Opportunities - Unique Aspects of CHS

Opportunities – unique aspects of CHS.

Subclinical CVD measures:  repeated measures of carotid wall thickness and plaque characteristics (1989-90, 1992-93, 1998-99); abdominal aorta ultrasound (1992-93); brain MRI (1992-94, 1997-99); ankle-arm index (1989-90, 1992-93, 1998-99); echocardiograms (1989-90, 1994-95).

Excellent outcomes – ICD-9 codes for all hospitalizations.  Adjudicated MI, angina, claudication, CHF, stroke and TIA.  Follow-up continues; first baseline exam occurred in 1989-90.

Biologic specimen repository -- availability of blood and DNA for new assays.

Age -- only a few other cohorts are this old or have been followed this long.  Mean age at baseline was 72.8 years, with a range of 65-100.

Race -- Only 924 African Americans, most enrolled in 1992-93, but with longer follow-up, power is increasing to look at racial differences or race-specific issues.

Sex – Women comprise 58% of the cohort.  Event rates in women are just picking up- CHD in women in their 80’s is a “new” epidemic.

Geographic variation -- Urban/rural, N/S, E/W.

Longitudinal Data allows for updating exposure status, analyzing change over time, exploring early vs. late events, and pre- and post- event comparisons.

Many of these aspects of CHS have been explored in publications or manuscripts in progress, but opportunities remain.

Largely unexplored areas.

CVD

• MI outcome is actually heterogeneous – little work done with subtypes, recurrence rates, post- MI natural history, changes in procedures over time, acute precipitants, etc.
• Angina, or “symptomatic CHD, not MI” has not been studied
• TIA  has not been explored.
• Serial ECG’s not examined

Healthy Aging - CHS as a study of the Aging process

• Physical function – longitudinal ADL’s, IADL’s, mobility
• Cognition – rich set of repeated measures 3MS and DSST
• Frailty – one of the most highly referenced papers in the Journal of Gerontology – more work to be done
• Healthy Aging/Functional Aging – Large numbers of survivors remain functional
• Unique studies of the “oldest old” now possible

Costs, Care and Quality of Life

• Linkages to CMS data underutilized to date
• Numerous aspects of QOL measured – most domains of SF-36 are in CHS, but not SF-36 itself
• Procedure and hospitalization data collected over time
• End-of life care – unique data from informant interview for out of hospital deaths
• Over the counter medications collected from 1993-94 on are largely unexplored.

Non-CVD outcomes

• Some work done on pneumonia, dementia, abdominal aortic aneurysms and cancer; ICD-9 codes available for all hospitalizations.  An Ancillary Study is obtaining cancer registry data for CHS participants.

Miscellaneous

• Benton Visual Exam administered in 1993-1997 and 1998-99 has not been analyzed.
• Two food frequency questionnaires were given, in 1989-90 & 1995-96.  Alcohol, fish and fiber have been analyzed, but little else.
• In 1998-99 an audiometry assessment was done, but not analyzed.
• In 1998-99 a vibration/tuning fork exam was done, but not analyzed.
• In Year 1996-97, a six minute walk was done and oximetry data collected.  Only 1 cross-sectional paper done so far.