailty compared with cause-specific risk. Miscalibration occurred mostly at high predicted risk ranges. Conclusions ASCVD prediction was good in this cohort of adults aged ≥65 years. Although calibration varied by multimorbidity patterns, frailty, and competing risks, miscalibration was mostly present at high predicted risk ranges and thus less likely to alter decision making for primary prevention therapy.

1 aNguyen, Quoc, Dinh1 aOdden, Michelle, C1 aPeralta, Carmen, A1 aKim, Dae, Hyun uhttps://chs-nhlbi.org/node/848502644nas a2200205 4500008004100000022001400041245016900055210006900224260001600293520193400309100001702243700002002260700002302280700002302303700002002326700002102346700001902367700001602386856003602402 2021 eng d a1758-535X00aAssociation of Retail Environment and Neighborhood Socioeconomic Status with Mortality among Community-dwelling Older Adults in the US: Cardiovascular Health Study.0 aAssociation of Retail Environment and Neighborhood Socioeconomic c2021 Oct 203 a

BACKGROUND: Few studies have examined the association of neighborhood environment and mortality among community-dwelling older populations. Geographic Information Systems (GIS)-based measures of neighborhood physical environment may provide new insights on the health effects of the social and built environment.

METHODS: We studied 4,379 community-dwelling older adults in the US aged ≥65 years from the Cardiovascular Health Study. Principal component analysis was used to identify neighborhood components from 48 variables assessing facilities and establishments, demographic composition, socio-economic status, and economic prosperity. We used a Cox model to evaluate the association of neighborhood components with five-year mortality. Age, sex, race, education, income, marital status, body mass index, smoking status, disability, coronary heart disease, and diabetes were included as covariates. We also examined the interactions between neighborhood components and sex and race (Black vs. white or other).

RESULTS: We identified five neighborhood components, representing facilities and resources, immigrant communities, community-level economic deprivation, resident-level socio-economic status and residents' age. Communities' economic deprivation and residents' socio-economic status were significantly associated with five-year mortality. We did not find interactions between sex or race and any of the five neighborhood components. The results were similar in a sensitivity analysis where we used ten-year mortality as the outcome.

CONCLUSIONS: We found that communities' economic status but not facilities in communities was associated with mortality among older adults. These findings revealed the importance and benefits living in a socio-economically advantaged neighborhood could have on health among older residents with different demographic backgrounds.

1 aZhang, Kehan1 aLovasi, Gina, S1 aOdden, Michelle, C1 aMichael, Yvonne, L1 aNewman, Anne, B1 aArnold, Alice, M1 aKim, Dae, Hyun1 aWu, Chenkai uhttps://chs-nhlbi.org/node/9008