03118nas a2200373 4500008004100000022001400041245012600055210006900181260001700250300001000267490000600277520203200283653002802315653003002343653002102373653002102394653003002415653001102445653002402456653002002480653001702500653001802517100001602535700001502551700001402566700002302580700001602603700001702619700001702636700001902653700002002672700001702692856003502709 1992 eng d a0894-731700aEchocardiographic design of a multicenter investigation of free-living elderly subjects: the Cardiovascular Health Study.0 aEchocardiographic design of a multicenter investigation of freel c1992 Jan-Feb a63-720 v53 a

The Framingham study has shown by M-mode echocardiography that left ventricular hypertrophy is a powerful, independent predictor for the development of coronary heart disease and that increased left atrial dimension has been associated with an increased risk of stroke. No previous population-based study has evaluated the risk factor correlates and predictive value for coronary heart disease and stroke of two-dimensional and Doppler, as well as M-mode, echocardiography. The Cardiovascular Health Study is a multi-year prospective epidemiologic study of 5201 men and women older than 65 recruited from four geographic sites in the United States. The main objectives of incorporating echocardiography were to determine whether echocardiographic indices, or changes in these indices, are (1) correlated with traditional risk factors for coronary heart disease and stroke; and (2) independent predictors of morbidity and mortality for coronary heart disease and stroke. Echocardiographic measurements of interest include those related to global and segmental left ventricular systolic and diastolic structure and function and left atrial size. For each subject, a baseline echocardiogram was recorded in super-VHS tape using a standard protocol and equipment. All studies were sent to a reading center where images were digitized and measurements were made using customized computer algorithms. Calculated data and images were stored on optical disks to facilitate retrieval and future comparisons in longitudinal studies. A second echocardiogram is scheduled in year 7, with a goal of determining whether changes in cardiac anatomy or function over a 5-year period are important predictors of morbidity or mortality from coronary heart disease and stroke. Quality control measures included standardized training of echocardiography technicians and readers, technician observation by a trained echocardiographer, periodic blind duplicate readings with reader review sessions, phantom studies, and quality control adults.

10aAllied Health Personnel10aCerebrovascular Disorders10aCoronary Disease10aEchocardiography10aEchocardiography, Doppler10aHumans10aProspective Studies10aQuality Control10aRisk Factors10aUnited States1 aGardin, J M1 aWong, N, D1 aBommer, W1 aKlopfenstein, H, S1 aSmith, V, E1 aTabatznik, B1 aSiscovick, D1 aLobodzinski, S1 aAnton-Culver, H1 aManolio, T A uhttps://chs-nhlbi.org/node/95103489nas a2200433 4500008004100000022001400041245011000055210006900165260001600234300001000250490000800260520229000268653001602558653000902574653002202583653003002605653002102635653002102656653003002677653001102707653001102718653002502729653002502754653000902779653002302788653003002811653001702841653001802858100001702876700001702893700001402910700001502924700001702939700001602956700001502972700001702987700001603004856003503020 1992 eng d a0003-481900aEligibility for cholesterol referral in community-dwelling older adults. The Cardiovascular Health Study.0 aEligibility for cholesterol referral in communitydwelling older  c1992 Apr 15 a641-90 v1163 a

OBJECTIVES: To assess the proportion of community-dwelling adults aged 65 years or older who are eligible for referral for lipoprotein analysis and intervention according to the National Cholesterol Education Program (NCEP) guidelines.

DESIGN: Cross-sectional study based on examinations and questionnaires collected in 1989 and 1990.

SETTING: Four communities in the U.S. in the Cardiovascular Health Study (CHS), a study of risk factors for heart disease and stroke in older adults.

PARTICIPANTS: A sample of 4810 men and women ages 65 to 100 randomly selected and recruited from Health Care Financing Administration Medicare eligibility lists for the four communities; not institutionalized, not wheelchair-bound, not currently receiving therapy for cancer, not currently taking lipid-lowering medications, and not having eaten in the preceding 9 hours.

MEASUREMENTS: Total cholesterol and lipoprotein analysis measured in all participants.

RESULTS: Total cholesterol levels were less than 5.17 mmol/L (200 mg/dL) in 37% of participants, 5.17 to 6.19 mmol/L (200 to 239 mg/dL) in 39%, and 6.20 mmol/L (240 mg/dL) or greater in 24%. Compared with their counterparts, older participants, especially those over 80 years of age, were more likely to have levels below 5.17 mmol/L, as were men, nonwhites, and those with coronary heart disease or two or more coronary heart disease risk factors (P less than 0.008 for all values). Based on this screening measurement, 2174 participants were eligible for lipoprotein analysis, 80% were eligible for dietary or drug therapy using NCEP guidelines. Overall, 46% of CHS participants were eligible for lipoprotein analysis and 36% for intervention by NCEP guidelines, based on a single cholesterol measurement.

CONCLUSION: A substantial proportion of older adults in this community sample were eligible for lipoprotein analysis and intervention. Prospective studies of elderly persons are needed to determine the risk for incident coronary heart disease according to NCEP classifications and the benefits of lipid-lowering treatments in persons in this age group so that intervention strategies may best be targeted to an appropriately high-risk group.

10aAge Factors10aAged10aAged, 80 and over10aCerebrovascular Disorders10aCholesterol, LDL10aCoronary Disease10aEligibility Determination10aFemale10aHumans10aHypercholesterolemia10aLongitudinal Studies10aMale10aPrimary Prevention10aReferral and Consultation10aRisk Factors10aUnited States1 aManolio, T A1 aFurberg, C D1 aWahl, P W1 aTracy, R P1 aBorhani, N O1 aGardin, J M1 aFried, L P1 aO'Leary, D H1 aKuller, L H uhttps://chs-nhlbi.org/node/80802674nas a2200397 4500008004100000022001400041245009300055210006900148260001300217300001100230490000700241520160300248653000901851653002201860653001001882653002801892653004301920653001601963653001101979653001801990653001102008653002502019653000902044653001502053653001602068653002402084653001702108100001702125700001902142700001502161700001602176700001702192700001602209700001502225856003602240 1993 eng d a0009-732200aEpidemiology of low cholesterol levels in older adults. The Cardiovascular Health Study.0 aEpidemiology of low cholesterol levels in older adults The Cardi c1993 Mar a728-370 v873 a

BACKGROUND: Low cholesterol levels have been associated with increased mortality from stroke, cancer, and other noncardiovascular diseases, but the reasons for this association remain unclear. One explanation is that persons with low cholesterol levels have early or occult disease that eventually leads to their deaths.

METHODS AND RESULTS: This possibility was explored in 2,091 men and 2,714 women 65-100 years old in the Cardiovascular Health Study, a multicenter observational study of risk factors for heart disease and stroke in older adults. Cholesterol levels < or = 160 mg/dL were present in 11.6% of men and 3.7% of women and increased in prevalence with age. After adjustment for age, total cholesterol levels in this range were associated with a twofold increased prevalence of treated diabetes in men and women and with a twofold increased prevalence of cancer diagnosed in the preceding 5 years in women only. Low cholesterol was also associated with lower levels of hemoglobin, albumin, and factor VII, suggesting a link with hepatic synthetic function. On multivariate analysis, factors most strongly associated with low cholesterol levels in men and women were decreased factor VII levels, decreased albumin, and diabetes.

CONCLUSIONS: Cross-sectional associations with low cholesterol levels differ by sex and suggest poorer health by some measures. The observed relations with treated diabetes and impaired hepatic synthetic function should be examined for risk of mortality in longitudinal data from this and other observational studies.

10aAged10aAged, 80 and over10aAging10aCardiovascular Diseases10aCardiovascular Physiological Phenomena10aCholesterol10aFemale10aHealth Status10aHumans10aLongitudinal Studies10aMale10aPrevalence10aProbability10aRegression Analysis10aRisk Factors1 aManolio, T A1 aEttinger, W, H1 aTracy, R P1 aKuller, L H1 aBorhani, N O1 aLynch, J, C1 aFried, L P uhttps://chs-nhlbi.org/node/144502634nas a2200301 4500008004100000022001400041245008300055210006900138260001600207300001100223490000700234520175200241653002401993653002402017653002802041653002302069653001102092653002502103653003102128653002902159100001702188700002002205700001702225700001702242700001902259700001902278856003502297 2006 eng d a1526-632X00aEducation and the cognitive decline associated with MRI-defined brain infarct.0 aEducation and the cognitive decline associated with MRIdefined b c2006 Aug 08 a435-400 v673 a

OBJECTIVE: To assess whether educational attainment, a correlate of cognitive reserve, predicts the amount of cognitive decline associated with a new brain infarct.

METHODS: The Cardiovascular Health Study is a population-based, longitudinal study of people aged 65 years and older. Cognitive function was measured annually using the Modified Mini-Mental State Examination (3MS) and the Digit-Symbol Substitution Test (DSST). The authors tested whether education level modified 1) the cross-sectional association between cognitive performance and MRI-defined infarct and 2) the change in cognitive function associated with an incident infarct at a follow-up MRI.

RESULTS: In cross-sectional analysis (n = 3,660), MRI-defined infarct was associated with a greater impact on 3MS performance in the lowest education quartile when compared with others (p for heterogeneity = 0.012). Among those with a follow-up MRI who had no infarct on initial MRI (n = 1,433), education level was not associated with the incidence, size, or location of new brain infarct. However, a new MRI-defined infarct predicted substantially greater decline in 3MS scores in the lowest education group compared with the others (6.3, 95% CI 4.4- to 8.2-point decline vs 1.7, 95% CI 0.7- to 2.7-point decline; p for heterogeneity < 0.001). Higher education was not associated with smaller declines in DSST performance in the setting of MRI-defined infarct.

CONCLUSIONS: Education seems to modify an individual's decline on a test of general cognitive function when there is incident brain infarct. These findings are consistent with the hypothesis that cognitive reserve influences the impact of vascular injury in the brain.

10aCerebral Infarction10aCognition Disorders10aCross-Sectional Studies10aEducational Status10aHumans10aLongitudinal Studies10aMagnetic Resonance Imaging10aNeuropsychological Tests1 aElkins, J, S1 aLongstreth, W T1 aManolio, T A1 aNewman, A, B1 aBhadelia, R, A1 aJohnston, S, C uhttps://chs-nhlbi.org/node/911