02615nas a2200385 4500008004100000022001400041245012400055210006900179260000900248300001100257490000900268520150100277653000901778653002801787653002301815653001101838653001101849653001401860653002301874653002001897653002501917653000901942653002401951653003001975653001802005100002002023700002402043700002502067700001902092700001502111700002102126700002202147700002402169856003602193 2014 eng d a1687-981300aResidential relocation by older adults in response to incident cardiovascular health events: a case-crossover analysis.0 aResidential relocation by older adults in response to incident c c2014 a9519710 v20143 a

OBJECTIVE: We use a case-crossover analysis to explore the association between incident cardiovascular events and residential relocation to a new home address.

METHODS: We conducted an ambidirectional case-crossover analysis to explore the association between incident cardiovascular events and residential relocation to a new address using data from the Cardiovascular Health Study (CHS), a community-based prospective cohort study of 5,888 older adults from four U.S. sites beginning in 1989. Relocation was assessed twice a year during follow-up. Event occurrences were classified as present or absent for the period preceding the first reported move, as compared with an equal length of time immediately prior to and following this period.

RESULTS: Older adults (65+) that experience incident cardiovascular disease had an increased probability of reporting a change of residence during the following year (OR 1.6, 95% confidence interval (CI) = 1.2-2.1). Clinical conditions associated with relocation included stroke (OR: 2.0, 95% CI: 1.2-3.3), angina (OR: 1.6, 95% CI: 1.0-2.6), and congestive heart failure (OR: 1.5, 95% CI: 1.0-2.1).

CONCLUSIONS: Major incident cardiovascular disease may increase the probability of residential relocation in older adults. Case-crossover analyses represent an opportunity to investigate triggering events, but finer temporal resolution would be crucial for future research on residential relocations.

10aAged10aCardiovascular Diseases10aCross-Over Studies10aFemale10aHumans10aIncidence10aLife Change Events10aLogistic Models10aLongitudinal Studies10aMale10aProspective Studies10aResidence Characteristics10aUnited States1 aLovasi, Gina, S1 aRichardson, John, M1 aRodriguez, Carlos, J1 aKop, Willem, J1 aAhmed, Ali1 aBrown, Arleen, F1 aGreenlee, Heather1 aSiscovick, David, S uhttps://chs-nhlbi.org/node/633502328nas a2200229 4500008004100000022001400041245007500055210006900130260001600199300001200215490000800227520165300235100002101888700002001909700002501929700002001954700002101974700002101995700002302016700002302039856003602062 2016 eng d a1476-625600aNeighborhood Socioeconomic Status and Cognitive Function in Late Life.0 aNeighborhood Socioeconomic Status and Cognitive Function in Late c2016 Jun 15 a1088-970 v1833 a

Neighborhood socioeconomic status (NSES) is associated with cognitive function, independently of individual demographic, health, and socioeconomic characteristics. However, research has been largely cross-sectional, and mechanisms of the association are unknown. In 1992-1993, Cardiovascular Health Study participants (n = 3,595; mean age = 74.8 years; 15.7% black) underwent cognitive testing and magnetic resonance imaging of white matter hyperintensities (WMH), and their addresses were geocoded. NSES was calculated using 1990 US Census data (block groups; 6 measures of wealth, education, and occupation). The Modified Mini-Mental State Examination (3MS) was used to assess general cognition, and the Digit Symbol Substitution Test (DSST) was used to assess speed of processing annually for 6 years. Associations of race-specific NSES tertiles with 3MS, DSST, and WMH were estimated using linear mixed-effects models accounting for geographic clustering, stratified by race, and adjusted for demographic, health, and individual socioeconomic status (education, income, lifetime occupational status) variables. In fully adjusted models, higher NSES was associated with higher 3MS scores in blacks (mean difference between highest and lowest NSES = 2.4 points; P = 0.004) and whites (mean difference = 0.7 points; P = 0.02) at baseline but not with changes in 3MS over time. NSES was marginally associated with DSST and was not associated with WMH. Adjustment for WMH did not attenuate NSES-3MS associations. Associations of NSES with cognition in late adulthood differ by race, are not explained by WMH, and are evident only at baseline.

1 aRosso, Andrea, L1 aFlatt, Jason, D1 aCarlson, Michelle, C1 aLovasi, Gina, S1 aRosano, Caterina1 aBrown, Arleen, F1 aMatthews, Karen, A1 aGianaros, Peter, J uhttps://chs-nhlbi.org/node/713203000nas a2200517 4500008004100000022001400041245014300055210006900198260001600267300001400283490000800297520149600305653000901801653002201810653002801832653003101860653002001891653002801911653001901939653000901958653001301967653001101980653002401991653002202015653001102037653001402048653002502062653000902087653001402096653003302110653002402143653001802167100002202185700002202207700002002229700002202249700001902271700002302290700002102313700002202334700002802356700002202384700002002406700002002426856003602446 2017 eng d a1476-625600aConcordance With Prevention Guidelines and Subsequent Cancer, Cardiovascular Disease, and Mortality: A Longitudinal Study of Older Adults.0 aConcordance With Prevention Guidelines and Subsequent Cancer Car c2017 Nov 15 a1168-11790 v1863 a

Reports on the associations between multiple clinical and behavioral health indicators and major health outcomes among older adults are scarce. We prospectively examined concordance with guidelines from the American Cancer Society and American Heart Association for disease prevention in relation to cancer, cardiovascular disease (CVD), and mortality among Cardiovascular Health Study enrollees aged 65-98 years who, at baseline assessment in 1989-1996 (n = 3,491), were free of CVD and cancer. Total and cause-specific mortality, as well as incidence of cancer and CVD, were lower with higher guideline concordance. Independent of body mass index, blood pressure, total cholesterol, and fasting plasma glucose, better health behaviors (diet, physical activity, and alcohol consumption) were associated with lower mortality (2-sided P < 0.0001). Among individuals with ideal levels for 3-4 of these 4 cardiometabolic biomarkers, those with poor concordance with health behavior recommendations had higher mortality compared with those who had the highest concordance with these behavioral recommendations (adjusted mortality hazard ratio = 1.82, 95% confidence interval: 1.25, 2.67). Older adults who are concordant with recommendations for cancer and CVD prevention have reduced rates of chronic disease and mortality. Interventions to achieve and maintain healthy lifestyle behaviors may offer benefits both in the presence and absence of adverse traditional clinical risk factors.

10aAged10aAged, 80 and over10aAmerican Cancer Society10aAmerican Heart Association10aBody Mass Index10aCardiovascular Diseases10aCause of Death10aDiet10aExercise10aFemale10aGuideline Adherence10aHealthy Lifestyle10aHumans10aIncidence10aLongitudinal Studies10aMale10aNeoplasms10aPractice Guidelines as Topic10aProspective Studies10aUnited States1 aGreenlee, Heather1 aStrizich, Garrett1 aLovasi, Gina, S1 aKaplan, Robert, C1 aBiggs, Mary, L1 aLi, Christopher, I1 aRichardson, John1 aBurke, Gregory, L1 aFitzpatrick, Annette, L1 aFretts, Amanda, M1 aPsaty, Bruce, M1 aFried, Linda, P uhttps://chs-nhlbi.org/node/756302644nas 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/900802677nas a2200241 4500008004100000022001400041245013900055210006900194260001600263520189900279100002102178700002002199700002302219700001802242700002002260700002102280700001802301700001902319700002102338700002002359700002002379856003602399 2021 eng d a1433-928500aAssociations between neighborhood greenspace and brain imaging measures in non-demented older adults: the Cardiovascular Health Study.0 aAssociations between neighborhood greenspace and brain imaging m c2021 Jan 033 a

PURPOSE: Greater neighborhood greenspace has been associated with brain health, including better cognition and lower odds of Alzheimer's disease in older adults. We investigated associations between neighborhood greenspace and brain-based magnetic resonance imaging (MRI) measures and potential effect modification by sex or apolipoprotein E genotype (APOE), a risk factor for Alzheimer's disease.

METHODS: We obtained a sample of non-demented participants 65 years or older (n = 1125) from the longitudinal, population-based Cardiovascular Health Study (CHS). Greenspace data were derived from the National Land Cover Dataset. Adjusted multivariable linear regression estimated associations between neighborhood greenspace five years prior to the MRI and left and right hippocampal volume and 10-point grades of ventricular size and burden of white matter hyperintensity. Interaction terms tested effect modification by APOE genotype and sex. CHS data (1989-1999) were obtained/analyzed in 2020.

RESULTS: Participants were on average 79 years old [standard deviation (SD) = 4], 58% were female, and 11% were non-white race. Mean neighborhood greenspace was 38% (SD = 28%). Greater proportion of greenspace in the neighborhood five years before MRI was borderline associated with lower ventricle grade (estimate: - 0.30; 95% confidence interval: - 0.61, 0.00). We observed no associations between greenspace and the other MRI outcome measures and no evidence of effect modification by APOE genotype and sex.

CONCLUSION: This study suggests a possible association between greater greenspace and less ventricular enlargement, a measure reflecting global brain atrophy. If confirmed in other longitudinal cohort studies, interventions and policies to improve community greenspaces may help to maintain brain health in older age.

1 aBesser, Lilah, M1 aLovasi, Gina, S1 aMichael, Yvonne, L1 aGarg, Parveen1 aHirsch, Jana, A1 aSiscovick, David1 aHurvitz, Phil1 aBiggs, Mary, L1 aGalvin, James, E1 aBartz, Traci, M1 aLongstreth, W T uhttps://chs-nhlbi.org/node/861602505nas a2200277 4500008004100000022001400041245007600055210006900131260001600200300001100216490000700227520169000234100002001924700002101944700002001965700002101985700002002006700002502026700002102051700002302072700002802095700002002123700002502143700002302168856003602191 2023 eng d a1873-205400aNeighborhood greenspace and cognition: The cardiovascular health study.0 aNeighborhood greenspace and cognition The cardiovascular health  c2023 Jan 03 a1029600 v793 a

OBJECTIVES: We examined whether greenspace measures (overall percent greenspace and forest, and number of greenspace types) were associated with clinically adjudicated dementia status.

METHODS: In a sample of non-demented older adults (n = 2141, average age = 75.3 years) from the Cardiovascular Health and Cognition Study, Cox proportional hazard and logistic regression analyses were used to estimate associations of baseline greenspace with risks of incident dementia and MCI, respectively, while adjusting for demographics, co-morbidities, and other neighborhood factors. We derived quartiles of percent greenness (greenspace), forest (percent tree canopy cover), and tertiles of greenspace diversity (number of greenspace types) for 5-km radial buffers around participant's residences at study entry (1989-1990) from the 1992 National Land Cover Dataset. Dementia status and mild cognitive impairment (MCI) over 10 years was clinically adjudicated.

RESULTS: We observed no significant association between overall percent greenspace and risk of mild cognitive impairment or dementia and mostly null results for forest and greenspace diversity. Forest greenspace was associated with lower odds of MCI (OR quartile 4 versus 1: 0.54, 95% CI: 0.29-0.98) and greenspace diversity was associated with lower hazard of incident dementia (HR tertile 2 versus 1: 0.70, 95% CI = 0.50-0.99).

DISCUSSION: We found divergent results for different types of greenspace and mild cognitive impairment or dementia. Improved greenspace type and diversity measurement could better characterize the association between greenspace and cognition.

1 aGodina, Sara, L1 aRosso, Andrea, L1 aHirsch, Jana, A1 aBesser, Lilah, M1 aLovasi, Gina, S1 aDonovan, Geoffrey, H1 aGarg, Parveen, K1 aPlatt, Jonathan, M1 aFitzpatrick, Annette, L1 aLopez, Oscar, L1 aCarlson, Michelle, C1 aMichael, Yvonne, L uhttps://chs-nhlbi.org/node/923802569nas a2200301 4500008004100000022001400041245012700055210006900182260001700251300001100268490000700279520165000286100002101936700002001957700002901977700002002006700002002026700002302046700001802069700002002087700002102107700002302128700001902151700002102170700002002191700002002211856003602231 2023 eng d a2352-872900aNeighborhood greenspace and neighborhood income associated with white matter grade worsening: Cardiovascular Health Study.0 aNeighborhood greenspace and neighborhood income associated with  c2023 Oct-Dec ae124840 v153 a

INTRODUCTION: We examined whether a combined measure of neighborhood greenspace and neighborhood median income was associated with white matter hyperintensity (WMH) and ventricle size changes.

METHODS: The sample included 1260 cognitively normal ≥ 65-year-olds with two magnetic resonance images (MRI; ≈ 5 years apart). WMH and ventricular size were graded from 0 (least) to 9 (most) abnormal (worsening = increase of ≥1 grade from initial to follow-up MRI scans). The four-category neighborhood greenspace-income measure was based on median neighborhood greenspace and income values at initial MRI. Multivariable logistic regression tested associations between neighborhood greenspace-income and MRI measures (worsening vs. not).

RESULTS: White matter grade worsening was more likely for those in lower greenspace-lower income neighborhoods than higher greenspace-higher income neighborhoods (odds ratio = 1.73; 95% confidence interval = 1.19-2.51).

DISCUSSION: The combination of lower neighborhood income and lower greenspace may be a risk factor for worsening white matter grade on MRI. However, findings need to be replicated in more diverse cohorts.

HIGHLIGHTS: Population-based cohort of older adults (≥ 65 years) with greenspace and MRI dataCombined measure of neighborhood greenspace and neighborhood income at initial MRIMRI outcomes included white matter hyperintensities (WMH) and ventricular sizeLongitudinal change in MRI outcomes measured approximately 5 years apartWorsening WMH over time more likely for lower greenspace-lower income neighborhoods.

1 aBesser, Lilah, M1 aLovasi, Gina, S1 aZambrano, Joyce, Jimenez1 aCamacho, Simone1 aDhanekula, Devi1 aMichael, Yvonne, L1 aGarg, Parveen1 aHirsch, Jana, A1 aSiscovick, David1 aHurvitz, Philip, M1 aBiggs, Mary, L1 aGalvin, James, E1 aBartz, Traci, M1 aLongstreth, W T uhttps://chs-nhlbi.org/node/953202679nas a2200229 4500008004100000022001400041245008600055210006900141260001600210520198100226100002002207700001702227700002002244700002302264700002202287700001602309700002002325700002502345700001902370700002402389856003602413 2023 eng d a1873-260700aTime-Varying Food Retail and Incident Disease in the Cardiovascular Health Study.0 aTimeVarying Food Retail and Incident Disease in the Cardiovascul c2023 Mar 053 a

INTRODUCTION: Natural experiments can strengthen evidence linking neighborhood food retail presence to dietary intake patterns and cardiometabolic health outcomes, yet sample size and follow-up duration are typically not extensive. To complement natural experiment evidence, longitudinal data were used to estimate the impacts of neighborhood food retail presence on incident disease.

METHODS: The Cardiovascular Health Study recruited adults aged 65+ years in 1989-1993. Analyses conducted in 2021-2022 included those in good baseline health, with addresses updated annually through the year of death (restricted to 91% who died during >2 decades of cohort follow-up). Baseline and annually updated presence of 2 combined food retail categories (supermarkets/produce markets and convenience/snack focused) was characterized using establishment-level data for 1-km and 5-km Euclidean buffers. Cox proportional hazards models estimated associations with time to each incident outcome (cardiovascular disease, diabetes), adjusting for individual and area-based confounders.

RESULTS: Among 2,939 participants, 36% with baseline supermarket/produce market presence within 1 km had excess incident cardiovascular disease (hazard ratio=1.12; 95% CI=1.01, 1.24); the association was attenuated and no longer statistically significant after adjustment for sociodemographic characteristics. Adjusted associations were robustly null for time-varying supermarket/produce market or convenience/fast food retail presence across analyses with outcomes of cardiovascular disease or diabetes incidence.

CONCLUSIONS: Food environment changes continue to be studied to provide an evidence base for policy decisions, and null findings in this longitudinal analysis add literature that casts doubt on the sufficiency of strategies targeting food retail presence alone of an elderly cohort for curtailing incident events of clinical importance.

1 aLovasi, Gina, S1 aBoise, Sarah1 aJogi, Siddharth1 aHurvitz, Philip, M1 aRundle, Andrew, G1 aDiez, Julia1 aHirsch, Jana, A1 aFitzpatrick, Annette1 aBiggs, Mary, L1 aSiscovick, David, S uhttps://chs-nhlbi.org/node/931903397nas a2200445 4500008004100000022001400041245013300055210006900188260001600257300001100273490000800284520211100292653000902403653002202412653001902434653001802453653001302471653002702484653001102511653001102522653000902533653001702542100002202559700002002581700002402601700002202625700002302647700002402670700002702694700002302721700002102744700002002765700002302785700002002808700002102828700002002849700002102869700002502890856003602915 2024 eng d a1879-102600aAssociations between toxicity-weighted concentrations and dementia risk: Results from the Cardiovascular Health Cognition Study.0 aAssociations between toxicityweighted concentrations and dementi c2024 Oct 01 a1737060 v9453 a

BACKGROUND: Air pollution is a modifiable risk factor for dementia. Yet, studies on specific sources of air pollution (i.e., toxic chemical emissions from industrial facilities) and dementia risk are scarce. We examined associations between toxicity-weighted concentrations of industrial pollution and dementia outcomes among a large, multi-site cohort of older adults.

METHODS: Participants (n = 2770) were ≥ 65 years old (Mean = 75.3, SD = 5.1 years) from the Cardiovascular Health Cognition Study (1992-1999). Toxicity-weighted concentrations were estimated using the Risk Screening Environmental Indicator (RSEI) model which incorporates total reported chemical emissions with toxicity, fate, and transport models. Estimates were aggregated to participants' baseline census tract, averaged across 1988-1992, and log2-transformed. Dementia status was clinically adjudicated in 1998-1999 and categorized by subtype (Alzheimer's, vascular, mixed). We assessed whether RSEI-estimated toxicity-weighted concentrations were associated with 1) odds of prevalent dementia and 2) incident dementia risk by subtype.

RESULTS: After adjusting for individual and census-tract level covariates, a doubling in toxicity-weighted concentrations was associated with 9 % higher odds of prevalent dementia (OR = 1.09, 95 % CI: 1.00, 1.19). In discrete-time survival models, each doubling in toxicity-weighted concentrations was associated with a 16 % greater hazard of vascular dementia (HR = 1.16, 95 % CI: 1.01, 1.34) but was not significantly associated with all-cause, Alzheimer's disease, or mixed dementia (p's > 0.05).

DISCUSSION: Living in regions with higher toxicity-weighted concentrations was associated with higher odds of prevalent dementia and a higher risk of incident vascular dementia in this large, community-based cohort of older adults. These findings support the need for additional studies to examine whether toxic chemical emissions from industrial and federal facilities may be a modifiable target for dementia prevention.

10aAged10aAged, 80 and over10aAir Pollutants10aAir Pollution10aDementia10aEnvironmental Exposure10aFemale10aHumans10aMale10aRisk Factors1 aCrane, Breanna, M1 aMoored, Kyle, D1 aDonahue, Patrick, T1 aCorrigan, Anne, E1 aCurriero, Frank, C1 aShields, Timothy, M1 aDesjardins, Michael, R1 aRichards, Emily, A1 aRosso, Andrea, L1 aLovasi, Gina, S1 aOdden, Michelle, C1 aLopez, Oscar, L1 aBiggs, Mary, Lou1 aNewman, Anne, B1 aAndrews, Ryan, M1 aCarlson, Michelle, C uhttps://chs-nhlbi.org/node/9737