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Wajngarten M. How to Improve Clinical Outcomes and Reduce Cardiovascular Risk in Older People with Cardiovascular Disease: Bridging Evidence Gaps. Eur Cardiol 2023; 18:e17. [PMID: 37405340 PMCID: PMC10316345 DOI: 10.15420/ecr.2022.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/07/2023] [Indexed: 07/06/2023] Open
Abstract
The geriatric population is greatly impacted by cardiovascular disease. Thus, it becomes essential to 'geriatricise' the cardiologist through the dissemination of geriatric cardiology. In the early days of geriatric cardiology, it was discussed whether it was simply cardiology 'well done'. Today, 40 years later, it seems clear that this is indeed the case. Patients with cardiovascular disease usually have several chronic conditions. Clinical practice guidelines often address a single condition and do not provide sufficient guidance for patients with multimorbidity. There are several evidence gaps regarding these patients. Physicians and members ofthe care team need a multidimensional understanding ofthe patient to better promote the optimisation of care. It is important to understand that ageing is inevitable, heterogeneous and increases vulnerability. Caregivers must know how to assess elderly patients in a multidomain practical way and how to recognise the factors that may have implications on treatment.
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Affiliation(s)
- Mauricio Wajngarten
- Department of Cardiology, Hospital Israelita Albert Einstein São Paulo, Brazil
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Makino K, Lee S, Bae S, Harada K, Chiba I, Katayama O, Tomida K, Morikawa M, Yamashiro Y, Sudo M, Takayanagi N, Shimada H. Light intensity physical activity is beneficially associated with brain volume in older adults with high cardiovascular risk. Front Cardiovasc Med 2022; 9:882562. [PMID: 35911542 PMCID: PMC9326229 DOI: 10.3389/fcvm.2022.882562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundOlder people with high cardiovascular risk, including those without cardiovascular diseases, are an at-risk population for dementia. Regular physical activity is generally recommended to maintain brain health; however, the optimal intensity of physical activity for maintaining brain volume in older adults with cardiovascular risk remains unclear. We examined the associations between intensity-specific physical activity and brain volume stratified by absolute cardiovascular risk level in older adults without cardiovascular diseases.Methods and resultsThis cross-sectional study involved 725 community-dwelling older Japanese adults without cardiovascular diseases. We estimated absolute cardiovascular risk using the World Health Organization risk estimation charts, which include variables such as age, sex, diabetes mellitus, smoking, systolic blood pressure, and total cholesterol, and stratified cardiovascular risk level into three risk categories: low (≤ 9%), moderate (10–14%), and high (≥15%). We measured daily physical activity using a triaxial accelerometer, and calculated the average time spent in moderate-to-vigorous intensity physical activity (MVPA) and light intensity physical activity (LPA). We performed brain T1-weighted magnetic resonance imaging and calculated the volume of the cortical gray matter, subcortical gray matter, and cerebral white matter, using the FreeSurfer software. In the overall sample, multivariable linear regression analysis showed that greater MVPA was significantly associated with greater volume of the cortical gray matter and cerebral white matter, and greater LPA was significantly associated with greater volume of the cerebral white matter. Additionally, in the analysis of the sample stratified by absolute cardiovascular risk level, cerebral white matter volume was significantly associated with both MVPA and LPA in the high cardiovascular risk group.ConclusionsThe association between physical activity and brain volume differed according to cardiovascular risk level in community-dwelling older adults. In a population at high cardiovascular risk, maintaining or increasing LPA might be a practical and achievable strategy for healthy brain aging.
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Affiliation(s)
- Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
- *Correspondence: Keitaro Makino
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Seongryu Bae
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ippei Chiba
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kouki Tomida
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masanori Morikawa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Motoki Sudo
- Tokyo Research Laboratories, Kao Corporation, Tokyo, Japan
| | | | - Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
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Franz CE, Xian H, Lew D, Hatton SN, Puckett O, Whitsel N, Beck A, Dale AM, Fang B, Fennema-Notestine C, Hauger RL, Jacobson KC, Lyons MJ, Reynolds CA, Kremen WS. Body mass trajectories and cortical thickness in middle-aged men: a 42-year longitudinal study starting in young adulthood. Neurobiol Aging 2019; 79:11-21. [PMID: 31026618 PMCID: PMC6591047 DOI: 10.1016/j.neurobiolaging.2019.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 01/30/2023]
Abstract
Evidence strongly suggests that being overweight or obese at midlife confers significantly higher risk for Alzheimer's disease and greater brain atrophy later in life. Few studies, however, examine associations between longitudinal changes in adiposity during early adulthood and later brain morphometry. Measures of body mass index (BMI) were collected in 373 men from the Vietnam Era Twin Study of Aging at average ages 20, 40, 56, and 62 years, yielding 2 BMI trajectories. We then examined associations between BMI phenotypes (trajectories, continuous BMI, obese/nonobese), cortical thickness, and white matter measures from structural magnetic resonance imaging at mean age 62 (time 4, range 56-66 years). Those on the obesity trajectory (N = 171) had a thinner cortex compared with the normal/lean trajectory (N = 202) in multiple frontal and temporal lobe bilateral regions of interest: superior, inferior, middle temporal gyri, temporal pole, fusiform gyrus, banks of the superior temporal sulcus, frontal pole, pars triangularis, caudal and rostral middle frontal gyri (all p < 0.05, false discovery rate corrected). Frontal lobe thinness tended to occur mainly in the right hemisphere. Results were similar for obese versus nonobese adults at age 62. There were no significant differences for white matter volume or abnormalities. Taken in the context of other research, these associations between brain structures and excess BMI at midlife suggest potential for increased risk for cognitive decline in later life.
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Affiliation(s)
- Carol E. Franz
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla CA, USA
| | - Hong Xian
- Department of Epidemiology & Biostatistics, St. Louis University, St. Louis, MO, USA
| | - Daphne Lew
- Department of Epidemiology & Biostatistics, St. Louis University, St. Louis, MO, USA
| | - Sean N. Hatton
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla CA, USA
| | - Olivia Puckett
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla CA, USA
| | - Nathan Whitsel
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla CA, USA
| | - Asad Beck
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Anders M. Dale
- Department of Radiology, University of California San Diego, La Jolla CA, USA
| | - Bin Fang
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla CA, USA
| | - Christine Fennema-Notestine
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla CA, USA,Department of Radiology, University of California San Diego, La Jolla CA, USA
| | - Richard L. Hauger
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla CA, USA,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, USA
| | - Kristen C. Jacobson
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Chandra A. Reynolds
- Department of Psychology, University of California Riverside, Riverside, CA, USA
| | - William S. Kremen
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla CA, USA,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, USA
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