03006nas a2200373 4500008004100000022001400041245007500055210006900130260001300199300001200212490000700224520199400231653000902225653002202234653002802256653001202284653001102296653001802307653002502325653001102350653002002361653000902381653001902390653002302409653001502432653002602447653001502473653001802488100002702506700001702533700002302550700002302573856003602596 2015 eng d a1532-541500aLower Extremity Proximal Muscle Function and Dyspnea in Older Persons.0 aLower Extremity Proximal Muscle Function and Dyspnea in Older Pe c2015 Aug a1628-330 v633 a

OBJECTIVES: To evaluate the association between performance on a single chair stand and moderate to severe exertional dyspnea.

DESIGN: Cross-sectional.

SETTING: Cardiovascular Health Study.

PARTICIPANTS: Community-dwelling individuals aged 65 and older (N = 4,413; mean age 72.6; female, n = 2,518 (57.1%); nonwhite, n = 199 (4.5%); obese, n = 788 (17.9%); history of smoking, n = 2,410 (54.6%)).

MEASUREMENTS: Performance on single chair stand (poor (unable to rise without arm use) vs normal (able to rise without arm use)), moderate to severe exertional dyspnea (American Thoracic Society grade ≥2), age, sex, ethnicity, obesity, smoking, frailty status (Fried-defined nonfrail, prefrail, frail), high cardiopulmonary risk (composite of cardiopulmonary diseases and diabetes mellitus), spirometric impairment, arthritis, depression, stroke, and kidney disease.

RESULTS: Poor performance on the single chair stand was established in 369 (8.4%) and moderate to severe exertional dyspnea in 773 (17.5%). Prefrail status was established in 2,210 (50.1%), frail status in 360 (8.2%), arthritis in 2,241 (51.4%), high cardiopulmonary risk in 2,469 (55.9%), spirometric impairment in 1,076 (24.4%), kidney disease in 111 (2.5%), depression in 107 (2.4%), and stroke in 93 (2.1%). In multivariable regression models, poor performance on the single chair stand was associated with moderate to severe exertional dyspnea (unadjusted odds ratio (OR) = 3.48, 95% confidence interval (CI) = 2.78-4.36; adjusted OR = 1.85, 95% CI = 1.41-2.41).

CONCLUSION: Poor performance on a single chair stand was associated with an adjusted 85% greater likelihood of moderate to severe exertional dyspnea than normal performance. These results suggest that reduced proximal muscle function of the lower extremities is associated with moderate to severe exertional dyspnea, even after adjusting for multiple confounders.

10aAged10aAged, 80 and over10aCross-Sectional Studies10aDyspnea10aFemale10aFrail Elderly10aGeriatric Assessment10aHumans10aLower Extremity10aMale10aMotor Activity10aMuscle Contraction10aPrevalence10aRetrospective Studies10aSpirometry10aUnited States1 aFragoso, Carlos, A Vaz1 aAraujo, Katy1 aLeo-Summers, Linda1 aVan Ness, Peter, H uhttps://chs-nhlbi.org/node/682102810nas a2200229 4500008004100000022001400041245009400055210006900149260001300218300001400231490000700245520212700252100001902379700002102398700002302419700001402442700002302456700002002479700001802499700002702517856003602544 2016 eng d a1532-541500aDyspnea in Community-Dwelling Older Persons: A Multifactorial Geriatric Health Condition.0 aDyspnea in CommunityDwelling Older Persons A Multifactorial Geri c2016 Oct a2042-20500 v643 a

OBJECTIVES: To evaluate the associations between a broad array of cardiorespiratory and noncardiorespiratory impairments and dyspnea in older persons.

DESIGN: Cross-sectional.

SETTING: Cardiovascular Health Study.

PARTICIPANTS: Community-dwelling persons (N = 4,413; mean age 72.6, 57.1% female, 4.5% African American, 27.2%

MEASUREMENTS: Dyspnea severity (moderate to severe defined as American Thoracic Society Grade ≥2) and several impairments, including those established using spirometry (forced expiratory volume in 1 second (FEV1 )), maximal inspiratory pressure (respiratory muscle strength), echocardiography, ankle-brachial index, blood pressure, whole-body muscle mass (bioelectrical impedance), single chair stand (lower extremity function), grip strength, serum hemoglobin and creatinine, Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination, medication use, and body mass index (BMI).

RESULTS: In a multivariable logistic regression model, impairments that had strong associations with moderate to severe dyspnea were FEV1 less than the lower limit of normal (adjusted odds ratio (aOR) = 2.88, 95% confidence interval (CI) = 2.37-3.49), left ventricular ejection fraction less than 45% (aOR = 2.12, 95% CI = 1.43, 3.16), unable to perform a single chair stand (aOR = 2.10, 95% CI = 1.61-2.73), depressive symptoms (CES-D score ≥16; aOR = 2.02, 95% CI = 1.26-3.23), and obesity (BMI ≥30; aOR = 2.07, 95% CI = 1.67-2.55). Impairments with modest but still statistically significant associations with moderate to severe dyspnea included respiratory muscle weakness, diastolic cardiac dysfunction, grip weakness, anxiety symptoms, and use of cardiovascular and psychoactive medications (aORs = 1.31-1.71).

CONCLUSION: In community-dwelling older persons, several cardiorespiratory and noncardiorespiratory impairments were significantly associated with moderate to severe dyspnea, akin to a multifactorial geriatric health condition.

1 aMiner, Brienne1 aTinetti, Mary, E1 aVan Ness, Peter, H1 aHan, Ling1 aLeo-Summers, Linda1 aNewman, Anne, B1 aLee, Patty, J1 aFragoso, Carlos, A Vaz uhttps://chs-nhlbi.org/node/725102648nas a2200205 4500008004100000022001400041245014600055210006900201260001600270520195300286100001902239700002002258700002302278700002002301700002602321700001802347700002202365700001902387856003602406 2018 eng d a1545-721400aLongitudinal Associations Between Cognitive Functioning and Depressive Symptoms Among Older Adult Spouses in the Cardiovascular Health Study.0 aLongitudinal Associations Between Cognitive Functioning and Depr c2018 Jul 033 a

OBJECTIVE: To examine the bidirectional associations between older adult spouses' cognitive functioning and depressive symptoms over time.

DESIGN: Longitudinal, dyadic path analysis with the actor-partner interdependence model.

SETTING: Data were from visit 5 (1992/1993), visit 8 (1995/1996), and visit 11 (1998/1999) of the Cardiovascular Health Study, a multisite, longitudinal, observational study of risk factors for cardiovascular disease in adults 65 years or older. Demographic information was from the 1989/1990 original and 1992/1993 African American cohort baseline visits.

PARTICIPANTS: Husbands and wives from 1,028 community-dwelling married couples (N = 2,065).

MEASUREMENTS: Cognitive functioning was measured with the Modified Mini-Mental State Exam. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale. Age, education, and disability (activities of daily living and instrumental activities of daily living) were included as covariates.

RESULTS: Cross-partner associations (partner effects) revealed that one spouse's greater depressive symptoms predicted the other spouse's lower cognitive functioning, but a spouse's lower cognitive functioning did not predict the other spouse's greater depressive symptoms over time. Within-individual associations (actor effects) revealed that an individual's lower cognitive functioning predicted the individual's greater depressive symptoms over time, but greater depressive symptoms did not predict lower cognitive functioning over time. Effects did not differ for husbands and wives.

CONCLUSION: Having a spouse who is depressed may increase one's risk of cognitive decline as well as one's risk of depression. Interventions for preventing cognitive decline and depression among older adults may be enhanced by considering the marital context.

1 aMonin, Joan, K1 aDoyle, Margaret1 aVan Ness, Peter, H1 aSchulz, Richard1 aMarottoli, Richard, A1 aBirditt, Kira1 aFeeney, Brooke, C1 aKershaw, Trace uhttps://chs-nhlbi.org/node/780602784nas a2200181 4500008004100000022001400041245010000055210006900155260001300224300001000237490000800247520221700255100002702472700002302499700002402522700002002546856003602566 2018 eng d a1532-306400aSpirometric impairments, cardiovascular outcomes, and noncardiovascular death in older persons.0 aSpirometric impairments cardiovascular outcomes and noncardiovas c2018 Apr a40-470 v1373 a

BACKGROUND: In prior work involving older persons, the reported associations of spirometric impairments with cardiovascular outcomes may have been confounded by age-related changes in lung function. Hence, using more age-appropriate spirometric criteria from the Global Lung Function Initiative (GLI), we have evaluated the associations of spirometric impairments, specifically restrictive-pattern and airflow-obstruction, with cardiovascular death (CV-death) and hospitalization (CV-hospitalization). In these analyses, we also evaluated the competing outcome of noncardiovascular death (nonCV-death) and calculated measures of relative and absolute risk.

METHODS: Our study sample was drawn from the Cardiovascular Health Study (CHS), including 4232 community-dwelling white persons aged ≥65 years. Multivariable regression models included the following baseline predictors: GLI-defined restrictive-pattern and airflow-obstruction, age, male gender, obesity, waist circumference, current smoker status, ≥10 pack-years of smoking, hypertension, dyslipidemia, diabetes, and cardiovascular and cerebrovascular disease. Outcomes included adjudicated CV-death, CV-hospitalization, and nonCV-death, ascertained over 10 years of follow-up. Measures of association included hazard ratios (HRs), rate ratios (RRs), and average attributable fraction (AAF), each with 95% confidence intervals.

RESULTS: Restrictive-pattern and airflow-obstruction were associated with CV-death (adjusted HRs: 1.57 [1.18, 2.09] and 1.29 [1.04, 1.60]) and with nonCV-death (adjusted HRs: 2.10 [1.63, 2.69] and 1.79 [1.51, 2.12]), respectively. Airflow-obstruction, but not restrictive-pattern, was also associated with CV-hospitalization (adjusted RRs: 1.18 [1.02, 1.36] and 1.20 [0.96, 1.50], respectively). The adjusted AAFs of restrictive-pattern and airflow-obstruction were 1.68% (0.46, 3.06) and 2.35% (0.22, 4.72) for CV-death, and 3.44% (1.97, 5.08) and 7.77% (5.15, 10.60) for nonCV-death, respectively.

CONCLUSION: Assessment of GLI-defined spirometric impairments contributes to broad geriatric risk stratifications for both cardiovascular and non-cardiovascular outcomes.

1 aFragoso, Carlos, A Vaz1 aVan Ness, Peter, H1 aMurphy, Terrence, E1 aMcAvay, Gail, J uhttps://chs-nhlbi.org/node/767302481nas a2200169 4500008004100000022001400041245010400055210006900159260001300228300001200241490000700253520194500260100002702205700002302232700002002255856003602275 2020 eng d a1943-365400aFEV as a Standalone Spirometric Predictor and the Attributable Fraction for Death in Older Persons.0 aFEV as a Standalone Spirometric Predictor and the Attributable F c2020 Feb a217-2260 v653 a

BACKGROUND: Commonly used thresholds for staging FEV have not been evaluated as standalone spirometric predictors of death in older persons. Specifically, the proportion of deaths attributed to a reduced FEV, when staged by commonly used thresholds in L, percent of predicted (% pred), and Z scores, has not been previously reported.

METHODS: In 4,232 white persons ≥ 65 y old, sampled from the Cardiovascular Health Study, FEV was stratified as stage 1 (FEV ≥ 2.00 L, ≥80% pred, and Z score ≥-1.64), stage 2 (FEV 1.50-1.99 L, 50-79%pred, and Z score -2.55 to -1.63), and stage 3 (FEV < 1.50 L, < 50% pred, and Z score < -2.55). Notably, a Z score threshold of -1.64 defines normal-for-age lung function as the lower limit of normal (ie, 5th percentile of distribution), and accounts for differences in age, sex, height, and ethnicity. Next, adjusted odds ratios and average attributable fractions for 10-y all-cause mortality were calculated, comparing FEV stages 2 and 3 against stage 1, expressed in L, % pred, and Z scores. The average attributable fraction estimates the proportion of deaths attributed to a predictor by combining the prevalence of the predictor with the relative risk of death conferred by that predictor.

RESULTS: FEV stage 2 and 3 in L, % pred, and Z scores yielded similar adjusted odds ratios of death: 1.40-1.51 for stage 2 and 2.35-2.66 for stage 3. Conversely, FEV stages 2 and 3 in L, % pred, and Z scores differed in prevalence: 12.8-28.6% for stage 2 and 6.4-17.5% for stage 3, and also differed in the adjusted average attributable fraction for death: 3.2-6.4% for stage 2 and 4.5-9.1% for stage 3.

CONCLUSIONS: In older persons, the proportion of deaths attributed to a reduced FEV is best stratified by Z score staging thresholds because these yield a similar relative risk of death but a more age- and sex-appropriate prevalence of FEV stage.

1 aFragoso, Carlos, A Vaz1 aVan Ness, Peter, H1 aMcAvay, Gail, J uhttps://chs-nhlbi.org/node/8291