Geriatric cardiology in one's own backyard?

Pathophysiology, epidemiology and therapy of agein

Lack of effect of pravastatin on cerebral blood flow or parenchymal volume loss in elderly at risk for vascular disease

<p><b>Background and Purpose:</b> Ageing is associated with a decline in cerebral blood flow. Animal studies have shown that cholesterol-lowering therapy with statins might preserve cerebral blood flow (CBF). We examined the effect of 40 mg pravastatin on the decline in CBF and brain volume in a subset of elderly subjects participating in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) trial.</p> <p><b>Methods:</b> Randomization was not stratified according to whether or not subjects participated in the MRI substudy. In 391 men (n=226) and women (n=165) aged 70 to 82 years (mean±SD, 75±3.2), we measured total CBF (in mL/min) at baseline and after a mean±SD follow-up of 33±1.4 months with a gradient-echo phase-contrast MRI technique. Total CBF was defined as the summed flows in both internal carotid and vertebral arteries. Parenchymal volume (whole brain) was segmented with the use of in-house–developed semiautomatic software.</p> <p><b>Results:</b> Total CBF significantly declined in the placebo-allocated group, from 521±83 to 504±92 mL/min (P=0.0036) and in the pravastatin-allocated group from 520±94 to 506±92 mL/min (P=0.018). This decline was not significantly different between treatment groups (P=0.56). There was also a significant reduction in brain volume over time (P<0.001), which was not different between the treatment groups (P=0.47). When expressed per unit of parenchymal volume, the decline in CBF over time was no longer statistically significant.</p> <p><b>Conclusions:</b> Elderly people at risk for cerebral vascular disease had a significant decline in CBF with increasing age that was explained by a concomitant reduction in brain volume. Treatment with 40 mg pravastatin daily had no beneficial effect on total CBF.</p&gt

Quality of life temporarily improved in patients in whom the diagnosis chronic mesenteric ischemia wasn’t confirmed after multidisciplinary evaluation in a tertiary referral centre

Objectives: Chronic Mesenteric Ischemia (CMI) is a disease in which abdominal symptoms are caused by insufficient mesenteric blood supply. Treatment results in improved quality of life (QoL). To put these results into perspective, the QoL of patients with symptoms potentially complying with CMI but without confirmation of the diagnosis was studied from six months up to four years.Methods: Between May and July 2020 follow-up questionnaires were sent to 144 patients that were suspected of CMI but in whom the diagnosis was not confirmed after a thorough multidisciplinary evaluation in a CMI expert centre. The baseline QoL was measured at first presentation. Three cohorts were included: 50 patients with a follow-up of six months, 45 patients with a follow-up of two years, and 49 patients with a follow-up of four years were invited to participate. The QoL was measured on a 100 points Visual Analogue Scale (VAS). A minimal clinically important difference of 7.5 was used as non-inferiority threshold.Results: The response rates were 34/50 (68%), 33/45 (73%), and 34/49 (69%). QoL improved in the six months group, with a mean change of 19 in VAS score (95% CI 11-27), in which baseline QoL was inferior to the QoL at follow-up (lower bound 95% CI above >7.5 threshold). The change in QoL was inconclusive in the other two groups, respectively 15 (95% CI 6-24) and 3 (95% CI -6-13). Furthermore, there was no significant change in QoL between patients without mesenteric stenosis and with one or two vessel stenosis (P=0.36) and between patients with occlusive stenosis and anatomic Median Arcuate Ligament Syndrome (MALS) (P=0.53).Conclusion: The QoL of patients suspected for CMI was clinically significantly improved after six months without additional treatment. However, this improvement faded completely after four years

Knee extension strength measurements should be considered as part of the comprehensive geriatric assessment

Pathophysiology, epidemiology and therapy of agein

Familial longevity is associated with an attenuated thyroidal response to recombinant human thyroid stimulating hormone

Context: Longevity is associated with higher circulating levels of TSH in the absence of differences in circulating thyroid hormones (TH), as previously observed in F2 members of long-lived families (F2-LLS) and their partners (F2-Con). The mechanism underlying this observed difference remains unknown.Objective: We hypothesized that the thyroid gland of members from long-lived families are less responsive to TSH stimulation, thereby requiring higher circulating TSH levels to maintain adequate TH levels.Methods: We performed a case-control intervention study with a single intramuscular (gluteal) injection with 0.1 mg recombinant human TSH in a subgroup of 14 F2-LLS and 15 similarly aged F2-Con. They were followed for 4 days. No serious adverse events were reported. For analyses, we compared time trajectories of TSH and TH, and the ratio of TH to TSH using area under the curve (AUC) calculations.Results: The AUC free T4/AUC TSH ratio was significantly lower in F2-LLS than in F2-Con (estimated mean [95% confidence interval] 1.6 [1.2-1.9] and 2.2 [1.9-2.6], respectively, P = 0.01). The AUC thyroglobulin/AUCTSH ratio was also lower in F2-LLS than in F2-Con (median [interquartile range] 2.1 [1.4-3.6] and 3.2 [2.7-7.4], respectively, P = 0.04). We observed the same trend with the AUC free T3/AUC TSH ratio, although the difference was not statistically significant (estimated mean [95% confidence interval] 0.6 [0.4-0.7] and 0.7 [0.6-0.8], respectively, P = 0.07).Conclusions: The present findings show that members of long-living families have a lower thyroid responsivity to TSH compared with their partners.Diabetes mellitus: pathophysiological changes and therap

PREDICTIVE VALUE OF LOW FERRITIN IN OLDER PERSONS WITH ANEMIA WITH AND WITHOUT INFLAMMATION: THE LEIDEN 85-PLUS STUDY

Pathophysiology, epidemiology and therapy of agein

Familial longevity is associated with lower baseline bone turnover but not differences in bone turnover in response to rhTSH

Context: Offspring from long-lived families have a different thyroid status than controls, characterised by higher circulating levels of thyroid stimulating hormone (TSH) and similar levels of thyroid hormone. Expression of the TSH receptor has previously been observed on various extrathyroidal tissues, including bone. However, potential physiological consequences of differences in circulating TSH as observed in familial longevity on bone tissue remain unclear. Objective: Based on the hypothesis that TSH may inhibit bone resorption, we explored whether offspring of long-lived families have lower bone turnover than controls at baseline as well as following a challenge with recombinant human TSH (rhTSH). Methods: Bone turnover markers CTX and P1NP were measured in fasted morning samples from 14 offspring and 12 controls at baseline and at 24 hour intervals following 0.1 mg rhTSH i.m. administration for four consecutive days. Results: At baseline, mean (SEM) CTX was 0.32 (0.03) ng/ml in offspring and 0.50 (0.04) ng/ml in controls, p < 0.01, whereas mean (SEM) P1NP was 39.6 (3.2) ng/ml in offspring and 61.8 (6.6) ng/ml in controls, p < 0.01. Following rhTSH administration, both CTX and P1NP levels transiently increased over time and normalized towards baseline after 72 h (general linear modelling: CTX time p = 0.01, P1NP time p < 0.01); the response was similar between offspring and controls. Conclusions: Bone turnover markers were lower at baseline in offspring from long-lived families than in controls but increased similarly following an rhTSH challenge.Pathophysiology, epidemiology and therapy of agein

No increased mortality risk in older persons with unexplained anaemia

Background: in older persons, anaemia is associated with a number of unfavourable outcomes. In approximately 30% of older persons with anaemia, the cause of the anaemia is unexplained. We assessed the clinical differences between subjects with explained and unexplained anaemia and investigated whether these subjects have different mortality patterns compared with subjects without anaemia.Design: observational prospective follow-up study.Setting: the Leiden 85-plus study.Participants: four hundred and ninety-one persons aged 86 years.Methods: the study population was divided in three groups: (i) no anaemia (reference group, n = 377), (ii) explained anaemia (iron deficiency, folate deficiency, vitamin B12 deficiency, signs of myelodysplastic syndrome or renal failure, n = 74) and (iii) unexplained anaemia, (n = 40). Mortality risks were estimated with Cox-proportional hazard models.Results: haemoglobin levels were significantly lower in subjects with explained anaemia than in subjects with unexplained anaemia (P < 0.01). An increased risk for mortality was observed in subjects with explained anaemia [HR: 1.93 (95% CI: 1.47-2.52), P < 0.001], but not in subjects with unexplained anaemia [HR: 1.19 (95% CI: 0.85-1.69), P = 0.31]. Adjusted analyses (sex, co-morbidity, MMSE, institutionalised and smoking) did not change the observed associations for both explained and unexplained anaemic subjects.Conclusion: older subjects with unexplained anaemia had similar survival compared with non-anaemic subjects. Increased mortality risks were observed in subjects with explained anaemia compared with non-anaemic subjects.Public Health and primary careGeriatrics in primary car

Apolipoprotein E genotype, lifestyle and coronary artery disease: gene-environment interaction analyses in the UK Biobank population

Background and aims: The APOE epsilon 4 genotype has a higher risk for developing coronary artery disease (CAD), but there is preliminary evidence that antioxidative lifestyle factors interact with APOE genotype on CAD risk. Here, we assessed the effect modification of physical activity, oily fish and polyunsaturated fatty acid (PUFA) intake with APOE genotype on risk of incident CAD. Methods: The present study comprised 345,659 white European participants from UK Biobank (mean age: 56.5 years, 45.7% men) without a history of CAD. Information regarding physical activity, oily fish intake and PUFA intake was collected through questionnaires, and information on incident CAD through linkage with hospital admission records. Analyses were performed using Cox proportional hazard models adjusted for age and sex. Results: Higher physical activity level and oily fish intake were both associated with a lower incidence of CAD. However, these associations were similar across the different APOE genotypes (p-values for interaction > 0.05). Most notable, higher PUFA intake was associated with a lower CAD risk in APOE epsilon 4 genotype carriers (hazard ratio: 0.76, 95% confidence interval: 0.63-0.92), and not in APOE epsilon 3/epsilon 3 genotype carriers (0.90; 0.79, 1.02), but without statistical evidence for effect modification (p-valueinteraction = 0.137). Conclusions: While higher physical activity and high fish and PUFA intake were associated with a lower risk of incident CAD, no evidence for interaction of these lifestyle factors with APOE genotype was observed in UK Biobank participants. Interventions intended to reduce cardiovascular risk might therefore be similarly effective across the APOE genotype carriers.Diabetes mellitus: pathophysiological changes and therap