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Puddu PE, Menotti A, Jacobs DR, Adachi H, Kafatos A, Tolonen H. Cardiovascular risk factors predict age at death in 60-year follow-up of the Seven Countries Study. Aging Clin Exp Res 2023; 35:193-202. [PMID: 36445565 DOI: 10.1007/s40520-022-02288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To study age at death (AD) and its determinants in cohorts of middle-aged men followed-up until extinction. MATERIAL AND METHODS A total of 9063 middle-aged men enrolled in 10 cohorts of 6 countries (USA, Finland, the Netherlands, Italy, Greece and Japan) within the Seven Countries Study were examined and then followed up for 60 years until extinction. AD was computed and a small number of risk factors were tested through multiple linear regression as possibly related to attained AD. RESULTS AD ranged across cohorts from 71.8 years in East Finland and 80.5 years in Crete with levels roughly lower in the USA and Northern Europe and higher elsewhere. Across cohorts, the correlation coefficients of systolic blood pressure (R = -0.58) and of CVD prevalence (R = -0.65) versus average AD were the only significant ones. At the individual level in the pool of all cohorts, a multiple linear regression model showed that age, vigorous physical activity, never and ex-smokers were favorably related to AD, while the reverse was true for systolic blood pressure, heart rate, serum cholesterol, CVD prevalence and silent ECG abnormalities. BMI had a parabolic relationship with AD. The predicting power of single risk factors, expressed in years gained or lost, was relatively small, but arbitrary combinations of several of them produced large differences in AD. CONCLUSIONS A small number of CVD risk factors were strongly associated with AD in a life-long follow-up.
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Affiliation(s)
- Paolo Emilio Puddu
- EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'ischémie Reperfusion Myocardique, Université de Normandie, Caen, Normandie, France. .,Association for Cardiac Research, Via Savoia, 78, 00198, Rome, Italy.
| | | | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Hisashi Adachi
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, School of Medicine, Kurume University, Kurume, Japan
| | - Antony Kafatos
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, University of Crete, Heraklion, Crete, Greece
| | - Hanna Tolonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Li H, Zhang J, Guo Q, Xie W, Zhan X, Chen Q, Xie X, Sun R, Cao Z, Jiang Y, Xu X, Zhang Y. Associations among carotid plaque progression, cerebrovascular/cardiovascular diseases and LDL-C/non-HDL-C goal achievement in diabetic patients: A retrospective cohort study. J Diabetes Complications 2023; 37:108381. [PMID: 36566606 DOI: 10.1016/j.jdiacomp.2022.108381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/19/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Impaired glycolipid metabolism can induce vascular injury and plaque formation. It is important to investigate the associations between carotid plaque progression and lipid-lowering goal achievement and cardiovascular disease. METHODS Diabetic patients who underwent at least 2 carotid ultrasound scans with intervals ≥0.5 years and were hospitalized in the Department of Endocrinology at Sun Yat-sen Memorial Hospital were included. Patients were divided into 3 groups based on carotid plaque progression: the persistent plaque absence, new-onset plaque and persistent plaque presence groups. The primary outcomes were CHD and stroke, while the secondary outcomes were low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) goal achievement. RESULTS There were 304 diabetic patients included, with a median follow-up period of 2.15 years. In multivariable logistic regression analysis, persistent plaque presence was positively associated with a 2.285-fold increase in coronary heart disease (CHD) prevalence, while new-onset plaque was associated with a 3.225-fold increase in stroke prevalence compared to persistent plaque absence in patients with follow-up periods ≥ 0.5 years. The association remained significant in patients with a follow-up period ≥ 1 year and ≥2 years. The velocity of average plaque length change was independently associated with increased ΔLDL-C (last - goal) (β = 0.073, P = 0.048). CONCLUSION Carotid plaque progression had long-term association with CHD and stroke starting from 0.5 years, while the velocity of average plaque length associated with increased ΔLDL-C (last - goal) might reflect patient response to statins. Repeated carotid plaque measurements might guide lipid-lowering therapies.
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Affiliation(s)
- Hongwei Li
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Gungzhou 510120, China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Jie Zhang
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Gungzhou 510120, China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Qi Guo
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Gungzhou 510120, China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou 510120, China
| | - Wei Xie
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China
| | - Xiaoying Zhan
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China
| | - Qian Chen
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Gungzhou 510120, China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou 510120, China
| | - Xiangkun Xie
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Gungzhou 510120, China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou 510120, China
| | - Runlu Sun
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Gungzhou 510120, China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou 510120, China
| | - Zhengyu Cao
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Gungzhou 510120, China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou 510120, China
| | - Yuan Jiang
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Gungzhou 510120, China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou 510120, China
| | - Xiaolin Xu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China.
| | - Yuling Zhang
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Gungzhou 510120, China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou 510120, China.
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Cespiati A, Petta S, Lombardi R, Di Marco V, Calvaruso V, Bertelli C, Pisano G, Fatta E, Sigon G, Iuculano F, Crapanzano L, Gibilaro G, Francione P, Craxì A, Fargion S, Fracanzani AL. Metabolic comorbidities and male sex influence steatosis in chronic hepatitis C after viral eradication by direct-acting antiviral therapy (DAAs): Evaluation by the controlled attenuation parameter (CAP). Dig Liver Dis 2021; 53:1301-1307. [PMID: 33214063 DOI: 10.1016/j.dld.2020.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic hepatitis C (CHC) is associated with hepatic steatosis, related to both a direct viral action and metabolic features. Vice-versa data on hepatic steatosis after viral eradication by direct-acting antiviral agents (DAA) are undefined although the presence of metabolic alterations could strongly influence the occurrence of steatosis as in NAFLD. The controlled attenuation parameter (CAP) (FibroscanⓇ) allows the qualitative and quantitative evaluation of fatty liver. AIM to evaluate in patients with CHC whether hepatic steatosis diagnosed by CAP modifies after DAAs-induced sustained virologic response (SVR). METHODS Data were collected the day of DAAs therapy starting and six months after SVR. CAP ≥ 248 dB/m defined the presence of steatosis. RESULTS 794 CHC SVR patients referring to 2 Italian Units were enrolled. Mean age was 64 ± 16 ys, 50% males, BMI 25.4 ± 4 kg/m2, genotype type-1 in 73%, type-3 in 8%. Prevalence of hepatic steatosis at baseline was 32% by US and 46% by CAP. De novo steatosis developed in 125 (29%), resolution in 122 (30%). At multivariate analysis de novo steatosis was independently associated with male sex (OR 1.7, CI 95% 1.09-2.67; p = 0.02) and baseline BMI (for unit increase OR 1.19, CI 95%1.11-1.29; p < 0.001). Baseline BMI (for unit increase OR 0.47, CI 95% 0.25-0.89; p = 0.02) and triglycerides (for unit increase OR 0.93, CI 95% 0.87-0.99; p = 0.03) prevented steatosis resolution after therapy. CONCLUSIONS after SVR de novo steatosis and resolution of baseline steatosis are closely related to the presence of metabolic comorbidities.
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Affiliation(s)
- Annalisa Cespiati
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Rosa Lombardi
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy.
| | - Vito Di Marco
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Vincenza Calvaruso
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Cristina Bertelli
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy
| | - Giuseppina Pisano
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy
| | - Erika Fatta
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy
| | - Giordano Sigon
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Federica Iuculano
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Luciano Crapanzano
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Gerlando Gibilaro
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Paolo Francione
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Antonio Craxì
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Silvia Fargion
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Anna Ludovica Fracanzani
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
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Robert M, Hot A, Mifsud F, Ndongo-Thiam N, Miossec P. Joint Destruction Is Associated With All Types of Cardiovascular Events in French Rheumatoid Patients: A Real-Life Study With Very Long Follow-Up. Front Med (Lausanne) 2020; 7:556086. [PMID: 33195306 PMCID: PMC7661545 DOI: 10.3389/fmed.2020.556086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/30/2020] [Indexed: 01/02/2023] Open
Abstract
Objective: Rheumatoid arthritis (RA) leads not only to joint destruction but also to systemic manifestations, with an increased incidence of cardiovascular events (CVE). Many studies have shown a link between RA severity and CV risk, but the duration of follow-up remains often insufficient to allow a conclusion. The CVE definition was generally reduced to myocardial infarction and stroke, and few studies were conducted in non-Anglo-Saxon countries with low CV incidence. This study aimed to assess the relationship between joint destruction and the occurrence of different types of CVE in a large cohort of French RA patients with a long-term follow-up. Methods: This historical cohort study included 571 RA patients followed between 1992 and 2012 in Lyon, France. The primary endpoint was the first occurrence of a CVE. Logistic regressions were used to identify factors associated with CVE occurrence. Cox proportional hazard models were performed as a separate analysis to take advantage of the long-term follow-up. Results: During a mean follow-up of 16.1 years, 30.3% of patients experienced a CVE, mostly acute arterial events. Joint destruction was associated with an increased risk of CVE [odds ratio = 3.72; 95% confidence interval (CI), 1.09–15.35; p = 0.047] among non-smoker RA patients. A survival analysis revealed that joint destruction was associated with a shorter time to onset of the first CVE only among non-smokers (hazard ratio = 3.44; 95% CI, 1.07–11.04; p = 0.038). Conclusion: Joint destruction is associated with CVE occurrence in RA patients from a population with a lower incidence of CV disease. This study suggests that RA patients, especially those with destruction, merit the institution of precise guidelines to manage this CV risk, and trials are required to evaluate them.
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Affiliation(s)
- Marie Robert
- Department of Clinical Immunology and Rheumatology, Immunogenomics and Inflammation Research Unit EA 4130, University of Lyon 1, Hôpital Edouard Herriot, Lyon, France
| | - Arnaud Hot
- Department of Internal Medicine, Immunogenomics and Inflammation Research Unit EA 4130, University of Lyon 1, Hôpital Edouard Herriot, Lyon, France
| | - François Mifsud
- Department of Clinical Immunology and Rheumatology, Immunogenomics and Inflammation Research Unit EA 4130, University of Lyon 1, Hôpital Edouard Herriot, Lyon, France
| | - Ndiémé Ndongo-Thiam
- Department of Clinical Immunology and Rheumatology, Immunogenomics and Inflammation Research Unit EA 4130, University of Lyon 1, Hôpital Edouard Herriot, Lyon, France
| | - Pierre Miossec
- Department of Clinical Immunology and Rheumatology, Immunogenomics and Inflammation Research Unit EA 4130, University of Lyon 1, Hôpital Edouard Herriot, Lyon, France
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Bérard E, Bongard V, Haas B, Dallongeville J, Moitry M, Cottel D, Ruidavets JB, Ferrières J. Prevalence and Treatment of Familial Hypercholesterolemia in France. Can J Cardiol 2019; 35:744-752. [PMID: 31151710 DOI: 10.1016/j.cjca.2019.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is known to be underdiagnosed and undertreated. The prevalence of heterozygous FH is estimated to be 1 in 500. Nevertheless, a recent meta-analysis of screening in the general population seems to show that the prevalence of FH is more likely to be 1 in 250. METHODS Analysis was based on the third French MONICA and MONALISA population surveys. Participants were randomly recruited in 1995 and 2005 from the general population of 3 regions of France. FH was diagnosed using a modified version of the Dutch Lipid Clinic Network (DLCN) without genetic testing. RESULTS The DLCN score was assessed in 7928 participants aged 35 to 74 years; 50% were men. The prevalence of definite or probable FH was 0.85% (95% CI, 0.63-1.06). Among patients with definite or probable FH, 12% had histories of premature cardiovascular disease (vs less than 1% among subjects without FH; P < 0.0001), 70% were treated (13% with high-intensity, 83% with moderate-intensity, and 4% with low-intensity statin therapy), 90% had cholesterol screening within the past 12 months, and 97% were aware of their hypercholesterolemia. None reached the recommended low-density lipoprotein cholesterol (LDL-C) target (< 2.5 or < 1.8 mmol/L for subjects in primary prevention vs in secondary prevention or with diabetes, respectively), with a mean distance to target of 3.0 mmol/L. CONCLUSIONS In a sample from the French general population aged 35 to 74 years, the prevalence of FH was close to 1 in 120, and the patients with FH were undertreated.
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Affiliation(s)
- Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM- Toulouse University, Toulouse University Hospital, Toulouse, France
| | - Vanina Bongard
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM- Toulouse University, Toulouse University Hospital, Toulouse, France
| | - Bernadette Haas
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France
| | - Jean Dallongeville
- INSERM, Lille University Hospital, Pasteur Institute of Lille, Lille, France
| | - Marie Moitry
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France
| | - Dominique Cottel
- INSERM, Lille University Hospital, Pasteur Institute of Lille, Lille, France
| | - Jean-Bernard Ruidavets
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM- Toulouse University, Toulouse University Hospital, Toulouse, France
| | - Jean Ferrières
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM- Toulouse University, Toulouse University Hospital, Toulouse, France; Department of Cardiology B, Toulouse University Hospital, Toulouse, France.
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Mourguet M, Chauveau D, Faguer S, Ruidavets J, Béjot Y, Ribes D, Huart A, Alric L, Balardy L, Astudillo L, Adoue D, Sailler L, Pugnet G. Increased ischemic stroke, acute coronary artery disease and mortality in patients with granulomatosis with polyangiitis and microscopic polyangiitis. J Autoimmun 2019; 96:134-141. [DOI: 10.1016/j.jaut.2018.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 01/19/2023]
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Menotti A, Puddu PE, Tolonen H, Kafatos A. Age at death in cohorts of middle-aged men followed-up until nearly extinction: the European areas of the Seven Countries Study. Ann Med 2018; 50:620-633. [PMID: 30207751 DOI: 10.1080/07853890.2018.1523551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES To describe age at death (AD) in ten cohorts of middle-aged men followed-up until nearly extinction as a function of personal characteristics measured at baseline. MATERIAL AND METHODS Cohorts of men aged 40-59 years in five European countries (Finland, the Netherlands, Italy, Serbia, Greece) were examined and then followed-up for mortality during 45 (3 cohorts) or 50 years (7 cohorts). Multiple linear regression (MLR) models were computed with AD as dependent variable and 35 personal characteristics as independent variables. RESULTS Out of 7047 men, 6798 (96.5%) died in 45-50 years. Average AD was 74.4 (median 75) years. Only five variables were significant in all the five countries when tested by MLR. By pooling together all countries and selecting variables by a stepwise technique, 20 were significant (p < .05): age at entry examination, being married, being a never smoker or an ex-smoker (versus current smokers), forced expiratory volume, high socio-economic status, arm circumference, subscapular skinfold, having moderate or vigorous physical activity (all with a positive relationship with AD); father early mortality, laterality/linearity index, high systolic blood pressure, high serum cholesterol, having a major cardiovascular disease, diabetes or chronic bronchitis (these with a negative relationship), while body mass index, subdivided into four classes, showed a parabolic relationship (versus a reference class). Each factor was associated with a difference of months or a few years to AD, while their combinations were associated with several years of greater or smaller AD. CONCLUSIONS The availability of a relatively small number of risk factors measured in middle-aged men allows making rough estimates of AD as related to all-cause mortality during a follow-up of 50 years. AD is also a valuable metrics to describe past health in nearly extinct populations. Key messages We aimed at studying the age at death (AD) of middle-aged men of the European cohorts of the Seven Countries Study, followed-up 45-50 years until nearly extinction, as a function of personal characteristics measured at baseline. Multiple linear regression (MLR) models were computed with AD as dependent variable and 35 personal characteristics or risk factors as independent variables and only five were significant in all individual countries, whereas pooling together all countries, 20 variables were significant as selected by stepwise MLR. Each factor was associated with differences of months or a few years to AD, while their combinations were associated with several years of greater or smaller AD. AD is a valuable metrics to describe past health in nearly extinct populations: it might also be used to communicate years of life gained by preventive measures on modifiable variables.
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Affiliation(s)
| | - Paolo Emilio Puddu
- b EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique , Université de Normandie , Caen , Normandie.,c Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences , Sapienza University of Rome , Rome , Italy
| | - Hanna Tolonen
- d Department of Public Health Solutions , National Institute for Health and Welfare , Helsinki , Finland
| | - Anthony Kafatos
- e Department of Social Medicine, Preventive Medicine and Nutrition Clinic , University of Crete , Heraklion , Greece
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Silverman JM, Schmeidler J. The protected survivor model: Using resistant successful cognitive aging to identify protection in the very old. Med Hypotheses 2018; 110:9-14. [PMID: 29317078 PMCID: PMC5927359 DOI: 10.1016/j.mehy.2017.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
Abstract
For some cardiovascular risk factors, association with risk for cognitive impairment observed in early old age is reduced, or paradoxically even reversed, as age of outcome increases. Successful cognitive aging is intact cognition in the oldest-old; we define resistant successful cognitive aging as successful cognitive aging despite high risk. The protected survivor model posits that a minority of the general population has a protective factor that mitigates the negative effect of a risk factor on successful cognitive aging for the unprotected majority. As age increases, differential failure rates increase the proportion of survivors with protection. Among the unprotected, the proportion with low risk increases, but among those with protection, high risk and low risk do not differ. Due to differential mortality, half the survivors are eventually protected - a majority among those with high risk, and a minority among those with low risk. According to the protective survivor model, an example of Simpson's paradox, the association of the risk factor with survival does not change within an individual, but the association in the surviving population changes as its age increases. We created quantitative illustrations of a simplified protected survivor model applied to successful cognitive aging to explain how the usual association of a risk factor with cognitive decline is reversed in the very old. In the illustrations, probability of subsequent survival was higher for survivors with high risk (mostly protected) than low risk (mostly not protected), an example of Simpson's paradox. Resistance to disease despite the presence of risk factors is consistent with the presence of countervailing protection. Based on the protected survivor model, we hypothesize that studies seeking protective factors against cognitive decline will be more effective by limiting a successful cognitive aging sample to resistant successful cognitive aging - to contrast with a sample without successful cognitive aging.
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Affiliation(s)
- Jeremy M Silverman
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, Box 1230, One Gustave L. Levy Place, New York, NY 10029, United States; James J. Peters Veterans Affairs Medical Center, Research & Development, Mail Code 151, 130 West Kingsbridge Road, Bronx, NY 10468, United States.
| | - James Schmeidler
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, Box 1230, One Gustave L. Levy Place, New York, NY 10029, United States
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