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Zhai L, Huo RR, Zuo YL. Atherogenic index of plasma and obesity-related risk of stroke in middle-aged and older Chinese adults: a national prospective cohort study. Diabetol Metab Syndr 2024; 16:245. [PMID: 39380102 DOI: 10.1186/s13098-024-01481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 09/29/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUD The association between the atherogenic index of plasma (AIP) and stroke risk is uncertain. Overweight and obese individuals frequently develop atherosclerosis, suggesting AIP may mediate the relationship between body mass index (BMI) and stroke risk. This study investigates whether AIP mediates the BMI-stroke association and evaluates the interaction effects of AIP and BMI on stroke risk in middle-aged and older Chinese adults. METHOD This study analyzes data from the China Health and Retirement Longitudinal Study (CHARLS), an ongoing nationally representative prospective cohort study that began in 2011. It includes 8 598 middle-aged and older Chinese adults without stroke at baseline. A mediation analysis, employing a novel two-stage regression method, was conducted to evaluate the indirect effect of BMI on stroke through AIP. RESULTS During a median follow-up of 7.1 years, 615 (7.2%) participants developed a stroke. After adjusting for confounders, AIP was significantly associated with stroke risk (hazard ratio [HR] per 1-SD increase, 1.24; 95% CI 1.14-1.35). Mediation analysis indicated that compared to normal weight, obesity similarly raised stroke risk by 78.0% (HR 1.78, 95% CI 1.40-2.27), with 29.67% (95% CI 14.27-45.08%) of the association mediated through AIP (HR 1.15, 95% CI 1.08-1.23). No significant multiplicative or additive interactions were observed between BMI and AIP on stroke. CONCLUSIONS This study found that the AIP appeared to be associated with stroke risk and mediates the association between obesity and stroke among middle-aged and older Chinese adults.
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Affiliation(s)
- Lu Zhai
- Department of Smart Health Elderly Care Services and Management, School of Nursing, Guangxi Health Science College, Nanning, China
| | - Rong-Rui Huo
- Department of Experimental Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yan-Li Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Shuang Yong Rd. #22, Nanning, 530021, China.
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Ren Q, Huang Y, Liu Q, Chu T, Li G, Wu Z. Association between triglyceride glucose-waist height ratio index and cardiovascular disease in middle-aged and older Chinese individuals: a nationwide cohort study. Cardiovasc Diabetol 2024; 23:247. [PMID: 38992634 PMCID: PMC11241990 DOI: 10.1186/s12933-024-02336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index and its combination with obesity indicators can predict cardiovascular diseases (CVD). However, there is limited research on the relationship between changes in the triglyceride glucose-waist height ratio (TyG-WHtR) and CVD. Our study aims to investigate the relationship between the change in the TyG-WHtR and the risk of CVD. METHODS Participants were from the China Health and Retirement Longitudinal Study (CHARLS). CVD was defined as self-reporting heart disease and stroke. Participants were divided into three groups based on changes in TyG-WHtR using K-means cluster analysis. Multivariable binary logistic regression analysis was used to examine the association between different groups (based on the change of TyG-WHtR) and CVD. A restricted cubic spline (RCS) regression model was used to explore the potential nonlinear association of the cumulative TyG-WHtR and CVD events. RESULTS During follow-up between 2015 and 2020, 623 (18.8%) of 3312 participants developed CVD. After adjusting for various potential confounders, compared to the participants with consistently low and stable TyG-WHtR, the risk of CVD was significantly higher in participants with moderate and increasing TyG-WHtR (OR 1.28, 95%CI 1.01-1.63) and participants with high TyG-WHtR with a slowly increasing trend (OR 1.58, 95%CI 1.16-2.15). Higher levels of cumulative TyG-WHtR were independently associated with a higher risk of CVD events (per SD, OR 1.27, 95%CI 1.12-1.43). CONCLUSIONS For middle-aged and older adults, changes in the TyG-WHtR are independently associated with the risk of CVD. Maintaining a favorable TyG index, effective weight management, and a reasonable waist circumference contribute to preventing CVD.
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Affiliation(s)
- Qiushi Ren
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Yang Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Quan Liu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Tongxin Chu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Gang Li
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, China.
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
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Rivier C, Szejko N, Renedo D, Clocchiatti-Tuozzo S, Huo S, de Havenon A, Zhao H, Gill T, Sheth K, Falcone G. Bidirectional relationship between epigenetic age and brain health events. RESEARCH SQUARE 2024:rs.3.rs-4378855. [PMID: 38978587 PMCID: PMC11230493 DOI: 10.21203/rs.3.rs-4378855/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Chronological age offers an imperfect estimate of the molecular changes that occur with aging. Epigenetic age, which is derived from DNA methylation data, provides a more nuanced representation of aging-related biological processes. This study examines the bidirectional relationship between epigenetic age and the occurrence of brain health events (stroke, dementia, and late-life depression). Using data from the Health and Retirement Study, we analyzed blood samples from over 4,000 participants to determine how epigenetic age relates to past and future brain health events. Study participants with a prior brain health event prior to blood collection were 4% epigenetically older (beta 0.04, SE 0.01), suggesting that these conditions are associated with faster aging than that captured by chronological age. Furthermore, a one standard deviation increase in epigenetic age was associated with 70% higher odds of experiencing a brain health event in the next four years after blood collection (OR 1.70, 95%CI 1.16-2.50), indicating that epigenetic age is not just a consequence but also a predictor of poor brain health. Both results were replicated through Mendelian Randomization analyses, supporting their causal nature. Our findings support the utilization of epigenetic age as a useful biomarker to evaluate the role of interventions aimed at preventing and promoting recovery after a brain health event.
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Cobert J, Jeon SY, Boscardin J, Chapman AC, Espejo E, Maley JH, Lee S, Smith AK. Resilience, Survival, and Functional Independence in Older Adults Facing Critical Illness. Chest 2024:S0012-3692(24)00700-1. [PMID: 38871280 DOI: 10.1016/j.chest.2024.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Older adults surviving critical illness often experience new or worsening functional impairments. Modifiable positive psychological constructs such as resilience may mitigate post-intensive care morbidity. RESEARCH QUESTION Is pre-ICU resilience associated with: (1) post-ICU survival; (2) the drop in functional independence during the ICU stay; or (3) the trend in predicted independence before vs after the ICU stay? STUDY DESIGN AND METHODS This retrospective cohort study was performed by using Medicare-linked Health and Retirement Study surveys from 2006 to 2018. Older adults aged ≥ 65 years admitted to an ICU were included. Resilience was calculated prior to ICU admission. The resilience measure was defined from the Simplified Resilience Score, which was previously adapted and validated for the Health and Retirement Study. Resilience was scored by using the Leave-Behind survey normalized to a scale from 0 (lowest resilience) to 12 (highest resilience). Outcomes were survival and probability of functional independence. Survival was modeled by using Gompertz models and independence using joint survival models adjusting for sociodemographic and clinical variables. Average marginal effects were estimated to determine independence probabilities. RESULTS Across 3,409 patients aged ≥ 65 years old admitted to ICUs, preexisting frailty (30.5%) and cognitive impairment (24.3%) were common. Most patients were previously independent (82.7%). Mechanical ventilation occurred in 14.8% and sepsis in 43.2%. Those in the highest resilience group (vs lowest resilience) had a lower risk of post-ICU mortality (adjusted hazard ratio, 0.81; 95% CI, 0.70-0.94). Higher resilience was associated with greater likelihood of post-ICU functional independence (estimated probability of functional independence 5 years after ICU discharge in highest-to-lowest resilience groups (adjusted hazard ratio [95% CI]): 0.53 (0.33-0.74), 0.47 (0.26-0.68), 0.49 (0.28-0.70), and 0.36 (0.17-0.55); P < .01. Resilience was not associated with a difference in the drop in independence during the ICU stay or a difference in the pre-ICU vs post-ICU trend in predicted independence . INTERPRETATION ICU survivors with higher resilience had increased rates of survival and functional independence, although the slope of functional decline before vs after the ICU stay did not differ according to resilience group.
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Affiliation(s)
- Julien Cobert
- Anesthesia Service, San Francisco VA Health Care System, San Francisco, CA; Department of Anesthesiology, University of California San Francisco, San Francisco, CA.
| | - Sun Young Jeon
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA; Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - John Boscardin
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - Allyson C Chapman
- Critical Care and Palliative Medicine, Department of Internal Medicine, University of California San Francisco, San Francisco, CA; Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Edie Espejo
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - Jason H Maley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sei Lee
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA; Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA; Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
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Qi Y, Shang X, Han T, Han N, Jiang Z, Yan H, Yue S, Sun Q, Liu L, Cui C. Serum cystatin C and stroke risk: a national cohort and Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1355948. [PMID: 38681764 PMCID: PMC11045987 DOI: 10.3389/fendo.2024.1355948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose The debate over the causal and longitudinal association between cystatin C and stroke in older adults persists. Our aim was to assess the link between cystatin C levels, both measured and genetically predicted, and stroke risk. Methods This study employed a retrospective cohort design using samples of the China Health and Retirement Longitudinal Study (CHARLS), which is a nationally representative cohort recruiting individuals aged 45 years or above. A multivariate logistic model and the two-sample Mendelian randomization framework were used to investigate the longitudinal and genetically predicted effect of serum cystatin C on stroke. Results The study population had a mean age of 59.6 (SD ±9.5), with 2,996 (46.1%) women. After adjusting for confounding factors, compared to those in the first quartile of cystatin C, those in the last quartile had the greatest risk of stroke incidence [odds ratio (OR), 1.380; 95% confidence interval (CI), 1.046-1.825]. The Mendelian randomization analysis showed that a genetically predicted cystatin C level was positively associated with total stroke (OR by inverse variance-weighted method, 1.114; 95% CI, 1.041-1.192). Conclusions This national cohort study suggests that higher serum cystatin C is associated with an increased risk of total stroke, which is further supported by Mendelian randomization.
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Affiliation(s)
- Yitian Qi
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Xinyun Shang
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Tianjiao Han
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Ning Han
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Ziwei Jiang
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Han Yan
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Siqi Yue
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Qichao Sun
- The First Bethune Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Lin Liu
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Cancan Cui
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
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Xian G, Chai Y, Gong Y, He W, Ma C, Zhang X, Zhang J, Ma Y. The relationship between healthy lifestyles and cognitive function in Chinese older adults: the mediating effect of depressive symptoms. BMC Geriatr 2024; 24:299. [PMID: 38549104 PMCID: PMC10979595 DOI: 10.1186/s12877-024-04922-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Previous studies have proven the positive relationship between healthy lifestyles and cognitive function in older adults. However, the specific impacts and mechanisms require further investigation. Therefore, this study aimed to investigate whether healthy lifestyles and cognitive function were associated with Chinese older adults and whether depressive symptoms mediated their association. METHODS 8272 valid samples were included using the latest data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Pearson's test was applied to investigate the relationship between the key variables. Regression models were employed to examine the mediating effects of healthy lifestyles, using Sobel's test and the bootstrap method to confirm path effects. RESULTS There was a significant correlation between healthy lifestyles, depressive symptoms, and cognitive function (p < 0.01). Healthy lifestyles directly impact cognitive function (β = 0.162, p < 0.01). Healthy lifestyles had a significant effect on depressive symptoms (β=-0.301, p < 0.01), while depressive symptoms have a significant impact on cognitive function (β=-0.108, p < 0.01). Depressive symptoms partially mediated the effect of healthy lifestyles on cognitive function (β = 0.032, p < 0.01). The Sobel and bootstrap tests confirmed the robustness of the regression analysis results. CONCLUSION Depressive symptoms mediate the relationship between healthy lifestyles and cognitive function. Our findings suggest that prevention strategies for cognitive impairment in older adults should focus on healthy lifestyles and mental health.
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Affiliation(s)
- Guowei Xian
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Yulin Chai
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Yunna Gong
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Wenfeng He
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Chunxiao Ma
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Xiaolin Zhang
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Jing Zhang
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Yong Ma
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China.
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He D, Wang Z, Li J, Yu K, He Y, He X, Liu Y, Li Y, Fu R, Zhou D, Zhu Y. Changes in frailty and incident cardiovascular disease in three prospective cohorts. Eur Heart J 2024:ehad885. [PMID: 38241094 DOI: 10.1093/eurheartj/ehad885] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/20/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND AND AIMS Previous studies found that frailty was an important risk factor for cardiovascular disease (CVD). However, previous studies only focused on baseline frailty status, not taking into consideration the changes in frailty status during follow-up. The aim of this study was to investigate the associations of changes in frailty status with incident CVD. METHODS This study used data of three prospective cohorts: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS). Frailty status was evaluated by the Rockwood frailty index and classified as robust, pre-frail, or frail. Changes in frailty status were assessed by frailty status at baseline and the second survey which was two years after the baseline. Cardiovascular disease was ascertained by self-reported physician-diagnosed heart disease (including angina, heart attack, congestive heart failure, and other heart problems) or stroke. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders. RESULTS A total of 7116 participants from CHARLS (female: 48.6%, mean age: 57.4 years), 5303 from ELSA (female: 57.7%, mean age: 63.7 years), and 7266 from HRS (female: 64.9%, mean age: 65.1 years) were included according to inclusion and exclusion criteria. The median follow-up periods were 5.0 years in the CHARLS, 10.7 years in the ELSA, and 9.5 years in the HRS. Compared with stable robust participants, robust participants who progressed to pre-frail or frail status had increased risks of incident CVD (CHARLS, HR = 1.84, 95% CI: 1.54-2.21; ELSA, HR = 1.53, 95% CI: 1.25-1.86; HRS, HR = 1.59, 95% CI: 1.31-1.92). In contrast, frail participants who recovered to robust or pre-frail status presented decreased risks of incident CVD (CHARLS, HR = 0.62, 95% CI: 0.47-0.81; ELSA, HR = 0.49, 95% CI: 0.34-0.69; HRS, HR = 0.70, 95% CI: 0.55-0.89) when compared with stable frail participants. These decreased risks of incident CVD were also observed in pre-frail participants who recovered to robust status (CHARLS, HR = 0.66, 95% CI: 0.52-0.83; ELSA, HR = 0.65, 95% CI: 0.49-0.85; HRS, HR = 0.71, 95% CI: 0.56-0.91) when compared with stable pre-frail participants. CONCLUSIONS Different changes in frailty status are associated with different risks of incident CVD. Progression of frailty status increases incident CVD risks, while recovery of frailty status decreases incident CVD risks.
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Affiliation(s)
- Di He
- Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
| | - Zhaoping Wang
- Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
| | - Jun Li
- Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
| | - Kaixin Yu
- Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
| | - Yusa He
- Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
| | - Xinyue He
- Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
| | - Yuanjiao Liu
- Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
| | - Yuhao Li
- Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
| | - Ruiyi Fu
- Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
| | - Dan Zhou
- Department of Big Data in Health Science, School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
- Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
| | - Yimin Zhu
- Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
- Cancer Center, Zhejiang University, 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang, China
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Waziry R, Gu Y, Boehme AK, Williams OA. Measures of Aging Biology in Saliva and Blood as Novel Biomarkers for Stroke and Heart Disease in Older Adults. Neurology 2023; 101:e2355-e2363. [PMID: 37848333 PMCID: PMC10752636 DOI: 10.1212/wnl.0000000000207909] [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] [Received: 07/24/2023] [Accepted: 08/24/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The role of aging biology as a novel risk factor and biomarker for vascular outcomes in different accessible body tissues such as saliva and blood remain unclear. We aimed to (1) assess the role of aging biology as a risk factor of stroke and heart disease among individuals of same chronologic age and sex and (2) compare aging biology biomarkers measured in different accessible body tissues as novel biomarkers for stroke and heart disease in older adults. METHODS This study included individuals who consented for blood and saliva draw in the Venous Blood Substudy and Telomere Length Study of the Health and Retirement Study (HRS). The HRS is a population-based, nationally representative longitudinal survey of individuals aged 50 years and older in the United States. Saliva-based measures included telomere length. Blood-based measures included DNA methylation and physiology biomarkers. Propensity scores-matched analyses and Cox regression models were conducted. RESULTS This study included individuals aged 50 years and older, who consented for blood (N = 9,934) and saliva (N = 5,808) draw in the HRS. Blood-based biomarkers of aging biology showed strong associations with incident stroke as follows: compared with the lowest tertile of blood-based biomarkers of aging, biologically older individuals had significantly higher risk of stroke based on DNA methylation Grim Age clock (adjusted hazard ratio [aHR] = 2.64, 95% CI 1.90-3.66, p < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.75, 95% CI 1.27-2.42, p < 0.001). In secondary analysis, biologically older individuals had increased risk of heart disease as follows: DNA methylation Grim Age clock (aHR = 1.77, 95% CI 1.49-2.11, p < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.61, 95% CI 1.36-1.90, p < 0.001). DISCUSSION Compared with saliva-based telomere length, blood-based aging physiology and some DNA methylation biomarkers are strongly associated with vascular disorders including stroke and are more precise and sensitive biomarkers of aging. Saliva-based telomere length and blood-based DNA methylation and physiology biomarkers likely represent different aspects of biological aging and accordingly vary in their precision as novel biomarkers for optimal vascular health.
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Affiliation(s)
- Reem Waziry
- From the Department of Neurology (R.W., Y.G., A.K.B., O.A.W.) and G.H. Sergievsky Center (Y.G.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center; Department of Epidemiology (Y.G.), Joseph P. Mailman School of Public Health, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York.
| | - Yian Gu
- From the Department of Neurology (R.W., Y.G., A.K.B., O.A.W.) and G.H. Sergievsky Center (Y.G.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center; Department of Epidemiology (Y.G.), Joseph P. Mailman School of Public Health, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York
| | - Amelia K Boehme
- From the Department of Neurology (R.W., Y.G., A.K.B., O.A.W.) and G.H. Sergievsky Center (Y.G.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center; Department of Epidemiology (Y.G.), Joseph P. Mailman School of Public Health, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York
| | - Olajide A Williams
- From the Department of Neurology (R.W., Y.G., A.K.B., O.A.W.) and G.H. Sergievsky Center (Y.G.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center; Department of Epidemiology (Y.G.), Joseph P. Mailman School of Public Health, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York
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Richards-Belle A, Poole N, Osborn DP, Bell V. Longitudinal associations between stroke and psychosis: a population-based study. Psychol Med 2023; 53:7698-7706. [PMID: 37272367 PMCID: PMC10755233 DOI: 10.1017/s0033291723001575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The co-occurrence of stroke and psychosis is a serious neuropsychiatric condition but little is known about the course of this comorbidity. We aimed to estimate longitudinal associations between stroke and psychosis over 10 years. METHODS A 10-year population-based study using data from the English Longitudinal Study of Ageing. A structured health assessment recorded (i) first-occurrence stroke and (ii) psychosis, at each wave. Each were considered exposures and outcomes in separate analyses. Logistic and Cox proportional hazards regression and Kaplan-Meier methods were used. Models were adjusted for demographic and health behaviour covariates, with missing covariates imputed using random forest multiple imputation. RESULTS Of 19 808 participants, 24 reported both stroke and psychosis (median Wave 1 age 63, 71% female, 50% lowest quintile of net financial wealth) at any point during follow-up. By 10 years, the probability of an incident first stroke in participants with psychosis was 21.4% [95% confidence interval (CI) 12.1-29.6] compared to 8.3% (95% CI 7.8-8.8) in those without psychosis (absolute difference: 13.1%; 95% CI 20.8-4.3, log rank p < 0.001; fully-adjusted hazard ratio (HR): 3.57; 95% CI 2.18-5.84). The probability of reporting incident psychosis in participants with stroke was 2.3% (95% CI 1.4-3.2) compared to 0.9% (95% CI 0.7-1.1) in those without (absolute difference: 1.4%; 95% CI 0.7-2.1, log rank p < 0.001; fully-adjusted HR: 4.98; 95% CI 2.55-9.72). CONCLUSIONS Stroke is an independent predictor of psychosis (and vice versa), after adjustment for potential confounders.
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Affiliation(s)
- Alvin Richards-Belle
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Norman Poole
- Department of Neuropsychiatry, South West London and St George's Mental Health NHS Trust, London, UK
| | | | - Vaughan Bell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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10
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Han Q, Chu J, Hu W, Liu S, Sun N, Chen X, He Q, Feng Z, Li T, Wu J, Shen Y. Association between coffee and incident heart failure: A prospective cohort study from the UK Biobank. Nutr Metab Cardiovasc Dis 2023; 33:2119-2127. [PMID: 37563067 DOI: 10.1016/j.numecd.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND AIMS The relationship between coffee consumption and heart failure (HF) incidence is inconclusive. This study aimed to explore the association between time-varying coffee consumption and incident HF using a longitudinal study design. METHODS AND RESULTS Data were obtained from the UK Biobank, comprising 497,503 adults (age, 56.5 ± 8.1 years; 54.6% women) who were free from HF at baseline in 2006-2010. The median follow-up time for the HF incidence was 11.9 years. Marginal structural models (MSM) were employed to adjust for potential time-varying confounders and account for bias caused by loss of follow-up. Furthermore, we used a restricted cubic spline to test and describe the nonlinear relationship between coffee consumption and HF risk. At baseline, 70.5% of participants reported drinking ≥1 cups/d coffee and 2.7% participants developed HF. After adjusting for potential confounders, we identified a nonlinear J-shaped association between coffee consumption and HF risk (P < 0.001). Compared with drinking coffee <1 cups/d, 1-2 cups/d (HR = 0.878; 95% CI: 0.838-0.920), 3-4 cups/d (HR = 0.920; 95% CI: 0.869-0.974) may be associated with a reduced risk of HF, while >6 cups/d (HR = 1.209; 95% CI: 1.056-1.385) may be associated with a higher risk of HF. However, sensitive analyses stratified by gender and smoking status indicated that >6 cups/d does not significantly increase the risk of HF. Additionally, the type of coffee was found to significant impact on the incidence of HF (P < 0.05). CONCLUSION In this large cohort of UK adults, moderate coffee consumption may reduce risk of HF incidence.
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Affiliation(s)
- Qiang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Jiadong Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Wei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Siyuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Na Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Xuanli Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Qida He
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Zhaolong Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Tongxing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Jun Wu
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China.
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11
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Ni Y, Zhou Y, Kivimäki M, Cai Y, Carrillo-Larco RM, Xu X, Dai X, Xu X. Socioeconomic inequalities in physical, psychological, and cognitive multimorbidity in middle-aged and older adults in 33 countries: a cross-sectional study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e618-e628. [PMID: 37924843 DOI: 10.1016/s2666-7568(23)00195-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Many physical, psychological, and cognitive disorders are highly clustered among populations with low socioeconomic status. However, the extent to which socioeconomic status is associated with different combinations of these disorders is unclear, particularly outside high-income countries. We aimed to evaluate these associations in 33 countries including high-income countries, upper-middle-income countries, and one lower-middle-income country. METHODS This cross-sectional multi-region study pooled individual-level data from seven studies on ageing between 2017 and 2020. Education and total household wealth were used to measure socioeconomic status. Physical disorder was defined as having one or more of the self-reported chronic conditions. Psychological and cognitive disorders were measured by study-specific instruments. The outcome included eight categories: no disorders, physical disorder, psychological disorder, cognitive disorder, and their four combinations. Multivariable-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% CIs for the associations of socioeconomic status with these outcomes separately for high-income countries, upper-middle-income countries, and the lower-middle-income country. FINDINGS Among 167 376 individuals aged 45 years and older, the prevalence of multimorbidity was 24·5% in high-income countries, 33·9% in upper-middle-income countries, and 8·1% in the lower-middle-income country (India). Lower levels of education, household wealth, and a combined socioeconomic status score were strongly associated with physical, psychological, and cognitive multimorbidity in high-income countries and upper-middle-income countries, with ORs (low vs high socioeconomic status) for physical-psychological-cognitive multimorbidity of 12·36 (95% CI 10·29-14·85; p<0·0001) in high-income countries and of 23·84 (18·85-30·14; p<0·0001) in upper-middle-income countries. The associations in the lower-middle-income country were mixed. Participants with both a low level of education and low household wealth had the highest odds of multimorbidity (eg, OR for physical-psychological-cognitive multimorbidity 21·21 [15·95-28·19; p<0·0001] in high-income countries, 37·07 [25·66-53·56; p<0·0001] in upper-middle-income countries, and 54·96 [7·66-394·38; p<0·0001] in the lower-middle-income country). INTERPRETATION In study populations from high-income countries, upper-middle-income countries, and the lower-middle-income country, the odds of multimorbidity, which included physical, psychological, and cognitive disorders, were more than ten times greater in individuals with low socioeconomic status. Equity-oriented policies and programmes that reduce social inequalities in multimorbidity are urgently needed to achieve Sustainable Development Goals. FUNDING Zhejiang University, Fundamental Research Funds for the Central Universities, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Wellcome Trust, Medical Research Council, National Institute on Aging, and Academy of Finland. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yujie Ni
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China
| | - Yaguan Zhou
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China
| | - Mika Kivimäki
- UCL Brain Sciences, University College London, London, UK
| | - Ying Cai
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Rodrigo M Carrillo-Larco
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Xin Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China
| | - Xiaochen Dai
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xiaolin Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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12
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Zhu C, Lian Z, Huang Y, Zhong Q, Wang J. Association between subjective well-being and all-cause mortality among older adults in China. BMC Psychiatry 2023; 23:624. [PMID: 37626305 PMCID: PMC10463678 DOI: 10.1186/s12888-023-05079-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Although several studies in high-income countries have suggested a positive association between subjective well-being (SWB) and mortality, studies conducted in low- and middle-income countries, such as China, are scarce. The purpose of this study is to examine the association between SWB and all-cause mortality among the older Chinese population. METHODS Data were from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a population-based longitudinal cohort study in 22 of 31 provinces in mainland China. A total of 13,282 individuals aged 65 ≥ years who were recruited in 2002 and followed-up until 2018 were included. SWB was assessed with an eight-item tool covering life satisfaction, positive affect (including optimism, happiness, personal control and conscientiousness) and negative affect (including anxiety, loneliness and uselessness). Cox proportional hazards regression methods were carried out to estimate the association between SWB and total mortality, adjusting for a wide range of potential confounders. Subgroup analyses and interaction analyses were further conducted. RESULTS During the 16.5 years of follow-up, 8459 deaths were identified. Greater SWB was independently associated with a reduced risk of all-cause mortality (adjusted hazard ratio [HR] = 0.85, 95% confidence interval [CI] = 0.81-0.89) after adjustment for age, sex, marital status, education level, place of residence, smoking status, drinking, exercise, diet, BMI, hypertension, diabetes, heart disease, cerebrovascular diseases and cancer. Of the eight individual SWB symptoms, only 2 items, feelings of uselessness (adjusted HR = 0.94, 95% CI = 0.89-0.99) and happiness (adjusted HR = 0.91, 95% CI = 0.86-0.95), were significantly associated with total mortality. Associations remained significant across all subgroups regardless of different characteristics. CONCLUSIONS Higher SWB overall and 2 certain symptoms (feelings of uselessness and happiness) were independently associated with all-cause mortality risk among older Chinese adults. The association was consistent across different groups, suggesting that promoting a healthier SWB may be beneficial to all older individuals irrespective of their characteristics.
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Affiliation(s)
- Chunsu Zhu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China
- Fujian Key Laboratory of Advanced Technology for Cancer Screening and Early Diagnosis, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Zhiwei Lian
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China.
| | - Yongying Huang
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China
| | - Qiaofeng Zhong
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China
| | - Jianmin Wang
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China
- Fujian Key Laboratory of Advanced Technology for Cancer Screening and Early Diagnosis, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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13
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Sawadogo W, Adera T, Alattar M, Perera R, Burch JB. Association Between Insomnia Symptoms and Trajectory With the Risk of Stroke in the Health and Retirement Study. Neurology 2023; 101:e475-e488. [PMID: 37286360 PMCID: PMC10401688 DOI: 10.1212/wnl.0000000000207449] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/10/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Insomnia is a common condition affecting more than a third of the US population. However, the link between insomnia symptoms and stroke is understudied and the underlying mechanism remains unclear. This study aimed to investigate the relationship between insomnia symptoms and the incidence of stroke. METHODS The Health and Retirement Study, a survey of Americans older than 50 years and their spouses, from 2002 to 2020 was used as the data source. Only those who were stroke-free at baseline were included in this study. The exposure variable was insomnia symptoms and was derived from self-reported sleep-related factors including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Repeated-measures latent class analysis was used to identify insomnia trajectories over time. To investigate the relationship between insomnia symptoms and stroke events reported during the follow-up period, Cox proportional hazards regression models were used. Mediation analyses of comorbidities were performed using causal mediation within a counterfactual framework. RESULTS A total of 31,126 participants were included with a mean follow-up of 9 years. The mean age was 61 years (SD = 11.1) and 57% were females. Insomnia symptom trajectories remained constant over time. Compared with those with no insomnia symptoms, an increased risk of stroke was observed for those with insomnia symptom scores ranging from 1 to 4 and 5 to 8 (hazard ratio (HR) = 1.16, 95% confidence interval (CI) 1.02-1.33) and (HR = 1.51, 95% CI 1.29-1.77), respectively, indicating a dose-response relationship. The association was stronger in participants younger than 50 years (HR = 3.84, 95% CI 1.50-9.85) than in those aged 50 years and older (HR = 1.38, 95% CI 1.18-1.62), comparing those with insomnia symptoms ranging from 5 to 8 with those with no insomnia symptoms. This association was mediated by diabetes, hypertension, heart disease, and depression. DISCUSSION Insomnia symptoms were associated with an increased risk of stroke, especially in adults younger than 50 years, and the risk was mediated by certain comorbidities. Increased awareness and management of insomnia symptoms may contribute to the prevention of stroke occurrence.
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Affiliation(s)
- Wendemi Sawadogo
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond.
| | - Tilahun Adera
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
| | - Maha Alattar
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
| | - Robert Perera
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
| | - James B Burch
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
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14
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Sato K, Noguchi H, Inoue K, Kawachi I, Kondo N. Retirement and cardiovascular disease: a longitudinal study in 35 countries. Int J Epidemiol 2023:7157039. [PMID: 37155837 PMCID: PMC10396426 DOI: 10.1093/ije/dyad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Many countries have been increasing their state pension age (SPA); nonetheless, there is little consensus on whether retirement affects the risk of cardiovascular disease (CVD). This study examined the associations of retirement with CVD and risk factors. METHODS We used harmonized longitudinal datasets from the Health and Retirement Study and its sister surveys in 35 countries. Data comprised 396 904 observations from 106 927 unique individuals aged 50-70 years, with a mean follow-up period of 6.7 years. Fixed-effects instrumental variable regressions were performed using the SPA as an instrument. RESULTS We found a 2.2%-point decrease in the risk of heart disease [coefficient = -0.022 (95% confidence interval: -0.031 to -0.012)] and a 3.0%-point decrease in physical inactivity [-0.030 (-0.049 to -0.010)] among retirees, compared with workers. In both sexes, retirement was associated with a decreased heart disease risk, whereas decreased smoking was observed only among women. People with high educational levels showed associations between retirement and decreased risks of stroke, obesity and physical inactivity. People who retired from non-physical labour exhibited reduced risks of heart disease, obesity and physical inactivity, whereas those who retired from physical labour indicated an increased risk of obesity. CONCLUSIONS Retirement was associated with a reduced risk of heart disease on average. Some associations of retirement with CVD and risk factors appeared heterogeneous by individual characteristics.
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Affiliation(s)
- Koryu Sato
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
- Graduate School of Economics, Waseda University, Tokyo, Japan
| | - Haruko Noguchi
- Graduate School of Economics, Waseda University, Tokyo, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
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15
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Liu L, May NS, Sato PY, Srivastava P, McClure LA. Association between Cardiovascular Risk and Coronavirus Disease 2019: Findings from 2021 National Health Interview Survey. Ann Epidemiol 2023; 82:1-7. [PMID: 36963621 PMCID: PMC10033151 DOI: 10.1016/j.annepidem.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE To examine the association between pre-existing cardiovascular disorders and the risk of coronavirus disease 2019 (COVID-19) among community-dwelling adults in the United States (US). METHODS We analyzed data from the 2021 National Health Interview Survey (NHIS), encompassing 28,848 nationally representative participants aged ≥18. We examined the association by two age groups, younger adults (aged 18-59) and older adults (aged>60). Weighted analyses were conducted to consider the complex sampling design used in the NHIS. RESULTS Our results show that 13.9% of younger and 8.2% of older adults were infected with coronavirus, corresponding to a nationwide estimate of 23,701,358 COVID-19 cases in younger adults and 6,310,206 in older adults in 2021. Subjects who lived in the South region of the US had the highest COVID-19 rate (13.4%), followed by the Midwest (12.6%), West (10.9%), and Northeast (10.4%). Pre-existing cardiovascular risk factors (overweight, obesity, hypertension, and diabetes) were significantly associated with increased risk for COVID-19 infection in younger and older adults. Pre-existing cardiovascular diseases (angina, heart attack, and coronary heart disease) were significantly associated with COVID-19 in older adults but not significantly in younger adults. Significant dose-response relationships existed between the increased number of pre-existing cardiovascular risk factors and COVID-19 infection, with the strongest association in non-Hispanic (NH) Black and Hispanic ethnicities compared to NH White. CONCLUSION Pre-existing cardiovascular disorders are significantly associated with the risk of COVID-19 infection. The magnitudes of this risk association are stronger among the minority populations than NH White. Further studies are needed to determine the long-term impact of COVID-19 infection and its relationship to pre-existing cardiovascular disorders.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104.
| | - Nathalie S May
- Department of Medicine, College of Medicine, Drexel University, Philadelphia, PA 19102
| | - Priscila Y Sato
- Department of Pharmacology and Physiology College of Medicine, Drexel University, Philadelphia, PA 19102
| | - Paakhi Srivastava
- Center for Weight, Eating and Lifestyle Science, College of Arts and Sciences, Drexel University, Philadelphia, PA 19104
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104
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Chen H, Zhou Y, Huang L, Xu X, Yuan C. Multimorbidity burden and developmental trajectory in relation to later‐life dementia: A prospective study. Alzheimers Dement 2022; 19:2024-2033. [PMID: 36427050 DOI: 10.1002/alz.12840] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study assessed the associations of multimorbidity burden and its developmental trajectory with later-life dementia. METHODS Among 5923 Health and Retirement Study participants, major chronic conditions including hypertension, diabetes mellitus, cancer, lung diseases, heart disease, stroke, psychological disorders, and arthritis were self- or proxy-reported in 1994-2008. Dementia diagnosis was self- or proxy-reported in 2008-2018. We used Cox regression to assess the associations of multimorbidity with incident dementia. RESULTS During follow-up (median = 8 years), 701 participants developed dementia. Each additional chronic condition in 2008 was related to 15% (confidence interval: 9% to 22%) higher hazard of dementia. Multimorbidity trajectories in 1994-2008 were classified as "rapid growth", "steady growth", "slow growth", and "no new condition" by the group-based trajectory modelling methods. Compared to "no new condition", the "rapid growth" trajectory was related to 32% (3% to 69%) higher dementia risk. CONCLUSIONS Both multimorbidity burden and its developmental trajectory were prospectively associated with risk of dementia.
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Affiliation(s)
- Hui Chen
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
| | - Yaguan Zhou
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
| | - Liyan Huang
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
| | - Xiaolin Xu
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
- School of Public Health Faculty of Medicine The University of Queensland Brisbane Australia
| | - Changzheng Yuan
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
- Department of Nutrition Harvard T.H. Chan School of Public Health Boston Massachusetts USA
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Zhang Y, Yang S, Chen J, Zhang Z, He P, Zhou C, Liu M, Ye Z, Wu Q, Li H, Zhang Y, Liu C, Qin X. Associations of serum cystatin C and its change with new-onset cardiovascular disease in Chinese general population. Nutr Metab Cardiovasc Dis 2022; 32:1963-1971. [PMID: 35738955 DOI: 10.1016/j.numecd.2022.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/08/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS The relation of serum cystatin C with new-onset cardiovascular disease (CVD) remains uncertain. We aimed to evaluate the prospective associations of serum cystatin C and its change with new-onset CVD in Chinese general population. METHODS AND RESULTS A total of 7064 participants free of CVD at baseline were enrolled from the China Health and Retirement Longitudinal Study. The change in serum cystatin C was calculated as cystatin C concentration at 2015 wave minus that at baseline (2011 wave). The primary outcome was new-onset CVD, defined as self-reported physician-diagnosed heart disease, stroke, or both during follow-up. The secondary outcomes were new-onset heart disease, and new-onset stroke. During a median follow-up duration of 7.0 years, a total of 1116 (15.8%) subjects developed new-onset CVD. Overall, after the adjustments for eGFR and other important covariates, there was a positive association between serum cystatin C and new-onset CVD (per SD mg/L increment; adjusted HR, 1.13; 95%CI: 1.08,1.18). When cystatin C was assessed as quintiles, the adjusted HRs for participants in the second, third, fourth and fifth quintiles were 1.15 (95%CI: 0.93, 1.41), 1.37 (95%CI: 1.11, 1.68), 1.47 (95%CI: 1.19, 1.81), and 2.03 (95%CI: 1.60, 2.56), respectively, compared with those in quintile 1 (P for trend<0.001). Furthermore, there was a positive association between the increase in cystatin C concentration and the subsequent new-onset CVD (per SD mg/L increment; adjusted HR, 1.14; 95%CI: 1.02,1.27). CONCLUSION Both serum cystatin C and its increase were positively associated with new-onset CVD among Chinese general population.
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Affiliation(s)
- Yanjun Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Sisi Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Jia Chen
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China; Department of Nephrology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, China
| | - Zhuxian Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Qimeng Wu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Huan Li
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Chengzhang Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China; Institute of Biomedicine, Anhui Medical University, Hefei 230032, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China.
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18
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Li Y, Wang X, Wang W, Li X, Guo L, Lu C. 6-Year trajectories of depressive symptoms and incident stroke in older adults: Results from the Health and Retirement Study. J Affect Disord 2022; 309:229-235. [PMID: 35489555 DOI: 10.1016/j.jad.2022.04.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depressive symptoms (DS) can increase the risk of stroke, but it is unclear whether long-term DS trajectories are associated with incident stroke. This study aimed to explore the association of long-term DS trajectories with incident stroke. METHODS This prospective cohort study included 11,002 adults aged 50 and older from the Health and Retirement Study during 1994-2018. DS was assessed using the 8-item version of the Center for Epidemiologic Studies Depression Scale. Stroke was obtained through self-report of doctors' diagnosis. The group-based trajectory model was used to determine DS trajectories from 1994 to 2000. Cox proportional hazard model was applied to explore the correlation of DS trajectories with incident stroke from 2000 to 2018. RESULTS We identified five distinct 6-year DS trajectories. Compared with the persistent no DS trajectory, the full-adjusted HRs (95% CIs) for the persistent mild, improving, worsening, and persistent high DS trajectories were 1.15 (1.01, 1.30), 1.27 (0.88, 1.84), 1.41 (1.17, 1.71), and 1.61 (1.21, 2.16), respectively. In addition, the persistent mild DS trajectories had the largest population attributable risk percent (PAR%). LIMITATIONS There was a lack of information on stroke subtypes. CONCLUSIONS This study suggests that compared with persistent no DS, persistent mild, worsening, and persistent high DS trajectories increase the risk of stroke in the elderly. Considering that the PAR% of stroke events in the persistent mild DS trajectory is the largest, we should pay attention not only to individuals with DS, but also to those being chronically close to the cut-off value of DS.
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Affiliation(s)
- Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaojie Wang
- Department of Neurology, Shenzhen Shekou People's Hospital, Shenzhen, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Xiuwen Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
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19
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Dong L, Mezuk B, Williams LS, Lisabeth LD. Trends in Outpatient Treatment for Depression in Survivors of Stroke in the United States, 2004-2017. Neurology 2022; 98:e2258-e2267. [PMID: 35379756 PMCID: PMC9162167 DOI: 10.1212/wnl.0000000000200286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Depression is highly prevalent and persistent among survivors of stroke. It is unknown how treatment for depression among survivors of stroke has changed in the evolving context of stroke care and mental health care in the general US population, especially among vulnerable sociodemographic subgroups who bear higher risks for stroke and unfavorable poststroke outcomes and experience disparities in access to and quality of stroke and mental health care. The study examined temporal trends in outpatient treatment for depression among survivors of stroke in the United States between 2004 and 2017. METHODS The study sample consisted of 10,243 adult survivors of stroke and 264,645 adults without stroke drawn from the Medical Expenditure Panel Survey, a nationally representative survey in the United States. Trends in outpatient treatment for depression and potential unmet needs in the stroke population, including variations across sociodemographic subgroups, were examined and compared with the nonstroke population. RESULTS The rate of receipt of outpatient treatment for depression among survivors of stroke was 17.7% in 2004-2005 and 16.0% in 2016-2017 (adjusted odds ratio for period change [aOR] 0.90, 95% CI 0.71-1.15). Older, male, non-Hispanic Black, and Hispanic survivors of stroke were less likely to receive treatment for depression. Approximately two-thirds of survivors of stroke who screened positive for depression received no outpatient treatment during a calendar year. The sociodemographic disparities and treatment gap persisted during the study period, which differed from the nonstroke population. Among survivors of stroke who received any treatment for depression, there was a remarkable increase in use of psychotherapy (aOR 2.26, 95% CI 1.28-4.01), despite its less frequent use compared with pharmacotherapy. DISCUSSION Although depression is common after stroke, the majority of survivors of stroke receive no treatment for depression. This gap has remained largely unchanged over past decades, with substantial sociodemographic differences. Efforts are needed to improve depression care for survivors of stroke and reduce disparities.
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Affiliation(s)
- Liming Dong
- From the Department of Epidemiology (L.D., B.M., L.D.L.), University of Michigan School of Public Health, Ann Arbor; School of Population Medicine and Public Health (L.D.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Health Services Research and Development Center for Health Information and Communication (L.S.W.), Roudebush VA Medical Center; Department of Neurology (L.S.W.), Indiana University School of Medicine; and Regenstrief Institute, Inc. (L.S.W.), Indianapolis, IN.
| | - Briana Mezuk
- From the Department of Epidemiology (L.D., B.M., L.D.L.), University of Michigan School of Public Health, Ann Arbor; School of Population Medicine and Public Health (L.D.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Health Services Research and Development Center for Health Information and Communication (L.S.W.), Roudebush VA Medical Center; Department of Neurology (L.S.W.), Indiana University School of Medicine; and Regenstrief Institute, Inc. (L.S.W.), Indianapolis, IN
| | - Linda S Williams
- From the Department of Epidemiology (L.D., B.M., L.D.L.), University of Michigan School of Public Health, Ann Arbor; School of Population Medicine and Public Health (L.D.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Health Services Research and Development Center for Health Information and Communication (L.S.W.), Roudebush VA Medical Center; Department of Neurology (L.S.W.), Indiana University School of Medicine; and Regenstrief Institute, Inc. (L.S.W.), Indianapolis, IN
| | - Lynda D Lisabeth
- From the Department of Epidemiology (L.D., B.M., L.D.L.), University of Michigan School of Public Health, Ann Arbor; School of Population Medicine and Public Health (L.D.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Health Services Research and Development Center for Health Information and Communication (L.S.W.), Roudebush VA Medical Center; Department of Neurology (L.S.W.), Indiana University School of Medicine; and Regenstrief Institute, Inc. (L.S.W.), Indianapolis, IN
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20
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Soh Y, Tiemeier H, Kawachi I, Berkman LF, Kubzansky LD. Eight-Year Depressive Symptom Trajectories and Incident Stroke: A 10-Year Follow-Up of the HRS (Health and Retirement Study). Stroke 2022; 53:2569-2576. [DOI: 10.1161/strokeaha.121.037768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Evidence suggests a link between depressive symptoms and risk of subsequent stroke. However, most studies assess depressive symptoms at only one timepoint, with few examining this relationship using repeatedly measured depressive symptoms. This study aimed to examine the relationship between depressive symptom trajectories and risk of incident stroke.
Methods:
This prospective cohort included 12 520 US individuals aged ≥50 years enrolled in the Health and Retirement Study, free of stroke at study baseline (1998). We used the 8-item Center for Epidemiologic Studies Depression scale to assess depressive symptoms (high defined as ≥3 symptoms; low <3 symptoms) at 4 consecutive, biennial timepoints from 1998 to 2004. We assigned individuals to 5 predefined trajectories based on their scores at each timepoint (consistently low, decreasing, fluctuating, increasing, and consistently high). Using self-reported doctors’ diagnoses, we assessed incident stroke over a subsequent 10-year period from 2006 to 2016. Cox regression models estimated the association of depressive symptom trajectories with risk of incident stroke, adjusting for demographics, health behaviors, and health conditions.
Results:
During follow-up, 1434 incident strokes occurred. Compared with individuals with consistently low symptoms, individuals with consistently high depressive symptoms (adjusted hazard ratio, 1.18 [95% CI, 1.02–1.36]), increasing symptoms (adjusted hazard ratio, 1.31 [95% CI, 1.10–1.57]), and fluctuating symptoms (adjusted hazard ratio, 1.21 [95% CI, 1.01–1.46]) all had higher hazards of stroke onset. Individuals in the decreasing symptom trajectory group did not show increased stroke risk.
Conclusions:
Depressive symptom trajectories characterized by high symptoms at multiple timepoints were associated with increased stroke risk. However, a trajectory with depressive symptoms that started high but decreased over time was not associated with higher stroke risk. Given the remitting-relapsing nature of depressive symptoms, it is important to understand the relationship between depressive symptoms and stroke risk over time through repeated assessments.
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Affiliation(s)
- Yenee Soh
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA. (Y.S., H.T., I.K., L.F.B., L.D.K.)
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA. (Y.S., H.T., I.K., L.F.B., L.D.K.)
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA. (Y.S., H.T., I.K., L.F.B., L.D.K.)
| | - Lisa F. Berkman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA. (Y.S., H.T., I.K., L.F.B., L.D.K.)
- Harvard Center for Population and Development, Cambridge, MA (L.F.B.)
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA. (Y.S., H.T., I.K., L.F.B., L.D.K.)
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA. (L.D.K.)
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21
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Zhu C, Wang J, Wang J, Zhong Q, Huang Y, Chen Y, Lian Z. Associations between depressive symptoms and sleep duration for predicting cardiovascular disease onset: A prospective cohort study. J Affect Disord 2022; 303:1-9. [PMID: 35104466 DOI: 10.1016/j.jad.2022.01.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The joint effects of depressive symptoms and sleep on the risk of cardiovascular disease (CVD) are not well understood. The purpose of this study was to assess the combined impact of depressive symptoms and sleep duration on the incidence of CVD among middle-aged and older Chinese individuals. METHODS Data were from the China Health and Longitudinal Study conducted in 2013, 2015, and 2018. A total of 9595 participants aged ≥ 45 years without a history of CVD in 2013 were included. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale (elevated depressive symptoms cutoff ≥ 10). Average sleep duration was self-reported. Logistic regression analyses adjusted for age, sex, marital status, education and other potential confounders were conducted. RESULTS In total, 1072 (11.2%) participants reported CVD incidents over the 5-year period. Elevated depressive symptoms (OR = 1.49, 95% CI = 1.30-1.72) and short sleep duration (OR = 1.21, 95% CI = 1.05-1.40) were independently associated with an increased CVD risk in the fully adjusted model. Individuals with short sleep duration/low depressive symptoms (OR = 1.34, 95% CI = 1.12-1.60), short sleep duration/elevated depressive symptoms (OR = 1.70, 95% CI = 1.41-2.50), or long sleep duration/elevated depressive symptoms (OR = 2.13, 95% CI = 1.38-3.27) were more likely to develop CVD than those with normal sleep duration/low depressive symptoms. LIMITATIONS Depressive symptoms and sleep duration were self-reported. CONCLUSIONS A stronger risk of CVD was found when depressive symptoms and short or long sleep durations occurred together, suggesting that an integrated approach to sleep and depressive symptoms might be a feasible strategy for the prevention of CVD.
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Affiliation(s)
- Chunsu Zhu
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China
| | - Jianmin Wang
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China
| | - Jiaxue Wang
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Qiaofeng Zhong
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China
| | - Yongying Huang
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China
| | - Ying Chen
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China
| | - Zhiwei Lian
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China.
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22
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Zhou Z, Zhang W, Fang Y. Early-life exposure to Chinese famine and stroke risk in mid- to late life: the mediating roles of cognitive function and depression. BMC Geriatr 2022; 22:294. [PMID: 35392831 PMCID: PMC8988351 DOI: 10.1186/s12877-022-02990-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/28/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Limited research has examined the role that famine exposure plays in adulthood stroke risk. We aim to explore the causal implications of early exposure to the Great Chinese Famine on stroke risk and determine whether these associations were mediated by cognitive function, and depression. METHODS We sampled 12,681 individuals aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) and divided them into fetally exposed, childhood-exposed, adolescence/adulthood-exposed and unexposed groups. Stroke was defined by self- or proxy-reported physician diagnosis. Based on a counterfactual framework, marginal structural models were used to estimate the natural direct effect and the natural indirect effects through cognitive function and depression for causal inference. RESULTS We found that early-life exposure to Chinese famine was directly related to increased stroke risk in mid- to late life. Cognitive function and depression accounted for a greater part of the effect for childhood famine exposure, mediating 36.35% (95%CI: 14.19, 96.19%) of the overall association between famine exposure and incident stroke, than for the fetal, adolescence/adulthood famine exposure groups. However, the natural indirect effect through depression was not significant in the fetally exposed group. The results were robust in the sensitivity analysis of model specification and unobserved confounding. CONCLUSIONS Our findings are consistent with the latency, pathway, and accumulation models, supporting the life-course theory. Early stages of life exposed to the Chinese Famine were associated with higher risk of stroke in mid- to late life. Enhanced cognitive and depression interventions may reduce stroke risk in middle-aged and older Chinese adults who exposure to famine in early life.
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Affiliation(s)
- Zi Zhou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Affairs and School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Wei Zhang
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, 361102, Fujian, China
| | - Ya Fang
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, 361102, Fujian, China.
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23
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Dong L, Mezuk B, Lisabeth LD. Trends in Prevalence of Serious Psychological Distress and Depression Among Adults with Stroke in the United States. J Stroke Cerebrovasc Dis 2022; 31:106235. [PMID: 34968891 PMCID: PMC9085723 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To examine national trends in prevalence of serious psychological distress and depression among adults with stroke in the United States (US) from 2004 to 2017, and variations across sociodemographic subgroups. METHODS Data were obtained from the household components of the 2004-2017 Medical Expenditure Panel Survey, a nationally representative survey in the US. History of stroke or transient ischemic attack was based on self-report. Psychological distress was measured by the Kessler-6 scale, and depressive symptoms were measured by the 2-item Patient Health Questionnaire. Logistic regression models were used to examine the trends in prevalence of serious psychological distress and depression overall and by age, sex, and race/ethnicity. RESULTS Among 10889 participants with stroke or transient ischemic attack, 60.0% were aged ≥ 65, 54.4% were female, and 72.2% were non-Hispanic white. The prevalence of serious psychological distress decreased from 14.9% in 2004-2005 to 11.3% in 2016-2017, corresponding to 7% lower odds every 2 years (adjusted odds ratio [aOR0.93, 95% confidence interval [CI]=0.89-0.97); and the prevalence of depression decreased from 23.1% in 2004-2005 to 18.3% in 2016-2017, corresponding to 5% lower odds every 2 years (aOR=0.95, 95% CI=0.92-0.98), after adjustment for sociodemographic characteristics, functional limitations, and antidepressant use. The trends varied significantly by age, but not sex and race/ethnicity. The overall decline was mainly driven by older adults above age 64. CONCLUSIONS Prevalence of serious psychological distress and depression among US adults with stroke decreased from 2004 to 2017, but the burden of mental health problems remained high.
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Affiliation(s)
- Liming Dong
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States.
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
| | - Lynda D. Lisabeth
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
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24
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Liu L, Hayden KM, May NS, Haring B, Liu Z, Henderson VW, Chen JC, Gracely EJ, Wassertheil-Smoller S, Rapp SR. Association between blood pressure levels and cognitive impairment in older women: a prospective analysis of the Women's Health Initiative Memory Study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e42-e53. [PMID: 35112096 PMCID: PMC8804967 DOI: 10.1016/s2666-7568(21)00283-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Whether blood pressure (BP), and at what level of controlled BP, reduces risk of cognitive impairment remains uncertain. We investigated the association of BP and hypertension treatment status with mild cognitive impairment and dementia in older women. METHODS We prospectively analysed a sample of 7207 community-dwelling women aged 65-79 years participating in the Women's Health Initiative Memory Study (WHIMS). Participants were recruited between May 28, 1996, and Dec 13, 1999, at 39 US clinical centres, and they were followed up until Dec 31, 2019. Cognitive function was assessed annually. Mild cognitive impairment and probable dementia were defined through a centralised adjudication process. BP was measured by trained and certified staff at baseline. Pulse pressure (PP) was calculated as systolic BP (SBP) minus diastolic BP. Hypertension was defined using the American Heart Association 2017 Guideline for High BP in Adults. Outcomes were (1) mild cognitive impairment, (2) probable dementia, and (3) cognitive loss (the combined endpoint of either mild cognitive impairment or probable dementia, or both). We estimated hazard ratios (HRs) to assess the association between hypertension, SBP, and PP with the risk of study outcomes using Cox proportional hazards regression models, with adjustment for key covariates. FINDINGS During a median follow-up of 9 years (IQR 6-15), 1132 (15·7%) participants were classified as mild cognitive impairment, 739 (10·3%) as probable dementia, and 1533 (21·3%) as cognitive loss. The incidence rates per 1000 person-years were 15·3 cases (95% CI 14·4-16·2) for mild cognitive impairment, 9·7 cases (9·0-10·4) for probable dementia, and 20·3 (19·3-21·3) for cognitive loss. Elevated SBP and PP were significantly associated with increased risk of mild cognitive impairment and cognitive loss (test for trends across SBP and PP strata, p<0·01). Individuals with hypertension, but with controlled SBP of less than 120 mm Hg did not have a significantly increased risk of mild cognitive impairment (HR 1·33, 95% CI 0·98-1·82, p=0·071), and of cognitive loss (1·09, 0·82-1·44, p=0·57) compared with normotension. Individuals on anti-hypertensive treatment with PP of less than 50 mm Hg did not have a significantly higher risk of mild cognitive impairment (1·26, 0·98-1·62, p=0·07) and of cognitive loss (1·17, 0·94-1·46, p=0·16). There were no significant associations between hypertension, SBP, or PP and probable dementia. INTERPRETATION Results of our study show significant associations of hypertension and elevated SBP and PP levels with risk of mild cognitive impairment and the combined endpoint of either mild cognitive impairment or probable dementia, suggesting that intensive control of hypertension, SBP, and PP can preserve cognitive health in older women. FUNDING National Heart, Lung, and Blood Institute, National Institutes of Health, and US Department of Health and Human Services.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Kathleen M Hayden
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Nathalie S May
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Bernhard Haring
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Zuolu Liu
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Victor W Henderson
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Jiu-Chiuan Chen
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Edward J Gracely
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Stephen R Rapp
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
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Dietary quality modifies the association between multimorbidity and change in mobility limitations among older Americans. Prev Med 2021; 153:106721. [PMID: 34293383 DOI: 10.1016/j.ypmed.2021.106721] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 06/25/2021] [Accepted: 07/11/2021] [Indexed: 11/21/2022]
Abstract
To identify potentially modifiable risk-factors in the age-related disablement process, we examined the association between change in mobility limitations and multimorbidity and how dietary quality moderates this association. Information from 3320 adults aged 65 and older in 2012 was drawn from the Health and Retirement Study and the Health Care and Nutrition Study. Mobility limitations reported in 2012 and change in mobility limitations from 2012 to 2014 were regressed on multimorbidity measured as number of chronic conditions in 2012, dietary quality measured in 2013 using the Alternative Healthy Eating Index-2010 (AHEI-2010), and their interaction term using Poisson regression. Respondents reported an average of 2.9 (SD, 2.9) mobility limitations in 2012 and 3.1 (SD, 3.0) mobility limitations in 2014, an average of 2.64 (SD, 1.4) chronic conditions in 2012, and mean AHEI-2010 score in 2013 of 57.1 (SD, 10.9). Greater AHEI-2010 scores were associated with fewer mobility limitations at baseline (p < .001) and slower progression of mobility limitations over the two-year observational window (p < .001). For those with AHEI-2010 scores ≥48.4, dietary quality appeared to moderate the association between multimorbidity and change in mobility limitations. These results suggest that improving dietary quality may be an effective means of reducing the progression of mobility limitations among older adults and that dietary quality may modify the effect of multimorbidity on progressive disablement. Our work adds to research supporting dietary quality as a potentially intervenable factor in the reduction of disablement in aging populations.
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Cui Y, Zhu C, Lian Z, Han X, Xiang Q, Liu Z, Zhou Y. Prospective association between depressive symptoms and stroke risk among middle-aged and older Chinese. BMC Psychiatry 2021; 21:532. [PMID: 34706692 PMCID: PMC8555147 DOI: 10.1186/s12888-021-03492-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to assess the association between baseline symptoms and changes in depressive symptoms and stroke incidents. METHODS We used data from the Chinese Health and Retirement Longitudinal Study conducted in 2013, 2015, and 2018. In total, 10,100 individuals aged ≥45 years and without a history of stroke in 2013 were included. Depressive symptoms were measured using the 10-item version of the Center for Epidemiological Studied Depression scale (elevated depressive symptoms cutoff ≥10). Changes of depressive symptoms were assessed by two successive surveys (stable low/no, recent onset, recently remitted, and stable high depressive symptoms). We assessed whether baseline depressive symptoms and changes of them were associated with stroke incidents reported through 2018. Logistic regression analyses adjusted for age, gender, education, marital status and other potential confounders were performed. RESULTS For the analysis of baseline depressive symptoms and stroke (n = 10,100), 545 (5.4%) reported stroke incidents in the following 5-year period. Individuals with elevated depressive symptoms in 2013 experienced a markedly higher stroke risk (odds ratio (OR) = 1.53, 95% confidence interval (CI) = 1.28-1.84) compared with those without elevated depressive symptoms. In the analysis of changes in depressive symptoms (n = 8491, 430 (5.1%) stroke events), participants with stable high (OR = 2.01, 95% CI = 1.58-2.56) and recent-onset (OR = 1.39, 95% CI = 1.04-1.85) depressive symptoms presented higher stroke risk compared to those with stable low/no depressive symptoms, while recently remitted symptoms (OR = 1.12, 95% CI = 0.80-1.57) were not associated with stroke risk. CONCLUSIONS In conclusion, stable high and newly started depressive symptoms were associated with increased stroke risk, whereas the improvement of depressive symptoms was not related to increase in stroke risk, suggesting that stroke risk may be decreased by effective management of depressive symptoms.
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Affiliation(s)
- Yimin Cui
- Department of Pharmacy, Peking University First Hospital, No. 6, Dahongluochang Street, Xicheng District, Beijing, 100034, China.
- School of Pharmaceutical Sciences, Peking University, Beijing, China.
| | - Chunsu Zhu
- Department of Pharmacy, Peking University First Hospital, No. 6, Dahongluochang Street, Xicheng District, Beijing, 100034, China
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zhiwei Lian
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Xueyan Han
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, No. 6, Dahongluochang Street, Xicheng District, Beijing, 100034, China
| | - Zhenming Liu
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Ying Zhou
- Department of Pharmacy, Peking University First Hospital, No. 6, Dahongluochang Street, Xicheng District, Beijing, 100034, China
- School of Pharmaceutical Sciences, Peking University, Beijing, China
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Mahmood A, Ray M, Dobalian A, Ward KD, Ahn S. Insomnia symptoms and incident heart failure: a population-based cohort study. Eur Heart J 2021; 42:4169-4176. [PMID: 34392357 PMCID: PMC8728724 DOI: 10.1093/eurheartj/ehab500] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/06/2021] [Accepted: 07/15/2021] [Indexed: 01/22/2023] Open
Abstract
AIMS Heart failure (HF) is an ongoing epidemic and a serious clinical and public health issue. Currently, little is known about prospective associations between insomnia symptoms and HF incidence. We investigated the longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, non-restorative sleep) and incident HF. METHODS AND RESULTS Data were obtained from the Health and Retirement Study in the US for a population-representative sample of 12,761 middle-aged and older adults (age ≥ 50 years; mean [SD] age, 66.7 [9.4] years; 57.7% females) who were free from HF at baseline in 2002. Respondents were followed for 16 years for incident HF. We employed marginal structural discrete-time survival analyses to adjust for potential time-varying biological, psycho-cognitive, and behavioral factors and to account for bias due to differential loss to follow-up. At baseline, 38.4% of the respondents reported experiencing at least one insomnia symptom. During the 16-year follow-up, 1,730 respondents developed incident HF. Respondents experiencing one (hazard ratio [HR]=1.22; 95% CI: 1.08-1.38), two (HR=1.45; 95% CI: 1.21-1.72), three (HR=1.66; 95% CI: 1.37-2.02), or four (HR=1.80; 95% CI: 1.25-2.59) insomnia symptoms had a higher hazard of incident HF than asymptomatic respondents. Respondents that had trouble initiating sleep (HR=1.17; 95%CI: 1.01-1.36), maintaining sleep (HR=1.14; 95% CI: 1.01-1.28), early-morning awakening (HR=1.20; 95% CI: 1.02-1.43), or non-restorative sleep (HR=1.25; 95% CI: 1.06-1.46) had a higher hazard of incident HF than asymptomatic respondents. CONCLUSION Insomnia symptoms, both cumulatively and individually, are associated with incident HF. Public health awareness and screening for insomnia symptoms in at-risk populations should be encouraged to reduce HF incidence.
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Affiliation(s)
- Asos Mahmood
- Division of Health Systems Management and Policy, The University of Memphis School of Public Health, 3825 Desoto Ave., Memphis, TN 38152-3530, USA
| | - Meredith Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, The University of Memphis School of Public Health, 3825 Desoto Ave., Memphis, TN 38152-3530, USA
| | - Aram Dobalian
- Division of Health Systems Management and Policy, The University of Memphis School of Public Health, 3825 Desoto Ave., Memphis, TN 38152-3530, USA
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, The University of Memphis School of Public Health, 3825 Desoto Ave., Memphis, TN 38152-3530, USA
| | - SangNam Ahn
- Division of Health Systems Management and Policy, The University of Memphis School of Public Health, 3825 Desoto Ave., Memphis, TN 38152-3530, USA
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Elayoubi J, Nelson ME, Haley WE, Hueluer G. The Role of Social Connection/Engagement in Episodic Memory Change in Stroke. THE GERONTOLOGIST 2021; 62:364-374. [PMID: 34270722 DOI: 10.1093/geront/gnab095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Positive associations between social connection/engagement and cognitive function are well documented. However, little is known about whether social connection/engagement can buffer the impact of serious brain injury such as stroke on cognitive functioning. RESEARCH DESIGN AND METHODS Participants were 898 individuals with incident stroke from the Health and Retirement Study (HRS) between 1998-2012. Multilevel modeling was used to examine how social connection/engagement were associated with episodic memory pre- and post-stroke. Models controlled for age, gender, education, race/ethnicity, number of health conditions, and functional health. RESULTS Participants who were lonely pre-stroke recalled significantly fewer words at time of stroke, and participants who had children residing within 10 miles pre-stroke showed significantly less decline in word recall over time. Participants who provided help to others pre-stroke showed less stroke-related decline in word recall. Within-person increase in partnered status, having friends, and helping others were related to better word recall in the post-stroke period. DISCUSSION AND IMPLICATIONS Higher pre-stroke levels of social connection/engagement predicted better episodic memory at stroke, smaller decline in episodic memory with stroke, and less decline in episodic memory over time. Increases in social connection/engagement from pre- to post-stroke also predicted better post-stroke episodic memory. Beyond the widely documented benefits of social connection/engagement to well-being, they may also increase cognitive stimulation and cognitive reserve and thus contribute to stroke recovery in the cognitive domain. Social connection/engagement is an important and modifiable risk factor in older adults.
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Affiliation(s)
- Joanne Elayoubi
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Monica E Nelson
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - William E Haley
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Gizem Hueluer
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
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Cheng G, He S, He Q, Xie X, Tang C, Xie Q, Wu X, Jiang N, Li C, Min X, Yan Y. Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study. Aging (Albany NY) 2021; 13:17380-17406. [PMID: 34198262 PMCID: PMC8312414 DOI: 10.18632/aging.203228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
The present study aimed to investigate the associations between the trajectory of blood pressure (BP) change and the risk of subsequent dementia and to explore the differences in age, gender, and hypertension subgroups. We included 10,660 participants aged ≥ 60 years from 1998 to 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Latent growth mixture models were used to estimate BP trajectories. Cox-proportional hazard models were used to analyze the effects of BP trajectories on the risk of dementia. According to the results, stabilized systolic BP (SBP) was found to be associated with a higher risk of dementia compared with normal SBP [adjusted hazard ratio (aHR): 1.62; 95% confidence interval (CI): 1.27-2.07] and elevated SBP (aHR: 2.22; 95% CI: 1.51-3.28) in and only in the subgroups of the oldest-old, women, and subjects without hypertension at baseline. Similarly, stabilized pulse pressure (PP) was associated with a higher risk of dementia compared with normal PP (aHR: 1.52; 95% CI: 1.24-1.88) and elevated PP (aHR: 2.12; 95% CI: 1.48-3.04) in and only in the subgroups of the oldest-old, women, and subjects with hypertension at baseline. These findings suggest that stabilized SBP and PP have predictive significance for the occurrence of dementia in late life, and the factors of age, gender, and late-life hypertension should be considered when estimating the risk of BP decline on dementia.
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Affiliation(s)
- Gang Cheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Simin He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiong He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xiaowei Xie
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Cai Tang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qunhui Xie
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xihong Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Ni Jiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xianying Min
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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Eng CW, Mayeda ER, Gilsanz P, Whitmer RA, Kim AS, Glymour MM. Temporal Trends in Stroke-Related Memory Change: Results From a US National Cohort 1998-2016. Stroke 2021; 52:1702-1711. [PMID: 33722061 DOI: 10.1161/strokeaha.120.031063] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Findings from the Framingham Heart Study suggest that declines in dementia incidence rates over recent decades are partially due to decreases in stroke incidence and mortality; however, whether trends of declining dementia rates extend to survivors of incident stroke remains unclear. We investigated evidence for temporal trends in memory change related to incident stroke in a nationally representative cohort. METHODS Adults age 50+ in the HRS (Health and Retirement Study) were followed across three successive 6-year epochs (epoch 1: 1998-2004, n=16 781; epoch 2: 2004-2010, n=15 345; and epoch 3: 2010-2016; n=15 949). Participants were included in an epoch if they were stroke-free at the start of that epoch. Annual rates of change in a composite z-standardized memory score were compared using demographic-adjusted linear regression models for stroke-free participants, those who survived after stroke, and those who died after stroke, considering memory change before stroke, at the time of stroke, and for years following stroke. RESULTS Crude stroke incidence rates decreased from 8.5 per 1000 person-years in epoch 1 to 6.8 per 1000 person-years in epoch 3. Rates of memory change before and following stroke onset were similar across epochs. Memory decrement immediately after stroke onset attenuated from -0.37 points (95% CI, -0.44 to -0.29) in epoch 1 to -0.26 (95% CI, -0.33 to -0.18) points in epoch 2 and -0.25 (95% CI, -0.33 to -0.17) points in epoch 3 (P value for linear trend=0.02). CONCLUSIONS Decreases in stroke-related dementia in recent years may be partially attributable to smaller memory decrements immediately after stroke onset. Findings suggest reductions in stroke incidence and improvements in stroke care may also reduce population burden of dementia. Further investigations into whether temporal trends are attributable to improvements in stroke care are needed.
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Affiliation(s)
- Chloe W Eng
- Department of Epidemiology and Biostatistics (C.W.E., M.M.G.), University of California San Francisco
| | - Elizabeth R Mayeda
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health (E.R.M.)
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland (P.G.)
| | - Rachel A Whitmer
- Department of Public Health Sciences, University of California Davis (R.A.W.)
| | - Anthony S Kim
- Department of Neurology (A.S.K.), University of California San Francisco
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics (C.W.E., M.M.G.), University of California San Francisco
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Parks AL, Jeon SY, Boscardin WJ, Steinman MA, Smith AK, Fang MC, Shah SJ. Long-term individual and population functional outcomes in older adults with atrial fibrillation. J Am Geriatr Soc 2021; 69:1570-1578. [PMID: 33675093 DOI: 10.1111/jgs.17087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long-term function and the contribution of strokes to disability have not been previously characterized. Our objective was to determine long-term function among older adults with AF and the relative contribution of stroke. METHODS We used data from the nationally representative Health and Retirement Study (1992-2014) with participants ≥65 years with incident AF. We examined the association of incident stroke with three outcomes: independence with activities of daily living (ADL), instrumental activities of daily living (IADL), and residence outside a nursing home (community-dwelling). We fit logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimated the contribution of strokes to the overall population burden of disability using the method of recycled predictions. RESULTS Among 3530 participants (median age 79 years, 53% women), 262 had a stroke over 17,396 person-years. Independent of stroke and accounting for comorbidities, annually, ADL independence decreased by 4.4%, IADL independence decreased by 3.9%, and community dwelling decreased by 1.2% (p < 0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home (p < 0.05 for all). Considering all causes of function loss, 1.7% of ADL disability-years, 1.2% of IADL disability-years, and 7.3% of nursing home years could be attributed to stroke over 7.4 years. CONCLUSION Older adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant functional decline and increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of disability, stroke was not the dominant determinant of population-level disability in older adults with AF.
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Affiliation(s)
- Anna L Parks
- Division of Hematology and Oncology, University of California, San Francisco, San Francisco, California, USA
| | - Sun Y Jeon
- Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, USA
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, USA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sachin J Shah
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
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Zhu D, Chung HF, Dobson AJ, Pandeya N, Anderson DJ, Kuh D, Hardy R, Brunner EJ, Avis NE, Gold EB, El Khoudary SR, Crawford SL, Mishra GD. Vasomotor menopausal symptoms and risk of cardiovascular disease: a pooled analysis of six prospective studies. Am J Obstet Gynecol 2020; 223:898.e1-898.e16. [PMID: 32585222 DOI: 10.1016/j.ajog.2020.06.039] [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: 01/20/2020] [Revised: 05/18/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Menopausal vasomotor symptoms (ie, hot flashes and night sweats) have been associated with unfavorable risk factors and surrogate markers of cardiovascular disease, but their association with clinical cardiovascular disease events is unclear. OBJECTIVE To examine the associations between different components of vasomotor symptoms, timing of vasomotor symptoms, and risk of cardiovascular disease. STUDY DESIGN We harmonized and pooled individual-level data from 23,365 women in 6 prospective studies that contributed to the International Collaboration for a Life Course Approach to Women's Reproductive Health and Chronic Disease Events consortium. Women who experienced cardiovascular disease events before baseline were excluded. The associations between frequency (never, rarely, sometimes, and often), severity (never, mild, moderate, and severe), and timing (before or after age of menopause; ie, early or late onset) of vasomotor symptoms and incident cardiovascular disease were analyzed. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. RESULTS In the adjusted model, no evidence of association was found between the frequency of hot flashes and incident cardiovascular disease, whereas women who reported night sweats "sometimes" (hazard ratio, 1.22; 95% confidence interval, 1.02-1.45) or "often" (hazard ratio, 1.29; 95% confidence interval, 1.05-1.58) had higher risk for cardiovascular disease. Increased severity of either hot flashes or night sweats was associated with higher risk of cardiovascular disease. The hazards ratios of cardiovascular disease in women with severe hot flashes, night sweats, and any vasomotor symptoms were 1.83 (95% confidence interval, 1.22-2.73), 1.59 (95% confidence interval, 1.07-2.37), and 2.11 (95% confidence interval, 1.62-2.76), respectively. Women who reported severity of both hot flashes and night sweats had a higher risk for cardiovascular disease (hazard ratio, 1.55; 95% confidence interval, 1.24-1.94) than those with hot flashes alone (hazard ratio, 1.33; 95% confidence interval, 0.94-1.88) and night sweats alone (hazard ratio, 1.32; 95% confidence interval, 0.84-2.07). Women with either early-onset (hazard ratio, 1.38; 95% confidence interval, 1.10-1.75) or late-onset (hazard ratio, 1.69; 95% confidence interval, 1.32-2.16) vasomotor symptoms had an increased risk for incident cardiovascular disease compared with women who did not experience vasomotor symptoms. CONCLUSION Severity rather than frequency of vasomotor symptoms (hot flashes and night sweats) was associated with increased risk of cardiovascular disease. Vasomotor symptoms with onset before or after menopause were also associated with increased risk of cardiovascular disease.
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Parks AL, Jeon SY, Boscardin WJ, Steinman MA, Smith AK, Fang MC, Shah SJ. Long-term individual and population functional outcomes in older adults with atrial fibrillation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.05.20223297. [PMID: 33173929 PMCID: PMC7654925 DOI: 10.1101/2020.11.05.20223297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Older adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long-term function and the contribution of strokes to disability has not been previously characterized. METHODS We performed a longitudinal, observational study in the nationally representative Health and Retirement Study (1992-2014). We included participants ≥65 years with Medicare claims who met incident AF diagnosis claims criteria. We examined the association of incident stroke with three functional outcomes: independence with activities of daily living (ADL) and instrumental activities of daily living (IADL) and community-dwelling. We fit separate logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimate the contribution of strokes to the overall population burden of functional impairment using the method of recycled predictions. RESULTS Among 3530 participants (median age 79 years, 53% women, median CHA2DS2-VASc 5), 262 had a stroke over 17,396 person-years. Independent of stroke and accounting for population comorbidities, annually, ADL dependence increased by 4.4%, IADL dependence increased by 3.9%, and nursing home residence increased by 1.2% (p<0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home (p<0.05 for all). Considering all causes of function loss, 1.7% of ADL disability-years, 1.2% of IADL disability-years, and 7.3% of nursing home years could be attributed to stroke over 7.4years. CONCLUSION Older adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant decline in function and an increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of functional loss, stroke was not the dominant determinant of population-level disability in older adults with AF. IMPACT STATEMENT We certify that this work is novel. Little is known about long-term function (ADL, IADL, community-dwelling) among older adults with AF and the association with stroke. This nationally representative study finds a high rate of function loss independent of stroke, and among those who suffer a stroke, a dramatic and immediate decline in function. Because of the high rate of function loss independent of stroke and the relatively low rate of stroke, on a population level, stroke is not the dominant determinant of disability in older adults with AF.
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Parks AL, Jeon SY, Boscardin WJ, Steinman MA, Smith AK, Fang MC, Shah SJ. Long-term individual and population functional outcomes in older adults with atrial fibrillation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.05.04.20091025. [PMID: 33173890 PMCID: PMC7654882 DOI: 10.1101/2020.05.04.20091025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Older adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long-term function and the contribution of strokes to disability has not been previously characterized. METHODS We performed a longitudinal, observational study in the nationally representative Health and Retirement Study (1992-2014). We included participants ≥65 years with Medicare claims who met incident AF diagnosis claims criteria. We examined the association of incident stroke with three functional outcomes: independence with activities of daily living (ADL) and instrumental activities of daily living (IADL) and community-dwelling. We fit separate logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimate the contribution of strokes to the overall population burden of functional impairment using the method of recycled predictions. RESULTS Among 3530 participants (median age 79 years, 53% women, median CHA 2 DS 2 -VASc 5), 262 had a stroke over 17,396 person-years. Independent of stroke and accounting for population comorbidities, annually, ADL dependence increased by 4.4%, IADL dependence increased by 3.9%, and nursing home residence increased by 1.2% (p<0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home (p<0.05 for all). Considering all causes of function loss, 1.7% of ADL disability-years, 1.2% of IADL disability-years, and 7.3% of nursing home years could be attributed to stroke over 7.4years. CONCLUSION Older adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant decline in function and an increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of functional loss, stroke was not the dominant determinant of population-level disability in older adults with AF. IMPACT STATEMENT We certify that this work is novel. Little is known about long-term function (ADL, IADL, community-dwelling) among older adults with AF and the association with stroke. This nationally representative study finds a high rate of function loss independent of stroke, and among those who suffer a stroke, a dramatic and immediate decline in function. Because of the high rate of function loss independent of stroke and the relatively low rate of stroke, on a population level, stroke is not the dominant determinant of disability in older adults with AF.
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Meza E, Eng CW, Sáenz JL, Gilsanz P, Glymour MM, Torres JM. Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population. J Am Geriatr Soc 2020; 68:2579-2586. [PMID: 32880905 PMCID: PMC7745730 DOI: 10.1111/jgs.16718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/05/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES Several longitudinal studies in high-income countries suggest that depression increases stroke risk. However, few prior studies have evaluated this association in low- and middle-income countries (LMICs), where rapidly aging populations may have markedly different vascular risk profiles. DESIGN Prospective cohort study. SETTING The Mexican Health and Aging Study is a national population-based study of older adults in Mexico. PARTICIPANTS A total of 10,693 Mexican adults aged 50 and older enrolled in 2001 with no history of prior stroke. MEASUREMENTS Depressive symptoms were assessed with a modified 9-item Centers for Epidemiologic Studies Depression Scale (elevated depressive symptom cutoff ≥5) in 2001 and 2003. We evaluated associations between baseline and short-term (2-year) changes in elevated depressive symptoms (categorized as stable low, recently remitted, recent-onset, or stable high symptoms) with incident self-reported or next-of-kin reported doctor-diagnosed stroke through 2015 using Cox proportional hazards models and sensitivity analyses applying inverse probability weights. RESULTS Over an average follow-up of 11.4 years (standard deviation = 4.2), 10,693 respondents reported 546 incident strokes. Individuals with elevated baseline depressive symptoms experienced a moderately higher hazard of incident stroke (hazard ratio [HR] = 1.13; 95% confidence interval [CI] = .95-1.36) compared with those without elevated baseline depressive symptoms. In analyses of short-term changes in elevated depressive symptoms (n = 8,808; 414 incident stokes), participants with recent-onset (HR = 1.38; 95% CI = 1.06-1.81) or stable high (HR = 1.42; 95% CI = 1.10-1.84) elevated depressive symptoms had a greater hazard of incident stroke compared to those with stable low/no depressive symptoms, whereas recently remitted (HR = 1.01; 95% CI = .74-1.37) symptoms was not associated with stroke hazard. CONCLUSION Strategies to reduce depressive symptoms merit evaluation as approaches to prevent stroke in middle-income countries. Findings are similar to those in high-income countries but should be replicated in other LMICs.
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Affiliation(s)
- Erika Meza
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Chloe W. Eng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
- Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Joseph L. Sáenz
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California
| | - Paola Gilsanz
- Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Medellena Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
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Shah SJ, Fang MC, Jeon SY, Gregorich SE, Covinsky KE. Geriatric Syndromes and Atrial Fibrillation: Prevalence and Association with Anticoagulant Use in a National Cohort of Older Americans. J Am Geriatr Soc 2020; 69:349-356. [PMID: 32989731 DOI: 10.1111/jgs.16822] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although guidelines recommend focusing primarily on stroke risk to recommend anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls and disability) are important when considering anticoagulants. Little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use. METHODS We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older Americans. Participants were asked questions to assess domains of aging, including function, cognition, and medical conditions. We included participants 65 years and older with 2 years of continuous Medicare enrollment who met AF diagnosis criteria by claims codes. We examined five geriatric syndromes: one or more falls within the last 2 years, receiving help with activities of daily living (ADLs) or instrumental ADLs (IADL), experienced incontinence, and cognitive impairment. We determined the prevalence of geriatric syndromes and their association with anticoagulant use, adjusting for ischemic stroke risk (i.e., CHA2 DS2 -VASc score [congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, and sex]). RESULTS In this study of 779 participants with AF (median age = 80 years; median CHA2 DS2 -VASc score = 4), 82% had one or more geriatric syndromes. Geriatric syndromes were common: 49% reported falls, 38% had ADL impairments, 42% had IADL impairments, 37% had cognitive impairments, and 43% reported incontinence. Overall, 65% reported anticoagulant use; guidelines recommend anticoagulant use for 97% of participants. Anticoagulant use rate decreased for each additional geriatric syndrome (average marginal effect = -3.7%; 95% confidence interval = -1.4% to -5.9%). Lower rates of anticoagulant use were reported in participants with ADL dependency, IADL dependency, and dementia. CONCLUSION Most older adults with AF had at least one geriatric syndrome, and geriatric syndromes were associated with reduced anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulant use in older adults.
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Affiliation(s)
- Sachin J Shah
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sun Y Jeon
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Steven E Gregorich
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
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Zuo ML, Li CM, Deng Y, Bhattacharyya S, Shuai P, Tse HF, Siu CW, Yin LX. The impact of cigarette smoking in predicting stroke using CHADS 2 and CHA 2DS 2-VASc schemas. Neurol Sci 2020; 42:159-166. [PMID: 32572660 PMCID: PMC7819918 DOI: 10.1007/s10072-020-04455-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/07/2020] [Indexed: 11/26/2022]
Abstract
Objective To determine the impact of smoking status in the prediction of stroke using CHADS2 and CHA2DS2-VASc schemes. Methods Five hundred twenty-eight consecutive patients with arrhythmic symptoms and without any documented arrhythmia from Queen Mary Hospital, Hong Kong, were followed up to determine the incidence of ischemic stroke, new-onset atrial fibrillation (AF), or all-cause mortality. Smoking status was classified into nonsmokers and smokers. The pairwise comparisons of C-statistics for outcomes were performed. Results During a median follow-up period of 6.2 years, 65 (12.3%) individuals developed ischemic stroke. Smokers experienced higher annual incidence of stroke, a new-onset AF, and all-cause death compare to nonsmokers, with corresponding hazard ratio (HR) of stroke, AF, and all-cause death being 2.51 (95% confidence intervals, CI 1.36als, CIse death bein 1.15a3.24), and 1.95 (95% CI 1.161.95 (95% CIath being 2.51 (95% confidence corr2 and CHA2DS2-VASc for stroke were 0.60 (95% CI 0.51 for stp = 0.09) and 0.59 (95% CI 0.50 (95%, p = 0.15) respectively, whereas the C-statistics of CHADS2 and CHA2DS2-VASc were 0.66 (95% CI 0.61 were 0p = 0.005), 0.75 (95% CI 0.7 CI 0.7p < 0.0001), respectively among nonsmokers. After incorporating smoking, both the CHADS2-smoking and CHA2DS2-VASc-smoking achieved better C-statistics for new-onset ischemic stroke prediction superior to baseline score systems in male groups. Conclusion Cigarette smoking status has impact on stroke stratification using CHADS2 and CHA2DS2-VASc scheme. The discrimination of the CHADS2 and CHA2DS2-VASc scheme for stroke can be significantly improved if smoking status is additionally considered.
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Affiliation(s)
- Ming-Liang Zuo
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Health Management Center, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 32# W. Sec 2, 1st Ring Rd, Chengdu, 610072 China
| | - Chun-Mei Li
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Health Management Center, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 32# W. Sec 2, 1st Ring Rd, Chengdu, 610072 China
| | - Yan Deng
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Health Management Center, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 32# W. Sec 2, 1st Ring Rd, Chengdu, 610072 China
| | - Sanjib Bhattacharyya
- College of Pharmaceutical Sciences, Southwest University, Beibei, Chongqing, 400715 China
| | - Ping Shuai
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Health Management Center, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 32# W. Sec 2, 1st Ring Rd, Chengdu, 610072 China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Room 1928, Block K, 102 Pokfulam Road, Hong Kong SAR, 999077 China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Room 1928, Block K, 102 Pokfulam Road, Hong Kong SAR, 999077 China
| | - Li-Xue Yin
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Health Management Center, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 32# W. Sec 2, 1st Ring Rd, Chengdu, 610072 China
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Buie JNJ, Zhao Y, Burns S, Magwood G, Adams R, Sims-Robinson C, Lackland DT. Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study. Ethn Dis 2020; 30:339-348. [PMID: 32346280 PMCID: PMC7186057 DOI: 10.18865/ed.30.2.339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery. Methods We examined Health and Retirement Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000-2014. Analysis of 1,002 first-time, non-Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily living (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes. Results Black stroke survivors were younger compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comorbidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of having increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites. Conclusion Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy.
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Affiliation(s)
- Joy N. J. Buie
- WISSDOM Center, Medical University of South Carolina, Charleston, SC
| | - Yujing Zhao
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Suzanne Burns
- WISSDOM Center, Medical University of South Carolina, Charleston, SC
- School of Occupational Therapy, Texas Women’s University, Denton, TX
| | - Gayenell Magwood
- WISSDOM Center, Medical University of South Carolina, Charleston, SC
- College of Nursing Medical University of South Carolina, Charleston, SC
| | - Robert Adams
- WISSDOM Center, Medical University of South Carolina, Charleston, SC
| | | | | | - WISSDOM Research Center Study Group
- WISSDOM Center, Medical University of South Carolina, Charleston, SC
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
- School of Occupational Therapy, Texas Women’s University, Denton, TX
- College of Nursing Medical University of South Carolina, Charleston, SC
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Risk of Stroke Among Survivors of the September 11, 2001, World Trade Center Disaster. J Occup Environ Med 2019; 60:e371-e376. [PMID: 29851739 DOI: 10.1097/jom.0000000000001361] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between 9/11-related posttraumatic stress disorder (PTSD), dust cloud exposure, and subsequent development of stroke among 42,527 enrollees in the World Trade Center (WTC) Health Registry. METHODS Using four waves of longitudinal data from the WTC Health Registry surveys, we employed Cox proportional hazards regression models to assess the associations. RESULTS Incidence of stroke was higher among those with PTSD or intense dust cloud exposure than those without, and it was even higher for those who had experienced both. In fully adjusted models, participants with PTSD had an increased risk of developing stroke [adjusted hazards ratio (AHR) 1.69, 95% confidence interval (95% CI) 1.42 to 2.02], as did those with intense dust exposure (AHR 1.29, 95% CI 1.09 to 1.53). CONCLUSION We found that individuals with 9/11-related PTSD and/or intense dust exposure may have an increased risk of developing stroke.
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Zhou Z, Lin C, Ma J, Towne SD, Han Y, Fang Y. The Association of Social Isolation With the Risk of Stroke Among Middle-Aged and Older Adults in China. Am J Epidemiol 2019; 188:1456-1465. [PMID: 31150041 DOI: 10.1093/aje/kwz099] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 12/21/2022] Open
Abstract
Given that there is limited research examining the specific role social isolation plays in stroke risk, we aimed to estimate the controlled direct effect of social isolation on stroke risk in China. A nationally representative sample (n = 12,662) of persons aged 45 years or more at baseline (2011), with corresponding follow-ups in 2013 and 2015, was taken from the China Health and Retirement Longitudinal Study. Stroke was assessed through a self- or proxy-reported physician's diagnosis. Social isolation was measured by incorporating marital status, frequency of contact with friends, family, and children, and participation in social activities. A marginal structural model with stabilized inverse probability weights was applied to examine the controlled direct effect of social isolation on stroke risk. Overall, 245 persons had a stroke within the 4-year timeline under study. The total effect model indicated that persons experiencing social isolation had a 64% increased risk of stroke (odds ratio (OR) = 1.64, 95% confidence interval (CI): 1.26, 2.13). Results from the marginal structural model also indicated that socially isolated persons had an increased risk of stroke (OR = 2.39, 95% CI: 1.49, 3.82) after adjustment for depression. Interventions to reduce social isolation may be particularly beneficial in preventing the occurrence of stroke among middle-aged and older adults in China.
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Affiliation(s)
- Zi Zhou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Cen Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jiaping Ma
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Samuel D Towne
- Department of Health Management and Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, Florida
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, Florida
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas
- Center for Population Health and Aging, Texas A&M University, College Station, Texas
| | - Yaofeng Han
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
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Liu L, Miura K, Kadota A, Fujiyoshi A, Gracely EJ, Xue F, Liu Z, Takashima N, Miyagawa N, Ohkubo T, Arima H, Okayama A, Okamura T, Ueshima H. The impact of sex on risk of cardiovascular disease and all-cause mortality in adults with or without diabetes mellitus: A comparison between the U.S. and Japan. J Diabetes Complications 2019; 33:417-423. [PMID: 31003923 DOI: 10.1016/j.jdiacomp.2019.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 01/02/2023]
Abstract
AIMS To test a hypothesis that women with diabetes mellitus (DM) versus those without DM had a significantly higher risk of heart disease (HD), stroke and all-cause mortality than their male counterparts in the U.S. as well as in Japan. METHODS We analyzed two nationally representative datasets, one from the U.S. NHANES III cohort (n = 13,169), and the other from the Japan NIPPON DATA90 cohort (n = 7445). Hazard ratios (HRs) of DM for risk of mortality and sex-DM interaction effect on mortality were analyzed prospectively using Cox's proportional hazards regression models. RESULTS Patients with DM had significantly higher mortality from HD, stroke and all-cause mortality in the U.S. and in Japan. However, the HRs of DM versus non-DM for HD and all-cause mortality were significantly higher in women compared to men in the U.S. (sex-DM interaction: HR = 1.59, p = 0.01, and 1.24, p = 0.045 for HD and all-cause mortality), but the sex-DM interaction effect was not statistically significant in the Japanese cohort. DISCUSSION Patients with DM had a significantly higher risk of mortality than those without DM in the U.S. and Japan. However, women with DM versus those without DM had a higher relative risk of HD and all-cause mortality than their counterparts in men in the U.S, but this sex difference by DM status was not observed in the Japanese cohort. Whether the sex-difference effect of DM on HD and all-cause mortality is due to a difference in metabolic disorders between the two populations warrants consideration and further studies.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan; Department of Hygiene, Wakayama Medical School, Wakayama, Japan
| | - Edward J Gracely
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA; Department of Family, Community, & Prevention Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Fuzhong Xue
- Department of Biostatistics, Shandong University School of Public Health, Jinan, Shandong, China
| | - Zuolu Liu
- Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Naoyuki Takashima
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan; International Center for Nutrition and Information, National Institute of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Shiga, Japan
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Valtorta NK, Kanaan M, Gilbody S, Hanratty B. Loneliness, social isolation and risk of cardiovascular disease in the English Longitudinal Study of Ageing. Eur J Prev Cardiol 2018; 25:1387-1396. [PMID: 30068233 DOI: 10.1177/2047487318792696] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background There is increasing evidence of an association between social relationships and morbidity in general, and cardiovascular disease in particular. However, recent syntheses of the evidence raise two important questions: is it the perceived quality or the more objective quantity of relationships that matters most; and what are the implications of changes in relationships over time? In this study, we investigate the cumulative effects of loneliness and social isolation on incident cardiovascular disease. Design A secondary analysis of prospective follow-up data from the English Longitudinal Study of Ageing (ELSA). Methods To assess the association between social isolation or loneliness and incident cardiovascular disease, lagged values of exposure to loneliness and isolation were treated as time-varying variables in discrete time survival models controlling for potential confounders and established cardiovascular disease risk factors. Results A total of 5397 men and women aged over 50 years were followed up for new fatal and non-fatal diagnoses of heart disease and stroke between 2004 and 2010. Over a mean follow-up period of 5.4 years, 571 new cardiovascular events were recorded. We found that loneliness was associated with an increased risk of cardiovascular disease (odds ratio 1.27, 95% confidence interval 1.01-1.57). Social isolation, meanwhile, was not associated with disease incidence. There was no evidence of a cumulative effect over time of social relationships on cardiovascular disease risk. Conclusions Loneliness is associated with an increased risk of developing coronary heart disease and stroke, independently of traditional cardiovascular disease risk factors. Our findings suggest that primary prevention strategies targeting loneliness could help to prevent cardiovascular disease.
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Affiliation(s)
- Nicole K Valtorta
- 1 Institute of Health and Society, Newcastle University Institute for Ageing, UK
| | - Mona Kanaan
- 2 Department of Health Sciences, University of York, UK
| | - Simon Gilbody
- 2 Department of Health Sciences, University of York, UK
| | - Barbara Hanratty
- 1 Institute of Health and Society, Newcastle University Institute for Ageing, UK
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Abstract
OBJECTIVE The objective of this study was to examine whether loneliness was associated with the risk of developing dementia in Chinese older adults and whether the association was moderated by gender. METHOD A 3-year cohort study was conducted using data from the 2008/2009 and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression was used to analyze the relationship between loneliness and dementia. The interaction between loneliness and gender was also evaluated. RESULTS At 3-year follow-up, 393 of the 7867 participants had dementia. Loneliness was associated with dementia (odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.11-1.56) after adjustment for sociodemographic characteristics, lifestyle, and baseline health status. A significant interaction between loneliness and gender was also found (OR = 0.81, 95% CI = 0.65-0.99). CONCLUSION Loneliness increased the risk of developing dementia among people aged 65 years and older in China. Moreover, the effect of loneliness on dementia risk varied by gender. Specifically, men who felt lonely were more likely to suffer from dementia than women.
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Affiliation(s)
- Zi Zhou
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics , Xiamen University , Xiamen , Fujian , China.,b Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health , Xiamen University , Xiamen , Fujian , China
| | - Ping Wang
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics , Xiamen University , Xiamen , Fujian , China.,b Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health , Xiamen University , Xiamen , Fujian , China
| | - Ya Fang
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics , Xiamen University , Xiamen , Fujian , China.,b Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health , Xiamen University , Xiamen , Fujian , China
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Murphy A, Palafox B, O'Donnell O, Stuckler D, Perel P, AlHabib KF, Avezum A, Bai X, Chifamba J, Chow CK, Corsi DJ, Dagenais GR, Dans AL, Diaz R, Erbakan AN, Ismail N, Iqbal R, Kelishadi R, Khatib R, Lanas F, Lear SA, Li W, Liu J, Lopez-Jaramillo P, Mohan V, Monsef N, Mony PK, Puoane T, Rangarajan S, Rosengren A, Schutte AE, Sintaha M, Teo KK, Wielgosz A, Yeates K, Yin L, Yusoff K, Zatońska K, Yusuf S, McKee M. Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study. Lancet Glob Health 2018; 6:e292-e301. [PMID: 29433667 PMCID: PMC5905400 DOI: 10.1016/s2214-109x(18)30031-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/30/2017] [Accepted: 01/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. METHODS We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. FINDINGS The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1·7), Tanzania (0-3·6), and Zimbabwe (0-5·1), to 49·3% in Canada (44·4-54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5-6·9) in Tanzania to 91·4% (86·6-94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. INTERPRETATION Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. FUNDING Full funding sources listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Adrianna Murphy
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK.
| | - Benjamin Palafox
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
| | - Owen O'Donnell
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, Netherlands; Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
| | - David Stuckler
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alvaro Avezum
- Institute of Cardiology, University of Santo Amaro, Sao Paulo, Brazil
| | - Xiulin Bai
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jephat Chifamba
- Department of Physiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Clara K Chow
- The University of Sydney and The George Institute for Global Health, Camperdown, NSW, Australia
| | - Daniel J Corsi
- Ottawa Hospital Research Institute, OMNI Research Group, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec City, QC, Canada
| | - Antonio L Dans
- University of the Philippines-Manila, Manila, Philippines
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica (ECLA) International, Rosario, Santa Fe, Argentina
| | | | - Noorhassim Ismail
- Department of Community Health, UKM Medical Centre, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Chamran Hospital, Isfahan, Iran
| | - Rasha Khatib
- Department of Public Health Sciences, Loyola Medical Center, Maywood, IL, USA
| | | | | | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Patricio Lopez-Jaramillo
- Fundación Oftalmológica de Santander-FOSCAL-FOSCAL Internacional, Floridablanca, Santander, Colombia
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and DrMohan's Diabetes Specialities Centre, Gopalapuram, Chennai, India
| | - Nahed Monsef
- Dubai Health Authority, Dubai, United Arab Emirates
| | - Prem K Mony
- St John's Medical College and Research Insitute, Bangalore, India
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, Western Cape Province, South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital/Östra, Göteborg, Sweden
| | - Aletta E Schutte
- South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Mariz Sintaha
- Independent University, Bangladesh, Dhaka, Bangladesh
| | - Koon K Teo
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selyang Campus, Selayang, Selangor and UCSI University, Cheras, Malaysia
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
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Zhou Z, Fu J, Hong YA, Wang P, Fang Y. Association between exercise and the risk of dementia: results from a nationwide longitudinal study in China. BMJ Open 2017; 7:e017497. [PMID: 29208615 PMCID: PMC5719269 DOI: 10.1136/bmjopen-2017-017497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study was conducted to examine the causal association between exercise and the risk of dementia among older Chinese adults. DESIGN Longitudinal population-based study with a follow-up duration of 9 years. SETTING Data for the Chinese Longitudinal Healthy Longevity Survey waves occurring from 2002 to 2011-2012 were extracted from the survey database. PARTICIPANTS In total, 7501 dementia-free subjects who were older than 65 years were included at baseline. Dementia was defined as a self-reported or proxy-reported physician's diagnosis of the disease. OUTCOME MEASURES AND METHODS Regular exercise and potential confounding variables were obtained via a self-report questionnaire. We generated longitudinal logistic regression models based on time-lagged generalised estimating equation to examine the causal association between exercise and dementia risk. RESULTS Of the 7501 older Chinese people included in this study, 338 developed dementia during the 9-year follow-up period after excluding those who were lost to follow-up or deceased. People who regularly exercised had lower odds of developing dementia (OR=0.53, 95% CI 0.33 to 0.85) than those who did not exercise regularly. CONCLUSION Regular exercise was associated with decreased risk of dementia. Policy-makers should develop effective public health programmes and build exercise-friendly environments for the general public.
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Affiliation(s)
- Zi Zhou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, China
| | - Jian Fu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, China
| | - Y. Alicia Hong
- School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Ping Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, China
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Shifren K, Anzaldi K. Optimism, well-being, depressive symptoms, and perceived physical health: a study among Stroke survivors. PSYCHOL HEALTH MED 2017; 23:46-57. [DOI: 10.1080/13548506.2017.1325505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kim Shifren
- Psychology Department, College of Liberal Arts Building, Towson University, Towson, MD, USA
| | - Kristen Anzaldi
- Psychology Department, College of Liberal Arts Building, Towson University, Towson, MD, USA
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47
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Rist PM, Capistrant BD, Mayeda ER, Liu SY, Glymour MM. Physical activity, but not body mass index, predicts less disability before and after stroke. Neurology 2017; 88:1718-1726. [PMID: 28381510 PMCID: PMC5409841 DOI: 10.1212/wnl.0000000000003888] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 02/13/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether physical activity and body mass index (BMI) predict instrumental or basic activities of daily living (I/ADL) trajectories before or after stroke compared to individuals who remained stroke-free. METHODS Using a prospective cohort, the Health and Retirement Study, we followed adults without a history of stroke in 1998 (n = 18,117) for up to 14 years. We estimated linear regression models of I/ADL trajectories comparing individuals who remained stroke-free throughout follow-up (n = 16,264), those who survived stroke (n = 1,374), and those who died after stroke and before the next interview wave (n = 479). We evaluated whether I/ADL trajectories differed by physical activity or BMI at baseline (before stroke), adjusting for demographic and socioeconomic covariates. RESULTS Compared to those who were physically active, stroke survivors who were physically inactive at baseline had a lower probability of independence in ADLs and IADLs 3 years after stroke (risk difference = -0.18 and -0.16 for ADLs and IADLs, respectively). However, a similar difference in the probability of independence was also present 3 years before stroke, and we observed no evidence that physical activity slowed the rate of decline in independence before or after stroke. Unlike the results for physical activity, we did not observe a consistent pattern for the probability of independence in ADLs or IADLs comparing obese stroke survivors to normal-weight or to overweight stroke survivors 3 years before stroke or 3 years after stroke. CONCLUSIONS Physical inactivity predicts a higher risk of being dependent both before and after stroke.
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Affiliation(s)
- Pamela M Rist
- From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco.
| | - Benjamin D Capistrant
- From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco
| | - Elizabeth Rose Mayeda
- From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco
| | - Sze Y Liu
- From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco
| | - M Maria Glymour
- From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco
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48
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Stephan BCM, Richardson K, Savva GM, Matthews FE, Brayne C, Hachinski V. Potential Value of Impaired Cognition in Stroke Prediction: A U.K. Population-Based Study. J Am Geriatr Soc 2017; 65:1756-1762. [PMID: 28369710 PMCID: PMC5574015 DOI: 10.1111/jgs.14878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives To determine whether the association between impaired cognition and greater risk of incident stroke is also observed when cognitive impairment is defined using different criteria for mild cognitive impairment (MCI). Design Prospective cohort study with 10 years of follow‐up. Setting Large multicentre study in the United Kingdom. Participants Individuals (aged 64–105) from the Medical Research Council Cognitive Function and Ageing Study (N = 13,004). From this, a subsample of 2,640 individuals was selected based on age, center, and cognitive ability to undergo a detailed cognitive assessment. Measurements Information on sociodemographic characteristics, health, cognition, and functional ability was collected in an interview. The Geriatric Mental State Automated Geriatric Examination for Computer Assisted Taxonomy and the Cambridge Cognitive Examination were used to determine cognitive status. Stroke incidence was derived from self‐report, informant report, and death certificates. Participants were divided into no, mild, moderate, and severe cognitive impairment according to their baseline Mini‐Mental State Examination (MMSE) score. MCI criteria were used to classify persons into four groups: no cognitive impairment, MCI, severe impairment (i.e. other cognitive impairment no dementia: OCIND) and dementia. Results Over 10 years, 703 incident strokes occurred. Lower MMSE score at baseline was associated with greater risk of incident stroke. When cognitive status was determined according to MCI criteria, those with severe impairment (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.0–2.2) and dementia (OR = 2.6, 95% CI = 1.6–3.4) had a significantly greater risk of stroke than those with no cognitive impairment. Conclusion Criteria for MCI, defined using MMSE scores or clinical criteria, can capture individuals at greater stroke risk. The results highlight the need to focus on stroke risk in individuals even with MCI.
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Affiliation(s)
- Blossom C M Stephan
- Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona E Matthews
- Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
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Liu L, Simon B, Shi J, Mallhi AK, Eisen HJ. Impact of diabetes mellitus on risk of cardiovascular disease and all-cause mortality: Evidence on health outcomes and antidiabetic treatment in United States adults. World J Diabetes 2016; 7:449-461. [PMID: 27795819 PMCID: PMC5065665 DOI: 10.4239/wjd.v7.i18.449] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/22/2016] [Accepted: 08/18/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults.
METHODS The analysis included a randomized population sample of 272149 subjects ages ≥ 18 years who participated in the National Health Interview Surveys (NHIS) in 2000-2009. Chronic conditions (hypertension, DM and CVD) were classified by participants’ self-reports of physician diagnosis. NHIS-Mortality Linked Files, and NHIS-Medical Expenditure Panel Survey Linkage Files on prescribed medicines for patients with DM were used to test the research questions. χ2, Poisson and Cox’s regression models were applied in data analysis.
RESULTS Of all participants, 22305 (8.2%) had DM. The prevalence of DM significantly increased from 2000 to 2009 in all age groups (P < 0.001). Within an average 7.39 (SD = 3) years of follow-up, male DM patients had 1.56 times higher risk of death from all-cause (HR = 1.56, 95%CI: 1.49-1.64), 1.72 times higher from heart disease [1.72 (1.53-1.93)], 1.48 times higher from cerebrovascular disease [1.48 (1.18-1.85)], and 1.67 times higher from CVD [1.67 (1.51-1.86)] than subjects without DM, respectively. Similar results were observed in females. In males, 10% of DM patients did not use any antidiabetic medications, 38.1% used antidiabetic monotherapy, and 51.9% used ≥ 2 antidiabetic medications. These corresponding values were 10.3%, 40.4% and 49.4% in females. A significant protective effect of metformin monotherapy or combination therapy (except for insulin) on all-cause mortality and a protective but non-significant effect on CVD mortality were observed.
CONCLUSION This is the first study using data from multiple linkage files to confirm a significant increased prevalence of DM in the last decade in the United States. Patients with DM have significantly higher risk of death from all-cause and CVD than those without DM. Antidiabetic mediations, specifically for metformin use, show a protective effect against all-cause and CVD mortalities.
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50
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van Hedel K, Mejía-Guevara I, Avendaño M, Sabbath EL, Berkman LF, Mackenbach JP, van Lenthe FJ. Work-Family Trajectories and the Higher Cardiovascular Risk of American Women Relative to Women in 13 European Countries. Am J Public Health 2016; 106:1449-56. [PMID: 27310346 PMCID: PMC4940665 DOI: 10.2105/ajph.2016.303264] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate whether less-healthy work-family life histories contribute to the higher cardiovascular disease prevalence in older American compared with European women. METHODS We used sequence analysis to identify distinct work-family typologies for women born between 1935 and 1956 in the United States and 13 European countries. Data came from the US Health and Retirement Study (1992-2006) and the Survey of Health, Aging, and Retirement in Europe (2004-2009). RESULTS Work-family typologies were similarly distributed in the United States and Europe. Being a lone working mother predicted a higher risk of heart disease, stroke, and smoking among American women, and smoking for European women. Lone working motherhood was more common and had a marginally stronger association with stroke in the United States than in Europe. Simulations indicated that the higher stroke risk among American women would only be marginally reduced if American women had experienced the same work-family trajectories as European women. CONCLUSIONS Combining work and lone motherhood was more common in the United States, but differences in work-family trajectories explained only a small fraction of the higher cardiovascular risk of American relative to European women.
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Affiliation(s)
- Karen van Hedel
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Iván Mejía-Guevara
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Mauricio Avendaño
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Erika L Sabbath
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Lisa F Berkman
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Johan P Mackenbach
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Frank J van Lenthe
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
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