1
|
Gloger EM, Segerstrom SC. Repetitive thought, cognition, and systemic inflammation in the midlife in the United States study. Psychol Health 2024; 39:651-669. [PMID: 35758133 PMCID: PMC10026601 DOI: 10.1080/08870446.2022.2092104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 04/28/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Poor cognition increases risk for negative health outcomes, and this may be explained by associations with systemic inflammation. Previously, amount of repetitive thought (Total RT) interacted with IQ to predict interleukin-6 (IL-6) in older adults. This study continued the investigation of repetitive thought (RT) as an element involved in the effect of cognition on inflammation. DESIGN Participants (N = 164) came from the Midlife in the United States Refresher project (Mage = 45.33, SD = 11.51, ranges = 25-74; 48.2% female; 85% Caucasian). Cognition was assessed via telephone, inflammatory biomarkers (IL-6, C-reactive protein (CRP), and tumour-necrosis factor-alpha (TNF- α)) analysed after blood draw, and RT derived from daily diary data. RESULTS Cognition significantly interacted with RT valence (p = .009) to explain CRP after covariate adjustment. Better cognition and more negative RT valence was associated with lower CRP (β = -0.190 [-.387, .008]). Worse cognition and more negative RT valence was associated with higher CRP (β = 0.133 [-.031, .297]). No significant effects were found for IL-6 or TNF-α. CONCLUSION RT may interact with cognition to affect different inflammatory biomarkers. Those with worse cognition may benefit more from skills related to regulating thought than those with better cognition.
Collapse
Affiliation(s)
- Elana M Gloger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | | |
Collapse
|
2
|
Who live longer than their age peers: individual predictors of longevity among older individuals. Aging Clin Exp Res 2023; 35:677-688. [PMID: 36583848 PMCID: PMC10014805 DOI: 10.1007/s40520-022-02323-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND There are a very few studies focusing on the individual-based survival with a long follow-up time. AIM To identify predictors and determine their joint predictive value for longevity using individual-based outcome measures. METHODS Data were drawn from Tampere Longitudinal Study on Aging (TamELSA), a study of individuals' age 60-89 years (N = 1450) with a mortality follow-up of up to 35 years. Two measures of longevity were used: the longevity difference (LD) and realized probability of dying (RPD), both of which compare each individual's longevity with their life expectancy as derived from population life tables. Independent variables were categorized into five domains: sociodemographic, health and functioning, subjective experiences, social activities, and living conditions. Linear regression models were used in three steps: bivariate analysis for each variable, multivariate analysis based on backward elimination for each domain, and one final model. RESULTS The most important predictors of both outcomes were marital status, years smoked regularly, mobility, self-rated health, endocrine and metabolic diseases, respiratory diseases, and unwillingness to do things or lack of energy. The explained variance in longevity was 13.8% for LD and 14.1% for RPD. This demonstrated a large proportion of unexplained error margins for the prediction of individual longevity, even though many known predictors were used. DISCUSSION AND CONCLUSIONS Several predictors associated with longer life were found. Yet, on an individual level, it remains difficult to predict who will live longer than their age peers. The stochastic element in the process of aging and in death may affect this prediction.
Collapse
|
3
|
Kraus VB, Ma S, Tourani R, Fillenbaum GG, Burchett BM, Parker DC, Kraus WE, Connelly MA, Otvos JD, Cohen HJ, Orenduff MC, Pieper CF, Zhang X, Aliferis CF. Causal analysis identifies small HDL particles and physical activity as key determinants of longevity of older adults. EBioMedicine 2022; 85:104292. [PMID: 36182774 PMCID: PMC9526168 DOI: 10.1016/j.ebiom.2022.104292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/15/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The hard endpoint of death is one of the most significant outcomes in both clinical practice and research settings. Our goal was to discover direct causes of longevity from medically accessible data. METHODS Using a framework that combines local causal discovery algorithms with discovery of maximally predictive and compact feature sets (the "Markov boundaries" of the response) and equivalence classes, we examined 186 variables and their relationships with survival over 27 years in 1507 participants, aged ≥71 years, of the longitudinal, community-based D-EPESE study. FINDINGS As few as 8-15 variables predicted longevity at 2-, 5- and 10-years with predictive performance (area under receiver operator characteristic curve) of 0·76 (95% CIs 0·69, 0·83), 0·76 (0·72, 0·81) and 0·66 (0·61, 0·71), respectively. Numbers of small high-density lipoprotein particles, younger age, and fewer pack years of cigarette smoking were the strongest determinants of longevity at 2-, 5- and 10-years, respectively. Physical function was a prominent predictor of longevity at all time horizons. Age and cognitive function contributed to predictions at 5 and 10 years. Age was not among the local 2-year prediction variables (although significant in univariable analysis), thus establishing that age is not a direct cause of 2-year longevity in the context of measured factors in our data that determine longevity. INTERPRETATION The discoveries in this study proceed from causal data science analyses of deep clinical and molecular phenotyping data in a community-based cohort of older adults with known lifespan. FUNDING NIH/NIA R01AG054840, R01AG12765, and P30-AG028716, NIH/NIA Contract N01-AG-12102 and NCRR 1UL1TR002494-01.
Collapse
Affiliation(s)
- Virginia Byers Kraus
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States.
| | - Sisi Ma
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States; University of Minnesota Department of Medicine, Minneapolis, MN, United States
| | - Roshan Tourani
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
| | - Gerda G Fillenbaum
- Psychiatry and Behavioral Sciences and Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
| | - Bruce M Burchett
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
| | - Daniel C Parker
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Margery A Connelly
- Laboratory Corporation of America® Holdings (Labcorp), Morrisville, NC, United States
| | - James D Otvos
- Laboratory Corporation of America® Holdings (Labcorp), Morrisville, NC, United States
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
| | - Melissa C Orenduff
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Carl F Pieper
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States; Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Xin Zhang
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Constantin F Aliferis
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States; University of Minnesota Consortium on Aging, Minneapolis, MN, United States; University of Minnesota Clinical and Translational Science Institute, Minneapolis, MN, United States; University of Minnesota Department of Medicine, Minneapolis, MN, United States
| |
Collapse
|
4
|
St. Sauver J, Rocca W, LeBrasseur N, Chamberlain A, Olson J, Jacobson D, McGree M, Mielke M. Inflammatory biomarkers, multi-morbidity, and biologic aging. J Int Med Res 2022; 50:3000605221109393. [PMID: 35796512 PMCID: PMC9274410 DOI: 10.1177/03000605221109393] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To study the association between multi-morbidity percentiles, which is a measure of clinical aging, and interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α. METHODS Participants 50 to 95 years of age from the Mayo Clinic Study of Aging were assigned age- and sex-specific multi-morbidity percentiles using look-up tables that were reported previously (n = 1646). Percentiles were divided into quintiles for analysis. Plasma IL-6, IL-10, and TNF-α levels were measured in 1595 participants. Median inflammatory marker levels were compared across multi-morbidity quintiles using nonparametric tests. RESULTS People with higher multi-morbidity percentiles had significantly higher IL-6 and TNF-α levels compared with those with lower multi-morbidity percentiles. Tests for trend across five multi-morbidity quintiles were significant among women for IL-6 and among participants 70 years of age or older for IL-6 and TNF-α. IL-10 was not associated with multi-morbidity percentiles. CONCLUSIONS Multi-morbidity percentiles may be a useful clinical index of biological age for future studies, particularly in women and people 70 years of age and older.
Collapse
Affiliation(s)
- Jennifer St. Sauver
- Department of Quantitative Health Sciences, Mayo Clinic,
Rochester, Minnesota
| | - Walter Rocca
- Department of Quantitative Health Sciences, Mayo Clinic,
Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Nathan LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester,
Minnesota
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester,
Minnesota
| | - Alanna Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic,
Rochester, Minnesota
| | - Janet Olson
- Department of Quantitative Health Sciences, Mayo Clinic,
Rochester, Minnesota
| | - Debra Jacobson
- Department of Quantitative Health Sciences, Mayo Clinic,
Rochester, Minnesota
| | - Michaela McGree
- Department of Quantitative Health Sciences, Mayo Clinic,
Rochester, Minnesota
| | - Michelle Mielke
- Department of Quantitative Health Sciences, Mayo Clinic,
Rochester, Minnesota
- Department of Epidemiology and Prevention, Wake Forest
University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
5
|
Fohner AE, Sitlani CM, Buzkova P, Doyle MF, Liu X, Bis JC, Fitzpatrick A, Heckbert SR, Huber SA, Kuller L, Longstreth WT, Feinstein MJ, Freiberg M, Olson NC, Seshadri S, Lopez O, Odden MC, Tracy RP, Psaty BM, Delaney JA, Floyd JS. Association of Peripheral Lymphocyte Subsets with Cognitive Decline and Dementia: The Cardiovascular Health Study. J Alzheimers Dis 2022; 88:7-15. [PMID: 35527553 PMCID: PMC9277688 DOI: 10.3233/jad-220091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Alison E. Fohner
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Colleen M. Sitlani
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Margaret F. Doyle
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Xiaojuan Liu
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Annette Fitzpatrick
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Department of Family Medicine and Global Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Susan R. Heckbert
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Sally A. Huber
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Lewis Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William T. Longstreth
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Matthew J. Feinstein
- Departments of Medicine, Preventive Medicine and Pathology, Northwestern University, Evanston, IL, USA
| | - Matthew Freiberg
- Department of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, USA
| | - Nels C. Olson
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, TX, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Oscar Lopez
- Departments of Neurology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle C. Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Russell P. Tracy
- Department of Biochemistry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Joseph A. Delaney
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
| | - James S. Floyd
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
6
|
Rostamian S, le. Cessie S, Marijt KA, Jukema JW, Mooijaart SP, van Buchem MA, van Hall T, Gussekloo J, Trompet S. Association of cognitive function with increased risk of cancer death and all-cause mortality: Longitudinal analysis, systematic review, and meta-analysis of prospective observational studies. PLoS One 2022; 17:e0261826. [PMID: 34995287 PMCID: PMC8741047 DOI: 10.1371/journal.pone.0261826] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background Disturbed cognitive function is associated with several causes of mortality; however, the association between cognitive function and the risk of cancer death has not been extensively investigated yet. We aimed to evaluate the association of cognitive function with the risk of cancer death and all-cause mortality in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) and Leiden 85-plus Study. Additionally, a systematic review and meta-analysis of longitudinal studies were conducted to evaluate the association of cognitive function and risk of cancer death. Methods Risk of cancer death and all-cause mortality were reported using hazard ratios (HRs) with 95% confidence interval (CI) in tertiles of cognitive function of PROSPER and Leiden85-Plus Study. Additionally, PubMed, Embase, Web of Science, Cochrane, PsycINFO, Academic Search Premier, CINHAL, and Emcare were searched up to November 1st, 2020 to perform a systematic review and meta-analysis. The relative risks (RRs) with 95%CI of cancer death per each standard deviation lower performance in cognitive measurements were calculated. Results Participants of PROSPER had 1.65-fold (95%CI 1.11–2.47) greater risk of cancer death (P for trend = 0.016) and 1.85-fold (95%CI 1.46–2.34) higher risk of all-cause mortality (P for trend<0.001), in multivariable models. Results of the Leiden-85 Plus Study showed that subjects with MMSE score below 24 had a lower chance of cancer death (HR 0.79, 95%CI 0.36–1.70, P for trend = 0.820) but had 2.18-fold (95%CI 1.57–3.02) higher risk of all-cause mortality compared to the reference group (P for trend<0.001). Besides, the results of systematic review and meta-analysis showed that per each standard deviation lower performance in cognitive function, individuals were at a 10% higher chance of cancer death (RR 1.10, 95%CI 1.00–1.20, P-value = 0.044). Conclusions Lower cognitive function performance is associated with a marginally increased risk of cancer death, in line with a significantly greater risk of all-cause mortality.
Collapse
Affiliation(s)
- Somayeh Rostamian
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Saskia le. Cessie
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Koen A. Marijt
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark A. van Buchem
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thorbald van Hall
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
- * E-mail:
| |
Collapse
|
7
|
Reinert NJ, Patel BM, Shaer QN, Wu L, Wisniewski S, Hager ES, Dyer MR, Thirumala PD. Cause-Specific Mortality as a Sequalae of Perioperative Stroke Following Cardiac and Vascular Surgery. Neurologist 2021; 27:21-26. [PMID: 34855676 PMCID: PMC8727499 DOI: 10.1097/nrl.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of data regarding cause-specific mortality following a perioperative stroke. In this study, we aim to establish the risk of cause-specific mortality associated with perioperative stroke following cardiac and vascular procedures at 30 days, 90 days, and 1-year postoperative. It is hoped that this fund of knowledge will enhance perioperative risk stratification and medical management for patients who have suffered a perioperative stroke. METHODS This is a retrospective cohort study evaluating 277,654 cardiac and vascular surgical patients dually documented within the Inpatient Discharge Claims Database and the Pennsylvania Department of Health Death Statistics database. A univariate assessment followed by a multivariate logistic regression analysis was used to determine the odds of cerebrovascular, cardiovascular, pulmonary, malignancy, infectious, and dementia causes of mortality following perioperative stroke. RESULTS Perioperative stroke significantly increased the odds of overall mortality (P<0.0001) as well as cause-specific mortality in all categories (P<0.05) except dementia (P=0.8907) at all-time endpoints. Cerebrovascular-related mortality was most impacted by perioperative stroke [adjusted odds ratio: 34.5 (29.1, 40.9), P<0.0001 at 30 d]. CONCLUSIONS Perioperative stroke in the cardiac and vascular surgical population is associated with increased odds of overall, cerebrovascular, cardiovascular, pulmonary, malignancy, and infectious causes of mortality at 30 days, 90 days, and 1-year postoperatively when compared with patients who did not experience a perioperative stroke.
Collapse
Affiliation(s)
- Nathan J. Reinert
- University of Pittsburgh Department of Neurology
- University of Pittsburgh Department of Neurosurgery
| | - Bansri M. Patel
- University of Pittsburgh Department of Neurology
- University of Pittsburgh Department of Neurosurgery
| | | | - Liwen Wu
- University of Pittsburgh Department of Biostatistics
| | | | - Eric S. Hager
- University of Pittsburgh Department of Vascular Surgery
| | | | | |
Collapse
|
8
|
Chen C, Han P, He F. Improving main analysis by borrowing information from auxiliary data. Stat Med 2021; 41:567-579. [PMID: 34796519 DOI: 10.1002/sim.9252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/22/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022]
Abstract
In many clinical and observational studies, auxiliary data from the same subjects, such as repeated measurements or surrogate variables, will be collected in addition to the data of main interest. Not directly related to the main study, these auxiliary data in practice are rarely incorporated into the main analysis, though they may carry extra information that can help improve the estimation in the main analysis. Under the setting where part of or all subjects have auxiliary data available, we propose an effective weighting approach to borrow the auxiliary information by building a working model for the auxiliary data, where improvement of estimation precision over the main analysis is guaranteed regardless of the specification of the working model. An information index is also constructed to assess how well the selected working model works to improve the main analysis. Both theoretical and numerical studies show the excellent and robust performance of the proposed method in comparison to estimation without using the auxiliary data. Finally, we utilize the Atherosclerosis Risk in Communities study for illustration.
Collapse
Affiliation(s)
- Chixiang Chen
- Division of Biostatistics and Bioinformatics, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Peisong Han
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Fan He
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
9
|
Rhoades DA, Farley J, Schwartz SM, Malloy KM, Wang W, Best LG, Zhang Y, Ali T, Yeh F, Rhoades ER, Lee E, Howard BV. Cancer mortality in a population-based cohort of American Indians - The strong heart study. Cancer Epidemiol 2021; 74:101978. [PMID: 34293639 PMCID: PMC8455435 DOI: 10.1016/j.canep.2021.101978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cancer mortality among American Indian (AI) people varies widely, but factors associated with cancer mortality are infrequently assessed. METHODS Cancer deaths were identified from death certificate data for 3516 participants of the Strong Heart Study, a population-based cohort study of AI adults ages 45-74 years in Arizona, Oklahoma, and North and South Dakota. Cancer mortality was calculated by age, sex and region. Cox proportional hazards model was used to assess independent associations between baseline factors in 1989 and cancer death by 2010. RESULTS After a median follow-up of 15.3 years, the cancer death rate per 1000 person-years was 6.33 (95 % CI 5.67-7.04). Cancer mortality was highest among men in North/South Dakota (8.18; 95 % CI 6.46-10.23) and lowest among women in Arizona (4.57; 95 % CI 2.87-6.92). Factors independently associated with increased cancer mortality included age, current or former smoking, waist circumference, albuminuria, urinary cadmium, and prior cancer history. Factors associated with decreased cancer mortality included Oklahoma compared to Dakota residence, higher body mass index and total cholesterol. Sex was not associated with cancer mortality. Lung cancer was the leading cause of cancer mortality overall (1.56/1000 person-years), but no lung cancer deaths occurred among Arizona participants. Mortality from unspecified cancer was relatively high (0.48/100 person-years; 95 % CI 0.32-0.71). CONCLUSIONS Regional variation in AI cancer mortality persisted despite adjustment for individual risk factors. Mortality from unspecified cancer was high. Better understanding of regional differences in cancer mortality, and better classification of cancer deaths, will help healthcare programs address cancer in AI communities.
Collapse
Affiliation(s)
- Dorothy A Rhoades
- Stephenson Cancer Center and Department of Medicine, University of Oklahoma Health Sciences Center, Robert M. Bird Library, 1105 N. Stonewall Ave. LIB 175, Oklahoma City, OK, 73117, United States.
| | - John Farley
- Dignity Health Cancer Institute at St. Joseph's Hospital and Medical Center, 500 West Thomas Road Phoenix, AZ, 85013, USA.
| | - Stephen M Schwartz
- M4-C308, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
| | - Kimberly M Malloy
- Department of Biostatistics and Epidemiology, Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St, Oklahoma City, OK, 73104, USA.
| | - Wenyu Wang
- Department of Biostatistics and Epidemiology, Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St, Oklahoma City, OK, 73104, USA.
| | - Lyle G Best
- Epidemiology Department, Missouri Breaks Industries Research Inc., 118 South Willow St, Eagle Butte, SD, 57625, USA.
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St, Oklahoma City, OK, 73104, USA.
| | - Tauqeer Ali
- Department of Biostatistics and Epidemiology, Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St, Oklahoma City, OK, 73104, USA.
| | - Fawn Yeh
- Department of Biostatistics and Epidemiology, Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St, Oklahoma City, OK, 73104, USA.
| | - Everett R Rhoades
- Department of Biostatistics and Epidemiology, Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St, Oklahoma City, OK, 73104, USA.
| | - Elisa Lee
- Department of Biostatistics and Epidemiology, Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St, Oklahoma City, OK, 73104, USA.
| | - Barbara V Howard
- MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA; Georgetown, Howard Universities Center for Clinical and Translational Research, Washington, DC, 2000, USA.
| |
Collapse
|
10
|
Cardiovascular damage phenotypes and all-cause and CVD mortality in older adults. Ann Epidemiol 2021; 63:35-40. [PMID: 34339835 DOI: 10.1016/j.annepidem.2021.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/12/2021] [Accepted: 07/25/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The association between CVD risk factors and mortality is well established, however, current tools for addressing subgroups have focused on the overall burden of disease. The identification of risky combinations of characteristics may lead to a better understanding of physiologic pathways that underlie morbidity and mortality in older adults. METHODS Participants included 5067 older adults from the Cardiovascular Health Study, followed for up to 6 years. Using latent class analysis (LCA), we created CV damage phenotypes based on probabilities of abnormal brain infarctions, major echocardiogram abnormalities, N-terminal probrain natriuretic peptide, troponin T, interleukin-6, c reactive-protein, galectin-3, cystatin C. We assigned class descriptions based on the probability of having an abnormality among risk factors, such that a healthy phenotype would have low probabilities in all risk factors. Participants were assigned to phenotypes based on the maximum probability of membership. We used Cox-proportional hazards regression to evaluate the association between the categorical CV damage phenotype and all-cause and CVD-mortality. RESULTS The analysis yielded 5 CV damage phenotypes consistent with the following descriptions: healthy (59%), cardio-renal (11%), cardiac (15%), multisystem morbidity (6%), and inflammatory (9%). All four phenotypes were statistically associated with a greater risk of all-cause mortality when compared with the healthy phenotype. The multisystem morbidity phenotype had the greatest risk of all-cause death (HR: 4.02; 95% CI: 3.44, 4.70), and CVD-mortality (HR: 4.90, 95% CI: 3.95, 6.06). CONCLUSIONS Five CV damage phenotypes emerged from CVD risk factor measures. CV damage across multiple systems confers a greater mortality risk compared to damage in any single domain.
Collapse
Key Words
- AAI, ankle arm index
- ADL, Activities of Daily Living
- AIC, Akaike Information Criterion
- APOE, Apolipoprotein e4
- BIC, Bayesian Information Criterion
- CHS, Cardiovascular Health Study
- CRP, C-reactive protein
- ECG, major echocardiogram abnormalities
- GOF, Goodness of Fit
- Gal3, galectin-3
- HR, Hazard Ratio
- IL-6, interleukin-6
- IMT, internal intima-media thickness
- LCA, Latent Class Analysis
- LDLcholesterol, Low-density Lipoprotein Cholesterol
- NTproBNP, N-terminal probrain natriuretic peptide
- Risk factors, Cardiovascular disease, Latent Class Analysis. Abbreviations: CVD, Cardiovascular Disease
- SCVD, Subclinical Cardiovascular Disease
- WMG, white matter grade
Collapse
|
11
|
Piggott DA, Tuddenham S. The gut microbiome and frailty. Transl Res 2020; 221:23-43. [PMID: 32360945 PMCID: PMC8487348 DOI: 10.1016/j.trsl.2020.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022]
Abstract
The human microbiome is constituted by an extensive network of organisms that lie at the host/environment interface and transduce signals that play vital roles in human health and disease across the lifespan. Frailty is a critical aging-related syndrome marked by diminished physiological reserve and heightened vulnerability to stress, predictive of major adverse clinical outcomes including death. While recent studies suggest the microbiome may impact key pathways critical to frailty pathophysiology, direct evaluation of the microbiome-frailty relationship remains limited. In this article, we review the complex interplay of biological, behavioral, and environmental factors that may influence shifts in gut microbiome composition and function in aging populations and the putative implications of such shifts for progression to frailty. We discuss HIV infection as a key prototype for elucidating the complex pathways via which the microbiome may precipitate frailty. Finally, we review considerations for future research efforts.
Collapse
Affiliation(s)
- Damani A Piggott
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland.
| | - Susan Tuddenham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
12
|
Thirumala PD, Reddy RP, Lopez OL, Chang YF, Becker JT, Kuller LH. Long-term cognitive decline and mortality after carotid endarterectomy. Clin Neurol Neurosurg 2020; 194:105823. [PMID: 32283472 PMCID: PMC7871212 DOI: 10.1016/j.clineuro.2020.105823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To date no studies have evaluated long term cognitive decline after carotid endarterectomy (CEA). We evaluated whether participants who had CEA were at increased risk of cognitive decline over participants who didn't undergo CEA. PATIENTS AND METHODS The patients in the study were participants in the Cardiovascular Health Study (CHS), a study of 5201 men and women over the age of 65 who were recruited from four communities (Pittsburgh, Pennsylvania; Sacramento, California; Winston-Salem, North Carolina; Hagerstown, Maryland) in 1988-89. The outcomes measured were 1) Decline in 3MSE and digit symbol substitution test (DSST) scores after CEA compared to before CEA. 2) All-cause mortality in CHS cohort among participants who did and did not have CEA. RESULTS CEA patients had significantly greater annual decrease in the DSST scores -2.43 (SD 4.21) compared to those who did not have a CEA -1.1 (SD 2.57) (p < 0.001) but this was not seen in the 3MSE scores. CEA patients had increased the risk of decline in DSST (OR 2.41, 95 % CI 1.49, 3.88) and 3MSE (OR 2.17, 95 % CI 1.35, 3.48) scores after adjusting for age, gender, race and educational status. CEA was associated with all-cause mortality in the long term with a HR of 2.72 (95 % CI 2.22, 3.34) after adjusting for covariates. Participants with lower baseline 3MSE scores HR 1.39 (1.27, 1.51), lower DSST scores <34 HR 1.69(1.54, 1.85) were more likely deceased. CONCLUSIONS CEA patients are at increased risk of lower scores on 3MSE and DSST testing in the long term. Mortality in the CHS cohort was higher in participants who underwent CEA. Further, lower 3MSE and DSST scores increased the risk of mortality.
Collapse
Affiliation(s)
| | - Rajiv P Reddy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Oscar L Lopez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Yue-Fang Chang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - James T Becker
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Lewis H Kuller
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| |
Collapse
|
13
|
Haghani A, Arpawong TE, Kim JK, Lewinger JP, Finch CE, Crimmins E. Female vulnerability to the effects of smoking on health outcomes in older people. PLoS One 2020; 15:e0234015. [PMID: 32497122 PMCID: PMC7272024 DOI: 10.1371/journal.pone.0234015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
Cigarette smoking is among the leading risk factors for mortality and morbidity. While men have a higher smoking prevalence, mechanistic experiments suggest that women are at higher risk for health problems due to smoking. Moreover, the comparison of smoking effects on multiple conditions and mortality for men and women has not yet been done in a population-based group with race/ethnic diversity. We used proportional hazards models and restricted mean survival time to assess differences in smoking effects by sex for multiple health outcomes using data from the U.S. Health and Retirement Study (HRS), a population-representative cohort of individuals aged 50+ (n = 22,708, 1992-2014). Men had experienced more smoking pack-years than women (22.0 vs 15.6 average pack-years). Age of death, onset of lung disorders, heart disease, stroke, and cancer showed dose-dependent effects of smoking for both sexes. Among heavy smokers (>28 pack-years) women had higher risk of earlier age of death (HR = 1.3, 95%CI:1.03-1.65) and stroke (HR = 1.37, 95%CI:1.02-1.83). Risk of cancer and heart disease did not differ by sex for smokers. Women had earlier age of onset for lung disorders (HR = 2.83, 95%CI:1.74-4.6), but men risk due to smoking were higher (Smoking-Sex interaction P<0.02) than women. Passive smoke exposure increased risk of earlier heart disease (HR = 1.33, 95%CI:1.07-1.65) and stroke (HR:1.54, 95%CI:1.07-2.22) for non-smokers, mainly in men. Smoking cessation after 15 years partially attenuated the deleterious smoking effects for all health outcomes. In sum, our results suggest that women are more vulnerable to ever smoking for earlier death and risk of stroke, but less vulnerable for lung disorders. From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity.
Collapse
Affiliation(s)
- Amin Haghani
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Thalida Em Arpawong
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Jung Ki Kim
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Juan Pablo Lewinger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Caleb E. Finch
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Eileen Crimmins
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| |
Collapse
|
14
|
Russ TC, Kivimäki M, Batty GD. Respiratory Disease and Lower Pulmonary Function as Risk Factors for Dementia: A Systematic Review With Meta-analysis. Chest 2020; 157:1538-1558. [PMID: 31952950 DOI: 10.1016/j.chest.2019.12.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/13/2019] [Accepted: 12/12/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In addition to affecting the oxygen supply to the brain, pulmonary function is a marker of multiple insults throughout life (including smoking, illness, and socioeconomic deprivation). In this meta-analysis of existing longitudinal studies, the hypothesis that lower pulmonary function and respiratory illness are linked to an elevated risk of dementia was tested. METHODS A systematic review was conducted of longitudinal studies using PubMed until April 1, 2019, and, where possible, results were pooled in random effects meta-analyses. RESULTS Ten studies relating pulmonary function to later dementia risk and 11 studies of respiratory illness and dementia (including one that assessed both factors) were identified. The lowest quartile of FEV1 compared with the highest was associated with a 1.4-fold (hazard ratio [HR], 1.46; 95% CI, 0.77-2.75) increased dementia risk (Ntotal = 62,209; two studies). A decrease of 1 SD in FEV1 was associated with a 28% increase in dementia risk (HR, 1.28; 95% CI, 1.03-1.60; Ntotal = 67,505; six studies). Respiratory illness was also associated with increased dementia risk to a similar degree (pooled HR, 1.54; 95% CI, 1.30-1.81; Ntotal = 288,641; 11 studies). CONCLUSIONS Individuals with poor pulmonary function experience an increased risk of dementia. The extent to which the association between poor pulmonary function and dementia is causal remains unclear and requires examination.
Collapse
Affiliation(s)
- Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; School of Philosophy, Psychology, and Language Sciences; and Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK; Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College, London, United Kingdom
| | - G David Batty
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Epidemiology and Public Health, University College, London, United Kingdom; School of Biological & Population Health Sciences, Oregon State University, Corvallis, OR
| |
Collapse
|
15
|
Shrestha P, Haugen CE, Chu NM, Shaffer A, Garonzik-Wang J, Norman SP, Walston JD, Segev DL, McAdams-DeMarco MA. Racial differences in inflammation and outcomes of aging among kidney transplant candidates. BMC Nephrol 2019; 20:176. [PMID: 31101015 PMCID: PMC6524264 DOI: 10.1186/s12882-019-1360-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/29/2019] [Indexed: 01/12/2023] Open
Abstract
Background Inflammation is more common among African Americans (AAs), and it is associated with frailty, poor physical performance, and mortality in community-dwelling older adults. Given the elevated inflammation levels among end-stage renal disease (ESRD) patients, inflammation may be associated with adverse health outcomes such as frailty, physical impairment, and poor health-related quality of life (HRQOL), and these associations may differ between AA and non-AA ESRD patients. Methods One thousand three ESRD participants were recruited at kidney transplant evaluation (4/2014–5/2017), and inflammatory markers (interleukin-6 [IL-6], tumor necrosis factor-a receptor-1 [TNFR1], C-reactive protein [CRP]) were measured. We quantified the association with frailty (Fried phenotype), physical impairment (Short Physical Performance Battery [SPPB]), and fair/poor HRQOL at evaluation using adjusted modified Poisson regression and tested whether these associations differed by race (AA vs. non-AA). Results Non-AAs had lower levels of TNFR1 (9.7 ng/ml vs 14.0 ng/ml, p < 0.001) and inflammatory index (6.7 vs 6.8, p < 0.001) compared to AAs, but similar levels of IL-6 (4.5 pg/ml vs 4.3 pg/ml, p > 0.9) and CRP (4.7 μg/ml vs 4.9 μg/ml, p = 0.4). Non-AAs had an increased risk of frailty with elevated IL-6 (RR = 1.58, 95% CI:1.27–1.96, p < 0.001), TNFR1 (RR = 1.60, 95% CI:1.25–2.05, p < 0.001), CRP (RR = 1.41, 95% CI:1.10–1.82, p < 0.01), and inflammatory index (RR = 1.82, 95% CI:1.44–2.31, p < 0.001). The associations between elevated inflammatory markers and frailty were not present among AAs. Similar results were seen with SPPB impairment and poor/fair HRQOL. Conclusions Non-AAs with elevated inflammatory markers may need closer follow-up and may benefit from prehabilitation to improve physical function, reduce frailty burden, and improve quality of life prior to transplant.
Collapse
Affiliation(s)
- Prakriti Shrestha
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, 615, N. Wolfe St, W6033, Baltimore, MD, 21205, USA
| | - Ashton Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Silas P Norman
- Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Jeremy D Walston
- Department of Medicine, Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, 615, N. Wolfe St, W6033, Baltimore, MD, 21205, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins School of Public Health, 615, N. Wolfe St, W6033, Baltimore, MD, 21205, USA.
| |
Collapse
|
16
|
Marron MM, Miljkovic I, Boudreau RM, Christensen K, Feitosa MF, Lee JH, Sebastiani P, Thyagarajan B, Wojczynski MK, Zmuda JM, Newman AB. A novel healthy metabolic phenotype developed among a cohort of families enriched for longevity. Metabolism 2019; 94:28-38. [PMID: 30710575 PMCID: PMC7099575 DOI: 10.1016/j.metabol.2019.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Long-lived individuals and their offspring have healthier metabolic characteristics than expected, such as more favorable levels of fasting glucose, insulin, and lipids than controls without longevity. Dysregulation in metabolic pathways has also shown to predict accelerated aging. Using information from the Long Life Family Study (LLFS), a multi-center study of two-generation families selected for exceptional longevity, we developed an indicator of healthy metabolism to determine whether metabolic health was more prevalent in a subset of LLFS families and whether it was heritable and associated with other metrics of healthy aging. METHODS A Latent Profile Analysis was applied to age- and gender-adjusted z-scores of fasting levels of glucose, insulin, triglycerides, and high-density lipoprotein cholesterol, body mass index, waist circumference, interleukin-6, and C-reactive protein. Families were defined as meeting the healthy metabolic phenotype if ≥2 and ≥50% of their offspring were classified into a latent subgroup with a profile of healthier metabolic markers than expected given age and gender relative to all LLFS offspring. RESULTS The log odds of being classified into the latent subgroup with a healthy profile of metabolic markers was heritable (h2 = 0.40, p < 0.001). Among 388 families, 39 (10%) met the healthy metabolic phenotype. Participants from these families had somewhat better cognition than those from remaining families. Proband-generation participants from families who met the healthy metabolic phenotype also had better pulmonary functioning and physical performance. CONCLUSIONS The better cognition, pulmonary function, and physical performance among probands from families with the healthy metabolic phenotype may indicate that this subset of LLFS families have a more extreme longevity phenotype than other LLFS families since cognitive, physical, and pulmonary function are top mortality predictors for older adults. Future work is needed to determine if rare or protective alleles confer a healthy metabolic phenotype in this subset of LLFS families with exceptional metabolism.
Collapse
Affiliation(s)
- Megan M Marron
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kaare Christensen
- The Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph H Lee
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | | | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Mary K Wojczynski
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph M Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Departments of Medicine and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
17
|
Frailty, Inflammatory Markers, and Waitlist Mortality Among Patients With End-stage Renal Disease in a Prospective Cohort Study. Transplantation 2019; 102:1740-1746. [PMID: 29677074 DOI: 10.1097/tp.0000000000002213] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among community-dwelling older adults, frailty is associated with heightened markers of inflammation and subsequent mortality. Although frailty is common among end-stage renal disease (ESRD) patients, the role of frailty and markers of inflammation in this population remains unclear. We quantified these associations in patients on the kidney transplant waitlist and tested whether frailty and/or markers of inflammation improve waitlist mortality risk prediction. METHODS We studied 1975 ESRD patients on the kidney transplant waitlist (November 1, 2009, to February 28, 2017) in a multi-center cohort study of frailty. Serum inflammatory markers (interleukin-6 [IL-6], soluble tumor necrosis factor-α receptor-1 [sTNFR1], and C-reactive protein [CRP]) were analyzed in 605 of these participants; we calculated the inflammatory index score using IL-6 and sTNFR1. We compared the C-statistic of an established registry-based prediction model for waitlist mortality adding frailty and/or inflammatory markers (1 SD change in log IL-6, sTNFR1, CRP, or inflammatory index). RESULTS The registry-based model had moderate predictive ability (c-statistic = 0.655). Frailty was associated with increased mortality (2.19; 95% confidence interval [CI], 1.26-3.79) but did not improve risk prediction (c-statistic = 0.646; P = 0.65). Like frailty, IL-6 (2.13; 95% CI, 1.41-3.22), sTNFR1 (1.70; 95% CI, 1.12-2.59), CRP (1.68; 95% CI, 1.06-2.67), and the inflammatory index (2.09; 95% CI, 1.38-3.16) were associated with increased mortality risk; unlike frailty, adding IL-6 (c-statistic = 0.777; P = 0.02), CRP (c-statistic = 0.728; P = 0.02), or inflammatory index (c-statistic = 0.777; P = 0.02) substantially improved mortality risk prediction. CONCLUSIONS Frailty and markers of inflammation were associated with increased waitlist mortality risk, but only markers of inflammation significantly improved ESRD risk prediction. These findings help clarify the accelerated aging physiology of ESRD and highlight easy-to-measure markers of increased waitlist mortality risk.
Collapse
|
18
|
Jacob ME, Marron MM, Boudreau RM, Odden MC, Arnold AM, Newman AB. Age, Race, and Gender Factors in Incident Disability. J Gerontol A Biol Sci Med Sci 2019; 73:194-197. [PMID: 29045556 DOI: 10.1093/gerona/glx194] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/09/2017] [Indexed: 11/14/2022] Open
Abstract
Background Incident disability rates enable the comparison of risk across populations. Understanding these by age, sex, and race is important for planning for the care of older adults and targeting prevention. Methods We calculated incident disability rates among older adults in the Cardiovascular Health Study, a study of 5,888 older adults aged ≥ 65 years over 6 years of follow-up. Disability was defined in the following two ways: (i) self-report of disability (severe difficulty or inability) in any of six Activities of Daily Living (ADL), and (ii) mobility difficulty (any difficulty walking half a mile or climbing 10 steps). Incident disability rates were calculated as events per 100 person years for age, gender, and race groups. Results The incidence of ADL disability, and mobility difficulty were 2.7 (2.5-2.8), and 9.8 (9.4-10.3) events per 100 person years. Women, older participants, and blacks had higher rates in both domains. Conclusion Incidence rates are considerably different based on the domain examined as well as age, race, and gender composition of the population. Prevention efforts should focus on high risk populations and attempt to ameliorate factors that increase risk in these groups.
Collapse
Affiliation(s)
- Mini E Jacob
- School of Public Health, Boston University, New England GRECC, VA Boston Healthcare System, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts
| | - Megan M Marron
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Michelle C Odden
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| |
Collapse
|
19
|
Odden MC, Koh WJH, Arnold AM, Rawlings AM, Psaty BM, Newman AB. Trajectories of Nonagenarian Health: Sex, Age, and Period Effects. Am J Epidemiol 2019; 188:382-388. [PMID: 30407481 PMCID: PMC6357807 DOI: 10.1093/aje/kwy241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 12/14/2022] Open
Abstract
The US population aged 90 years or more is growing rapidly, and there are limited data on their health. The Cardiovascular Health Study is a prospective study of black and white adults aged ≥65 years recruited in 2 waves (1989-1990 and 1992-1993) from Medicare eligibility lists in Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania. We created a synthetic cohort of the 1,889 participants who had reached age 90 years at baseline or during follow-up through July 16, 2015. Participants entered the cohort at 90 years of age, and we evaluated their changes in health after age 90 years (median duration of follow-up, 3 years (interquartile range, 1.3-5)). Measures of health included cardiovascular events, cognitive function, depressive symptoms, prescription medications, self-rated health, and functional status. The mortality rate was high: 19.0 per 100 person-years (95% confidence interval : 17.8, 20.3) in women and 20.9 per 100 person-years (95% confidence interval: 19.2, 22.8) in men. Cognitive function and all measures of functional status declined with age; these changes were similar by sex. When we isolated period effects, we found that medication use increased over time. These estimates can help inform future research and can help health-care systems meet the needs of this growing population.
Collapse
Affiliation(s)
- Michelle C Odden
- Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - William Jen Hoe Koh
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Alice M Arnold
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Andreea M Rawlings
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Bruce M Psaty
- Cardiovascular Health Research Unit and Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
- Departments of Epidemiology and Health Services, School of Public Health, University of Washington, Seattle, Washington
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
20
|
Schulman IH, Balkan W, Hare JM. Mesenchymal Stem Cell Therapy for Aging Frailty. Front Nutr 2018; 5:108. [PMID: 30498696 PMCID: PMC6249304 DOI: 10.3389/fnut.2018.00108] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022] Open
Abstract
Chronic diseases and degenerative conditions are strongly linked with the geriatric syndrome of frailty and account for a disproportionate percentage of the health care budget. Frailty increases the risk of falls, hospitalization, institutionalization, disability, and death. By definition, frailty syndrome is characterized by declines in lean body mass, strength, endurance, balance, gait speed, activity and energy levels, and organ physiologic reserve. Collectively, these changes lead to the loss of homeostasis and capability to withstand stressors and resulting vulnerabilities. There is a strong link between frailty, inflammation, and the impaired ability to repair tissue injury due to decreases in endogenous stem cell production. Although exercise and nutritional supplementation provide benefit to frail patients, there are currently no specific therapies for frailty. Bone marrow-derived allogeneic mesenchymal stem cells (MSCs) provide therapeutic benefits in heart failure patients irrespective of age. MSCs contribute to cellular repair and tissue regeneration through their multilineage differentiation capacity, immunomodulatory, and anti-inflammatory effects, homing and migratory capacity to injury sites, and stimulatory effect on endogenous tissue progenitors. The advantages of using MSCs as a therapeutic strategy include standardization of isolation and culture expansion techniques and safety in allogeneic transplantation. Based on this evidence, we performed a randomized, double-blinded, dose-finding study in elderly, frail individuals and showed that intravenously delivered allogeneic MSCs are safe and produce significant improvements in physical performance measures and inflammatory biomarkers. We thus propose that frailty can be treated and the link between frailty and chronic inflammation offers a potential therapeutic target, addressable by cell therapy.
Collapse
Affiliation(s)
- Ivonne Hernandez Schulman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, United States.,Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Wayne Balkan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| |
Collapse
|
21
|
Marron MM, Ives DG, Boudreau RM, Harris TB, Newman AB. Racial Differences in Cause-Specific Mortality Between Community-Dwelling Older Black and White Adults. J Am Geriatr Soc 2018; 66:1980-1986. [PMID: 30277581 PMCID: PMC6366626 DOI: 10.1111/jgs.15534] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To understand which causes of death are higher in black than white community-dwelling older adults and determine whether differences in baseline risk factors explain racial differences in mortality. DESIGN Longitudinal cohort study (Health, Aging, and Body Composition Study). SETTING Pittsburgh, Pennsylvania; and Memphis, Tennessee. PARTICIPANTS Black and white men and women aged 70 to 79 during recruitment (N=3,075; 48% men, 42% black) followed for a median of 13 years. MEASUREMENTS A committee of physicians adjudicated cause of death, which was categorized as cardiovascular disease (CVD), stroke, cancer, dementia, pulmonary, infection, kidney, or other causes. Using competing risks regression, we examined whether known risk factors at baseline (demographic characteristics, smoking, body mass index, chronic diseases, physical function, cognition) could explain racial differences in cause-specific mortality risk. RESULTS During follow-up, 1,991 (65%) participants died. Black participants died at higher rates from cancer (hazard ratio (HR)=1.36, 95% confidence interval (CI)=1.14-1.63), kidney disease (HR=2.09, 95% CI=1.16-3.74), stroke (HR=1.31, 95% CI=0.98-1.76); and CVD (HR=1.16, 95% CI=0.98-1.37). Poorer physical and cognitive performance at baseline among black participants explained most of the racial difference in risks of dying from kidney disease, stroke, and CVD but not cancer. When examining types of cancer deaths, black participants died at higher rates from multiple myeloma, pancreatic cancer, and prostate cancer, which baseline risk factors did not explain either. CONCLUSION Factors contributing to poorer physical and cognitive performance in similarly aged black men and women could be targets to reduce excess mortality from CVD, stroke, and kidney disease. More work is needed to identify factors contributing to cancer mortality disparities.
Collapse
Affiliation(s)
- Megan M. Marron
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Diane G. Ives
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | | | - Tamara B. Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD
| | - Anne B. Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
- Departments of Medicine and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
22
|
Lu Y, Monaco G, Camous X, Andiappan AK, Rotzschke O, Ng TP, Larbi A. Biomarker Signatures Predicting 10-Year All-Cause and Disease-Specific Mortality. J Gerontol A Biol Sci Med Sci 2018; 74:469-479. [DOI: 10.1093/gerona/gly138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Yanxia Lu
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Biopolis, Singapore
| | - Gianni Monaco
- Institute of Ageing and Chronic Disease, University of Liverpool, UK
| | - Xavier Camous
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Biopolis, Singapore
| | - Anand Kumar Andiappan
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Biopolis, Singapore
| | - Olaf Rotzschke
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Biopolis, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Biopolis, Singapore
- Department of Biology, Faculty of Science, University Tunis El Manar, Tunis, Tunisia
- Geriatrics Division, Department of Medicine, Research Center on Ageing, University of Sherbrooke, Quebec, Canada
| |
Collapse
|
23
|
Maldonato NM, Sperandeo R, Caiazzo G, Cioffi V, Cozzolino P, De Santo RM, Fusco ML, Iorio VS, Gigante E, Marone P, Nascivera N, Scognamiglio C. Keep moving without hurting: The interaction between physical activity and pain in determining cognitive function at the population level. PLoS One 2018; 13:e0197745. [PMID: 29856761 PMCID: PMC5983501 DOI: 10.1371/journal.pone.0197745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/08/2018] [Indexed: 01/12/2023] Open
Abstract
Background A number of studies have evaluated the association between cognitive function, pain, and physical activity. To our knowledge, however, no previous studies have evaluated these factors at the population level. Aims To evaluate the association between cognitive function in the elderly with pain, physical activity, and the interaction between these variables. Estimates are generated for the United States population. Methods We made use of the NHANES database (1999–2002), making adjustments so that our results represent the United States population. Cognitive function was evaluated through the Digit Symbol Substitution Test. Our main predictors were (1) pain, defined as soreness of either the shoulder, neck, lower back and joint, or a severe headache (2) physical activity, measured as the performance while performing tasks at home, physical activity intensity, walking, bicycle riding, and muscle strengthening. Results Most individual pain sites were not significantly associated with cognitive function, while all physical activity factors were associated with an increase in cognitive function. When evaluating the sample subset of those with cognitive scores lower than the median, a combination of more pain and less physical activity was consistently associated with lower cognitive scores when compared to those performing more physical activity with or without pain. When evaluating individuals with cognitive scores above the median, a similar association pattern was perceived. Conclusions Among the population of individuals above the age of 60, higher cognitive levels are associated with more physical activity and less with pain, although both factors might impact cognition. Public policy resources should be commensurate with these findings when targeting cognitive function among the aging population.
Collapse
Affiliation(s)
- Nelson Mauro Maldonato
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
- * E-mail:
| | | | - Giovanni Caiazzo
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy
| | - Valeria Cioffi
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy
| | - Pasquale Cozzolino
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy
| | - Rosa Maria De Santo
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy
| | - Maria Luigia Fusco
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy
| | - Vittoria Silviana Iorio
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy
| | - Elena Gigante
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy
| | - Patrizia Marone
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy
| | - Nicole Nascivera
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy
| | - Chiara Scognamiglio
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy
| |
Collapse
|
24
|
Spirometric impairments, cardiovascular outcomes, and noncardiovascular death in older persons. Respir Med 2018; 137:40-47. [PMID: 29605211 DOI: 10.1016/j.rmed.2018.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/06/2018] [Accepted: 02/24/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND In prior work involving older persons, the reported associations of spirometric impairments with cardiovascular outcomes may have been confounded by age-related changes in lung function. Hence, using more age-appropriate spirometric criteria from the Global Lung Function Initiative (GLI), we have evaluated the associations of spirometric impairments, specifically restrictive-pattern and airflow-obstruction, with cardiovascular death (CV-death) and hospitalization (CV-hospitalization). In these analyses, we also evaluated the competing outcome of noncardiovascular death (nonCV-death) and calculated measures of relative and absolute risk. METHODS Our study sample was drawn from the Cardiovascular Health Study (CHS), including 4232 community-dwelling white persons aged ≥65 years. Multivariable regression models included the following baseline predictors: GLI-defined restrictive-pattern and airflow-obstruction, age, male gender, obesity, waist circumference, current smoker status, ≥10 pack-years of smoking, hypertension, dyslipidemia, diabetes, and cardiovascular and cerebrovascular disease. Outcomes included adjudicated CV-death, CV-hospitalization, and nonCV-death, ascertained over 10 years of follow-up. Measures of association included hazard ratios (HRs), rate ratios (RRs), and average attributable fraction (AAF), each with 95% confidence intervals. RESULTS Restrictive-pattern and airflow-obstruction were associated with CV-death (adjusted HRs: 1.57 [1.18, 2.09] and 1.29 [1.04, 1.60]) and with nonCV-death (adjusted HRs: 2.10 [1.63, 2.69] and 1.79 [1.51, 2.12]), respectively. Airflow-obstruction, but not restrictive-pattern, was also associated with CV-hospitalization (adjusted RRs: 1.18 [1.02, 1.36] and 1.20 [0.96, 1.50], respectively). The adjusted AAFs of restrictive-pattern and airflow-obstruction were 1.68% (0.46, 3.06) and 2.35% (0.22, 4.72) for CV-death, and 3.44% (1.97, 5.08) and 7.77% (5.15, 10.60) for nonCV-death, respectively. CONCLUSION Assessment of GLI-defined spirometric impairments contributes to broad geriatric risk stratifications for both cardiovascular and non-cardiovascular outcomes.
Collapse
|
25
|
Greenlee H, Strizich G, Lovasi GS, Kaplan RC, Biggs ML, Li CI, Richardson J, Burke GL, Fitzpatrick AL, Fretts AM, Psaty BM, Fried LP. Concordance With Prevention Guidelines and Subsequent Cancer, Cardiovascular Disease, and Mortality: A Longitudinal Study of Older Adults. Am J Epidemiol 2017; 186:1168-1179. [PMID: 29020206 PMCID: PMC5860231 DOI: 10.1093/aje/kwx150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 11/11/2016] [Accepted: 11/16/2016] [Indexed: 12/23/2022] Open
Abstract
Reports on the associations between multiple clinical and behavioral health indicators and major health outcomes among older adults are scarce. We prospectively examined concordance with guidelines from the American Cancer Society and American Heart Association for disease prevention in relation to cancer, cardiovascular disease (CVD), and mortality among Cardiovascular Health Study enrollees aged 65-98 years who, at baseline assessment in 1989-1996 (n = 3,491), were free of CVD and cancer. Total and cause-specific mortality, as well as incidence of cancer and CVD, were lower with higher guideline concordance. Independent of body mass index, blood pressure, total cholesterol, and fasting plasma glucose, better health behaviors (diet, physical activity, and alcohol consumption) were associated with lower mortality (2-sided P < 0.0001). Among individuals with ideal levels for 3-4 of these 4 cardiometabolic biomarkers, those with poor concordance with health behavior recommendations had higher mortality compared with those who had the highest concordance with these behavioral recommendations (adjusted mortality hazard ratio = 1.82, 95% confidence interval: 1.25, 2.67). Older adults who are concordant with recommendations for cancer and CVD prevention have reduced rates of chronic disease and mortality. Interventions to achieve and maintain healthy lifestyle behaviors may offer benefits both in the presence and absence of adverse traditional clinical risk factors.
Collapse
Affiliation(s)
- Heather Greenlee
- Correspondence to Dr. Heather Greenlee, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4-B402, Seattle, WA 98109-1024 (e-mail: )
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Lin H, Lunetta KL, Zhao Q, Rong J, Benjamin EJ, Mendelson MM, Joehanes R, Levy D, Larson MG, Murabito JM. Transcriptome-wide association study of inflammatory biologic age. Aging (Albany NY) 2017; 9:2288-2301. [PMID: 29135455 PMCID: PMC5723687 DOI: 10.18632/aging.101321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/02/2017] [Indexed: 05/16/2023]
Abstract
Chronic low grade inflammation is a fundamental mechanism of aging. We estimated biologic age using nine biomarkers from diverse inflammatory pathways and we hypothesized that genes associated with inflammatory biological age would provide insights into human aging. In Framingham Offspring Study participants at examination 8 (2005 to 2008), we used the Klemera-Doubal method to estimate inflammatory biologic age and we computed the difference (∆Age) between biologic age and chronologic age. Gene expression in whole blood was measured using the Affymetrix Human Exon 1.0 ST Array. We used linear mixed effect models to test associations between inflammatory ∆Age and gene expression (dependent variable) adjusting for age, sex, imputed cell counts, and technical covariates. Our study sample included 2386 participants (mean age 67A±9 years, 55% women). There were 448 genes significantly were associated with inflammatory ∆Age (P<2.8x10-6), 302 genes were positively associated and 146 genes were negatively associated. Pathway analysis among the identified genes highlighted the NOD-like receptor signaling and ubiquitin mediated proteolysis pathways. In summary, we identified 448 genes that were significantly associated with inflammatory biologic age. Future functional characterization may identify molecular interventions to delay aging and prolong healthspan in older adults.
Collapse
Affiliation(s)
- Honghuang Lin
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Kathryn L. Lunetta
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Qiang Zhao
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Jian Rong
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Emelia J. Benjamin
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Section of Cardiovascular Medicine and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Michael M. Mendelson
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Roby Joehanes
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel Levy
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Martin G. Larson
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Joanne M. Murabito
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| |
Collapse
|
27
|
Circulating interleukin-6 levels and cardiovascular and all-cause mortality in the elderly population: A meta-analysis. Arch Gerontol Geriatr 2017; 73:257-262. [DOI: 10.1016/j.archger.2017.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 12/21/2022]
|
28
|
Abstract
OBJECTIVE Higher intelligence quotient (IQ) correlates with lower systemic inflammation, consistent with an association between lower IQ and disease risk. The present study examined the role of repetitive thought (RT) in the relationship between IQ and interleukin (IL)-6. RT is thinking attentively, repeatedly, and frequently about oneself and one's world and is characterized by valence (positive-negative), purpose (searching-solving), and total quantity (much-little). METHODS Estimated IQ and RT dimension scores were assessed at baseline in a sample of older adults (N = 120, mean age = 74 years), who thereafter had blood drawn up to 10 times semiannually (n = 799). Models were adjusted for body mass index, chronological age, and statin medication. RESULTS Higher IQ was associated with lower IL-6 (γ = -0.225, SE = 0.111, p = .045). Of the RT dimensions, only more total RT predicted lower IL-6 (γ = -0.037, SE = 0.011, p = .001), an effect that was not moderated by valence or purpose. More total RT accounted for part of the effect of IQ on IL-6 (indirect effect = -0.06 [confidence interval = -0.14 to -0.002]). There was also a significant interaction between IQ and total RT (F(1,119) = 6.97, p = .009), in which more total RT was more strongly associated with lower IL-6 for people with lower IQ. CONCLUSIONS Although some forms of RT such as worry may have negative health correlates for older adults, engaging in RT per se can be healthy insofar as it also encompasses planning, processing, and coping. Older adults with higher IQ were more likely to engage in RT, but those with average IQ benefitted the most with regard to a marker of systemic inflammation.
Collapse
|
29
|
Goldman N, Glei DA, Weinstein M. The Best Predictors of Survival: Do They Vary by Age, Sex, and Race? POPULATION AND DEVELOPMENT REVIEW 2017; 43:541-560. [PMID: 29398738 PMCID: PMC5791760 DOI: 10.1111/padr.12079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AbstractWe consider a broad set of variables used by social scientists and clinicians to identify the leading predictors of five‐year survival among American adults. We address a question not considered in earlier research: Do the strongest predictors of survival vary by age, sex or race/ethnicity? The analysis uses hazard models with 30 well‐established predictors to examine five‐year survival in the National Health and Nutrition Examination Survey. We find that the simple measure of self‐assessed health and self‐reported measures of functional ability and disability are the strongest predictors in all demographic groups, and are generally ranked considerably higher than biomarkers. Among the biomarkers, serum albumin is highly ranked in most demographic groups, whereas clinical measures of cardiovascular and metabolic function are consistently among the weakest predictors. Despite these similarities, there is substantial variation in the leading predictors across demographic groups, most notably by race and ethnicity
Collapse
|
30
|
Lima-Costa MF, Melo Mambrini JVD, Lima Torres KCD, Peixoto SV, de Oliveira C, Tarazona-Santos E, Teixeira-Carvalho A, Martins-Filho OA. Predictive value of multiple cytokines and chemokines for mortality in an admixed population: 15-year follow-up of the Bambui-Epigen (Brazil) cohort study of aging. Exp Gerontol 2017; 98:47-53. [PMID: 28803133 DOI: 10.1016/j.exger.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/05/2017] [Accepted: 08/01/2017] [Indexed: 11/20/2022]
Abstract
Inflammation, particularly elevated IL-6 serum levels, has been associated with increased mortality risk, mostly in Caucasians. The influence of genetic ethno-racial background on this association is unknown. We examined associations between baseline serum levels of Interleukin-6 (IL-6) and other cytokines (IL1-2, TNF, IL-10, and IL1β) and chemokines (CCL2, CCL5, CXCL8, CXCL9 and CXCL10) with 15-year mortality in 1,191 admixed Brazilians aged 60years and over. Elevated IL6 level (but not other biomarkers) was associated with increased risk of deaths with fully adjusted hazard ratios of 1.51 (95% CI=1.15, 1.97), 1.54 (95% CI=1.20, 1.96) and 1.79 (95% CI=1.40, 2.29) for the 2nd, 3rd and the highest quartiles, respectively. Genomic African and Native American proportions did not modify the association (p>0.05). The discriminatory ability to predict death of a model based on IL-6 alone was similar as that of a comprehensive morbidity score (C statistics=0.59 and 0.60, respectively). The abilities of IL-6 and the morbidity score models to predict death remained stable for very long term after the baseline measurement. Our results indicate that genome-based African and Native American ancestries have no impact on the prognostic value of IL-6 for mortality.
Collapse
Affiliation(s)
| | | | | | - Sérgio Viana Peixoto
- Rene Rachou Research Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil; School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London, UK
| | | | | | - Olindo Assis Martins-Filho
- Rene Rachou Research Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil; Institute of Biological Sciences, Federal University of Minas Gerais, Minas Gerais, Brazil
| |
Collapse
|
31
|
Buford TW. (Dis)Trust your gut: the gut microbiome in age-related inflammation, health, and disease. MICROBIOME 2017; 5:80. [PMID: 28709450 PMCID: PMC5512975 DOI: 10.1186/s40168-017-0296-0] [Citation(s) in RCA: 240] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/04/2017] [Indexed: 05/08/2023]
Abstract
Chronic inflammation represents one of the most consistent biologic features of aging. However, the precise etiology of persistent low-grade increases in inflammation remains unclear. Recent evidence suggests that the gut microbiome may play a key role in age-related inflammation. Indeed, several studies have indicated that older adults display an altered composition of the gut microbiota, and early evidence indicates that this dysbiosis is associated with the presence of several key circulating inflammatory analytes. The present review summarizes knowledge on age-related inflammation and discusses how potential relationships with gut dysbiosis may lead to novel treatment strategies in the future."The pattern of disease is an expression of the response of man to his total environment (physical, biological, and social); this response is, therefore, determined by anything that affects man himself or his environment." - Rene Dubos, 1961.
Collapse
Affiliation(s)
- Thomas W Buford
- Department of Medicine, University of Alabama at Birmingham, 933 19th Street South, Birmingham, AL, 35294, USA.
| |
Collapse
|
32
|
Odden MC, Koh WJH, Arnold AM, Psaty BM, Newman AB. Health and Functional Status of Adults Aged 90 Years in the United States. JAMA Intern Med 2017; 177:732-734. [PMID: 28319228 PMCID: PMC5639915 DOI: 10.1001/jamainternmed.2017.0242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michelle C. Odden
- School of Biological and Population Health Sciences, Oregon State University, Corvallis
| | | | - Alice M. Arnold
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, and Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Anne B. Newman
- Graduate School of Public Health, University of Pittsburgh, PA
| |
Collapse
|
33
|
Extermann M, Leeuwenburgh C, Samiian L, Sehovic M, Xu J, Cubitt C, Jacobsen PB, Pahor M, Grobmyer SR, Manini TM. Impact of chemotherapy on medium-term physical function and activity of older breast cancer survivors, and associated biomarkers. J Geriatr Oncol 2017; 8:69-75. [PMID: 27743848 PMCID: PMC5299045 DOI: 10.1016/j.jgo.2016.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/01/2016] [Accepted: 09/21/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Chemotherapy is less often prescribed in older individuals due to concerns about post-treatment morbidity and quality of life. We evaluated the physical performance of breast cancer survivors treated with and without adjuvant chemotherapy. MATERIALS AND METHODS We conducted a case-control study in 56 estrogen receptor positive breast cancer survivors (BCS) on adjuvant aromatase inhibitors 1-2years after definitive surgery. Cases had received adjuvant chemotherapy (n=27; age 70.5±3.6years) versus age-matched controls who had not (n=29; age 70.0±4.3years). Measures of grip strength, physical activity and performance, walking speed, fatigue, and self-reported physical function were collected. Biological correlates of inflammation, frailty and markers of DNA and RNA oxidation were compared. RESULTS Grip strength (controls: 21±7.4 vs. CASES 29.7±5.0kg, p=0.20), physical activity (5403±3204 vs. 6801±9320steps/day, p=0.45), physical performance (short physical performance battery score: 10.1±1.8 vs. 10.4±1.1, p=0.52) and long-distance walking speed (1.2±0.21 vs. 1.3±0.41m/s, p=0.17) were similar between the two groups. Self-reported physical function was marginally lower in cases than controls (controls: 72±24 vs. CASES 57±34AU, p=0.07). Fatigue disruptiveness was not different between groups (controls: 11.1±13.0 vs. CASES 15.7±16.2AU, p=0.24). Similarly, the inflammation, oxidation, and frailty markers did not present a significant difference between groups, except for vitamin D levels (p=0.04). CONCLUSION Older women who received chemotherapy reported having slightly lower physical function, but a similar physical performance compared to women who did not. These data suggest that older BCS treated with chemotherapy recover to an extent similar to survivors who only received hormonal therapy.
Collapse
Affiliation(s)
| | | | - Laila Samiian
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Marina Sehovic
- Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Jinze Xu
- Division of Aging, University of Florida, Gainesville, FL, USA
| | | | - Paul B Jacobsen
- Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Marco Pahor
- Division of Aging, University of Florida, Gainesville, FL, USA
| | | | - Todd M Manini
- Division of Aging, University of Florida, Gainesville, FL, USA
| |
Collapse
|
34
|
Kaplan RC, Strizich G, Aneke-Nash C, Dominguez-Islas C, Bužková P, Strickler H, Rohan T, Pollak M, Kuller L, Kizer JR, Cappola A, Li CI, Psaty BM, Newman A. Insulinlike Growth Factor Binding Protein-1 and Ghrelin Predict Health Outcomes Among Older Adults: Cardiovascular Health Study Cohort. J Clin Endocrinol Metab 2017; 102:267-278. [PMID: 27820656 PMCID: PMC5413102 DOI: 10.1210/jc.2016-2779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/04/2016] [Indexed: 02/04/2023]
Abstract
CONTEXT Multiple diseases may explain the association of the growth hormone/insulinlike growth factor-I (GH/IGF-I) axis with longevity. OBJECTIVE To relate circulating GH/IGF-I system protein levels with major health events. DESIGN AND SETTING This is a cohort study set in 4 US communities. PARTICIPANTS Adults (N = 2268) 65 years and older free of diabetes and cardiovascular disease. MEASUREMENTS We assessed insulinlike growth factor binding protein-1 (IGFBP-1) and ghrelin in fasting and 2-hour oral glucose tolerance test (OGTT) blood samples, as well as fasting IGF-I and IGFBP-3. Hazard ratios for mortality and a composite outcome for first incident myocardial infarction, stroke, heart failure, hip fracture, or death were adjusted for sociodemographic, behavioral, and physiological covariates. RESULTS During 13,930 person-years of follow-up, 48.1% of individuals sustained one or more components of the composite outcome and 31.8% died. Versus the lowest quartiles, the highest quartiles of fasting and 2-hour ghrelin were associated with 27% higher (95% confidence interval [CI]: 6%, 53%) and 39% higher (95% CI: 14%, 71%) risks of the composite outcome, respectively. The highest quartile of 2-hour IGFBP-1 was associated with 35% higher (95% CI: 1%, 52%) risk of the composite end point. Similarly, higher mortality was significantly associated with higher fasting and 2-hour ghrelin levels and with 2-hour IGFBP-1 level. When examined together, 2-hour post-OGTT levels of IGFBP-1 and ghrelin tended to predict outcomes better than fasting levels. CONCLUSIONS Circulating IGFBP-1 and ghrelin measured during an OGTT predicted major health events and death in older adults, which may explain the influence of the GH/IGF-I axis on lifespan and health.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Thomas Rohan
- Department of Epidemiology and Population Health and
| | - Michael Pollak
- Department of Medicine and Oncology, McGill University, Montreal, Quebec, Canada H4A 3J1
| | - Lewis Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
| | - Jorge R Kizer
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461
| | - Anne Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Christopher I Li
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; and
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Epidemiology and Health Services, University of Washington & Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101
| | - Anne Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
| |
Collapse
|
35
|
McCabe EL, Larson MG, Lunetta KL, Newman AB, Cheng S, Murabito JM. Association of an Index of Healthy Aging With Incident Cardiovascular Disease and Mortality in a Community-Based Sample of Older Adults. J Gerontol A Biol Sci Med Sci 2016; 71:1695-1701. [PMID: 27117172 PMCID: PMC5106860 DOI: 10.1093/gerona/glw077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/07/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The healthy aging index (HAI) was developed as a marker of health in multiple systems that can identify individuals who age most successfully. METHODS We calculated an HAI in 934 Framingham Offspring Study participants aged 60 or older at baseline. Heart rate and C-reactive protein (CRP) were added in modified versions of the HAI. Cox proportional hazard models were used to quantify the association of the HAI with mortality, cardiovascular disease (CVD), and cancer. We used fully conditional specification to multiply impute missing values for HAI components, increasing the sample size by 44%. RESULTS Over 10 years of follow-up, there were 138 deaths, 103 incident cases of CVD, and 138 incident cases of cancer. In models adjusted for age, sex, and behavioral risk factors, the HAI was associated with mortality (hazard ratio [HR] per unit of HAI 1.24, 95% confidence interval [CI] 1.13-1.36) and with CVD (HR 1.27, 95% CI 1.13-1.42), but not with cancer (HR 1.01, 95% CI 0.91-1.11) in observed (non-missing) data. In multivariable models further adjusting for prevalent diseases, results were slightly attenuated. When including heart rate and CRP, a modified HAI gave stronger associations. Results with imputed data are similar to results from complete case analyses. CONCLUSIONS In our large community-based sample, the HAI is a strong predictor of mortality and CVD. Other factors that are strongly associated with mortality, such as heart rate and CRP can improve the ability of the HAI to identify the healthiest older adults.
Collapse
Affiliation(s)
- Elizabeth L McCabe
- Department of Biostatistics, Boston University School of Public Health, Massachusetts
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Massachusetts
- Framingham Heart Study, Massachusetts
- Department of Mathematics and Statistics, Boston University, Massachusetts
| | - Kathryn L Lunetta
- Department of Biostatistics, Boston University School of Public Health, Massachusetts
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Susan Cheng
- Framingham Heart Study, Massachusetts
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joanne M Murabito
- Framingham Heart Study, Massachusetts.
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Massachusetts
| |
Collapse
|
36
|
Jacob ME, Yee LM, Diehr PH, Arnold AM, Thielke SM, Chaves PHM, Gobbo LD, Hirsch C, Siscovick D, Newman AB. Can a Healthy Lifestyle Compress the Disabled Period in Older Adults? J Am Geriatr Soc 2016; 64:1952-1961. [PMID: 27603679 DOI: 10.1111/jgs.14314] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/17/2016] [Accepted: 02/13/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life. DESIGN Community-based cohort study of older adults followed from 1989 to 2015. SETTING Four U.S. communities. PARTICIPANTS Community-living men and women aged 65 and older (N = 5,248, mean age 72.7 ± 5.5, 57% female, 15.2% minority) who were not wheelchair dependent and were able to give informed consent at baseline. MEASUREMENTS Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index (BMI), social networks, and social support, were measured at baseline. Activities of daily living (ADLs) were assessed at baseline and throughout follow-up. Years of life (YoL) was defined as years until death. Years of able life (YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression or expansion of the disabled period. RESULTS The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity was associated with 7.3 percentage points (95% confidence interval (CI) = 5.4-9.2) lower YAL/YoL% than normal weight. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7% (95% CI = 1.6-5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with 0.5 percentage points (95% CI = 0.3-0.8) higher YAL/YoL%. CONCLUSION The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors.
Collapse
Affiliation(s)
- Mini E Jacob
- Geriatric Research, Education, and Clinical Center, Boston, Massachusetts.,Health and Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Laura M Yee
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Paula H Diehr
- Department of Biostatistics, University of Washington, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Stephen M Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Geriatric Research, Education, and Clinical Center, Seattle Veterans Affairs Medical Center, Seattle, Washington
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Liana Del Gobbo
- Division of Cardiovascular Medicine, Stanford University, Palo, Alto
| | - Calvin Hirsch
- Division of General Medicine, University of California Davis Medical Center, Sacramento, California
| | | | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
| |
Collapse
|
37
|
Abstract
Hypertension is a highly prevalent condition with numerous health risks, and the incidence of hypertension is greatest among older adults. Traditional discussions of hypertension have largely focused on the risks for cardiovascular disease and associated events. However, there are a number of collateral effects, including risks for dementia, physical disability, and falls/fractures which are increasingly garnering attention in the hypertension literature. Several key mechanisms--including inflammation, oxidative stress, and endothelial dysfunction--are common to biologic aging and hypertension development and appear to have key mechanistic roles in the development of the cardiovascular and collateral risks of late-life hypertension. The objective of the present review is to highlight the multi-dimensional risks of hypertension among older adults and discuss potential strategies for treatment and future areas of research for improving overall care for older adults with hypertension.
Collapse
|
38
|
Batty GD, Deary IJ, Zaninotto P. Association of Cognitive Function With Cause-Specific Mortality in Middle and Older Age: Follow-up of Participants in the English Longitudinal Study of Ageing. Am J Epidemiol 2016; 183:183-90. [PMID: 26803665 DOI: 10.1093/aje/kwv139] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We examined the little-tested associations between general cognitive function in middle and older age and later risk of death from chronic diseases. In the English Longitudinal Study of Ageing (2002-2012), 11,391 study participants who were 50-100 years of age at study induction underwent a battery of cognitive tests and provided a range of collateral data. In an analytical sample of 9,204 people (4,982 women), there were 1,488 deaths during follow-up (mean duration, 9.0 years). When we combined scores from 4 cognition tests that represented 3 acknowledged key domains of cognitive functioning (memory, executive function, and processing speed), cognition was inversely associated with deaths from cancer (per each 1-standard-deviation decrease in general cognitive function score, hazard ratio = 1.21, 95% CI: 1.10, 1.33), cardiovascular disease (hazard ratio = 1.71, 95% CI: 1.55, 1.89), other causes (hazard ratio = 2.07, 95% CI: 1.79, 2.40), and respiratory illness (hazard ratio = 2.48, 95% CI: 2.12, 2.90). Controlling for a range of covariates, such as health behaviors and socioeconomic status, and left-censoring to explore reverse causality had very little impact on the strength of these relationships. These findings indicate that cognitive test scores can provide relatively simple indicators of the risk of death from an array of chronic diseases and that these associations appear to be independent of other commonly assessed risk factors.
Collapse
|
39
|
Association of Smoking, Alcohol, and Obesity with Cardiovascular Death and Ischemic Stroke in Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study and Cardiovascular Health Study (CHS). PLoS One 2016; 11:e0147065. [PMID: 26756465 PMCID: PMC4710457 DOI: 10.1371/journal.pone.0147065] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 12/27/2015] [Indexed: 11/23/2022] Open
Abstract
Atrial fibrillation (AF) is associated with an increased risk of ischemic stroke and cardiovascular (CV) death. Whether modifiable lifestyle risk factors are associated with these CV outcomes in AF is unknown. Among Atherosclerosis Risk in Communities (ARIC) study and Cardiovascular Health Study (CHS) participants with incident AF, we estimated the risk of composite endpoint of ischemic stroke or CV death associated with candidate modifiable risk factor (smoking, heavy alcohol consumption, or high body mass index [BMI]), and computed the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) of incorporating each factor into the CHA2DS2-VASc. Among 1222 ARIC (mean age: 63.4) and 756 CHS (mean age: 79.1) participants with incident AF, during mean follow-up of 6.9 years and 5.7 years, there were 332 and 335 composite events respectively. Compared with never smokers, current smokers had a higher incidence of the composite endpoint in ARIC [HR: 1.65 (1.21–2.26)] but not in CHS [HR: 1.05 (0.69–1.61)]. In ARIC, the addition of current smoking did not improve risk prediction over and above the CHA2DS2-VASc. No significant associations were observed with alcohol consumption or BMI with CVD outcomes in AF patients from either cohort. Smoking is associated with an increased risk of ischemic stroke or CV death in ARIC, which comprised mostly middle-aged to young-old (65–74 years), but not in CHS, which comprised mostly middle-old or oldest-old (≥75 years) adults with AF. However, addition of smoking to the CHA2DS2-VASc score did not improve risk prediction of these outcomes.
Collapse
|
40
|
Abstract
OBJECTIVES Late-life bereavement is associated with an increased risk of mortality. This study assesses the associations among bereavement, cardiovascular disease (CVD), and depressive symptoms on mortality in older men and women. METHODS We examined data from the Cardiovascular Health Study, a prospective population-based cohort study of older adults. We compared mortality in those who became bereaved from 1989 to 1999 (n = 593) to an age- and sex-matched sample of individuals who remained married (n = 593). Cox regression was used to examine the association between bereavement and 3-year all-cause mortality and whether or not the association differed by sex, presence of CVD, or postbereavement depressive symptoms. RESULTS One hundred ninety-nine (16.8%) individuals died. There was no association of bereavement with mortality (hazard ratio [HR] = 0.98 [0.74-1.30]). However, there were significant interaction effects of bereavement with participant sex (p < .001) and CVD (p = .010). Bereavement decreased the risk of mortality in women (HR = 0.67 [0.46-0.97]) and increased the risk of mortality in men (HR = 1.77 [1.14-2.75]). Within sex, the association of bereavement with mortality differed according to CVD status. The reduced risk of mortality associated with bereavement in women was only observed in women with CVD, and the increased risk in men was only observed in men without CVD. High levels of depressive symptoms attenuated the relation between bereavement and mortality in men without CVD. CONCLUSIONS The relation between bereavement and mortality was different in men and women and varied by CVD status. Bereavement decreased mortality in women with CVD and increased mortality in men without CVD.
Collapse
|
41
|
Thielke SM, Diehr PH, Yee LM, Arnold AM, Quiñones AR, Whitson HE, Jacob ME, Newman AB. Sex, Race, and Age Differences in Observed Years of Life, Healthy Life, and Able Life among Older Adults in The Cardiovascular Health Study. J Pers Med 2015; 5:440-51. [PMID: 26610574 PMCID: PMC4695864 DOI: 10.3390/jpm5040440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 10/30/2015] [Accepted: 11/18/2015] [Indexed: 11/16/2022] Open
Abstract
Objective: Longevity fails to account for health and functional status during aging. We sought to quantify differences in years of total life, years of healthy life, and years of able life among groups defined by age, sex, and race. Design: Primary analysis of a cohort study. Setting: 18 years of annual evaluations in four U.S. communities. Participants: 5888 men and women aged 65 and older. Measurements: Years of life were calculated as the time from enrollment to death or 18 years. Years of total, healthy, and able life were determined from self-report during annual or semi-annual contacts. Cumulative years were summed across each of the age and sex groups. Results: White women had the best outcomes for all three measures, followed by white men, non-white women, and non-white men. For example, at the mean age of 73, a white female participant could expect 12.9 years of life, 8.9 of healthy life and 9.5 of able life, while a non-white female could expect 12.6, 7.0, and 8.0 years, respectively. A white male could expect 11.2, 8.1, and 8.9 years of life, healthy life, and able life, and a non-white male 10.3, 6.2, and 7.9 years. Regardless of starting age, individuals of the same race and sex groups spent similar amounts (not proportions) of time in an unhealthy or unable state. Conclusion: Gender had a greater effect on longevity than did race, but race had a greater effect on years spent healthy or able. The mean number of years spent in an unable or sick state was surprisingly independent of the lifespan.
Collapse
Affiliation(s)
- Stephen M Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
- Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA 98108, USA.
| | - Paula H Diehr
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA.
- Department of Health Services, University of Washington, Seattle, WA 98195, USA.
| | - Laura M Yee
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA.
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA.
- Department of Health Services, University of Washington, Seattle, WA 98195, USA.
| | - Ana R Quiñones
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
| | - Heather E Whitson
- Department of Medicine (Geriatrics) and the Aging Center, Duke University Medical Center, Durham, NC 27708, USA.
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC 27705, USA.
| | - Mini E Jacob
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| |
Collapse
|
42
|
Piggott DA, Varadhan R, Mehta SH, Brown TT, Li H, Walston JD, Leng SX, Kirk GD. Frailty, Inflammation, and Mortality Among Persons Aging With HIV Infection and Injection Drug Use. J Gerontol A Biol Sci Med Sci 2015; 70:1542-7. [PMID: 26386010 DOI: 10.1093/gerona/glv107] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 06/12/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Serum markers of inflammation increase with age and have been strongly associated with adverse clinical outcomes among both HIV-infected and uninfected adults. Yet, limited data exist on the predictive and clinical utility of aggregate measures of inflammation. This study sought to evaluate the relationship of a recently validated aggregate inflammatory index with frailty and mortality among aging HIV-infected and uninfected injection drug users. METHODS Frailty was assessed among HIV-infected and uninfected participants in the AIDS Linked to the IntraVenous Experience (ALIVE) cohort study using the five Fried phenotypic criteria: weight loss, exhaustion, low physical activity, decreased grip strength, and slow gait. The aggregate inflammatory index was constructed from serum measures of interleukin-6 and soluble tumor necrosis factor-α receptor-1. Multinomial logistic regression was used to assess the relationship of frailty with inflammation. Cox proportional hazards models were used to estimate risk for all-cause mortality. RESULTS Among 1,326 subjects, the median age was 48 years and 29% were HIV-infected. Adjusting for sociodemographics, comorbidity, and HIV status, frailty was significantly associated with each standard deviation increase in log interleukin-6 (odds ratio 1.33; 95% CI, 1.09-1.61), log tumor necrosis factor-α receptor-1 (odds ratio 1.25; 95% CI, 1.04-1.51) and inflammatory index score (odds ratio 1.39; 95% CI, 1.14-1.68). Adjusting for sociodemographics, comorbidity, HIV status, and frailty, the inflammatory index score was independently associated with increased mortality (HR 1.65; 95% CI, 1.44-1.89). CONCLUSION A recently validated, simple, biologically informed inflammatory index is independently associated with frailty and mortality risk among aging HIV-infected and uninfected injection drug users.
Collapse
Affiliation(s)
- Damani A Piggott
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland.
| | - Ravi Varadhan
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Todd T Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Huifen Li
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremy D Walston
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sean X Leng
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory D Kirk
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
43
|
Interleukin-6 as a first-rated serum inflammatory marker to predict mortality and hospitalization in the oldest old: A regression and CART approach in the BELFRAIL study. Exp Gerontol 2015; 69:53-61. [DOI: 10.1016/j.exger.2015.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/29/2015] [Accepted: 06/02/2015] [Indexed: 12/11/2022]
|
44
|
Abstract
BACKGROUND To our knowledge, a systematic comparison of predictors of mortality in middle-aged to elderly individuals has not yet been done. We investigated predictors of mortality in UK Biobank participants during a 5 year period. We aimed to investigate the associations between most of the available measurements and 5 year all-cause and cause-specific mortality, and to develop and validate a prediction score for 5 year mortality using only self-reported information. METHODS Participants were enrolled in the UK Biobank from April, 2007, to July, 2010, from 21 assessment centres across England, Wales, and Scotland with standardised procedures. In this prospective population-based study, we assessed sex-specific associations of 655 measurements of demographics, health, and lifestyle with all-cause mortality and six cause-specific mortality categories in UK Biobank participants using the Cox proportional hazard model. We excluded variables that were missing in more than 80% of the participants and all cardiorespiratory fitness test measurements because summary data were not available. Validation of the prediction score was done in participants enrolled at the Scottish centres. UK life tables and census information were used to calibrate the score to the overall UK population. FINDINGS About 500,000 participants were included in the UK Biobank. We excluded participants with more than 80% variables missing (n=746). Of 498,103 UK Biobank participants included (54% of whom were women) aged 37-73 years, 8532 (39% of whom were women) died during a median follow-up of 4·9 years (IQR 4·33-5·22). Self-reported health (C-index including age 0·74 [95% CI 0·73-0·75]) was the strongest predictor of all-cause mortality in men and a previous cancer diagnosis (0·73 [0·72-0·74]) was the strongest predictor of all-cause mortality in women. When excluding individuals with major diseases or disorders (Charlson comorbidity index >0; n=355 043), measures of smoking habits were the strongest predictors of all-cause mortality. The prognostic score including 13 self-reported predictors for men and 11 for women achieved good discrimination (0·80 [0·77-0·83] for men and 0·79 [0·76-0·83] for women) and significantly outperformed the Charlson comorbidity index (p<0·0001 in men and p=0·0007 in women). A dedicated website allows the interactive exploration of all results along with calculation of individual risk through an online questionnaire. INTERPRETATION Measures that can simply be obtained by questionnaires and without physical examination were the strongest predictors of all-cause mortality in the UK Biobank population. The prediction score we have developed accurately predicts 5 year all-cause mortality and can be used by individuals to improve health awareness, and by health professionals and organisations to identify high-risk individuals and guide public policy. FUNDING Knut and Alice Wallenberg Foundation and the Swedish Research Council.
Collapse
Affiliation(s)
- Andrea Ganna
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
45
|
Wu IC, Lin CC, Hsiung CA. Emerging roles of frailty and inflammaging in risk assessment of age-related chronic diseases in older adults: the intersection between aging biology and personalized medicine. Biomedicine (Taipei) 2015; 5:1. [PMID: 25722960 PMCID: PMC4333299 DOI: 10.7603/s40681-015-0001-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/15/2015] [Indexed: 12/11/2022] Open
Abstract
A chronic disease in older adults usually runs a course that is less predictable than in younger individuals. Unexplained variations in disease incidence, prognosis, therapeutic responses, and toxicity are frequently observed among older adults. This heterogeneity poses huge challenges to the current one-size-fits-all health care systems, and calls for more personalized managements of chronic diseases in older adults. Aging is characterized by progressive deterioration of bodily functions with increasing risk of failure over time. The entire process is hierarchically organized, and progresses from intracellular events to changes at systemic and ultimately organism levels at different rates among different individuals. Aging biology exerts great influences on the development and progression of most age-related chronic diseases. Thus, aging biology could contribute to the complexity of illnesses that increase with age, and aging biomarkers possess a great potential to enable personalized health risk assessment and health care. We review evidences supporting the roles of aging biomarkers in risk assessment of prevalent age-related diseases. Frailty phenotype is an objectively measured indicator of advanced-stage aging that is characterized by organism-level dysfunction. In contrast, altered inflammation markers level signifies an earlier stage between cellular abnormalities and systems dysfunction. Results of human observational studies and randomized controlled trials indicate that these measures, albeit simple, greatly facilitate classification of older patients with cancer, chronic kidney disease, cardiovascular diseases and type 2 diabetes mellitus into groups that vary in disease incidence, prognosis and therapeutic response/toxicity. As the detailed mechanisms underlying the complex biologic process of aging are unraveled in the future, a larger array of biomarkers that correlate with biologic aging at different stages will be discovered. Following the translational research framework described in this article, these research efforts would result in innovations in disease prevention and management that address the huge unmet health needs of aging populations.
Collapse
Affiliation(s)
- I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, No. 35 Keyan Road, Zhunan, Miaoli County 350, Miaoli, Taiwan ; Program for Ageing, College of Medicine, China Medical University, Taichung 404, 404 Taichung, Taiwan
| | - Cheng-Chieh Lin
- Program for Ageing, College of Medicine, China Medical University, Taichung 404, 404 Taichung, Taiwan ; Department of Family Medicine, China Medical University Hospital, 404 Taichung, Taiwan
| | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, No. 35 Keyan Road, Zhunan, Miaoli County 350, Miaoli, Taiwan ; Program for Ageing, College of Medicine, China Medical University, Taichung 404, 404 Taichung, Taiwan
| |
Collapse
|
46
|
Glei DA, Goldman N, Rodríguez G, Weinstein M. Beyond Self-Reports: Changes in Biomarkers as Predictors of Mortality. POPULATION AND DEVELOPMENT REVIEW 2014; 40:331-360. [PMID: 25089065 PMCID: PMC4117355 DOI: 10.1111/j.1728-4457.2014.00676.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The proliferation of biosocial surveys has increased the importance of weighing the costs and benefits of adding biomarker collection to population-based surveys. A crucial question is whether biomarkers offer incremental value beyond self-reported measures, which are easier to collect and impose less respondent burden. We use longitudinal data from a nationally representative sample of older Taiwanese (n = 639, aged 54+ in 2000, examined in 2000 and 2006 with mortality follow-up through 2011) to address that question with respect to predicting all-cause mortality. A summary measure of biomarkers improves mortality prediction (as measured by the area under the receiver operating characteristic curve) compared with self-reports alone, but individual biomarkers perform better than the summary score. We find that incorporating change in biomarkers over a six-year period yields a small improvement in mortality prediction compared with one-time measurement. But, is the incremental value worth the costs?
Collapse
Affiliation(s)
- Dana A. Glei
- Senior Research Investigator, Center for Population and
Health, Georgetown University
- Corresponding Author: Dana A. Glei, 5985 San
Aleso Ct., Santa Rosa, CA 95409-3912, USA. Phone (707) 539-5592;
| | - Noreen Goldman
- Hughes-Rogers Professor of Demography and Public Affairs,
Office of Population Research, Princeton University
| | - Germán Rodríguez
- Senior Research Demographer, Office of Population Research,
Princeton University
| | - Maxine Weinstein
- Distinguished Professor, Center for Population and Health,
Georgetown University
| |
Collapse
|
47
|
Míguez-Burbano MJ, Vargas M, Quiros C, Lewis JE, Espinoza L, Deshratan A. Menthol cigarettes and the cardiovascular risks of people living with HIV. J Assoc Nurses AIDS Care 2014; 25:427-35. [PMID: 24581861 DOI: 10.1016/j.jana.2014.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
Abstract
The possibility that menthol cigarettes add to the deleterious cardiovascular effects of smoking has been barely discussed. Although cardiovascular diseases (CVD) are at the forefront of medical concerns of people living with HIV (PLWH), an important, yet unknown, issue for clinicians and public health authorities is whether use of menthol-flavored cigarettes heightens CVD risk factors. Our study aims to assess traditional (10-year risk using the Framingham Risk Model) and nontraditional CVD risk factors and to contrast the effects of menthol-flavored versus non-menthol-flavored cigarettes on these risk factors. Compared to controls, menthol smokers were twice as likely to have hypertension. Users of menthol-flavored cigarettes had higher body mass index values, and increased risk of abdominal obesity. Multivariate analyses indicated that menthol smokers doubled the odds of having moderate to high CVD risk. This finding is highly significant given the widespread use of menthol-flavored cigarettes, particularly among women, minorities, and PLWH.
Collapse
|
48
|
Kulminski AM, Arbeev KG, Culminskaya I, Arbeeva L, Ukraintseva SV, Stallard E, Christensen K, Schupf N, Province MA, Yashin AI. Age, gender, and cancer but not neurodegenerative and cardiovascular diseases strongly modulate systemic effect of the Apolipoprotein E4 allele on lifespan. PLoS Genet 2014; 10:e1004141. [PMID: 24497847 PMCID: PMC3907310 DOI: 10.1371/journal.pgen.1004141] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 12/06/2013] [Indexed: 02/04/2023] Open
Abstract
Enduring interest in the Apolipoprotein E (ApoE) polymorphism is ensured by its evolutionary-driven uniqueness in humans and its prominent role in geriatrics and gerontology. We use large samples of longitudinally followed populations from the Framingham Heart Study (FHS) original and offspring cohorts and the Long Life Family Study (LLFS) to investigate gender-specific effects of the ApoE4 allele on human survival in a wide range of ages from midlife to extreme old ages, and the sensitivity of these effects to cardiovascular disease (CVD), cancer, and neurodegenerative disorders (ND). The analyses show that women's lifespan is more sensitive to the e4 allele than men's in all these populations. A highly significant adverse effect of the e4 allele is limited to women with moderate lifespan of about 70 to 95 years in two FHS cohorts and the LLFS with relative risk of death RR = 1.48 (p = 3.6×10−6) in the FHS cohorts. Major human diseases including CVD, ND, and cancer, whose risks can be sensitive to the e4 allele, do not mediate the association of this allele with lifespan in large FHS samples. Non-skin cancer non-additively increases mortality of the FHS women with moderate lifespans increasing the risks of death of the e4 carriers with cancer two-fold compared to the non-e4 carriers, i.e., RR = 2.07 (p = 5.0×10−7). The results suggest a pivotal role of non-sex-specific cancer as a nonlinear modulator of survival in this sample that increases the risk of death of the ApoE4 carriers by 150% (p = 5.3×10−8) compared to the non-carriers. This risk explains the 4.2 year shorter life expectancy of the e4 carriers compared to the non-carriers in this sample. The analyses suggest the existence of age- and gender-sensitive systemic mechanisms linking the e4 allele to lifespan which can non-additively interfere with cancer-related mechanisms. Discovering genetic origins of healthspan and lifespan could lead to breakthroughs in increasing the years of healthy and long life. In this paper we characterize the association of the e4 allele of the well-studied ApoE gene with lifespan in two generations of participants of large longitudinal studies, the Framingham Heart Study and the Long Life Family Study, and investigate the role of major human diseases such as cardiovascular disease, cancer, and neurodegenerative disorders in this association. This wide range of systemic analyses is possible given the large sample with directly genotyped ApoE polymorphism available from these studies (N = 9841, with 2557 deaths). The analyses show that women's lifespan is more sensitive to the e4 allele than men's in these populations. However, the strongly adverse effect of the e4 allele is not observed for all women, but only for those 70 to 95 years old. Cardiovascular disease, cancer, and neurodegenerative disorders do not mediate the association of the e4 allele with lifespan. However, cancer, but not cardiovascular and neurodegenerative diseases, non-additively enhances this effect resulting in 4.2 years of difference in mean lifespan for the e4 allele carriers compared to the non-carriers.
Collapse
Affiliation(s)
- Alexander M. Kulminski
- Center for Population Health and Aging, Duke University, Durham, North Carolina, United States of America
- Institute for Genome Science and Policy, Duke University, Durham, North Carolina, United States of America
- Social Science Research Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Konstantin G. Arbeev
- Center for Population Health and Aging, Duke University, Durham, North Carolina, United States of America
- Social Science Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Irina Culminskaya
- Center for Population Health and Aging, Duke University, Durham, North Carolina, United States of America
- Social Science Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Liubov Arbeeva
- Center for Population Health and Aging, Duke University, Durham, North Carolina, United States of America
| | - Svetlana V. Ukraintseva
- Center for Population Health and Aging, Duke University, Durham, North Carolina, United States of America
- Institute for Genome Science and Policy, Duke University, Durham, North Carolina, United States of America
- Social Science Research Institute, Duke University, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Eric Stallard
- Center for Population Health and Aging, Duke University, Durham, North Carolina, United States of America
- Social Science Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Kaare Christensen
- The Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
- Department of Clinical Genetics and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, United States of America
| | - Michael A. Province
- Washington University School of Medicine, Division of Statistical Genomics, St. Louis, Missouri, United States of America
| | - Anatoli I. Yashin
- Center for Population Health and Aging, Duke University, Durham, North Carolina, United States of America
- Institute for Genome Science and Policy, Duke University, Durham, North Carolina, United States of America
- Social Science Research Institute, Duke University, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| |
Collapse
|
49
|
Determinants of premature mortality in a city population: an eight-year observational study concerning subjects aged 18-64. Int J Occup Med Environ Health 2014; 26:724-41. [PMID: 24464538 DOI: 10.2478/s13382-013-0154-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/07/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Premature deaths constitute 31.1% of all deaths in Łódź. Analysis of the causes of premature deaths may be helpful in the evaluation of health risk factors. Moreover, findings of this study may enhance prophylactic measures. MATERIAL AND METHODS In 2001, 1857 randomly selected citizens, aged 18-64, were included in the Countrywide Integrated Noncommunicable Diseases Intervention (CINDI) Programme. In 2009, a follow-up study was conducted and information on the subjects of the study was collected concerning their health status and if they continued to live in Łódź. The Cox proportional hazards model was used for evaluation of hazard coefficients. We adjusted our calculations for age and sex. The analysis revealed statistically significant associations between the number of premature deaths of the citizens of Łódź and the following variables: a negative self-evaluation of health - HR = 3.096 (95% CI: 1.729-5.543), poor financial situation - HR = 2.811 (95% CI: 1.183-6.672), occurring in the year preceding the study: coronary pain - HR = 2.754 (95% CI: 1.167-6.494), depression - HR = 2.001 (95% CI: 1.222-3.277) and insomnia - HR = 1.660 (95% CI: 1.029-2.678). Our research study also found a negative influence of smoking on the health status - HR = 2.782 (95% CI: 1.581-4.891). Moreover, we conducted survival analyses according to sex and age with Kaplan-Meier curves. CONCLUSIONS The risk factors leading to premature deaths were found to be highly significant but possible to reduce by modifying lifestyle-related health behaviours. The confirmed determinants of premature mortality indicate a need to spread and intensify prophylactic activities in Poland, which is a post-communist country, in particular, in the field of cardiovascular diseases.
Collapse
|
50
|
Sebastiani P, Sun FX, Andersen SL, Lee JH, Wojczynski MK, Sanders JL, Yashin A, Newman AB, Perls TT. Families Enriched for Exceptional Longevity also have Increased Health-Span: Findings from the Long Life Family Study. Front Public Health 2013; 1:38. [PMID: 24350207 PMCID: PMC3859985 DOI: 10.3389/fpubh.2013.00038] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/12/2013] [Indexed: 11/17/2022] Open
Abstract
Hypothesizing that members of families enriched for longevity delay morbidity compared to population controls and approximate the health-span of centenarians, we compared the health-spans of older generation subjects of the Long Life Family Study (LLFS) to controls without family history of longevity and to centenarians of the New England Centenarian Study (NECS) using Bayesian parametric survival analysis. We estimated hazard ratios, the ages at which specific percentiles of subjects had onsets of diseases, and the gain of years of disease-free survival in the different cohorts compared to referent controls. Compared to controls, LLFS subjects had lower hazards for cancer, cardiovascular disease, severe dementia, diabetes, hypertension, osteoporosis, and stroke. The age at which 20% of the LLFS siblings and probands had one or more age-related diseases was approximately 10 years later than NECS controls. While female NECS controls generally delayed the onset of age-related diseases compared with males controls, these gender differences became much less in the older generation of the LLFS and disappeared amongst the centenarians of the NECS. The analyses demonstrate extended health-span in the older subjects of the LLFS and suggest that this aging cohort provides an important resource to discover genetic and environmental factors that promote prolonged health-span in addition to longer life-span.
Collapse
Affiliation(s)
- Paola Sebastiani
- Department of Biostatistics, Boston University School of Public Health , Boston, MA , USA
| | - Fangui X Sun
- Department of Biostatistics, Boston University School of Public Health , Boston, MA , USA
| | - Stacy L Andersen
- Geriatrics Division, Department of Medicine, Boston University School of Medicine and Boston Medical Center , Boston, MA , USA
| | - Joseph H Lee
- Department of Epidemiology, Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University , New York, NY , USA
| | | | - Jason L Sanders
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, PA , USA
| | - Anatoli Yashin
- Social Science Research Institute, Duke University , Durham, NC , USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, PA , USA
| | - Thomas T Perls
- Geriatrics Division, Department of Medicine, Boston University School of Medicine and Boston Medical Center , Boston, MA , USA
| |
Collapse
|