03094nas a2200349 4500008004100000022001400041245010800055210006900163260001600232300000700248490000600255520208600261653002302347653002602370653002302396653002202419653002102441653002002462653001802482653001102500653002002511653001302531653002302544653001402567653001802581653004002599100001702639700001702656700001602673700002002689856003502709 2007 eng d a1471-245800aThe effect of different public health interventions on longevity, morbidity, and years of healthy life.0 aeffect of different public health interventions on longevity mor c2007 Apr 05 a520 v73 a

BACKGROUND: Choosing cost-effective strategies for improving the health of the public is difficult because the relative effects of different types of interventions are not well understood. The benefits of one-shot interventions may be different from the benefits of interventions that permanently change the probability of getting sick, recovering, or dying. Here, we compare the benefits of such types of public health interventions.

METHODS: We used multi-state life table methods to estimate the impact of five types of interventions on mortality, morbidity (years of life in fair or poor health), and years of healthy life (years in excellent, very good, or good health).

RESULTS: A one-shot intervention that makes all the sick persons healthy at baseline would increase life expectancy by 3 months and increase years of healthy life by 6 months, in a cohort beginning at age 65. An equivalent amount of improvement can be obtained from an intervention that either decreases the probability of getting sick each year by 12%, increases the probability of a sick person recovering by 16%, decreases the probability that a sick person dies by 15%, or decreases the probability that a healthy person dies by 14%. Interventions aimed at keeping persons healthy increased longevity and years of healthy life, while decreasing morbidity and medical expenditures. Interventions focused on preventing mortality had a greater effect on longevity, but had higher future morbidity and medical expenditures. Results differed for older and younger cohorts and depended on the value to society of an additional year of sick life.

CONCLUSION: Interventions that promote health and prevent disease performed well, but other types of intervention were sometimes better. The value to society of interventions that increase longevity but also increase morbidity needs further research. More comprehensive screening and treatment of new Medicare enrollees might improve their health and longevity without increasing future medical expenditures.

10aActuarial Analysis10aCost-Benefit Analysis10aDisease Management10aHealth Priorities10aHealth Promotion10aHealth Services10aHealth Status10aHumans10aLife Expectancy10aMedicare10aModels, Biological10aMorbidity10aUnited States10aUnited States Public Health Service1 aDiehr, Paula1 aDerleth, Ann1 aCai, Liming1 aNewman, Anne, B uhttps://chs-nhlbi.org/node/95302475nas a2200385 4500008004100000022001400041245006400055210006300119260001300182300001000195490000700205520146200212653001601674653000901690653002201699653001101721653002201732653001801754653001101772653000901783653001401792653001901806653002401825653001701849653002001866653001801886653002201904100002101926700002001947700001801967700002301985700002302008700002302031856003502054 2007 eng d a1079-500600aFrailty and risk of venous thromboembolism in older adults.0 aFrailty and risk of venous thromboembolism in older adults c2007 Jan a79-820 v623 a

BACKGROUND: Frailty is a common risk factor for morbidity and mortality in elderly persons. Recent evidence links frailty to activation of coagulation and inflammatory pathways. We aimed to determine whether frailty in community-dwelling older adults is a risk factor for venous thromboembolism (VTE).

METHODS: We conducted a prospective cohort study in four U.S. communities involving 4859 participants 65 years old and older. At baseline, in 1989-1993, we assessed frailty based on weight loss, grip strength, feelings of exhaustion, walk time, and physical activity. Incident VTE (deep vein thrombosis or pulmonary embolus) through 2002 was identified by review of hospital records.

RESULTS: Fifty-two percent of the sample was classified as having intermediate or definite frailty. After adjustment for age, race, sex, body mass index, and diabetes, the relative risk of total VTE (n = 150) for people who were frail compared with no frailty was 1.31 (95% confidence interval [CI], 0.93-1.84). The comparably adjusted relative risk for idiopathic VTE (n = 58) was 1.79 (95% CI, 1.02-3.13).

CONCLUSIONS: The incidence rates of idiopathic VTE was higher in community-dwelling older adults with baseline frailty compared with no frailty. Further studies of the clotting process in frailty may allow the development of an improved strategy to determine VTE risk in this vulnerable subset of older adults.

10aAge Factors10aAged10aAged, 80 and over10aFemale10aFollow-Up Studies10aFrail Elderly10aHumans10aMale10aMorbidity10aMotor Activity10aProspective Studies10aRisk Factors10aThromboembolism10aUnited States10aVenous Thrombosis1 aFolsom, Aaron, R1 aBoland, Lori, L1 aCushman, Mary1 aHeckbert, Susan, R1 aRosamond, Wayne, D1 aWalston, Jeremy, D uhttps://chs-nhlbi.org/node/94203247nas a2200409 4500008004100000022001400041245007500055210006900130260001300199300001200212490000700224520212300231653003102354653000902385653002202394653002702416653002802443653002102471653001102492653002202503653002502525653001802550653001102568653000902579653001402588653002602602653001702628653001702645653001802662100002402680700001702704700001702721700002302738700002002761700002002781856003602801 2010 eng d a1532-541500aGeriatric impairments and disability: the cardiovascular health study.0 aGeriatric impairments and disability the cardiovascular health s c2010 Sep a1686-920 v583 a

OBJECTIVES: To determine the relative importance of geriatric impairments (in muscle strength, physical capacity, cognition, vision, hearing, and psychological status) and chronic diseases in predicting subsequent functional disability in longitudinal analyses.

DESIGN: Longitudinal data from the Cardiovascular Health Study were analyzed. Multivariable Cox hazards regression modeling was used to analyze associations between time-dependent predictors and onset of disability in activities of daily living (ADLs) and mobility.

SETTING: Four communities across the United States (Sacramento County, CA; Washington County, MD; Forsyth County, NC; and Allegheny County, PA).

PARTICIPANTS: Five thousand eight hundred eighty-eight elderly persons.

MEASUREMENTS: Data were collected annually through in-person examinations.

RESULTS: ADL disability developed in 15% of participants and mobility disability in 30%. A single multivariable model was developed that included demographics, marital status, body mass index, and number of impairments and diseases. The hazard ratios (HRs) of having one, two, and three or more geriatric impairments (vs none) for the outcome of ADL disability were 2.12 (95% confidence interval (CI)=1.63-2.75), 4.25 (95% CI=3.30-5.48), and 7.87 (95% CI=6.10-10.17), respectively, and for having one, two, and three or more chronic diseases were 1.75 (95% CI=1.41-2.19), 2.45 (95% CI=1.95-3.07), and 3.26 (95% CI=2.53-4.19), respectively. Similarly, the HRs of having one, two, and three or more impairments for the outcome of mobility disability were 1.48 (95% CI=1.27-1.73), 2.08 (95% CI=1.77-2.45), and 3.70 (95% CI=3.09-4.42), respectively, and for having one, two, and three or more diseases were 2.06 (95% CI=1.76-2.40), 2.80 (95% CI=2.36-3.31), and 4.20 (95% CI=3.44-5.14), respectively.

CONCLUSION: Number of geriatric impairments was more strongly associated than number of chronic diseases with subsequent ADL disability and nearly as strongly associated with the subsequent mobility disability.

10aActivities of Daily Living10aAged10aAged, 80 and over10aCardiac Rehabilitation10aCardiovascular Diseases10aDisabled Persons10aFemale10aFollow-Up Studies10aGeriatric Assessment10aHealth Status10aHumans10aMale10aMorbidity10aRetrospective Studies10aRisk Factors10aTime Factors10aUnited States1 aChaudhry, Sarwat, I1 aMcAvay, Gail1 aNing, Yuming1 aAllore, Heather, G1 aNewman, Anne, B1 aGill, Thomas, M uhttps://chs-nhlbi.org/node/123203609nas a2200397 4500008004100000022001400041245007200055210006900127260001600196300001300212490000800225520257600233653001002809653000902819653001902828653002802847653001902875653002202894653001102916653001602927653001102943653002602954653000902980653001602989653001403005653000903019653001703028653001203045100002103057700001803078700001803096700001603114700001803130700002703148856003603175 2012 eng d a1538-359800aLifetime risk and years lived free of total cardiovascular disease.0 aLifetime risk and years lived free of total cardiovascular disea c2012 Nov 07 a1795-8010 v3083 a

CONTEXT: Estimates of lifetime risk for total cardiovascular disease (CVD) may provide projections of the future population burden of CVD and may assist in clinician-patient risk communication. To date, no lifetime risk estimates of total CVD have been reported.

OBJECTIVES: To calculate lifetime risk estimates of total CVD by index age (45, 55, 65, 75 years) and risk factor strata and to estimate years lived free of CVD across risk factor strata.

DESIGN, SETTING, AND PARTICIPANTS: Pooled survival analysis of as many as 905,115 person-years of data from 1964 through 2008 from 5 National Heart, Lung, and Blood Institute-funded community-based cohorts: Framingham Heart Study, Framingham Offspring Study, Atherosclerosis Risk in Communities Study, Chicago Heart Association Detection Project in Industry Study, and Cardiovascular Health Study. All participants were free of CVD at baseline with risk factor data (blood pressure [BP], total cholesterol [TC], diabetes, and smoking status) and total CVD outcome data.

MAIN OUTCOME MEASURES: Any total CVD event (including fatal and nonfatal coronary heart disease, all forms of stroke, congestive heart failure, and other CVD deaths).

RESULTS: At an index age of 45 years, overall lifetime risk for total CVD was 60.3% (95% CI, 59.3%-61.2%) for men and 55.6% (95% CI, 54.5%-56.7%) for women. Men had higher lifetime risk estimates than women across all index ages. At index ages 55 and 65 years, men and women with at least 1 elevated risk factor (BP, 140-149/90-99 mm Hg; or TC, 200-239 mg/dL; but no diabetes or smoking), 1 major risk factor, or at least 2 major risk factors (BP, ≥160/100 mm Hg or receiving treatment; TC, ≥240 mg/dL or receiving treatment; diabetes mellitus; or current smoking) had lifetime risk estimates to age 95 years that exceeded 50%. Despite an optimal risk factor profile (BP, <120/80 mm Hg; TC, <180 mg/dL; and no smoking or diabetes), men and women at the index age of 55 years had lifetime risks (through 85 years of age) for total CVD of greater than 40% and 30%, respectively. Compared with participants with at least 2 major risk factors, those with an optimal risk factor profile lived up to 14 years longer free of total CVD.

CONCLUSIONS: Lifetime risk estimates for total CVD were high (>30%) for all individuals, even those with optimal risk factors in middle age. However, maintenance of optimal risk factor levels in middle age was associated with substantially longer morbidity-free survival.

10aAdult10aAged10aBlood Pressure10aCardiovascular Diseases10aCohort Studies10aDiabetes Mellitus10aFemale10aForecasting10aHumans10aKaplan-Meier Estimate10aMale10aMiddle Aged10aMorbidity10aRisk10aRisk Factors10aSmoking1 aWilkins, John, T1 aNing, Hongyan1 aBerry, Jarett1 aZhao, Lihui1 aDyer, Alan, R1 aLloyd-Jones, Donald, M uhttps://chs-nhlbi.org/node/5861