10 research outputs found
MODIFICATION BY FRAILTY STATUS OF AMBIENT AIR POLLUTION EFFECTS ON LUNG FUNCTION IN OLDER ADULTS IN THE CARDIOVASCULAR HEALTH STUDY
Older adult susceptibility to air pollution health effects is well-recognized. Advanced age may act as a partial surrogate for conditions associated with aging. The authors investigated whether gerontologic frailty (a clinical health status metric) modified the effects of ambient ozone or particulate matter (PM10) air pollution on lung function in 3382 older adults using 7 years of followup data from the Cardiovascular Health Study (CHS) and the CHS Environmental Factors Ancillary Study. Monthly average pollution and annual frailty assessments were related to up to 3 repeated measurements of lung function using novel cumulative summaries of pollution and frailty histories that account for duration as well as concentration. Frailty history was found to modify long-term pollution effects on Forced Vital Capacity (FVC). For example, the decrease in FVC associated with a 70 ppb-month increase in the cumulative sum of monthly average O3 exposure was 8.8 mL (95% confidence interval (CI): 7.4, 10.1) for a woman who had spent the prior 7 years prefrail or frail compared to 3.3 mL (95% CI: 2.7, 4.0) for a similar not frail woman (interaction P\u3c0.001)
SURROGATE SCREENING MODELS FOR THE LOW PHYSICAL ACTIVITY CRITERION OF FRAILTY
Background and Aims. Low physical activity, one of five criteria in a validated clinical phenotype of frailty, is assessed by a standardized questionnaire on up to 20 leisure time activities. Because of the time demanded to collect the interview data, it has been challenging to translate to studies other than the Cardiovascular Health Study (CHS), for which it was developed. Considering subsets of activities, we identified and evaluated streamlined surrogate assessment methods and compared them to one implemented in the Womenâs Health and Aging Study (WHAS).
Methods. Using data on men and women ages 65 and older from the CHS, we applied logistic regression models to rank activities by ârelative influenceâ in predicting low physical activity. We considered subsets of the most influential activities as inputs to potential surrogate models (logistic regressions). We evaluated predictive accuracy and predictive validity using the area under receiver operating characteristic curves and assessed criterion validity using proportional hazards models relating frailty status (defined using the surrogate) to mortality.
Results. Walking for exercise and moderately strenuous household chores were highly influential for both genders. Women required fewer activities than men for accurate classification. The WHAS model (8 CHS activities) was an effective surrogate, but a surrogate using 6 activities (walking, chores, gardening, general exercise, mowing and golfing) was also highly predictive.
Conclusions. We recommend a 6 activity questionnaire to assess physical activity for men and women. If efficiency is essential and the study involves only women, fewer activities can be included
Bone mineral density and risk of heart failure in older adults: The Cardiovascular Health Study
Background
Despite increasing evidence of a common link between bone and heart health, the relationship between bone mineral density (
BMD
) and heart failure (
HF
) risk remains insufficiently studied.
Methods and Results
We investigated whether
BMD
measured by dualâenergy xâray absorptiometry was associated with incident
HF
in an older cohort. Cox models were stratified by sex and interactions of
BMD
with race assessed.
BMD
was examined at the total hip and femoral neck separately, both continuously and by World Health Organization categories. Of 1250 participants, 442 (55% women) developed
HF
during the median followâup of 10.5Â years. In both black and nonblack women, neither total hip nor femoral neck
BMD
was significantly associated with
HF
; there was no significant interaction by race. In black and nonblack men, total hip, but not femoral neck,
BMD
was significantly associated with
HF
, with evidence of an interaction by race. In nonblack men, lower total hip
BMD
was associated with higher
HF
risk (hazard ratio, 1.13 [95% CI, 1.01â1.26] per 0.1Â g/cm
2
decrement), whereas in black men, lower total hip
BMD
was associated with lower
HF
risk (hazard ratio, 0.74 [95% CI, 0.59â0.94]). There were no black men with total hip osteoporosis. Among nonblack men, total hip osteoporosis was associated with higher
HF
risk (hazard ratio, 2.83 [95% CI, 1.39â5.74]) compared with normal
BMD
.
Conclusions
Among older adults, lower total hip
BMD
was associated with higher
HF
risk in nonblack men but lower risk in black men, with no evidence of an association in women. Further research is needed to replicate these findings and to study potential underlying pathways.
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O2â03â02: Vitamin D and the risk of developing neuroimaging abnormalities
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152624/1/alzjjalz201507143.pd
Vitamin D and the risk of dementia and Alzheimer disease
Objective: To determine whether low vitamin D concentrations are associated with an increased risk of incident all-cause dementia and Alzheimer disease. Methods: One thousand six hundred fifty-eight elderly ambulatory adults free from dementia, cardiovascular disease, and stroke who participated in the US population?based Cardiovascular Health Study between 1992?1993 and 1999 were included. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined by liquid chromatography-tandem mass spectrometry from blood samples collected in 1992?1993. Incident all-cause dementia and Alzheimer disease status were assessed during follow-up using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer\u27s Disease and Related Disorders Association criteria. Results: During a mean follow-up of 5.6 years, 171 participants developed all-cause dementia, including 102 cases of Alzheimer disease. Using Cox proportional hazards models, the multivariate adjusted hazard ratios (95% confidence interval [CI]) for incident all-cause dementia in participants who were severely 25(OH)D deficient (\u3c25 nmol/L) and deficient (?25 to \u3c50 nmol/L) were 2.25 (95% CI: 1.23?4.13) and 1.53 (95% CI: 1.06?2.21) compared to participants with sufficient concentrations (?50 nmol/L). The multivariate adjusted hazard ratios for incident Alzheimer disease in participants who were severely 25(OH)D deficient and deficient compared to participants with sufficient concentrations were 2.22 (95% CI: 1.02?4.83) and 1.69 (95% CI: 1.06?2.69). In multivariate adjusted penalized smoothing spline plots, the risk of all-cause dementia and Alzheimer disease markedly increased below a threshold of 50 nmol/L. Conclusion: Our results confirm that vitamin D deficiency is associated with a substantially increased risk of all-cause dementia and Alzheimer disease. This adds to the ongoing debate about the role of vitamin D in nonskeletal conditions
O2â03â01: Vitamin D and decline in global cognition and memory in the cardiovascular health study
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152485/1/alzjjalz201507142.pd