03587nas a2200421 4500008004100000022001400041245015700055210006900212260001300281300001200294490000700306520239900313653000902712653002102721653001702742653002802759653003002787653002102817653001102838653001102849653000902860653002002869653001502889653002402904653001702928653002002945100001702965700001602982700001802998700001803016700001503034700001803049700001403067700001603081700001603097700001703113856003503130 1992 eng d a0039-249900aDistribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group.0 aDistribution and correlates of sonographically detected carotid  c1992 Dec a1752-600 v233 a

BACKGROUND AND PURPOSE: This article describes the prevalence of extracranial carotid atherosclerosis assessed by ultrasonography, its association with risk factors, and its relation to symptomatic coronary disease and stroke in men and women aged > or = 65 years.

METHODS: Maximum percent stenosis, maximum common carotid artery wall thickness, and maximum internal carotid artery wall thickness were assessed using duplex ultrasound in 5,201 men and women aged > or = 65 years in the Cardiovascular Health Study, a study of the risk factors and natural history of cardiovascular disease in the elderly. Existing coronary disease and stroke were assessed by physical examination and participant history.

RESULTS: Detectable carotid stenosis was present in 75% of men and 62% of women, although the prevalence of > or = 50% stenosis was low, 7% in men and 5% in women. Maximum stenosis and maximum wall thickness measurements increased with age and were uniformly greater at all ages in men than in women (p < 0.00001). Established risk factors for atherosclerosis (hypertension, smoking, diabetes) and indications of vascular disease (left ventricular hypertrophy, major electrocardiographic abnormality, bruits, and history of heart disease or stroke) related to all three carotid artery measures in the elderly. Of the three ultrasound measures, the best correlate for a history of coronary disease was maximum internal carotid artery wall thickness. For stroke the best correlate was common carotid artery wall thickness. Multiple logistic regression models of prevalent coronary heart disease and stroke that included the ultrasound findings indicated, after adjustment for age and sex, that maximum internal wall thickness and maximum common carotid wall thickness were significant correlates of both. Maximum stenosis did not add significantly to the correlation.

CONCLUSIONS: In the elderly the incidence of carotid atherosclerosis was high, although the frequency of severe disease was low. The prevalence and severity of carotid atherosclerosis continued to increase with age even in the late decades of life, and more disease was found in men than in women at all ages. Known risk factors for atherosclerosis continued to relate to carotid abnormalities in the later decades of life, both in symptomatic and asymptomatic subjects.

10aAged10aArteriosclerosis10aCardiomegaly10aCarotid Artery Diseases10aCerebrovascular Disorders10aCoronary Disease10aFemale10aHumans10aMale10aMedical Records10aPrevalence10aRegression Analysis10aRisk Factors10aUltrasonography1 aO'Leary, D H1 aPolak, J, F1 aKronmal, R, A1 aKittner, S, J1 aBond, M, G1 aWolfson, S, K1 aBommer, W1 aPrice, T, R1 aGardin, J M1 aSavage, P, J uhttps://chs-nhlbi.org/node/74903948nas a2200385 4500008004100000022001400041245015000055210006900205260001300274300001100287490000700298520283000305653000903135653001003144653000803154653002103162653003303183653002803216653001103244653001103255653000903266653002603275653003303301653002803334653003003362653001703392100001703409700002003426700001703446700001303463700001503476700001703491700001803508856003603526 1993 eng d a0009-732200aAnkle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group.0 aAnklearm index as a marker of atherosclerosis in the Cardiovascu c1993 Sep a837-450 v883 a

BACKGROUND: Peripheral arterial disease measured noninvasively by the ankle-arm index (AAI) is common in older adults, largely asymptomatic, and associated with clinically manifest cardiovascular disease (CVD). The criteria for an abnormal AAI have varied in previous studies. To determine whether there is an inverse dose-response relation between the AAI and clinical CVD, subclinical disease, and risk factors, we examined the relation of the AAI to cardiovascular risk factors, other noninvasive measures of subclinical atherosclerosis using carotid ultrasound, echocardiography and electrocardiography, and clinical CVD.

METHODS AND RESULTS: The AAI was measured in 5084 participants > or = 65 years old at the baseline examination of the Cardiovascular Health Study. All subjects had detailed assessment of prevalent CVD, measures of cardiovascular risk factors, and noninvasive measures of disease. Participants were stratified by baseline clinical CVD status and AAI (< 0.8, > or = 0.8 to < 0.9, > or = 0.9 to < 1.0, > or = 1.0 to < 1.5). Analyses tested for a dose-response relation of the AAI with clinical CVD, risk factors, and subclinical disease. The cumulative frequency of a low AAI was 7.4% of participants < 0.8, 12.4% < 0.9, and 23.6% < 1.0. participants with an AAI < 0.8 were more than twice as likely as those with an AAI of 1.0 to 1.5 to have a history of myocardial infarction, angina, congestive heart failure, stroke, or transient ischemic attack (all P < .01). In participants free of clinical CVD at baseline, the AAI was inversely related to history of hypertension, history of diabetes, and smoking, as well as systolic blood pressure, serum creatinine, fasting glucose, fasting insulin, measures of pulmonary function, and fibrinogen level (all P < .01). Risk factor associations with the AAI were similar in men and women free of CVD except for serum total and low-density lipoprotein cholesterol, which were inversely associated with AAI level only in women. Risk factors associated with an AAI of < 1.0 in multivariate analysis included smoking (odds ratio [OR], 2.55), history of diabetes (OR, 3.84), increasing age (OR, 1.54), and nonwhite race (OR, 2.36). In the 3372 participants free of clinical CVD, other noninvasive measures of subclinical CVD, including carotid stenosis by duplex scanning, segmental wall motion abnormalities by echocardiogram, and major ECG abnormalities were inversely related to the AAI (all P < .01).

CONCLUSIONS: There was an inverse dose-response relation of the AAI with CVD risk factors and subclinical and clinical CVD among older adults. The lower the AAI, the greater the increase in CVD risk; however, even those with modest, asymptomatic reductions in the AAI (0.8 to 1.0) appear to be at increased risk of CVD.

10aAged10aAnkle10aArm10aArteriosclerosis10aBlood Pressure Determination10aCardiovascular Diseases10aFemale10aHumans10aMale10aMultivariate Analysis10aPeripheral Vascular Diseases10aPopulation Surveillance10aPredictive Value of Tests10aRisk Factors1 aNewman, A, B1 aSiscovick, D, S1 aManolio, T A1 aPolak, J1 aFried, L P1 aBorhani, N O1 aWolfson, S, K uhttps://chs-nhlbi.org/node/144102779nas a2200409 4500008004100000022001400041245010900055210006900164260001300233300001100246490000700257520166200264653000901926653001801935653003101953653001901984653002802003653001902031653001602050653001102066653001102077653000902088653001602097653001902113653001502132653003102147653001702178653001202195653002002207653001802227100001702245700001802262700002202280700001602302700001502318856003602333 1996 eng d a1079-564200aRisk factors for abdominal aortic aneurysms in older adults enrolled in The Cardiovascular Health Study.0 aRisk factors for abdominal aortic aneurysms in older adults enro c1996 Aug a963-700 v163 a

B-mode ultrasound examinations of the abdominal aorta were performed from 1990 to 1992 to evaluate the prevalence of abdominal aortic aneurysm (AAA) in a subgroup of the Pittsburgh cohort (656 participants, aged 65 to 90 years) of the Cardiovascular Health Study (CHS). In this pilot study, we evaluated various definitions of aneurysm and the reproducibility of the measurements. In year 5 (1992 to 1993) of the CHS, the entire cohort (4741 participants) was examined. AAA was defined as an infrarenal aortic diameter of > or= 3.0 cm, or a ratio of infrarenal to suprarenal diameter of > or= 1.2, or a history of AAA repair. For the entire CHS cohort, prevalence of aneurysms was 9.5% (451/4741) overall, with a prevalence among men of 14.2% (278/1956) and prevalence among women of 6.2% (173/2785). Variables significantly related to AAA were older age; male sex; history of angina, coronary heart disease, and myocardial infarction; lower ankle-arm blood pressure ratio; higher maximum carotid stenosis; greater intima-media thickness of the internal carotid artery; higher creatinine; lower HDL levels and higher LDL levels; and cigarette smoking. The study has documented the strong association of cardiovascular risk factors and measures of clinical and subclinical atherosclerosis and cardiovascular disease and prevalence of aneurysms. We used a definition that is more sensitive than previously reported (diameter or ratio), which allowed the detection of smaller aneurysms and possibly those at an earlier stage of development. Follow-up of this cohort may lead to new criteria for determining the risk factors for progression of aneurysms.

10aAged10aAnthropometry10aAortic Aneurysm, Abdominal10aBlood Pressure10aCardiovascular Diseases10aCohort Studies10aComorbidity10aFemale10aHumans10aMale10aMiddle Aged10aPilot Projects10aPrevalence10aReproducibility of Results10aRisk Factors10aSmoking10aUltrasonography10aUnited States1 aAlcorn, H, G1 aWolfson, S, K1 aSutton-Tyrrell, K1 aKuller, L H1 aO'Leary, D uhttps://chs-nhlbi.org/node/145903565nas a2200517 4500008004100000022001400041245022800055210006900283260001300352300001300365490000700378520201100385653002202396653003902418653000902457653001002466653002102476653002002497653004302517653002602560653002102586653002102607653002102628653001902649653004002668653001102708653001502719653001802734653001102752653001702763653000902780653001602789653002402805653001702829653001602846653001202862653001802874653001702892653002002909100001402929700001702943700001602960700001802976700001702994856003603011 1997 eng d a0039-249900aDoes the association of risk factors and atherosclerosis change with age? An analysis of the combined ARIC and CHS cohorts. The Atherosclerosis Risk in Communities (ARIC) and Cardiovascular Health Study (CHS) investigators.0 aDoes the association of risk factors and atherosclerosis change  c1997 Sep a1693-7010 v283 a

INTRODUCTION: A decrease in the estimated relative risk of cerebrovascular and cardiovascular diseases associated with known disease risk factors has been observed among elderly cohorts, perhaps suggesting that continued risk factor management in the elderly may not be as efficacious as with younger age groups. In this paper, the differential magnitude of the association of risk factors with atherosclerosis across the age spectrum from 45 years to older than 75 years is presented.

METHODS: Subclinical atherosclerosis as measured by carotid ultrasonography and risk factor prevalence were assessed using similar methods among participants aged 45 to 64 years in the Atherosclerosis Risk in Communities (ARIC) study and among participants 65 years and older in the Cardiovascular Health Study (CHS). Pooling these two cohorts provided data on the relationship of risk factors and atherosclerosis on nearly 19,000 participants over a broad age range. Regression analyses were used to assess the consistency of the magnitude of the association of risk factors with atherosclerosis across the age spectrum separately for black and white participants in cross-sectional analyses.

RESULTS: As expected, each of the risk factors was globally (across all ages) associated with increased atherosclerosis. However, the magnitude of the association did not differ across the age spectrum for hypertension, low density lipoprotein cholesterol (LDL-c), fibrinogen, or body mass index (BMI). For whites, there was a significantly greater impact of smoking and HDL-C among older age strata but a smaller impact of diabetes. For black women, the impact of HDL-C decreased among the older age strata.

CONCLUSIONS: These data suggest that most risk factors continue to be associated with increased atherosclerosis at older ages, possibly suggesting a continued value in investigation of strategies to reduce atherosclerosis by controlling risk factors at older ages.

10aAfrican Americans10aAfrican Continental Ancestry Group10aAged10aAging10aArteriosclerosis10aBody Mass Index10aCardiovascular Physiological Phenomena10aCardiovascular System10aCarotid Arteries10aCholesterol, HDL10aCholesterol, LDL10aCohort Studies10aEuropean Continental Ancestry Group10aFemale10aFibrinogen10aHealth Status10aHumans10aHypertension10aMale10aMiddle Aged10aRegression Analysis10aRisk Factors10aSex Factors10aSmoking10aTunica Intima10aTunica Media10aUltrasonography1 aHoward, G1 aManolio, T A1 aBurke, G, L1 aWolfson, S, K1 aO'Leary, D H uhttps://chs-nhlbi.org/node/148602708nas a2200361 4500008004100000022001400041245015500055210006900210260001300279300001100292490000700303520165900310653000901969653002401978653002902002653002102031653003002052653001902082653001102101653001102112653000902123653001502132653001702147653001202164653002902176100002002205700001702225700001702242700001702259700001602276700001802292856003602310 1998 eng d a0039-249900aAsymptomatic internal carotid artery stenosis defined by ultrasound and the risk of subsequent stroke in the elderly. The Cardiovascular Health Study.0 aAsymptomatic internal carotid artery stenosis defined by ultraso c1998 Nov a2371-60 v293 a

BACKGROUND AND PURPOSE: We sought in this study to relate carotid ultrasound findings in asymptomatic older adults to the 5-year risk of various cerebrovascular outcomes used in the Asymptomatic Carotid Atherosclerosis Study (ACAS).

METHODS: The Cardiovascular Health Study (CHS) is a longitudinal study of people 65 years and older. Analyses of internal carotid artery stenosis defined by multiple different cutoffs of peak systolic velocity, rather than one particular cutoff, were performed in the 5441 participants who underwent carotid ultrasound and lacked a history of transient ischemic attack or stroke. The 5-year risks of 7 cerebrovascular disease outcomes used in ACAS were estimated for each cutoff.

RESULTS: Associations with the 5-year risk of outcomes were substantially elevated only at cutoffs with high peak systolic velocities. In this population, the number of people with such high velocities was small. For example, with a cutoff of approximately 2.5 m/s, suggesting a stenosis of >70%, the 5-year risk of an ipsilateral fatal or nonfatal stroke was 5%, and only 0.5% of the group had velocities at least this high.

CONCLUSIONS: In a group of older adults likely to participate in a screening program, as evidenced by willingness to participate in CHS, high peak systolic velocities consistent with high-grade carotid stenosis were uncommon and risk of subsequent cerebrovascular disease outcomes was relatively low. These findings do not suggest that similar populations of older adults would benefit from a program using ultrasound to screen for asymptomatic carotid stenosis.

10aAged10aBlood Flow Velocity10aCarotid Artery, Internal10aCarotid Stenosis10aCerebrovascular Disorders10aCohort Studies10aFemale10aHumans10aMale10aPrevalence10aRisk Factors10aSystole10aUltrasonography, Doppler1 aLongstreth, W T1 aShemanski, L1 aLefkowitz, D1 aO'Leary, D H1 aPolak, J, F1 aWolfson, S, K uhttps://chs-nhlbi.org/node/151703311nas a2200385 4500008004100000022001400041245017500055210006900230260001600299300001000315490000800325520216900333653000902502653002102511653003002532653002602562653001102588653001102599653001402610653000902624653002602633653003202659653002402691653001702715653001802732653001702750653002002767100001702787700001602804700001802820700001702838700001602855700001802871856003602889 1999 eng d a0028-479300aCarotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group.0 aCarotidartery intima and media thickness as a risk factor for my c1999 Jan 07 a14-220 v3403 a

BACKGROUND: The combined thickness of the intima and media of the carotid artery is associated with the prevalence of cardiovascular disease. We studied the associations between the thickness of the carotid-artery intima and media and the incidence of new myocardial infarction or stroke in persons without clinical cardiovascular disease.

METHODS: Noninvasive measurements of the intima and media of the common and internal carotid artery were made with high-resolution ultrasonography in 5858 subjects 65 years of age or older. Cardiovascular events (new myocardial infarction or stroke) served as outcome variables in subjects without clinical cardiovascular disease (4476 subjects) over a median follow-up period of 6.2 years.

RESULTS: The incidence of cardiovascular events correlated with measurements of carotid-artery intima-media thickness. The relative risk of myocardial infarction or stroke increased with intima-media thickness (P<0.001). The relative risk of myocardial infarction or stroke (adjusted for age and sex) for the quintile with the highest thickness as compared with the lowest quintile was 3.87 (95 percent confidence interval, 2.72 to 5.51). The association between cardiovascular events and intima-media thickness remained significant after adjustment for traditional risk factors, showing increasing risks for each quintile of combined intima-media thickness, from the second quintile (relative risk, 1.54; 95 percent confidence interval, 1.04 to 2.28), to the third (relative risk, 1.84; 95 percent confidence interval, 1.26 to 2.67), fourth (relative risk, 2.01; 95 percent confidence interval, 1.38 to 2.91), and fifth (relative risk, 3.15; 95 percent confidence interval, 2.19 to 4.52). The results of separate analyses of myocardial infarction and stroke paralleled those for the combined end point.

CONCLUSIONS: Increases in the thickness of the intima and media of the carotid artery, as measured noninvasively by ultrasonography, are directly associated with an increased risk of myocardial infarction and stroke in older adults without a history of cardiovascular disease.

10aAged10aCarotid Arteries10aCerebrovascular Disorders10aDisease-Free Survival10aFemale10aHumans10aIncidence10aMale10aMyocardial Infarction10aProportional Hazards Models10aProspective Studies10aRisk Factors10aTunica Intima10aTunica Media10aUltrasonography1 aO'Leary, D H1 aPolak, J, F1 aKronmal, R, A1 aManolio, T A1 aBurke, G, L1 aWolfson, S, K uhttps://chs-nhlbi.org/node/1520