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Metabolic Clusters and Outcomes in Older Adults: The Cardiovascular Health Study.
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| Title | Metabolic Clusters and Outcomes in Older Adults: The Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2018 |
| Authors | Mukamal, KJ, Siscovick, DS, de Boer, IH, Ix, JH, Kizer, JR, Djoussé, L, Fitzpatrick, AL, Tracy, RP, Boyko, EJ, Kahn, SE, Arnold, AM |
| Journal | J Am Geriatr Soc |
| Volume | 66 |
| Issue | 2 |
| Pagination | 289-296 |
| Date Published | 2018 02 |
| ISSN | 1532-5415 |
| Keywords | Aged, Aged, 80 and over, Blood Glucose, C-Reactive Protein, Cardiovascular Diseases, Diabetes Mellitus, Female, Glomerular Filtration Rate, Humans, Incidence, Insulin, Longitudinal Studies, Male, Prospective Studies, Risk Factors, United States |
| Abstract | <p><b>BACKGROUND/OBJECTIVES: </b>Few studies have the requisite phenotypic information to define metabolic patterns that may inform our understanding of the pathophysiology and consequences of diabetes in older adults. We sought to characterize clusters of older adults on the basis of shared metabolic features.</p><p><b>DESIGN: </b>Population-based prospective cohort study.</p><p><b>SETTING: </b>Four U.S. Cardiovascular Health Study field centers.</p><p><b>PARTICIPANTS: </b>Individuals aged 65 and older taking no glucose-lowering agents (N = 2,231).</p><p><b>MEASUREMENTS: </b>K-means cluster analysis of 11 metabolic parameters (fasting and postload serum glucose and plasma insulin, fasting C-peptide, body mass index, C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), albuminuria, carboxymethyl lysine (an advanced glycation end-product), procollagen III N-terminal propeptide (a fibrotic marker)) and their associations with incident cardiovascular disease, diabetes, disability, and mortality over 8 to 14.5 years of follow-up and with measures of subclinical cardiovascular disease.</p><p><b>RESULTS: </b>A 6-cluster solution provided robust differentiation into distinct, identifiable clusters. Cluster A (n = 739) had the lowest glucose and insulin and highest eGFR and the lowest rates of all outcomes. Cluster B (n = 419) had high glucose and insulin and intermediate rates of most outcomes. Cluster C (n = 118) had the highest insulin. Cluster D (n = 129) had the highest glucose with much lower insulin. Cluster E (n = 314) had the lowest eGFR and highest albuminuria. Cluster F (n = 512) had the highest CRP. Rates of CVD, mortality, and subclinical atherosclerosis were highest in clusters C, D, and E and were similar to rates in participants with treated diabetes. Incidence of disability was highest in Cluster C.</p><p><b>CONCLUSION: </b>Clustering according to metabolic parameters identifies distinct phenotypes that are strongly associated with clinical and functional outcomes, even at advanced age.</p> |
| DOI | 10.1111/jgs.15205 |
| Alternate Journal | J Am Geriatr Soc |
| PubMed ID | 29431855 |
| PubMed Central ID | PMC5813705 |
| Grant List | N01 HC085086 / HC / NHLBI NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States U01 HL130114 / HL / NHLBI NIH HHS / United States HHSN268200800007C / HL / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States R01 HL094555 / HL / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States N01 HC085080 / HC / NHLBI NIH HHS / United States R01 AG053325 / AG / NIA NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States P30 DK020541 / DK / NIDDK NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01 HC085079 / HC / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States N01HC85080 / HL / NHLBI NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States P30 DK017047 / DK / NIDDK NIH HHS / United States |
ePub date:
18/02