Trajectories of the Framingham general cardiovascular risk profile in midlife and poor motor function later in life: the Whitehall II study

Association between education and walking speed: counterfactual mediation analysis in favor of a motor reserve hypothesis

We quantified the extent to which the association between education and fast walking speed (FWS) is explained by 17 mediators (cardiovascular risk factors/diseases, comorbidities, health behaviors, socioprofessional characteristics, cognition), and examined whether mediators interact with education, in favor of a reserve hypothesis. Cross-sectional analyses are based on Constances (a population-based study of French adults 45-69 years). Three-meter FWS was measured using photoelectric cells. Education was categorized as lower vs higher. After multiple imputation of missing values, we used counterfactual mediation models for multiple mediators allowing for education × mediator interactions, to estimate the total effect (TE), total indirect effect (TIE), and mediated interaction (IMD) of lower education on FWS. Analyses are based on 71 222 participants (52.6% women; mean age = 57.2 years; 27.2% higher education; mean FWS = 180.2 cm/s). In joint mediation analyses, the TE of lower education was -8.19 cm/s (95% CI, -8.87 to -7.51), with a TIE of -5.76 cm/s (95% CI, -6.10 to -5.41; proportion mediated = 70.3%; 95% CI, 65.6-75.0). The IMD was negative (-2.52; 95% CI, -3.31 to -1.72); 30.8% of the TE and 43.8% of the TIE were attributable to the IMD. Several mediators explain a large part of the association between lower education and slower FWS. The detrimental effect of mediators was more pronounced in participants with lower than in those with higher education, in agreement with a reserve hypothesis.

Cardiovascular risk burden and disability: findings from the International Mobility in Aging Study (IMIAS)

BACKGROUND

The association of cardiovascular risk burden with disability is unclear. We examined the association between trajectories of the Framingham general cardiovascular disease risk score (FGCRS) with the trajectories of limitations of physical function in older adults.

METHODS

A total of 1219 participants with no disabilities from the International Mobility in Aging Study (IMIAS) study who had up to three repeated measures of FGCRS between 2012-2016 and without a history of stroke or coronary heart disease at baseline and follow-up were included. FGCRS at baseline was assessed and categorized into tertiles. Physical function was evaluated with the Short Physical Performance Battery (SPPB). The data were analyzed using linear mixed-effects models.

RESULTS

At baseline, FGCRS ranged between 3-94 (mean score: 24 ± 15.8), participants were 32 (2.6%), 502 (41.2%) and 685 (56.2%) in lowest, middle, and highest tertiles, respectively. In the trajectories of limitations of physical function, the lowest FGCRS had no differences, while the middle and highest had a decrease in physical performance between 2012-2014 (P = 0.0001). Age, being female, living in Andes Mountains, having middle and highest FGCRS, higher alcohol consumption, being obese, lack of exercise and cognitive impairment increase the probability of disability (P < 0.05). Alternatively, living in more developed regions and having a higher educational level reduced the probability of disability during the follow-up time (P < 0.05).

CONCLUSIONS

Higher cardiovascular risk burden is associated with decreased physical performance, especially in gait. Results suggest SPPB may provide a measure of cardiovascular health in older adults.

The 30-year cardiovascular risk trajectories and their independently associated factors in participants of a Brazilian cohort (CUME Study)

We aimed to analyze the different trajectories of 30-year cardiovascular risk (CVR) and its independently associated factors in participants of the CUME Study, a prospective study with alumni from federal universities of Minas Gerais State, Brazil. In this study, 1,286 participants who answered the baseline (2016) and follow-up (2018 and 2020) questionnaires were included. Trajectories of CVR, according to the Framingham score, were identified with the latent class growth modelling technique with the use of the censored normal model. Analysis of the factors independently associated with each of the trajectories was conducted with multinomial logistic regression technique. Three CVR trajectories were identified: Low-Low (68.3%), Medium-Medium (26.2%), and High-High (5.5%). Male sex, living in a stable union, and having moderate and high intakes of ultra-processed foods were positively associated with the Medium-Medium and High-High CVR trajectories. Having non-healthcare professional training and working were positively associated with the Medium-Medium CVR trajectory, whereas being physically active was negatively associated with the High-High CVR trajectory. In conclusion, more than one-third of participants had CVR trajectories in the Medium-Medium and High-High categories. Food consumption and physical activity are modifiable factors that were associated with these trajectories; thus, implementing health promotion measures could help prevent the persistence or worsen of CVR. On the other hand, sociodemographic and labor characteristics are non-modifiable factors that were associated with Medium-Medium and High-High trajectories, which could help identify people who should be monitored with more caution by health services.

Adolescent childbirth and mobility disability among women ages 15-49: an analysis of population health surveys from 14 low-income and middle-income countries

OBJECTIVES

Adolescent childbirth is associated with older adult adverse health outcomes that negatively affect mobility function, but these associations have not been studied globally in large samples of reproductive-age women. This study examines the association between age at first childbirth and mobility disability in national surveys from low-income and middle-income countries, and hypotheses that adolescent childbirth is associated with mobility disability.

DESIGN

Cross-sectional analysis.

SETTING

Population health surveys from 2013 to 2018 containing mobility disability measures among ever-pregnant women ages 15-49. These included 13 Demographic Health Surveys from Haiti, Pakistan, Uganda, Cambodia, Colombia, South Africa, Timor-Leste, Albania, Gambia, Maldives, Peru, Senegal and Yemen and 1 Maternal Health Survey from Ghana.

PARTICIPANTS

The sample included 157 988 women ages 15-49 years.

PRIMARY OUTCOME MEASURE

Adolescent childbirth was defined as 10-19 years of age. Poisson regression models were used to estimate prevalence ratios (PRs) of mobility disability among women who first gave birth during adolescence and in adult life (ages 20-45 years) in each country and across the whole sample. Countries were also analysed according to the use of standard and non-standard mobility disability measures. Covariates included current age, urban/rural residence, education and household wealth.

RESULTS

Prevalence of adolescent childbirth (17.5%-66.2%) and mobility disability (0.32%-21.45%) varied widely across countries. Adolescent childbirth was significantly (p<0.05) associated with greater mobility disability in six of eight countries using standard disability measures. Among the six countries that did not use standard disability measures, none showed a statistically significant association between adolescent childbirth and mobility disability. Considering the whole sample and adjusting for all covariates, women who gave birth during adolescence had greater prevalence of mobility disability (pooled PR 1.19, 95% CI 1.06-1.31).

CONCLUSIONS

This analysis suggests a moderate and consistent association of adolescent childbearing with subsequent mobility disability.

Characteristics of reproductive history, use of exogenous hormones and walking speed among women: Data from the CONSTANCES French Cohort Study

OBJECTIVE

To investigate the cross-sectional associations of reproductive history and use of exogenous hormones with fast walking speed (WS) in women.

STUDY DESIGN

Between 2012 and 2020, 33,892 French women aged 45 years or more, recruited at health centers, underwent physical function tests and self-reported information on reproductive history and use of exogenous hormones. Linear mixed models with the center as random intercept were used to estimate the association of exposures with WS.

MAIN OUTCOME MEASURES

Fast WS.

RESULTS

Mean WS was 172.2 cm/s. WS increased with age at menarche (β_+1y = 0.23, 95 % confidence interval = 0.05 to 0.40), age at first birth (β_+1y = 0.20, 95 % CI = 0.13 to 0.27) and duration of breastfeeding (β_{for ≥10 vs ≤5months} = 1.38; 95 % CI = 0.39 to 2.36). In addition, parity was quadratically associated with WS, with women with 3 children having the highest WS (p for U-shaped relationship < 0.01). Menopausal status had no impact on WS but age at menopause was positively associated with WS (β_+5y = 0.52, 95 % CI = 0.17 to 0.87) and partly explained the deleterious impact of artificial menopause on WS. WS increased with reproductive lifetime duration (β_+5y = 0.49, 95 % CI = 0.16 to 0.83) and decreased with time since onset of menopause (β_+5y = -0.65, 95 % CI = -0.99 to -0.31). By contrast, there was no association of WS with oral contraception and postmenopausal hormone therapy.

CONCLUSION

Our findings suggest that reproductive life characteristics may be associated with WS and timing of exposure could play a role.

The influence of modifiable cardiovascular risk factors on cognition, functioning, and inflammatory markers in first-episode psychosis: Results from a 2-year follow-up study

To explore the influence of cardiovascular risk factors (CVRFs) on cognitive symptoms, functional impairment, and systemic inflammatory markers in first-episode psychosis (FEP) patients at baseline and 2-year follow-up. Method: In a sample of 70 FEP patients and 85 age- and sex-matched healthy controls, we assessed nine modifiable CVRFs. All participants were classified into two subgroups according to their CVRF profile: lower (0-1 CVRFs) or higher (≥2 CVRFs). The following outcomes were measured at baseline and 2-year follow-up: cognition; functional outcomes; and white blood cell (WBC) subtype. Adjusted general linear models were conducted to study the effect of diagnosis and CVRF profile on cognition, functioning, WBC, and longitudinal changes in these variables. At baseline, FEP patients with a higher CVRF profile showed a significantly slower performance on the TMT-A test for psychomotor speed and higher lymphocyte levels than patients with a lower CVRF profile. No longitudinal changes were observed in primary outcomes at 2-year follow-up. Among FEP patients with a higher CVRF profile, slower psychomotor speed performance did not correlate with increased lymphocyte levels. Our findings suggest that the cognitive effects of CVRFs manifest early in the course of psychosis, thus highlighting the importance of targeting both CVRFs and cognitive deficits in FEP.

Contribution of muscle satellite cells to sarcopenia

Sarcopenia, a disorder characterized by age-related muscle loss and reduced muscle strength, is associated with decreased individual independence and quality of life, as well as a high risk of death. Skeletal muscle houses a normally mitotically quiescent population of adult stem cells called muscle satellite cells (MuSCs) that are responsible for muscle maintenance, growth, repair, and regeneration throughout the life cycle. Patients with sarcopenia are often exhibit dysregulation of MuSCs homeostasis. In this review, we focus on the etiology, assessment, and treatment of sarcopenia. We also discuss phenotypic and regulatory mechanisms of MuSC quiescence, activation, and aging states, as well as the controversy between MuSC depletion and sarcopenia. Finally, we give a multi-dimensional treatment strategy for sarcopenia based on improving MuSC function.

Influence of Cardiovascular Risk Burden on Motor Function Among Older Adults: Mediating Role of Cardiovascular Diseases Accumulation and Cognitive Decline

Purpose

This study aimed to investigate the association of the cardiovascular risk burden assessed by the Framingham General Cardiovascular Risk Score (FGCRS) with the trajectories of motor function over time and to assess the mediating effects of cardiovascular diseases (CVDs) accumulation and cognitive decline in such association.

Methods

In Rush Memory and Aging Project, a total of 1,378 physical health participants (mean age: 79.3 ± 7.3 years) were followed up for up to 22 years. FGCRS at baseline was assessed and categorized into tertiles (lowest, middle, and highest). Global motor function (including dexterity, gait, and hand strength) was assessed annually with 10 motor tests. CVDs (including stroke, congestive heart failure, and other heart diseases) were ascertained at baseline and follow-ups, and the number of CVDs accumulation over time was assessed. Global cognitive function was tested annually by 19 tests. Data were analyzed using the linear mixed-effects models and mediation analysis.

Results

At baseline, FGCRS ranged from 4 to 28 (mean score: 15.6 ± 3.7). Over the follow-up (median: 5.3 years; interquartile range: 2.9-9.0 years), in multi-adjusted mixed-effects models, the highest FGCRS was associated with faster decline in global motor function (β = -0.0038; 95% confidence interval [CI]: -0.0069 to -0.0008), dexterity (β = -0.0056; 95% CI: -0.0093 to -0.0020), gait (β = -0.0039; 95% CI: -0.0077 to -0.0001), and hand strength (β = -0.0053; 95% CI: -0.0098 to -0.0008) compared with the lowest tertile. In mediation analysis, CVDs accumulation and cognitive decline mediated 8.4% and 42.9% of the association between FGCRS and global motor function over time, respectively.

Conclusion

Higher cardiovascular risk burden is associated with a faster decline in motor function including dexterity, gait, and hand strength. CVDs accumulation and cognitive decline may partially mediate the association between cardiovascular risk burden and global motor function decline.

Community-Based Rehabilitation Promotes the Functional Recovery of Patients After Intracerebral Hemorrhage

BACKGROUND

Intracerebral hemorrhage (ICH), a severe disorder with the high death rate, high recurrence rate and high disability rate, affected the quality of human life. Community-based rehabilitation (CBR) helps disabled people at both community and family levels. However, the effect of CBR on the recovery of people after ICH remains unclear.

METHODS

Patients were treated with the CBR training program, subsequently, medication compliance test, clinical neural impairment measurements, functional comprehensive assessments, improved Barthel index score, and life qualities assessments were to performed at 3-month or 6-month intervention of CBR to evaluate the influence of CBR on the medication compliance, physical function and life quality of patients after ICH.

RESULTS

After the treatment of CBR, we observed that, the rate of medication compliance, motor function, functional comprehensive rating scale score, modified Barthel index score, and generic quality of life inventory-74 in the CBR-treated group were significantly higher than that in the control group; the neural impairment measure score in the CBR-treated group was significantly decreased in comparison to the control group.

CONCLUSION

CBR increased the medication compliance, promoted the recovery of the neurological function and improved the life qualities of ICH patients.

Association of cerebral small vessel disease burden with brain structure and cognitive and vascular risk trajectories in mid-to-late life

We characterize the associations of total cerebral small vessel disease (SVD) burden with brain structure, trajectories of vascular risk factors, and cognitive functions in mid-to-late life. Participants were 623 community-dwelling adults from the Whitehall II Imaging Sub-study with multi-modal MRI (mean age 69.96, SD = 5.18, 79% men). We used linear mixed-effects models to investigate associations of SVD burden with up to 25-year retrospective trajectories of vascular risk and cognitive performance. General linear modelling was used to investigate concurrent associations with grey matter (GM) density and white matter (WM) microstructure, and whether these associations were modified by cognitive status (Montreal Cognitive Asessment [MoCA] scores of < 26 vs. ≥ 26). Severe SVD burden in older age was associated with higher mean arterial pressure throughout midlife (β = 3.36, 95% CI [0.42-6.30]), and faster cognitive decline in letter fluency (β = -0.07, 95% CI [-0.13--0.01]), and verbal reasoning (β = -0.05, 95% CI [-0.11--0.001]). Moreover, SVD burden was related to lower GM volumes in 9.7% of total GM, and widespread WM microstructural decline (FWE-corrected p < 0.05). The latter association was most pronounced in individuals who demonstrated cognitive impairments on MoCA (MoCA < 26; F_3,608 = 2.14, p = 0.007). These findings highlight the importance of managing midlife vascular health to preserve brain structure and cognitive function in old age.

Modelling of longitudinal data to predict cardiovascular disease risk: a methodological review

OBJECTIVE

The identification of methodology for modelling cardiovascular disease (CVD) risk using longitudinal data and risk factor trajectories.

METHODS

We screened MEDLINE-Ovid from inception until 3 June 2020. MeSH and text search terms covered three areas: data type, modelling type and disease area including search terms such as "longitudinal", "trajector*" and "cardiovasc*" respectively. Studies were filtered to meet the following inclusion criteria: longitudinal individual patient data in adult patients with ≥3 time-points and a CVD or mortality outcome. Studies were screened and analyzed by one author. Any queries were discussed with the other authors. Comparisons were made between the methods identified looking at assumptions, flexibility and software availability.

RESULTS

From the initial 2601 studies returned by the searches 80 studies were included. Four statistical approaches were identified for modelling the longitudinal data: 3 (4%) studies compared time points with simple statistical tests, 40 (50%) used single-stage approaches, such as including single time points or summary measures in survival models, 29 (36%) used two-stage approaches including an estimated longitudinal parameter in survival models, and 8 (10%) used joint models which modelled the longitudinal and survival data together. The proportion of CVD risk prediction models created using longitudinal data using two-stage and joint models increased over time.

CONCLUSIONS

Single stage models are still heavily utilized by many CVD risk prediction studies for modelling longitudinal data. Future studies should fully utilize available longitudinal data when analyzing CVD risk by employing two-stage and joint approaches which can often better utilize the available data.

Physical activity and exercise: Strategies to manage frailty

Frailty, a consequence of the interaction of the aging process and certain chronic diseases, compromises functional outcomes in the elderly and substantially increases their risk for developing disabilities and other adverse outcomes. Frailty follows from the combination of several impaired physiological mechanisms affecting multiple organs and systems. And, though frailty and sarcopenia are related, they are two different conditions. Thus, strategies to preserve or improve functional status should consider systemic function in addition to muscle conditioning. Physical activity/exercise is considered one of the main strategies to counteract frailty-related physical impairment in the elderly. Exercise reduces age-related oxidative damage and chronic inflammation, increases autophagy, and improves mitochondrial function, myokine profile, insulin-like growth factor-1 (IGF-1) signaling pathway, and insulin sensitivity. Exercise interventions target resistance (strength and power), aerobic, balance, and flexibility work. Each type improves different aspects of physical functioning, though they could be combined according to need and prescribed as a multicomponent intervention. Therefore, exercise intervention programs should be prescribed based on an individual's physical functioning and adapted to the ensuing response.

Motoric cognitive risk syndrome: Integration of two early harbingers of dementia in older adults

Dementia is characterized by a long preclinical phase that may last years to decades before the onset of mild cognitive impairment. Slow gait speed and subjective memory complaint commonly co-occur during this preclinical phase, and each is a strong independent predictor of cognitive decline and dementia. Motoric cognitive risk (MCR) syndrome is a pre-dementia syndrome that combines these two early harbingers of dementia. The risk of cognitive decline or dementia is stronger for MCR than for either slow gait speed or subjective memory complaint alone. Slow gait speed and subjective memory complaint have several common risk factors: cardiovascular disease, diabetes mellitus, abnormal cortisol profiles, low vitamin D levels, brain atrophy with decreased hippocampal volume, and increased deposition of beta-amyloid in the brain. The underlying pathogenesis of MCR remains poorly understood. Metabolomics and proteomics have great potential to provide new insights into biological pathways involved in MCR during the long preclinical phase preceding dementia.

Health Consequences of Sarcopenic Obesity: A Narrative Review

Sarcopenia is defined as the age-related loss of muscle mass and strength or physical performance. Increased amounts of adipose tissue often accompany sarcopenia, a condition referred to as sarcopenic obesity. The prevalence of sarcopenic obesity among adults is rapidly increasing worldwide. However, the lack of a universal definition of sarcopenia limits comparisons between studies. Sarcopenia and obesity have similar pathophysiologic factors, including lifestyle behaviors, hormones, and immunological factors, all of which may synergistically affect the risk of developing a series of adverse health issues. Increasing evidence has shown that sarcopenic obesity is associated with accelerated functional decline and increased risks of cardiometabolic diseases and mortality. Therefore, the identification of sarcopenic obesity may be critical for clinicians in aging societies. In this review, we discuss the effect of sarcopenic obesity on multiple health outcomes and its role as a predictor of these outcomes based on the components of sarcopenia, including muscle mass, muscle strength, and physical performance.

Midlife Cardiovascular Status and Old Age Physical Functioning Trajectories in Older Businessmen

OBJECTIVES

The associations between cardiovascular disease (CVD) risk and later physical functioning have been observed, but only a few studies with follow-up into old age are available. We investigated the association between cardiovascular status in midlife and physical functioning trajectories in old age.

DESIGN

Prospective cohort study.

SETTING

Helsinki Businessmen Study.

PARTICIPANTS

We studied white men born between 1919 and 1934 in the Helsinki Businessmen Study (HBS, initial n = 3490).

MEASUREMENTS

Three CVD status groups were formed based on clinical measurements carried out in 1974: signs of CVD (diagnosed clinically or with changes in ECG, chronic disease present or used medication, n = 563); healthy and low CVD risk (n = 593) and high CVD risk (n = 1222). Of them, 1560 men had data on physical functioning from at least one of four data collection waves between 2000-2010. Ten questions from the RAND-36 (SF-36) survey were used to construct physical functioning trajectories with latent class growth mixture models. Mortality was accounted for in competing risk models.

RESULTS

A five-class solution provided the optimal number of trajectories: "intact," "high stable," "high and declining," "intermediate and declining," and "consistently low" functioning. Compared with low CVD risk, high CVD risk in midlife decreased the risk of being classified into the intact (fully adjusted β = -3.98; standard error = 2.0; P = .046) relative to the consistently low physical functioning trajectory. Compared with low CVD risk, those with signs of CVD were less likely to follow the intact, high stable, or high and declining relative to the consistently low trajectory (all P < .018).

CONCLUSION

Among businessmen, a more favorable CVD profile in midlife was associated with better development of physical functioning in old age. J Am Geriatr Soc 67:2490-2496, 2019.

Association of Midlife Cardiovascular Risk Profiles With Cerebral Perfusion at Older Ages

Importance

Poor cardiovascular health is an established risk factor for dementia, but little is known about its association with brain physiology in older adults.

Objective

To examine the association of cardiovascular risk factors, measured repeatedly during a 20-year period, with cerebral perfusion at older ages.

Design, Setting, and Participants

In this longitudinal cohort study, individuals were selected from the Whitehall II Imaging Substudy. Participants were included if they had no clinical diagnosis of dementia, had no gross brain structural abnormalities on magnetic resonance imaging scans, and had received pseudocontinuous arterial spin labeling magnetic resonance imaging. Cardiovascular risk was measured at 5-year intervals across 5 phases from September 1991 to October 2013. Arterial spin labeling scans were acquired between April 2014 and December 2014. Data analysis was performed from June 2016 to September 2018.

Exposures

Framingham Risk Score (FRS) for cardiovascular disease, comprising age, sex, high-density lipoprotein cholesterol level, total cholesterol level, systolic blood pressure, use of antihypertensive medications, cigarette smoking, and diabetes, was assessed at 5 visits.

Main Outcomes and Measures

Cerebral blood flow (CBF; in milliliters per 100 g of tissue per minute) was quantified with pseudocontinuous arterial spin labeling magnetic resonance imaging.

Results

Of 116 adult participants, 99 (85.3%) were men. At the first examination, mean (SD) age was 47.1 (5.0) years; at the last examination, mean (SD) age was 67.4 (4.9) years. Mean (SD) age at MRI scan was 69.3 (5.0) years. Log-FRS increased with time (B = 0.058; 95% CI, 0.044 to 0.072; P < .001). Higher cumulative FRS over the 20-year period (measured as the integral of the rate of change of log-FRS) was associated with lower gray matter CBF (B = -0.513; 95% CI -0.802 to -0.224; P < .001) after adjustment for age, sex, education, socioeconomic status, cognitive status, arterial transit time, use of statins, and weekly alcohol consumption. Voxelwise analyses revealed that this association was significant in 39.6% of gray matter regions, including the posterior cingulate, precuneus, lateral parietal cortex, occipital cortex, hippocampi, and parahippocampal gyrus. The strength of the association of higher log-FRS with lower CBF decreased progressively from the first examination (R2 = 0.253; B = -10.816; 99% CI -18.375 to -3.257; P < .001) to the last (R2 = 0.188; B = -7.139; 99% CI -14.861 to 0.582; P = .02), such that the most recent FRS measurement at mean (SD) age 67.4 (4.9) years was not significantly associated with CBF with a Bonferroni-corrected P < .01 .

Conclusions and Relevance

Cardiovascular risk in midlife was significantly associated with lower gray matter perfusion at older ages, but this association was not significant for cardiovascular risk in later life. This finding could inform the timing of cardiovascular interventions so as to be optimally effective.

Risk Factors for Injurious Falls in Older Adults: The Role of Sex and Length of Follow-Up

OBJECTIVES

To identify sex-specific associations between risk factors and injurious falls over the short (<4 years) and long (4-10 years) term.

DESIGN

Longitudinal cohort study between 2001 and 2011.

SETTING

Swedish National Study on Aging and Care, Kungsholmen, Sweden.

PARTICIPANTS

Community-dwelling adults aged 60 and older (N = 3,112).

MEASUREMENTS

An injurious fall was defined as a fall that required inpatient or outpatient care. Information was collected on participant and exposure characteristics using structured interviews, clinical examinations, and physical function tests at baseline.

RESULTS

The multivariate model showed that, in the short term, living alone (hazard ratio (HR)=1.83, 95% confidence interval (CI)=1.13-2.96), dependency in instrumental activities of daily living (IADLs) (HR=2.59, 95% CI=1.73-3.87), and previous falls (HR=1.71, 95% CI=1.08-2.72) were independently associated with injurious falls in women. Low systolic blood pressure (HR=1.96, 95% CI=1.04-3.71), impaired chair stands (HR=3.00, 95% CI=1.52-5.93), and previous falls (HR=2.81, 95% CI=1.32-5.97) were associated with injurious falls in men. Long-term risk factors were underweight (HR=2.03, 95% CI=1.40-2.95), cognitive impairment (HR=1.49, 95% CI=1.08-2.06), fall-risk increasing drugs (HR=1.67, 95% CI=1.27-2.20 for ≥2 drugs), and IADL dependency (HR=1.58, 95% CI=1.32-5.97) for women and smoking (HR=1.71, 95% CI=1.03-2.84), heart disease (HR=2.20, 95% CI=1.5-3.24), impaired balance (HR=1.68, 95% CI=1.08-2.62), and a previous fall (HR=3.61, 95% CI=1.98-6.61) for men.

CONCLUSION

Men and women have different fall risk profiles, and these differences should be considered when developing preventive strategies. Some risk factors were more strongly predictive of injurious falls over shorter than longer periods and vice versa, suggesting that it may be possible to identify older men and women at short- and long-term risk of injurious falls. J Am Geriatr Soc 67:246-253, 2019.

Midlife contributors to socioeconomic differences in frailty during later life: a prospective cohort study

Background

Health inequalities persist into old age. We aimed to investigate risk factors for socioeconomic differences in frailty that could potentially be modified through policy measures.

Methods

In this multi-wave longitudinal cohort study (Whitehall II study), we assessed participants' socioeconomic status, behavioural and biomedical risk factors, and disease status at age 45–55 years, and frailty (defined according to the Fried phenotype) at baseline and at one or more of three clinic visits about 18 years later (mean age 69 years [SD 5·9]). We used logistic mixed models to examine the associations between socioeconomic status and risk factors at age 50 years and subsequent prevalence of frailty (adjusted for sex, ethnic origin, and age), with sensitivity analyses and multiple imputation for missing data.

Findings

Between Sept 9, 2007, and Dec 8, 2016, 6233 middle-aged adults were measured for frailty. Frailty was present in 562 (3%) of 16 164 person-observations, and varied by socioeconomic status: 145 (2%) person-observations had high socioeconomic status, 241 (4%) had intermediate status, and 176 (7%) had low socioeconomic status, adjusting for sex and age. Risk factors for frailty included cardiovascular disease, depression, smoking, high or abstinent alcohol consumption, low fruit and vegetable consumption, physical inactivity, poor lung function, hypertension, and overweight or obesity. Cardiometabolic markers for future frailty were high ratio of total to high-density lipoprotein cholesterol, and raised interleukin-6 and C-reactive protein concentrations. The five most important factors contributing to the frailty gradient, assessed by percent attenuation of the association between socioeconomic status and frailty, were physical activity (13%), interleukin-6 (13%), body-mass index category (11%), C-reactive protein (11%), and poor lung function (10%). Overall, socioeconomic differences in frailty were reduced by 40% in the maximally-adjusted model compared with the minimally-adjusted model.

Interpretation

Behavioural and cardiometabolic risk factors in midlife account for more than a third of socioeconomic differences in frailty. Our findings suggest that interventions targeting physical activity, obesity, smoking, and low-grade inflammation in middle age might reduce socioeconomic differences in later-life frailty.

Funding

British Heart Foundation and British Medical Research Council.

Scale for supported care in primary care: a methodological study

OBJECTIVE

To develop a predictive scale for determining complications in adults with hypertension and actions for care supported in primary care.

METHOD

Methodological research developed in the municipality of Curitiba-PR in 2013 and 2014, carried out in two stages, the first through the collection of data from 387 adults with hypertension through a structured interview and anxiety scales, depression, quality of life, medication adherence and social support. The second step was the construction of the scale from the statistically significant variables in the multivariate analysis.

RESULTS

The scale consisted of age, sex, smoking, time of diagnosis, and risk classification in the health unit, medications in use and depression. Later, through literature review, actions were suggested for supported self-care.

CONCLUSION

The scale enables identification of factors that may predict the development of complications of hypertension and provides actions to supported care.

Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study

OBJECTIVE

To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages.

DESIGN

Multi-cohort population based study.

SETTING

37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017.

PARTICIPANTS

109 107 men and women aged 45-90 years.

MAIN OUTCOME MEASURE

Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors.

RESULTS

According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors.

CONCLUSIONS

The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning.

Cardiovascular Health Is Associated With Physical Function Among Older Community Dwelling Men and Women

Background

Age related decline in physical function is a significant concern affecting the quality of life of older individuals.

Methods

We examined the associations between baseline overall cardiovascular health (CVH), its components, and physical function in 906 men and women from the InCHIANTI cohort. Physical function was assessed using the Short Performance Physical Battery and poor physical function was defined as an Short Performance Physical Battery score less than 10. Overall CVH score, ranging from 0 to 12 in the cohort, was operationalized using adherence to ideal levels for health behaviors including smoking status, physical activity, body mass index, and diet quality; and health factors including blood pressure, plasma cholesterol, fasting blood glucose, with higher scores indicating better CVH.

Results

Mean age at baseline was 74 (SD = 6.7) years and 55% were women. At baseline and over 9 years, as compared to the lowest tertile of overall CVH score, the highest tertile was associated with a 69% (p < .001) and 63% (p < .001), respectively, lower risk of poor physical function. Among the CVH components, adherence to ideal levels of health behaviors was more strongly and consistently associated with lower odds of poor physical function than health factors.

Conclusions

Better overall CVH was protective against poor physical function in community-dwelling men and women aged 65 years and older. Improving CVH may be instrumental in the prevention of poor physical function in older adults.

Cardiovascular Risk Burden and Future Risk of Walking Speed Limitation in Older Adults

OBJECTIVES

To explore the association between cardiovascular risk factor (CRF) burden and limitation in walking speed, balance, and chair stand and to verify whether these associations vary according to age and cognitive status.

DESIGN

Longitudinal population-based study.

SETTING

Urban area of Stockholm, Sweden.

PARTICIPANTS

Individuals aged 60 and older who participated in the Swedish National Study on Aging and Care in Kungsholmen and were free of limitations in walking speed (n = 1,441), balance (n = 1,154), or chair stands (n = 1,496) at baseline (2001-04).

MEASUREMENTS

At baseline, data on demographic characteristics, CRFs, other lifestyle factors, C-reactive protein, and cognitive function were collected. CRF burden was measured using the Framingham general cardiovascular risk score (FRS). Limitations in walking speed (<0.8 m/s), balance (<5 seconds), and chair stand (inability to rise 5 times) were determined at 3-, 6-, and 9-year follow-up. Data were analyzed using Cox proportional hazards models stratified according to age (<78, ≥78).

RESULTS

During follow-up, 326 persons developed limitations in walking speed, 303 in balance, and 374 in chair stands. An association between the FRS and walking speed limitation was evident only in adults younger than 78 (for each 1-point increase in FRS: hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.02-1.17) after controlling for potential confounders including cognitive function (correspondingly, in adults aged ≥78: HR = 0.98, 95% CI = 0.92-1.03). Also, higher FRS was significantly associated with faster decline in walking speed (P < .001).

CONCLUSION

A higher FRS is associated with greater risk of subsequent development of walking speed limitation in adults younger than 78, independent of cognitive function. Interventions targeting multiple CRFs in younger-old people may help in maintaining mobility function.

Relative Handgrip Strength Is a Simple Indicator of Cardiometabolic Risk among Middle-Aged and Older People: A Nationwide Population-Based Study in Taiwan

Background

Muscle strength may play an important role in cardiovascular health. The study was intended to evaluate the association between cardiometabolic risk, risk of coronary artery disease and handgrip strength by using the relative handgrip strength.

Materials and Methods

Data of 927 Taiwanese aged 53 years and older (510 men and 417 women) were retrieved from a nationwide representative population-based cohort cross-sectional study in 2006. All participants were interviewed face-to-face and received measures of anthropometry, dominant handgrip strength, relative handgrip strength (summation of both handgrip strength divided by body mass index) and serum biomarkers.

Results

Multivariate linear regression analysis showed the significant association between relative handgrip strength and favorable cardiometabolic risk factors including blood pressure, triglyceride, total cholesterol to high density cholesterol(HDL-C) ratio, glycohemoglobin (HbA1c), uric acid, Framingham risk score in men, and HDL-C, fasting glucose, HbA1c, log hsCRP in women. Dominant hand grip strength was only associated with log hsCRP in women. (p<0.05 for all), but was not significant associated with all cardiovascular biomarkers and FRS in both sex.

Conclusions

Joint with handgrip strength and body size, as relative handgrip strength, may be a better tool to capture conceptual concomitant health, which may be a simple, inexpensive, and easy-to-use tool when targeting cardiovascular health in public health level.

Sarcopenia and Health Care Utilization in Older Women

BACKGROUND

Although there are several consensus definitions of sarcopenia, their association with health care utilization has not been studied.

METHODS

We included women from the prospective Study of Osteoporotic Fractures with complete assessment of sarcopenia by several definitions at the Study of Osteoporotic Fractures Year 10 (Y10) exam (1997-1998) who also had available data from Medicare Fee- For-Service Claims (N = 566) or Kaiser Encounter data (N = 194). Sarcopenia definitions evaluated were: International Working Group, European Working Group for Sarcopenia in Older Persons, Foundation for the NIH Sarcopenia Project, Baumgartner, and Newman. Hurdle models and logistic regression were used to assess the relation between sarcopenia status (the summary definition and the components of slowness, weakness and/or lean mass) and outcomes that included hospitalizations, cumulative inpatient days/year, short-term (part A paid) skilled nursing facility stay in the 3 years following the Y10 visit.

RESULTS

None of the consensus definitions, nor the definition components of weakness or low lean mass, was associated with increased risk of hospitalization or greater likelihood of short-term skilled nursing facility stay. Women with slowness by any criterion definition were about 50% more likely to be hospitalized; had a greater rate of hospitalization days amongst those hospitalized; and had 1.8 to 2.1 times greater likelihood of a short-term skilled nursing facility stay than women without slowness. There was the suggestion of a protective association of low lean mass by the various criterion definitions on short-term skilled nursing facility stay.

CONCLUSION

Estimated effects of sarcopenia on health care utilization were negligible. However, slowness was associated with greater health care utilization.

Frailty and sarcopenia as the basis for the phenotypic manifestation of chronic diseases in older adults

Frailty is a functional status that precedes disability and is characterized by decreased functional reserve and increased vulnerability. In addition to disability, the frailty phenotype predicts falls, institutionalization, hospitalization and mortality. Frailty is the consequence of the interaction between the aging process and some chronic diseases and conditions that compromise functional systems and finally produce sarcopenia. Many of the clinical manifestations of frailty are explained by sarcopenia which is closely related to poor physical performance. Reduced regenerative capacity, malperfusion, oxidative stress, mitochondrial dysfunction and inflammation compose the sarcopenic skeletal muscle alterations associated to the frailty phenotype. Inflammation appears as a common determinant for chronic diseases, sarcopenia and frailty. The strategies to prevent the frailty phenotype include an adequate amount of physical activity and exercise as well as pharmacological interventions such as myostatin inhibitors and specific androgen receptor modulators. Cell response to stress pathways such as Nrf2, sirtuins and klotho could be considered as future therapeutic interventions for the management of frailty phenotype and aging-related chronic diseases.

Relationship of regional brain β-amyloid to gait speed

OBJECTIVE

To investigate in vivo the relationship of regional brain β-amyloid (Aβ) to gait speed in a group of elderly individuals at high risk for dementia.

METHODS

Cross-sectional associations between brain Aβ as measured with [18F]florbetapir PET and gait speed were examined in 128 elderly participants. Subjects ranged from healthy to mildly cognitively impaired enrolled in the control arm of the multidomain intervention in the Multidomain Alzheimer Preventive Trial (MAPT). Nearly all participants presented spontaneous memory complaints. Regional [18F]florbetapir (AV45) standardized uptake volume ratios were obtained via semiautomated quantitative analysis using the cerebellum as reference region. Gait speed was measured by timing participants while they walked 4 meters. Associations were explored with linear regression, correcting for age, sex, education, body mass index (BMI), and APOE genotype.

RESULTS

We found a significant association between Aβ in the posterior and anterior putamen, occipital cortex, precuneus, and anterior cingulate and slow gait speed (all corrected p < 0.05). A multivariate model emphasized the locations of the posterior putamen and the precuneus. Aβ burden explained up to 9% of the variance in gait speed, and significantly improved regression models already containing demographic variables, BMI, and APOE status.

CONCLUSIONS

The present PET study confirms, in vivo, previous postmortem evidence showing an association between Alzheimer disease (AD) pathology and gait speed, and provides additional evidence on potential regional effects of brain Aβ on motor function. More research is needed to elucidate the neural mechanisms underlying these regional associations, which may involve motor and sensorimotor circuits hitherto largely neglected in the pathophysiology of AD.

Adiposity, obesity, and arterial aging: longitudinal study of aortic stiffness in the Whitehall II cohort

We sought to determine whether adiposity in later midlife is an independent predictor of accelerated stiffening of the aorta. Whitehall II study participants (3789 men; 1383 women) underwent carotid-femoral applanation tonometry at the mean age of 66 and again 4 years later. General adiposity by body mass index, central adiposity by waist circumference and waist:hip ratio, and fat mass percent by body impedance were assessed 5 years before and at baseline. In linear mixed models adjusted for age, sex, ethnicity, and mean arterial pressure, all adiposity measures were associated with aortic stiffening measured as increase in pulse wave velocity (PWV) between baseline and follow-up. The associations were similar in the metabolically healthy and unhealthy, according to Adult Treatment Panel-III criteria excluding waist circumference. C-reactive protein and interleukin-6 levels accounted for part of the longitudinal association between adiposity and PWV change. Adjusting for chronic disease, antihypertensive medication and risk factors, standardized effects of general and central adiposity and fat mass percent on PWV increase (m/s) were similar (0.14, 95% confidence interval: 0.05-0.24, P=0.003; 0.17, 0.08-0.27, P<0.001; 0.14, 0.05-0.22, P=0.002, respectively). Previous adiposity was associated with aortic stiffening independent of change in adiposity, glycaemia, and lipid levels across PWV assessments. We estimated that the body mass index-linked PWV increase will account for 12% of the projected increase in cardiovascular risk because of high body mass index. General and central adiposity in later midlife were strong independent predictors of aortic stiffening. Our findings suggest that adiposity is an important and potentially modifiable determinant of arterial aging.

Prediabetes and associated disorders

Prediabetes represents an elevation of plasma glucose above the normal range but below that of clinical diabetes. Prediabetes includes individuals with IFG, IGT, IFG with IGT and elevated HbA1c levels. Insulin resistance and β-cell dysfunction are characteristic of this disorder. The diagnosis of prediabetesis is vital as both IFG and IGT are indeed well-known risk factors for type 2 diabetes with a greater risk in the presence of combined IFG and IGT. Furthermore, as will be illustrated in this review, prediabetes is associated with associated disorders typically only considered in with established diabetes. These include cardiovascular disease, periodontal disease, cognitive dysfunction, microvascular disease, blood pressure abnormalities, obstructive sleep apnea, low testosterone, metabolic syndrome, various biomarkers, fatty liver disease, and cancer. As the vast majority of individuals with prediabetes are unaware of their diagnosis, it is therefore vital that the associated conditions are identified, particularly in the presence of mild hyperglycemia, so they may benefit from early intervention.

Framingham cardiovascular disease risk scores and incident frailty: the English longitudinal study of ageing

Cross-sectional studies show that frailty is common in older people with cardiovascular disease. Whether older people at higher risk of developing cardiovascular disease are more likely to become frail is unclear. We used multinomial logistic regression to examine the prospective relation between Framingham cardiovascular disease risk scores and incidence of physical frailty or pre-frailty, defined according to the Fried criteria, in 1,726 men and women aged 60 to over 90 years from the English Longitudinal Study of Ageing who had no history of cardiovascular disease at baseline. Men and women with higher Framingham cardiovascular risk scores were more likely to become frail over the 4-year follow-up period. For a standard deviation higher score at baseline, the relative risk ratio (95 % confidence interval) for incident frailty, adjusted for sex and baseline frailty status, was 2.76 (2.18, 3.49). There was a significant association between Framingham cardiovascular risk score and risk of pre-frailty: 1.69 (1.46, 1.95). After further adjustment for other potential confounding factors, the relative risk ratios for frailty and pre-frailty were 2.15 (1.68, 2.75) and 1.50 (1.29, 1.74), respectively. The associations were unchanged after excluding incident cases of cardiovascular disease. Separate adjustment for each component of the risk score suggested that no single component was driving the associations between cardiovascular risk score and incident pre-frailty or frailty. Framingham cardiovascular risk scores may be useful for predicting the development of physical frailty in older people. We now need to understand the biological mechanisms whereby cardiovascular risk increases the risk of frailty.