Vascular status and physical functioning: the association between vascular status and physical functioning in middle-aged and elderly men: a cross-sectional study

Association Between Pulse Wave Velocity and Frailty, Disability, and Mortality in Community-Dwelling Older Adults

Background

Arterial stiffness leads to several adverse events in the older population, but there is a lack of data on its association with frailty, disability, and mortality in the same population.

Objectives

The purpose of this study was to evaluate the role of arterial stiffness in the loss of functional ability (frailty and disability) and mortality.

Methods

Data were taken from community-dwelling aged 65 years participants without diabetes in the Toledo Study of Healthy Ageing cohort. Pulse wave velocity (PWV), assessed through SphygmoCor, was recorded at baseline. Median follow-up time were 2.99 years for frailty (frailty phenotype [FP] and Frailty Trait Scale-5 [FTS5]) and disability (Katz Index) and 6.2 for mortality. Logistic regressions models were built for disability and frailty and Cox proportional hazards model for death, adjusted by age and sex, comorbidity, cardiovascular risk factors, asymmetric dimethylarginine levels, and polypharmacy.

Results

Overall, 978 (mean age 74.5 ± 5.6 years, 56.7% female) participants were included. Different cut-off points were shown for each outcome. PWV >11.5 m/s was cross-sectionally associated with frailty (FP: OR fully-adjusted model: 1.69, 95% CI: 1.45-1.97; FTS5: OR: 1.51, 95% CI: 1.22-1.87) and disability (OR: 1.51, 95% CI: 1.26-1.79); PWV >10 m/s with incident frailty by FP (OR: 1.36, 95% CI: 1.10-1.68) and FTS5 (OR: 1.40, 95% CI: 1.12-1.75), and PWV >11 m/s with death (HR: 1.28, 95% CI: 1.09-1.50). For incident (OR: 1.28, 95% CI: 1.06-1.55) and worsening disability (OR: 1.21, 95% CI: 1.02-1.45) the threshold was 12.5 m/s. Below these cut-off points, age was the best predictor of adverse outcomes.

Conclusions

Arterial stiffness predicts frailty, disability, and mortality in older people, with different cut-off points, ie,severity degrees, for each of the assessed outcomes.

Abdominal aortic calcification is associated with decline in handgrip strength in the U.S. adult population ≥40 years of age

BACKGROUND AND AIMS

The present study investigated the association between abdominal aortic calcification (AAC) and handgrip strength (HGS) and the ability of HGS to predict an increased AAC phenotype in adults.

METHODS AND RESULTS

The analysis consisted of data for 3140 men and women aged ≥40 years (51.7% women) from the 2013-2014 NHANES. Lateral scans of the thoraco-lumbar spine (L1-L4) were scored for AAC using a validated 8-point scale (AAC-8); subjects with a score of ≥3 were considered at increased risk for cardiovascular disease due to a high AAC phenotype. HGS was assessed using a grip dynamometer. The prevalence of severe AAC in the population was 9.0%. Decline in HGS was associated with higher AAC-8 scores in men and women (p < 0.001). General linear model analysis showed that HGS levels were negatively associated with high AAC (p < 0.001) and AAC-8 status for both sexes. Likewise, for each 5-kg higher HGS, there lower odds of a high AAC phenotype (in men OR = 0.73, CI95%, 0.64-0.84) and (women OR = 0.58, CI95%, 0.47-0.70). Receiver operating characteristic curve analysis showed that the HGS threshold value to detect high risk of AAC in adults was ≥37.3 kg (AUC = 0.692) in men and 25.1 kg (AUC = 0.705) in women.

CONCLUSION

Lower muscular strength, as measured by HGS, is associated with higher AAC scores in the U.S. population ≥40 years of age. Accordingly, maintenance of muscular strength during aging may protect adults against vascular calcification, an independent predictor of cardiovascular events. HGS measurement seems to be a valid screening tool for detecting a high ACC phenotype in adults.

Muscle mass reduction, low muscle strength, and their combination are associated with arterial stiffness in community-dwelling elderly population: the Wakayama Study

Age-related loss of skeletal muscle mass and function is associated with some predisposing factors that increase the risk of vascular damage. This study aimed to examine whether muscle mass reduction, low muscle strength, and their combination were related to arterial stiffness in community-dwelling elderly population. Study participants consisted of 1046 elderly individuals (aged 72 ± 5 years) without cardiovascular disease, chronic kidney disease, or liver disease. Bioelectrical impedance analysis was performed to estimate appendicular skeletal muscle mass (ASM). A value for ASM was normalized for height (ASM index, kg/m²). Handgrip strength (HGS) was measured using a Smedley grip dynamometer. Brachial-ankle pulse wave velocity (baPWV) was evaluated as an index of arterial stiffness using a simple automatic oscillometric technique. When participants were stratified based on baPWV cut-off values (< 1800 cm/s, 1800 to 1999 cm/s, ≥ 2000 cm/s), ASM index and HGS progressively decreased with an increase in baPWV levels (P for trend < 0.001). In multiple regression analysis, baPWV was significantly associated with ASM index (β = -0.270, P < 0.001) and HGS (β = -0.102, P < 0.001) independent of potential confounding factors. The baPWV of the subgroup with low ASM index and low HGS was significantly higher than that of those with only low ASM index or low HGS (P < 0.001). These results suggest that loss of skeletal muscle mass and function is associated with increased arterial stiffness in the elderly population, and the combination of muscle mass reduction and low muscle strength may lead to greater arterial stiffness than each of the individual conditions.

Association between atherosclerosis and handgrip strength in non-hypertensive populations in India and Japan

Aim

Although several risk factors contribute to the development of sarcopenia, whether preclinical atherosclerosis contributes to the risk of sarcopenia is not established. The present cross‐sectional study aimed to investigate if there is an association between preclinical atherosclerosis and muscle strength among two ethnic populations.

Methods

Participants included individuals aged ≥40 years and enrolled in the third follow‐up examination of the Andhra Pradesh Children and Parents Study, India, and in the baseline assessments of the Nagasaki Islands Study, Japan. Preclinical atherosclerosis was evaluated by carotid intima‐media thickness, brachial‐ankle pulse wave velocity, cardio‐ankle vascular index. The association of carotid intima‐media thickness and pulse wave velocity/cardio‐ankle vascular index with handgrip strength (HGS) was analyzed separately in the sexes and for hypertensive status from the two cohorts using a multivariable linear regression model.

Results

Data on a total of 1501 participants in India and 3136 participants in Japan were analyzed. Carotid intima‐media thickness was negatively associated with HGS in non‐hypertensive Indian men (B coefficient = −5.38, P = 0.036). Arterial stiffness was also associated with HGS in non‐hypertensive Indian men (B = −0.97, P = 0.001), but not in hypertensive Indian men. Same as Indian men, we found the significant associations between arterial stiffness and HGS in non‐hypertensive women in both India and Japan (B = −0.44, P = 0.020, B = −0.63, P = 0.016, respectively), but not in hypertensive women.

Conclusions

The negative association between preclinical atherosclerosis and HGS was dominantly found in non‐hypertensive participants. Geriatr Gerontol Int 2018; 18: 1071–1078.

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

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

Atherosclerosis and physical functioning in older men, a longitudinal study

OBJECTIVE

Functional decline is a major threat to independency, progressing into functional limitations and eventually leading to disability. Chronic diseases, especially cardiovascular diseases, are important determinants of functional limitations and disability. Vascular damage exits long before it is clinically manifest and can have adverse effects on health, physical and cognitive functioning. The objective was to investigate the association between non-invasive atherosclerosis measures and physical functioning in older men.

DESIGN

Prospective cohort study.

SETTING

The study was conducted in the general community.

PARTICIPANTS

195 independently living older men.

MEASUREMENTS

Atherosclerosis was measured by intima media thickness (CIMT) of the common carotid artery using ultrasonography and assessment for presence of atherosclerotic plaques. Physical functioning was measured by isometric handgrip strength and leg extensor strength using a hand held dynamometer, lower extremity function using the physical performance score and ability to perform activities of daily life using the modified Stanford health assessment questionnaire. Linear regression analysis was performed to estimate the associations between CIMT or plaques and physical functioning.

RESULTS

After adjustment for confounders, higher baseline CIMT was associated with lower isometric handgrip strength at follow up (βCIMT = -7.21, 95% CI[-13.64;-0.77]). No other associations were found between CIMT and physical functioning. In addition, no associations were found for the presence of plaques and physical functioning either at baseline, or at follow-up.

CONCLUSION

Atherosclerosis, as measured by higher CIMT, is related to a lower isometric handgrip strength at follow-up, but no further associations with physical functioning were found in this longitudinal study among independently living older men.

Vascular function and handgrip strength in rheumatoid arthritis patients

OBJECTIVE

To examine the relationship of handgrip strength with forearm blood flow (BF) and vascular resistance (VR) in rheumatoid arthritis (RA) patients.

METHODS

Forearm BF at rest (RBF) and after upper arm occlusion (RHBF), and handgrip strength were examined in 78 individuals (RA = 42 and controls (CT) = 36). Subsequently, VR at rest (RVR) and after occlusion (RHVR) were calculated.

RESULTS

The patients' RBF (P = 0.02) and RHBF (P = 0.0001) were less, whereas RVR (P = 0.002) and RHVR (P = 0.0001) were greater as compared to the CTs. Similarly, handgrip strength was lower in the RAs (P = 0.0001). Finally, handgrip strength was directly associated with RBF (r = 0.43; P = 0.0001), and RHBF (r = 0.5; P = 0.0001), and inversely related to RVR (r = -0.3; P = 0.009) and RHVR (r = -0.3; P = 0.007).

CONCLUSION

The present study uniquely identifies an association between regional measures of forearm blood flow and handgrip strength in patients and healthy control. In addition, this study confirms the presence of vascular and muscle dysfunction in patients with rheumatoid arthritis, as evidenced by lower forearm blood flow indices, at rest and following occlusion, and lower handgrip strength as compared to healthy individuals.

Physical performance characteristics related to disability in older persons: a systematic review

BACKGROUND

Progressive disability develops with older age in association with underlying disease, comorbidity and frailty. Physical performance characteristics are important to improve the physical condition of older persons and therefore may be able to prevent or delay the onset of (progressive) disability. However lack of understanding of the physiology and etiology of functional decline leading to disability causes a problem in the development of effective preventive interventions. The aim of the present review is to determine which physical performance characteristics are determinants of disability in the older general population.

METHODS

We searched systematically the electronic databases of PubMed (MEDLINE), CINAHL, Cochrane Library, Psychlit and Embase for cohort studies and randomized controlled trials assessing disability in the older general population. Outcomes of interest were handgrip strength, upper and lower extremity function, balance gait and physical activity. The searching strategy resulted in 22 studies included in the present systematic review.

RESULTS

Although heterogeneity was present in the measurements of disability, consistent findings were shown for physical performance characteristics and disability. In general, a lower score of the physical performance characteristics was associated with a higher probability of (the development of) disability. The association for other aspects of gait (e.g. gait-step continuity, gait-step symmetry, path deviation and turning) and disability seems to be present, though the number of studies is limited.

CONCLUSION

In the present systematic review, associations were found for hand grip strength, upper and lower body strength, gait speed, physical activity and the probability of disability.