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Tran C, Yeap BB, Ball J, Clayton-Chubb D, Hussain SM, Brodtmann A, Tonkin AM, Neumann JT, Schneider HG, Fitzgerald S, Woods RL, McNeil JJ. Testosterone and the risk of incident atrial fibrillation in older men: further analysis of the ASPREE study. EClinicalMedicine 2024; 72:102611. [PMID: 38707912 PMCID: PMC11067494 DOI: 10.1016/j.eclinm.2024.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Background A cardiovascular safety trial of testosterone in men with cardiovascular risk factors or disease found no difference in rates of major adverse cardiovascular events (MACE) or death but noted more atrial fibrillation (AF) events in testosterone-treated men. We investigated the relationship between endogenous testosterone concentrations with risk of developing AF in healthy older men. Methods Post-hoc analysis of 4570 male participants in the ASPirin in Reducing Events in the Elderly (ASPREE) study. Men were aged ≥ 70 years, had no history of cardiovascular disease (including AF), thyroid disease, prostate cancer, dementia, or life-threatening illnesses. Risk of AF was modelled using Cox proportional hazards regression. Findings Median (IQR) age was 73.7 (71.6-77.1) years and median (IQR) follow-up 4.4 (3.3-5.5) years, during which 286 men developed AF (15.3 per 1000 participant-years). Baseline testosterone was higher in men who developed incident AF compared men who did not [17.0 (12.4-21.2) vs 15.7 (12.2-20.0) nmol/L]. There was a non-linear association of baseline testosterone with incident AF. The risk for AF was higher in men with testosterone in quintiles (Q) 4&5 (Q4:Q3, HR = 1.91; 95%CI = 1.29-2.83 and Q5:Q3HR = 1.98; 95%CI = 1.33-2.94). Results were similar after excluding men who experienced MACE or heart failure during follow-up. Interpretation Circulating testosterone concentrations within the high-normal range are independently associated with an increased risk of incident AF amongst healthy older men. This suggests that AF may be an adverse consequence of high-normal total testosterone concentrations. Funding National Institute on Aging and National Cancer Institute at the National Institutes of Health; Australian Government (NHMRC, CSIRO); Monash University; and AlfredHealth.
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Affiliation(s)
- Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bu B. Yeap
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Johannes T. Neumann
- University Heart and Vascular Center Hamburg, University Medical Center Hamburg – Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lubeck, Germany
| | - Hans G. Schneider
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Clinical Biochemistry Unit Alfred Pathology Service Alfred Health Melbourne, Victoria, Australia
| | - Sharyn Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Davis SR, Azene ZN, Tonkin AM, Woods RL, McNeil JJ, Islam RM. Higher testosterone is associated with higher HDL-cholesterol and lower triglyceride concentrations in older women: an observational study. Climacteric 2024; 27:282-288. [PMID: 38345304 DOI: 10.1080/13697137.2024.2310530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/20/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study aimed to determine whether concentrations of testosterone and its main precursor after menopause, dehydroepiandrosterone (DHEA), are associated with lipoproteins and other lipids in community-dwelling older women. METHODS The Sex Hormones in Older Women (SHOW) study was an observational study of 6358 Australian women, aged at least 70 years, with no prior major adverse cardiovascular event who had sex hormones measured by liquid chromatography-tandem mass spectrometry. Associations between hormones and lipids were examined using multilinear regression adjusted for potential confounders. RESULTS The cross-sectional analyses included 3231 participants, median age 74.0 (interquartile range 71.7-77.9) years. Compared with concentrations in the lowest quartile (Q1), testosterone concentrations in the highest quartiles (Q3 and Q4) were positively associated with high-density lipoprotein cholesterol (HDL-C) (p = 0.002 and p < 0.001, respectively) while Q4 testosterone concentrations were positively associated with total cholesterol (p = 0.038). Q2, Q3 and Q4 testosterone concentrations were significantly inversely associated with triglycerides (TG) (p = 0.024, p = 0.003 and p < 0.001, respectively). For DHEA, Q4 concentrations was positively associated with non-HDL-C (p = 0.024). CONCLUSIONS In older women, higher endogenous testosterone concentrations are significantly associated with higher HDL-C and lower TG, indicating a less atherogenic profile. These findings suggest a neutral, or potentially protective, cardiovascular disease effect of testosterone in older women.
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Affiliation(s)
- S R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Z N Azene
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - A M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - R L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - J J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - R M Islam
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Neumann JT, Twerenbold R, Weimann J, Ballantyne CM, Benjamin EJ, Costanzo S, de Lemos JA, deFilippi CR, Di Castelnuovo A, Donfrancesco C, Dörr M, Eggers KM, Engström G, Felix SB, Ferrario MM, Gansevoort RT, Giampaoli S, Giedraitis V, Hedberg P, Iacoviello L, Jørgensen T, Kee F, Koenig W, Kuulasmaa K, Lewis JR, Lorenz T, Lyngbakken MN, Magnussen C, Melander O, Nauck M, Niiranen TJ, Nilsson PM, Olsen MH, Omland T, Oskarsson V, Palmieri L, Peters A, Prince RL, Qaderi V, Vasan RS, Salomaa V, Sans S, Smith JG, Söderberg S, Thorand B, Tonkin AM, Tunstall-Pedoe H, Veronesi G, Watanabe T, Watanabe M, Zeiher AM, Zeller T, Blankenberg S, Ojeda F. Prognostic Value of Cardiovascular Biomarkers in the Population. JAMA 2024:2818624. [PMID: 38739396 DOI: 10.1001/jama.2024.5596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Importance Identification of individuals at high risk for atherosclerotic cardiovascular disease within the population is important to inform primary prevention strategies. Objective To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors. Design, Setting, and Participants Individual-level analysis including data on cardiovascular biomarkers from 28 general population-based cohorts from 12 countries and 4 continents with assessments by participant age. The median follow-up was 11.8 years. Exposure Measurement of high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, B-type natriuretic peptide, or high-sensitivity C-reactive protein. Main Outcomes and Measures The primary outcome was incident atherosclerotic cardiovascular disease, which included all fatal and nonfatal events. The secondary outcomes were all-cause mortality, heart failure, ischemic stroke, and myocardial infarction. Subdistribution hazard ratios (HRs) for the association of biomarkers and outcomes were calculated after adjustment for established risk factors. The additional predictive value of the biomarkers was assessed using the C statistic and reclassification analyses. Results The analyses included 164 054 individuals (median age, 53.1 years [IQR, 42.7-62.9 years] and 52.4% were women). There were 17 211 incident atherosclerotic cardiovascular disease events. All biomarkers were significantly associated with incident atherosclerotic cardiovascular disease (subdistribution HR per 1-SD change, 1.13 [95% CI, 1.11-1.16] for high-sensitivity cardiac troponin I; 1.18 [95% CI, 1.12-1.23] for high-sensitivity cardiac troponin T; 1.21 [95% CI, 1.18-1.24] for N-terminal pro-B-type natriuretic peptide; 1.14 [95% CI, 1.08-1.22] for B-type natriuretic peptide; and 1.14 [95% CI, 1.12-1.16] for high-sensitivity C-reactive protein) and all secondary outcomes. The addition of each single biomarker to a model that included established risk factors improved the C statistic. For 10-year incident atherosclerotic cardiovascular disease in younger people (aged <65 years), the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein resulted in a C statistic improvement from 0.812 (95% CI, 0.8021-0.8208) to 0.8194 (95% CI, 0.8089-0.8277). The combination of these biomarkers also improved reclassification compared with the conventional model. Improvements in risk prediction were most pronounced for the secondary outcomes of heart failure and all-cause mortality. The incremental value of biomarkers was greater in people aged 65 years or older vs younger people. Conclusions and Relevance Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality. The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality.
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Affiliation(s)
- Johannes Tobias Neumann
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christie M Ballantyne
- Center for Cardiometabolic Disease Prevention, Department of Medicine, College of Medicine, Baylor University, Houston, Texas
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - James A de Lemos
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | | | | | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, National Institute of Health, Rome, Italy
| | - Marcus Dörr
- Department of Internal Medicine B, University Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Kai M Eggers
- Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Stephan B Felix
- Department of Internal Medicine B, University Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Marco M Ferrario
- Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Pär Hedberg
- Department of Clinical Physiology and Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, Libera Università Mediterranea, Casamassima, Italy
| | - Torben Jørgensen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre for Clinical Research and Prevention, BFH Hospital, Copenhagen, Denmark
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, Northern Ireland
| | - Wolfgang Koenig
- German Heart Center, Technical University of Munich, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
- German Center for Cardiovascular Disease Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Joshua R Lewis
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Medical School, University of Western Australia, Perth
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Thiess Lorenz
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Magnus N Lyngbakken
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Olle Melander
- Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Matthias Nauck
- German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Teemu J Niiranen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Internal Medicine, University of Turku, Turku, Finland
| | - Peter M Nilsson
- Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Michael H Olsen
- Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health, University of Southern Denmark, Odense
| | - Torbjorn Omland
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Viktor Oskarsson
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, National Institute of Health, Rome, Italy
| | - Anette Peters
- German Center for Cardiovascular Disease Research, Partner Site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Richard L Prince
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Medical School, University of Western Australia, Perth
| | - Vazhma Qaderi
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ramachandran S Vasan
- Department of Medicine, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- University of Texas School of Public Health and the University of Texas Health Science Center, San Antonio
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Susana Sans
- Catalan Department of Health, Barcelona, Spain
| | - J Gustav Smith
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, Scotland
| | - Giovanni Veronesi
- Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, School of Medicine, Yamagata University, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, School of Medicine, Yamagata University, Yamagata, Japan
| | - Andreas M Zeiher
- Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany
- German Center for Cardiovascular Disease Research, Partner Site Rhine-Main, Mainz, Germany
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Francisco Ojeda
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hussain SM, Tonkin AM, Watts GF, Lacaze P, Yu C, Beilin LJ, Zhou Z, Newman AB, Neumann JT, Tran C, McNeil JJ. Sex-dependent associations of plasma high-density lipoprotein cholesterol and mortality risk in healthy older men and women: two prospective cohort studies. GeroScience 2024; 46:1461-1475. [PMID: 37610595 PMCID: PMC10828260 DOI: 10.1007/s11357-023-00904-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023] Open
Abstract
The relationship between high plasma high-density lipoprotein cholesterol (HDL-C) and cause and mortality are not well established in healthy older people. This study examined the associations between HDL-C levels and mortality in initially healthy older men and women. This analysis included participants from the Aspirin in Reducing Events in the Elderly (ASPREE; n=18,668) trial and a matched cohort from the UK Biobank (UKB; n=62,849 ≥65 years). Cox regression was used to examine hazard ratios between HDL-C categories <1.03 mmol/L, 1.03-1.55 mmol/L (referent category), 1.55-2.07 mmol/L, and >2.07 mmol/L and all-cause, cancer, cardiovascular disease (CVD), and "non-cancer non-CVD" mortality. Genetic contributions were assessed using a polygenic score for HDL-C. Among ASPREE participants (aged 75±5 years), 1836 deaths occurred over a mean follow-up of 6.3±1.8 years. In men, the highest category of HDL-C levels was associated with increased risk of all-cause (HR 1.60, 95% CI 1.26-2.03), cancer (HR 1.37, 95% CI 0.96-2.00), and "non-cancer non-CVD" mortality (HR 2.35, 95% CI 1.41-3.42) but not CVD mortality (HR 1.08, 95% CI 0.60-1.94). The associations were replicated among UKB participants (aged 66.9±1.5 years), including 8739 deaths over a mean follow-up of 12.7±0.8 years. There was a non-linear association between HDL-C levels and all-cause and cause-specific mortality. The association between HDL-C levels and mortality was unrelated to variations in the HDL-C polygenic score. No significant association was found between HDL-C levels and mortality in women. Higher HDL-C levels are associated with increased risk from cancer and "non-cancer non-CVD" mortality in healthy older men but no such relationship was observed in women.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia.
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Perth, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chenglong Yu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lawrence J Beilin
- School of Medicine, University of Western Australia, Perth, Australia
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Anne B Newman
- Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, USA
| | - Johannes T Neumann
- Department of Cardiology, University Heart & Vascular Center (UHZ), Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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5
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Zhou Z, Tonkin AM, Curtis AJ, Murray A, Zhu C, Reid CM, Williamson JD, Ryan J, McNeil JJ, Beilin LJ, Ernst ME, Stocks N, Lacaze P, Shah RC, Woods RL, Wolfe R, Gall S, Zoungas S, Orchard SG, Nelson MR. Low-Density-Lipoprotein Cholesterol and Mortality Outcomes Among Healthy Older Adults: A Post Hoc Analysis of ASPREE Trial. J Gerontol A Biol Sci Med Sci 2024; 79:glad268. [PMID: 38038339 PMCID: PMC10960624 DOI: 10.1093/gerona/glad268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The prognostic implication of cholesterol levels in older adults remains uncertain. This study aimed to examine the relationship between low-density-lipoprotein cholesterol (LDL-c) and mortality outcomes in older individuals. METHODS This post hoc analysis examined the associations of LDL-c levels with mortality risks from all-cause, cardiovascular disease (CVD), cancer, and combined non-CVD/noncancer conditions in a cohort of individuals aged ≥65 years from the ASPirin in Reducing Events in the Elderly trial (NCT01038583). At baseline, participants had no diagnosed dementia, physical disability, or CVD, and were not taking lipid-lowering agents. Outcome analyses were performed using multivariable Cox models. RESULTS We analyzed 12 334 participants (mean age: 75.2 years). Over a median 7-year follow-up, 1 250 died. Restricted cubic splines found a U-shaped relation for LDL-c and all-cause mortality, cancer mortality, and noncancer/non-CVE mortality (nadir: 3.3-3.4 mmol/L); the risk of CVD mortality was similar at LDL-c below 3.3 mmol/L and increased above 3.3 mmol/L. Similar trends were observed in analyses modeling LDL-c by quartiles. When modeling LDL-c as a continuous variable, the risk of all-cause mortality, cancer mortality, and noncancer/non-CVD mortality was decreased by 9%, 16%, and 18%, respectively, per 1-mmol/L higher LDL-c, and the risk of CVD mortality was increased by 19% per 1-mmol/L higher LDL-c. Reduced all-cause and non-CVD/noncancer mortality risks were only significant in males but not females (pinteraction < .05). CONCLUSIONS There were U-shaped relationships between LDL-c and all-cause mortality, cancer mortality, and noncancer/non-CVD mortality in healthy older adults. Higher LDL-c levels were associated with an increased risk of CVD mortality. Future studies are warranted to confirm our results.
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Affiliation(s)
- Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea J Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, Minnesota, USA
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jeff D Williamson
- Sticht Center on Aging and Alzheimer’s Prevention, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Nigel Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Parker EJ, Orchard SG, Gilbert TJ, Phung JJ, Owen AJ, Lockett T, Nelson MR, Reid CM, Tonkin AM, Abhayaratna WP, Gibbs P, McNeil JJ, Woods RL. The ASPREE Healthy Ageing Biobank: Methodology and participant characteristics. PLoS One 2024; 19:e0294743. [PMID: 38421995 PMCID: PMC10903821 DOI: 10.1371/journal.pone.0294743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/07/2023] [Indexed: 03/02/2024] Open
Abstract
ASPirin in Reducing Events in the Elderly (ASPREE), a placebo-controlled prevention trial of low dose aspirin, provided the opportunity to establish a biospecimen biobank from initially healthy persons aged 70+ years for future research. The ASPREE Healthy Ageing Biobank (ASPREE Biobank) collected, processed and stored blood and urine samples at -80degC or under nitrogen vapour at two timepoints, three years apart, from a willing subset of Australian ASPREE participants. Written informed consent included separate opt-in questions for biomarker and genetic testing. Fractionated blood and urine were aliquoted into multiple low-volume, barcoded cryotubes for frozen storage within 4 hours of collection. Specially designed and outfitted mobile laboratories provided opportunities for participation by people in regional and rural areas. Detailed, high quality demographic, physiological and clinical data were collected annually through the ASPREE trial. 12,219 participants contributed blood/urine at the first timepoint, 10,617 of these older adults provided 3-year follow-up samples, and an additional 1,712 provided saliva for DNA. The mean participant age was 74 years, 54% were female and 46% lived outside major cities. Despite geographical and logistical challenges, nearly 100% of blood/urine specimens were processed and frozen within 4 hours of collection into >1.4 million aliquots. After a median of 4.7 years, major clinical events among ASPREE Biobank participants included 332 with dementia, 613 with cardiovascular disease events, 1259 with cancer, 357 with major bleeds and 615 had died. The ASPREE Biobank houses and curates a large number of biospecimens collected prior to the clinical manifestations of major disease, and 3-year follow-up samples, all linked to high quality, extensive phenotypic information. This provides the opportunity to identify or validate diagnostic, prognostic and predictive biomarkers, and potentially study biological effectors, of ageing-related diseases or maintenance of older-age good health.
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Affiliation(s)
- Emily J Parker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tom J Gilbert
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - James J Phung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Trevor Lockett
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, North Ryde, New South Wales, Australia
- Technical Director, Rhythm Biosciences Ltd, Parkville, Victoria, Australia
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Walter P Abhayaratna
- ANU Medical School, Australian National University, Garran, Australian Capital Territory, Australia
| | - Peter Gibbs
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hussain SM, Robb C, Tonkin AM, Lacaze P, Chong TTJ, Beilin LJ, Yu C, Watts GF, Ryan J, Ernst ME, Zhou Z, Neumann JT, McNeil JJ. Association of plasma high-density lipoprotein cholesterol level with risk of incident dementia: a cohort study of healthy older adults. Lancet Reg Health West Pac 2024; 43:100963. [PMID: 38456089 PMCID: PMC10920036 DOI: 10.1016/j.lanwpc.2023.100963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 03/09/2024]
Abstract
Background Recent studies have reported associations between high plasma high-density lipoprotein cholesterol (HDL-C) levels and risk of all-cause mortality, age-related macular degeneration, sepsis and fractures, but associations with dementia risk remain unclear. To determine whether high plasma HDL-C levels are associated with increased incident dementia risk in initially-healthy older people. Methods We conducted a post-hoc analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial; a double-blind, randomized, placebo-controlled trial of daily low-dose aspirin in healthy older people. ASPREE recruited 16,703 participants aged ≥70 years (from Australia) and 2411 participants aged ≥65 years (from the US) between 2010 and 2014. Participants had no diagnosed cardiovascular disease, dementia, physical disability, or life-threatening illness at enrolment and were cognitively healthy (3MS score ≥78). All-cause dementia was a primary trial endpoint, and determined by DSM-IV criteria. Cox regression was used to examine hazard ratios between HDL-C categories <40 mg/dL, 40-60 mg/dL (reference category), 60-80 mg/dL, and >80 mg/dL and dementia. Restricted cubic spline curves were used to determine nonlinear associations. Data analysis was performed from October 2022 to January 2023. Findings Of the 18,668 participants, 850 (4.6%) cases of incident dementia were recorded over 6.3 (SD 1.8) years. Participants with high HDL-C (>80 mg/dL) had a 27% higher risk of dementia (HR 1.27, 95% CI 1.03, 1.58). Age stratified analyses demonstrated that the risk of incident dementia was higher in participants ≥75 years compared to participants <75 years (HR 1.42, 95% CI 1.10, 1.83 vs HR 1.02, 95% CI 0.68, 1.51). Associations remained significant after adjusting for covariates including age, sex, country of enrolment, daily exercise, education, alcohol consumption, weight change over time, non-HDL-C, HDL-C-PRS, and APOE genotype. Interpretation In a population of initially-healthy older adults aged ≥75 years, high HDL-C levels were associated with increased risk of all-cause dementia. Funding National Institutes of Health, USA; National Health and Medical Research Council Australia; Monash University (Melbourne, VIC, Australia); and the Victorian Cancer Agency (Australia).
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria, 3010, Australia
| | - Catherine Robb
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Trevor T.-J. Chong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, 3800, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, 3181, Australia
- Department of Clinical Neurosciences, St Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | | | - Chenglong Yu
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Gerald F. Watts
- School of Medicine, University of Western Australia, Perth, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Johannes T. Neumann
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
- Department of Cardiology, University Heart & Vascular Center Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
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Ball J, Neumann JT, Tonkin AM, Kirchhof P, Freedman B, Brodtmann A, Reid C, Nelson MR, Beilin LJ, Fitzgerald S, Stub D, Woods RL, McNeil JJ. Low-dose aspirin and incident atrial fibrillation in healthy older individuals: a post-hoc analysis of the ASPREE trial. Eur Heart J Cardiovasc Pharmacother 2024; 10:81-82. [PMID: 37951294 PMCID: PMC10766903 DOI: 10.1093/ehjcvp/pvad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/13/2023]
Affiliation(s)
- J Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - J T Neumann
- University Heart and Vascular Center Hamburg, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), 10785 Berlin, Germany
| | - A M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - P Kirchhof
- University Heart and Vascular Center Hamburg, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), 10785 Berlin, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - B Freedman
- Heart Rhythm and Stroke Group, Heart Research Institute, Sydney 2042, Australia
- Charles Perkins Centre, The University of Sydney, Sydney 2050, Australia
| | - A Brodtmann
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - C Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- School of Population Health, Curtin University, Perth, Western Australia 6102, Australia
| | - M R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - L J Beilin
- UWA Medical School, University of Western Australia, Perth 6009, Australia
| | - S Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - D Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
- Department of Cardiology, Alfred Health, Melbourne, Victoria 3004, Australia
| | - R L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - J J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
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Alif SM, Benke GP, Ronaldson KJ, Walker-Bone K, Woods RL, Tran C, Beilin LJ, Tonkin AM, Owen AJ, McNeil JJ. Occupational characteristics and disability-free survival after retirement age: an exploratory analysis from the ASPREE study. Front Public Health 2023; 11:1191343. [PMID: 38192557 PMCID: PMC10773837 DOI: 10.3389/fpubh.2023.1191343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/24/2023] [Indexed: 01/10/2024] Open
Abstract
Background Certain occupational characteristics have been linked with poor health and reduced longevity. However, the association between occupational characteristics and survival free of disability in a post-retirement age group has not been investigated. Methods We investigated outcomes in 12,215 healthy older Australian adults in the Aspirin in Reducing Events in the Elderly (ASPREE) and ASPREE Longitudinal Study of Older Persons (ALSOP) sub-study. The ISCO-88 major occupational groups, settings, and activity levels were assigned based on free-text job descriptions. The Finnish Job Exposure Matrix was used to assign occupational characteristics to the three longest-held jobs. The primary endpoint, disability-free survival, was defined as a composite measure of death, dementia, or persistent physical disability. The endpoint of all-cause mortality was analyzed separately. Because of multiple exploratory analyses, only those associations with a two-sided value of p less than 0.005 were considered statistically significant. Cox proportional hazard models were used to calculate adjusted hazard ratios. Results Having worked in an 'elementary' occupation was associated with a reduction in disability-free survival. A specific impact on disability-free survival was observed among those whose work had involved high accident risk and adverse social climate. No significant relationship was identified with those previously exposed to sedentary work, vigorous physical activity, work primarily outdoors, or a range of other occupational characteristics. All-cause mortality was not increased among any of the occupational groups. Conclusion This exploratory study found a reduction in disability-free survival among people who worked in 'elementary' occupations, with specific risks associated with occupations involving high accident risks and adverse social climate.
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Affiliation(s)
- Sheikh M. Alif
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Institute of Health and Wellbeing, Federation University Australia, Berwick, VIC, Australia
| | - Geza P. Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kathlyn J. Ronaldson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Karen Walker-Bone
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lawrence J. Beilin
- School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alice J. Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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10
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Zhou Z, Ryan J, Tonkin AM, Zoungas S, Lacaze P, Wolfe R, Orchard SG, Murray AM, McNeil JJ, Yu C, Watts GF, Hussain SM, Beilin LJ, Ernst ME, Stocks N, Woods RL, Zhu C, Reid CM, Shah RC, Chong TTJ, Sood A, Sheets KM, Nelson MR. Association Between Triglycerides and Risk of Dementia in Community-Dwelling Older Adults: A Prospective Cohort Study. Neurology 2023; 101:e2288-e2299. [PMID: 37879942 PMCID: PMC10727221 DOI: 10.1212/wnl.0000000000207923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/22/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It has been suggested that higher triglyceride levels were associated with a lower risk of Alzheimer disease. This study aimed to examine the association of triglycerides with dementia and cognition change in community-dwelling older adults. METHODS This prospective longitudinal study used data from the Aspirin in Reducing Events in the Elderly (ASPREE) randomized trial of adults aged 65 years or older without dementia or previous cardiovascular events at enrollment. The main outcome was incident dementia. Other outcomes included changes in composite cognition and domain-specific cognition (global cognition, memory, language and executive function, and psychomotor speed). The association between baseline triglycerides and dementia risk was estimated using Cox proportional hazard models adjusting for relevant risk factors. Linear mixed models were used to investigate cognitive change. The analysis was repeated in a subcohort of participants with available APOE-ε4 genetic data with additional adjustment for APOE-ε4 carrier status and an external cohort (UK Biobank) with similar selection criteria applied. RESULTS This study included 18,294 ASPREE participants and 68,200 UK Biobank participants (mean age: 75.1 and 66.9 years; female: 56.3% and 52.7%; median [interquartile range] triglyceride: 106 [80-142] mg/dL and 139 [101-193] mg/dL), with dementia recorded in 823 and 2,778 individuals over a median follow-up of 6.4 and 12.5 years, respectively. Higher triglyceride levels were associated with lower dementia risk in the entire ASPREE cohort (hazard ratio [HR] with doubling of triglyceride: 0.82, 95% CI 0.72-0.94). Findings were similar in the subcohort of participants with APOE-ε4 genetic data (n = 13,976) and in the UK Biobank cohort (HR was 0.82 and 0.83, respectively, all p ≤ 0.01). Higher triglycerides were also associated with slower decline in composite cognition and memory over time (p ≤ 0.05). DISCUSSION Older adults with higher triglyceride levels within the normal to high-normal range had a lower dementia risk and slower cognitive decline over time compared with individuals with lower triglyceride levels. Higher triglyceride levels may be reflective of better overall health and/or lifestyle behaviors that would protect against dementia development. Future studies are warranted to investigate whether specific components within the total circulating pool of plasma triglycerides may promote better cognitive function, with the hope of informing the development of new preventive strategies.
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Affiliation(s)
- Zhen Zhou
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia.
| | - Joanne Ryan
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Andrew M Tonkin
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Sophia Zoungas
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Paul Lacaze
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Rory Wolfe
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Suzanne G Orchard
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Anne M Murray
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - John J McNeil
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Chenglong Yu
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Gerald F Watts
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Sultana Monira Hussain
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Lawrence J Beilin
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Michael E Ernst
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Nigel Stocks
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Robyn L Woods
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Chao Zhu
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Raj C Shah
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Trevor T-J Chong
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Ajay Sood
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Kerry M Sheets
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Mark R Nelson
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
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11
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Vishwanath S, Hopper I, Chowdhury E, Wolfe R, Freak-Poli R, Reid CM, Tonkin AM, Murray AM, Shah RC, Chong TTJ, Woods RL, McNeil J, Orchard SG, Nelson MR, Steves CJ, Ryan J. Cardiovascular Disease Risk Scores and Incident Dementia and Cognitive Decline in Older Men and Women. Gerontology 2023; 70:143-154. [PMID: 37984339 PMCID: PMC10866179 DOI: 10.1159/000535284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Risk factors for cardiovascular disease (CVD) also increase the risk of dementia. However, whether commonly used CVD risk scores are associated with dementia risk in older adults who do not have a history of CVD, and potential gender differences in this association, remains unclear. The aim of this study was to determine whether CVD risk scores are prospectively associated with cognitive decline and dementia in initially healthy older men and women. METHODS A total of19,114 participants from a prospective cohort of individuals aged 65+ years without known CVD or dementia were recruited. The atherosclerotic cardiovascular disease risk score (ASCVDRS), Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP), and the Framingham risk score (FRS) were calculated at baseline. Risk of dementia (according to DSM-IV criteria) and cognitive decline (defined as a >1.5 standard deviation decline in global cognition, episodic memory, psychomotor speed, or verbal fluency from the previous year) were assessed using hazard ratio. RESULTS Over a median follow-up of 6.4 years, 850 individuals developed dementia and 4,352 cognitive decline. Men and women in the highest ASCVDRS tertile had a 41% (95% CI 1.08, 1.85) and 45% (1.11, 1.89) increased risk of dementia compared to the lowest tertile, respectively. Likewise, men and women in the highest SCORE2-OP tertile had a 64% (1.24, 2.16) and 60% (1.22, 2.11) increased risk of dementia compared to the lowest tertile, respectively. Findings were similar, but the risk was slightly lesser when examining risk of cognitive decline for both ASCVDRS and SCORE2-OP. However, FRS was only associated with the risk of cognitive decline among women (highest vs. lowest tertiles: 1.13 [1.01-1.26]). CONCLUSION These findings suggest the utility of the ASCVDRS and SCORE2-OP in clinical practice, to not only assess future risk of CVD, but also as potential early indicators of cognitive impairment, even in relatively healthy older men and women.
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Affiliation(s)
- Swarna Vishwanath
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology and General Medicine Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Enayet Chowdhury
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- GenesisCare, Leabrook, South Australia, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Bentley, Washington, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
- Department of Medicine, Division of Geriatrics Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA
| | - Raj C Shah
- Department of Family and Preventive Medicine and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Trevor T-J Chong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Clinical Neurosciences, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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12
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Smith CL, Kasza J, Woods RL, Lockery JE, Kirpach B, Reid CM, Storey E, Nelson MR, Shah RC, Orchard SG, Ernst ME, Tonkin AM, Murray AM, McNeil JJ, Wolfe R. Compliance-Adjusted Estimates of Aspirin Effects Among Older Persons in the ASPREE Randomized Trial. Am J Epidemiol 2023; 192:2063-2074. [PMID: 37552955 PMCID: PMC10988226 DOI: 10.1093/aje/kwad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/09/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
The Aspirin in Reducing Events in the Elderly (ASPREE) Trial recruited 19,114 participants across Australia and the United States during 2010-2014. Participants were randomized to receive either 100 mg of aspirin daily or matching placebo, with disability-free survival as the primary outcome. During a median 4.7 years of follow-up, 37% of participants in the aspirin group permanently ceased taking their study medication and 10% commenced open-label aspirin use. In the placebo group, 35% and 11% ceased using study medication and commenced open-label aspirin use, respectively. In order to estimate compliance-adjusted effects of aspirin, we applied rank-preserving structural failure time models. The results for disability-free survival and most secondary endpoints were similar in intention-to-treat and compliance-adjusted analyses. For major hemorrhage, cancer mortality, and all-cause mortality, compliance-adjusted effects of aspirin indicated greater risks than were seen in intention-to-treat analyses. These findings were robust in a range of sensitivity analyses. In accordance with the original trial analyses, compliance-adjusted results showed an absence of benefit with aspirin for primary prevention in older people, along with an elevated risk of clinically significant bleeding.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - R Wolfe
- Correspondence to Dr. Rory Wolfe, School of Public Health and Preventive Medicine, 553 St. Kilda Road, Monash University, Melbourne, VIC 3004, Australia (e-mail: )
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13
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Yu C, Bakshi A, Watts GF, Renton AE, Fulton‐Howard B, Goate AM, Natarajan P, Chasman DI, Robman L, Woods RL, Guymer R, Wolfe R, Thao LTP, McNeil JJ, Tonkin AM, Nicholls SJ, Lacaze P. Genome-Wide Association Study of Cardiovascular Resilience Identifies Protective Variation in the CETP Gene. J Am Heart Assoc 2023; 12:e031459. [PMID: 37929782 PMCID: PMC10727421 DOI: 10.1161/jaha.123.031459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
Background The risk of atherosclerotic cardiovascular disease (ASCVD) increases sharply with age. Some older individuals, however, remain unaffected despite high predicted risk. These individuals may carry cardioprotective genetic variants that contribute to resilience. Our aim was to assess whether asymptomatic older individuals without prevalent ASCVD carry cardioprotective genetic variants that contribute to ASCVD resilience. Methods and Results We performed a genome-wide association study using a 10-year predicted ASCVD risk score as a quantitative trait, calculated only in asymptomatic older individuals aged ≥70 years without prevalent ASCVD. Our discovery genome-wide association study of N=12 031 ASCVD event-free individuals from the ASPREE (Aspirin in Reducing Events in the Elderly) trial identified 2 independent variants, rs9939224 (P<5×10-8) and rs56156922 (P<10-6), in the CETP (cholesteryl ester transfer protein) gene. The CETP gene is a regulator of plasma high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and lipoprotein(a) levels, and it is a therapeutic drug target. The associations were replicated in the UK Biobank (subpopulation of N=13 888 individuals aged ≥69 years without prevalent ASCVD). Carriers of the identified CETP variants (versus noncarriers) had higher plasma high-density lipoprotein cholesterol levels, lower plasma low-density lipoprotein cholesterol levels, and reduced risk of incident ASCVD events during follow-up. Expression quantitative trait loci analysis predicted the identified CETP variants reduce CETP gene expression across various tissues. Previously reported associations between genetic CETP inhibition and increased risk of age-related macular degeneration were not observed among the 3917 ASPREE trial participants with retinal imaging and genetic data available. Conclusions Common genetic variants in the CETP gene region are associated with cardiovascular resilience during aging. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583.
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Affiliation(s)
- Chenglong Yu
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Andrew Bakshi
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Gerald F. Watts
- School of MedicineUniversity of Western AustraliaPerthWAAustralia
- Lipid Disorders Clinic, Cardiometabolic Service, Department of CardiologyRoyal Perth HospitalPerthWAAustralia
| | - Alan E. Renton
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Brian Fulton‐Howard
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Alison M. Goate
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Pradeep Natarajan
- Cardiovascular Research Center and Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Program in Population and Medical Genetics and the Cardiovascular Disease InitiativeBroad Institute of Harvard and MITCambridgeMA
- Department of MedicineHarvard Medical SchoolBostonMA
| | - Daniel I. Chasman
- Preventive Medicine Division, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Liubov Robman
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
- Centre for Eye Research AustraliaThe University of Melbourne, Royal Victorian Eye and Ear HospitalMelbourneVICAustralia
| | - Robyn L. Woods
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Robyn Guymer
- Centre for Eye Research AustraliaThe University of Melbourne, Royal Victorian Eye and Ear HospitalMelbourneVICAustralia
| | - Rory Wolfe
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Le Thi Phuong Thao
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - John J. McNeil
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Andrew M. Tonkin
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Stephen J. Nicholls
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
- Monash Cardiovascular Research Centre, Victorian Heart InstituteMonash UniversityClaytonVICAustralia
| | - Paul Lacaze
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
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Robb C, Carr PR, Ball J, Owen A, Beilin LJ, Newman AB, Nelson MR, Reid CM, Orchard SG, Neumann JT, Tonkin AM, Wolfe R, McNeil JJ. Association of a healthy lifestyle with mortality in older people. BMC Geriatr 2023; 23:646. [PMID: 37821846 PMCID: PMC10568769 DOI: 10.1186/s12877-023-04247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviours such as smoking, high alcohol consumption, poor diet or low physical activity are associated with morbidity and mortality. Public health guidelines provide recommendations for adherence to these four factors, however, their relationship to the health of older people is less certain. METHODS The study involved 11,340 Australian participants (median age 7.39 [Interquartile Range (IQR) 71.7, 77.3]) from the ASPirin in Reducing Events in the Elderly study, followed for a median of 6.8 years (IQR: 5.7, 7.9). We investigated whether a point-based lifestyle score based on adherence to guidelines for a healthy diet, physical activity, non-smoking and moderate alcohol consumption was associated with subsequent all-cause and cause-specific mortality. RESULTS In multivariable adjusted models, compared to those in the unfavourable lifestyle group, individuals in the moderate lifestyle group (Hazard Ratio (HR) 0.73 [95% CI 0.61, 0.88]) and favourable lifestyle group (HR 0.68 [95% CI 0.56, 0.83]) had lower risk of all-cause mortality. A similar pattern was observed for cardiovascular related mortality and non-cancer/non-cardiovascular related mortality. There was no association of lifestyle with cancer-related mortality. CONCLUSIONS In a large cohort of initially healthy older people, reported adherence to a healthy lifestyle is associated with reduced risk of all-cause and cause-specific mortality. Adherence to all four lifestyle factors resulted in the strongest protection.
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Affiliation(s)
- Catherine Robb
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia.
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Anne B Newman
- Department of Epidemiology, Centre for Aging and Population Health, University of Pittsburgh, Pittsburgh, USA
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
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Vishwanath S, Hopper I, Wolfe R, Polekhina G, Reid CM, Tonkin AM, Murray AM, Shah RC, Storey E, Woods RL, McNeil J, Orchard SG, Nelson MR, Steves CJ, Ryan J. Cognitive trajectories and incident dementia after a cardiovascular event in older adults. Alzheimers Dement 2023; 19:3670-3678. [PMID: 36856152 PMCID: PMC10440246 DOI: 10.1002/alz.13006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a recognized risk factor for dementia. Here we determined the extent to which an incident CVD event modifies the trajectory of cognitive function and risk of dementia. METHODS 19,114 adults (65+) without CVD or dementia were followed prospectively over 9 years. Incident CVD (fatal coronary heart disease, nonfatal myocardial infarction [MI], stroke, hospitalization for heart failure) and dementia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) were adjudicated by experts. RESULTS Nine hundred twenty-two participants had incident CVD, and 44 developed dementia after CVD (4.9% vs. 4.4% for participants without CVD). Following a CVD event there was a short-term drop in processing speed (-1.97, 95% confidence interval [CI]: -2.57 to -1.41), but there was no significant association with longer-term processing speed. In contrast, faster declines in trajectories of global function (-0.56, 95% CI: -0.76 to -0.36), episodic memory (-0.10, 95% CI: -0.16 to -0.04), and verbal fluency (-0.19, 95% CI: -0.30 to -0.01) were observed. DISCUSSION Findings highlight the importance of monitoring cognition after a CVD event.
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Affiliation(s)
- Swarna Vishwanath
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Galina Polekhina
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- School of Public Health, Curtin University, Western Australia, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Anne M. Murray
- Berman Center for Outcomes & Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- Department of Medicine, Division of Geriatrics Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Raj C. Shah
- Department of Family Medicine and the Rush Alzheimer’s Disease Centre, Rush University Medical Centre, Chicago, IL, USA
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Mark R. Nelson
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Claire J. Steves
- Department of Twin Research & Genetic Epidemiology, King’s College London, United Kingdom
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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Hussain SM, Newman AB, Beilin LJ, Tonkin AM, Woods RL, Neumann JT, Nelson M, Carr PR, Reid CM, Owen A, Ball J, Cicuttini FM, Tran C, Wang Y, Ernst ME, McNeil JJ. Associations of Change in Body Size With All-Cause and Cause-Specific Mortality Among Healthy Older Adults. JAMA Netw Open 2023; 6:e237482. [PMID: 37036703 PMCID: PMC10087052 DOI: 10.1001/jamanetworkopen.2023.7482] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/25/2023] [Indexed: 04/11/2023] Open
Abstract
Importance The association between weight change and subsequent cause-specific mortality among older adults is not well described. The significance of changes in waist circumference (WC) has also not been compared with weight change for this purpose. Objective To examine the associations of changes in body weight and WC with all-cause and cause-specific mortality. Design, Setting, and Participants This cohort study is a post hoc analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial, which recruited participants between March 1, 2010, and December 31, 2014. The study included community-based older adults (16 703 Australian participants aged ≥70 years and 2411 US participants aged ≥65 years) without evident cardiovascular disease (CVD), dementia, physical disability, or life-limiting chronic illness. Data analysis was performed from April to September 2022. Exposures Body weight and WC were measured at baseline and at annual visit 2. Analysis models were adjusted for baseline body mass index because height and weight were measured at baseline, allowing for calculation of body mass index and other variables. Both body weight and WC changes were categorized as change within 5% (stable), decrease by 5% to 10%, decrease by more than 10%, increase by 5% to 10%, and increase by more than 10%. Main Outcomes and Measures All-cause, cancer-specific, CVD-specific, and noncancer non-CVD-specific mortality. Mortality events were adjudicated by an expert review panel. Cox proportional hazards regression and competing risk analyses were used to calculate hazard ratios (HRs) and 95% CIs. Results Among 16 523 participants (mean [SD] age, 75.0 [4.3] years; 9193 women [55.6%]), 1256 deaths were observed over a mean (SD) of 4.4 (1.7) years. Compared with men with stable weight, those with a 5% to 10% weight loss had a 33% higher (HR, 1.33; 95% CI, 1.07-1.66) risk of all-cause mortality, and those with more than a 10% decrease in body weight had a 289% higher (HR, 3.89; 95% CI, 2.93-5.18) risk. Compared with women with stable weight, those with a 5% to 10% weight loss had a 26% higher (HR, 1.26; 95% CI, 1.00-1.60) risk of all-cause mortality, and those with more than a 10% decrease in body weight had a 114% higher (HR, 2.14; 95% CI, 1.58-2.91) risk. Weight loss was associated with a higher cancer-specific mortality (>10% decrease among men: HR, 3.49; 95% CI, 2.26-5.40; 5%-10% decrease among women: HR, 1.44; 95% CI, 1.46-2.04; >10% decrease among women: HR, 2.78; 95% CI, 1.82-4.26), CVD-specific mortality (>10% decrease among men: HR, 3.14; 95% CI, 1.63-6.04; >10% decrease among women: HR, 1.92; 95% CI, 1.05-3.51), and noncancer non-CVD-specific mortality (>10% decrease among men: HR, 4.98; 95% CI, 3.14-7.91). A decrease in WC was also associated with mortality. Conclusions and Relevance This cohort study of healthy older adults suggests that weight loss was associated with an increase in all-cause and cause-specific mortality, including an increased risk of cancer, CVD, and other life-limiting conditions. Physicians should be aware of the significance of weight loss, especially among older men.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anne B. Newman
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lawrence J. Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Johannes T. Neumann
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Mark Nelson
- Discipline of General Practice, University of Tasmania, Hobart, Australia
| | - Prudence R. Carr
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia M. Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ekram AS, Tonkin AM, Ryan J, Beilin L, Ernst ME, Espinoza SE, McNeil JJ, Nelson MR, Reid CM, Newman AB, Woods RL. The association between frailty and incident cardiovascular disease events in community-dwelling healthy older adults. Am Heart J Plus 2023; 28:100289. [PMID: 37168270 PMCID: PMC10168683 DOI: 10.1016/j.ahjo.2023.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 05/13/2023]
Abstract
Study objective This study examined the association between frailty and incident cardiovascular disease (CVD) events, major adverse cardiovascular events (MACE), and CVD-related mortality. Design Longitudinal cohort study. Setting The ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial in Australia and the United States. Participants 19,114 community-dwelling older adults (median age 74.0 years; 56.4 % females). Interventions Pre-frailty and frailty were assessed using a modified Fried phenotype and a deficit accumulation Frailty Index (FI) at baseline. Main outcome measures CVD was defined as a composite of CVD death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for heart failure; MACE included all except heart failure. Cox proportional hazards regression was used to analyze the association between frailty and CVD outcomes over a median follow-up of 4.7 years. Results Baseline pre-frail and frail groups had a higher risk of incident CVD events (Hazard Ratio (HR): 1.31; 95 % Confidence Interval (CI): 1.14-1.50 for pre-frail and HR: 1.63; 95 % CI: 1.15-2.32 for frail) and MACE (pre-frail HR: 1.26; 95 % CI: 1.08-1.47 and frail HR: 1.51; 95 % CI: 1.00-2.29) than non-frail participants according to Fried phenotype after adjusting for traditional CVD risk factors. Effect sizes were similar or larger when frailty was assessed with FI; similar results for men and women. Conclusion Frailty increases the likelihood of developing CVD, including MACE, in community-dwelling older men and women without prior CVD events. Screening for frailty using Fried or FI method could help identify community-dwelling older adults without prior CVD events who are more likely to develop CVD, including MACE, and may facilitate targeted preventive measures to reduce their risk.
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Affiliation(s)
- A.R.M. Saifuddin Ekram
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia
| | - Lawrence Beilin
- The Medical School Royal Perth Hospital Unit, University of Western Australia (M570), 35 Stirling Highway, Perth, WA 6009, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Sara E. Espinoza
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7001, Australia
| | - Christopher M. Reid
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Anne B. Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia
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18
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Zhou Z, Curtis AJ, Owen A, Wolfe R, Murray AM, Tonkin AM, Ernst ME, Orchard SG, Zhu C, Carr PR, Reid CM, Espinoza SE, Shah RC, Woods RL, Ryan J, McNeil JJ, Nelson MR, Zoungas S. Prediabetes, diabetes and loss of disability-free survival in a community-based older cohort: a post-hoc analysis of the ASPirin in Reducing Events in the Elderly trial. Age Ageing 2023; 52:7136745. [PMID: 37097768 PMCID: PMC10128162 DOI: 10.1093/ageing/afad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/13/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Evidence for the prognostic implications of hyperglycaemia in older adults is inconsistent. OBJECTIVE To evaluate disability-free survival (DFS) in older individuals by glycaemic status. METHODS This analysis used data from a randomised trial recruiting 19,114 community-based participants aged ≥70 years, who had no prior cardiovascular events, dementia and physical disability. Participants with sufficient information to ascertain their baseline diabetes status were categorised as having normoglycaemia (fasting plasma glucose [FPG] < 5.6 mmol/l, 64%), prediabetes (FPG 5.6 to <7.0 mmol/l, 26%) and diabetes (self-report or FPG ≥ 7.0 mmol/l or use of glucose-lowering agents, 11%). The primary outcome was loss of disability-free survival (DFS), a composite of all-cause mortality, persistent physical disability or dementia. Other outcomes included the three individual components of the DFS loss, as well as cognitive impairment-no dementia (CIND), major adverse cardiovascular events (MACE) and any cardiovascular event. Cox models were used for outcome analyses, with covariate adjustment using inverse-probability weighting. RESULTS We included 18,816 participants (median follow-up: 6.9 years). Compared to normoglycaemia, participants with diabetes had greater risks of DFS loss (weighted HR: 1.39, 95% CI 1.21-1.60), all-cause mortality (1.45, 1.23-1.72), persistent physical disability (1.73, 1.35-2.22), CIND (1.22, 1.08-1.38), MACE (1.30, 1.04-1.63) and cardiovascular events (1.25, 1.02-1.54) but not dementia (1.13, 0.87-1.47). The prediabetes group did not have an excess risk for DFS loss (1.02, 0.93-1.12) or other outcomes. CONCLUSIONS Among older people, diabetes was associated with reduced DFS, and higher risk of CIND and cardiovascular outcomes, whereas prediabetes was not. The impact of preventing or treating diabetes in this age group deserves closer attention.
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Affiliation(s)
- Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrea J Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne M Murray
- Division of Geriatrics, Department of Medicine Hennepin HealthCare, Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IA, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Sara E Espinoza
- Sam and Ann Barshop Institute, UT Health San Antonio, San Antonio, TX, USA
- Geriatrics Research, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Raj C Shah
- Department of Family and Preventive Medicine, The Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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19
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Azene ZN, Davis SR, McNeil JJ, Tonkin AM, Handelsman DJ, Islam RM. Estrone, sex hormone binding globulin and lipid profiles in older women: an observational study. Climacteric 2023; 26:114-120. [PMID: 36693423 PMCID: PMC10033393 DOI: 10.1080/13697137.2023.2165908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We investigated whether estrone and sex hormone binding globulin (SHBG) concentrations are associated with lipid concentrations in older postmenopausal women. METHODS This was a cross-sectional study of 6358 Australian women, aged 70-95 years, recruited between 2010 and 2014. Associations between estrone and SHBG and lipid concentrations were examined in participants not using medications that influence estrogen concentrations or lipid-lowering therapy. Linear regression models included age, body mass index, smoking, alcohol consumption, renal function and diabetes, with the lowest quartile (Q1) as the reference for estrone and SHBG. RESULTS The study included 3231 participants with median age of 74.0 (interquartile range 71.7-77.9) years. Estrone concentration Q3 and Q4 were positively associated with high-density lipoprotein cholesterol (HDL-C) (p = 0.017 and p = 0.046, respectively). Inverse associations were seen for estrone Q4 with total cholesterol (p = 0.018), Q2 and Q4 with non-HDL-C (p = 0.045 and p = 0.002, respectively) and Q3 and Q4 with triglycerides (p = 0.030 and p = 0.001, respectively). For SHBG, Q2, Q3 and Q4 were positively associated with HDL-C (all p < 0.001), and inversely with non-HDL-C (all p = 0.001) and triglycerides (all p < 0.001). CONCLUSIONS Estrone and SHBG are associated with lipid concentrations in older women. SHBG, but not estrone, may provide additional clinical predictive utility for the assessment of cardiometabolic disease risk in older women.
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Affiliation(s)
- Z N Azene
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - S R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia
| | - J J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - A M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - D J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
| | - R M Islam
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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20
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Venkataraman P, Neil AL, Mitchell GK, Stanton T, Nicholls S, Tonkin AM, Watts GF, Marwick TH. The cost-effectiveness of coronary calcium score-guided statin therapy initiation for Australians with family histories of premature coronary artery disease. Med J Aust 2023; 218:216-222. [PMID: 36841547 DOI: 10.5694/mja2.51860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 02/27/2023]
Abstract
OBJECTIVES To compare the cost-effectiveness of coronary artery calcium (CAC) score-guided statin therapy criteria and American College of Cardiology/American Heart Association (ACC/AHA) guidelines (10-year pooled cohort equation [PCE] risk ≥ 7.5%) with selection according to Australian guidelines (5-year absolute cardiovascular disease risk [ACVDR] ≥ 10%), for people with family histories of premature coronary artery disease. STUDY DESIGN, SETTING Markov microsimulation state transition model based on data from the Coronary Artery calcium score: Use to Guide management of Hereditary Coronary Artery Disease (CAUGHT-CAD) trial and transition probabilities derived from published statin prescribing and adherence outcomes and clinical data. PARTICIPANTS 1083 people with family histories of premature coronary artery disease but no symptomatic cardiovascular disease. MAIN OUTCOME MEASURES Relative cost-effectiveness over fifteen years, from the perspective of the Australian health care system, compared with usual care (Australian guidelines), assessed as incremental cost-effectiveness ratios (ICERs), with a notional willingness-to-pay threshold of $50 000 per quality-adjusted life-year (QALY) gained. RESULTS Applying the Australian guidelines, 77 people were eligible for statin therapy (7.1%); with ACVDR 5-year risk ≥ 2% and CAC score > 0, 496 people (46%); with ACVDR 5-year risk ≥ 2% and CAC score ≥ 100, 155 people (14%); and with the ACC/AHA guidelines, 256 people (24%). The ICERs for CAC-guided selection were $33 108 (CAC ≥ 100) and $53 028 per QALY gained (CAC > 0); the ACC/AHA guidelines approach (ICER, $909 241 per QALY gained) was not cost-effective. CAC score-guided selection (CAC ≥ 100) was cost-effective for people with 5-year ACVDR of at least 5%. CONCLUSION Expanding the number of people at low to intermediate CVD risk eligible for statin therapy should selectively target people with subclinical atherosclerosis identified by CAC screening. This approach can be more cost-effective than simply lowering treatment eligibility thresholds.
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Affiliation(s)
| | - Amanda L Neil
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, TAS
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Robb C, Carr P, Ball J, Owen A, Beilin LJ, Newman AB, Nelson MR, Reid CM, Orchard SG, Neumann JT, Tonkin AM, Wolfe R, McNeil JJ. Association of a Healthy Lifestyle with Mortality in Older People. Res Sq 2023:rs.3.rs-2541145. [PMID: 36993471 PMCID: PMC10055537 DOI: 10.21203/rs.3.rs-2541145/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Background Unhealthy lifestyle behaviours such as smoking, high alcohol consumption, poor diet or low physical activity are associated with morbidity and premature mortality. Public health guidelines provide recommendations for adherence to these four factors, however, their impact on the health of older people is less certain. Methods The study involved 11,340 Australian participants (median age 7.39 [Interquartile Range (IQR) 71.7, 77.3]) from the ASPirin in Reducing Events in the Elderly study, followed for a median of 6.8 years (IQR: 5.7, 7.9). We investigated whether a point-based lifestyle score based on adherence to guidelines for a healthy diet, physical activity, non-smoking and moderate alcohol consumption was associated with all-cause and cause-specific mortality. Results In multivariable adjusted models, compared to those in the unfavourable lifestyle group, individuals in the moderate lifestyle group (Hazard Ratio (HR) 0.73 [95% CI 0.61, 0.88]) and favourable lifestyle group (HR 0.68 [95% CI 0.56, 0.83]) had lower risk of all-cause mortality. A similar pattern was observed for cardiovascular related mortality and non-cancer/non-cardiovascular related mortality. There was no association of lifestyle with cancer-related mortality. Stratified analysis indicated larger effect sizes among males, those ≤ 73 years old and among those in the aspirin treatment group. Conclusions In a large cohort of initially healthy older people, reported adherence to a healthy lifestyle is associated with reduced risk of all-cause and cause-specific mortality.
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22
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Carr PR, Webb KL, Neumann JT, Thao LTP, Beilin LJ, Ernst ME, Fitzgibbon B, Gasevic D, Nelson MR, Newman AB, Orchard SG, Owen A, Reid CM, Stocks NP, Tonkin AM, Woods RL, McNeil JJ. Associations of body size with all-cause and cause-specific mortality in healthy older adults. Sci Rep 2023; 13:3799. [PMID: 36882434 PMCID: PMC9992380 DOI: 10.1038/s41598-023-29586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/07/2023] [Indexed: 03/09/2023] Open
Abstract
In the general population, body mass index (BMI) and waist circumference are recognized risk factors for several chronic diseases and all-cause mortality. However, whether these associations are the same for older adults is less clear. The association of baseline BMI and waist circumference with all-cause and cause-specific mortality was investigated in 18,209 Australian and US participants (mean age: 75.1 ± 4.5 years) from the ASPirin in Reducing Events in the Elderly (ASPREE) study, followed up for a median of 6.9 years (IQR: 5.7, 8.0). There were substantially different relationships observed in men and women. In men, the lowest risk of all-cause and cardiovascular mortality was observed with a BMI in the range 25.0-29.9 kg/m2 [HR25-29.9 vs 21-24.9 kg/m2: 0.85; 95% CI, 0.73-1.00] while the highest risk was in those who were underweight [HRBMI <21 kg/m2 vs BMI 21-24.9 kg/m2: 1.82; 95% CI 1.30-2.55], leading to a clear U-shaped relationship. In women, all-cause mortality was highest in those with the lowest BMI leading to a J-shaped relationship (HRBMI <21 kg/m2 vs BMI 21-24.9 kg/m2: 1.64; 95% CI 1.26-2.14). Waist circumference showed a weaker relationship with all-cause mortality in both men and women. There was little evidence of a relationship between either index of body size and subsequent cancer mortality in men or women, while non-cardiovascular non-cancer mortality was higher in underweight participants. For older men, being overweight was found to be associated with a lower risk of all-cause mortality, while among both men and women, a BMI in the underweight category was associated with a higher risk. Waist circumference alone had little association with all-cause or cause-specific mortality risk.Trial registration ASPREE https://ClinicalTrials.gov number NCT01038583.
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Affiliation(s)
- Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Katherine L Webb
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Department of Cardiology, University Heart & Vascular Centre, Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Le T P Thao
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Bernadette Fitzgibbon
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Anne B Newman
- Centre for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Nigel P Stocks
- Discipline of General Practice, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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23
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Hussain SM, Ebeling PR, Barker AL, Beilin LJ, Tonkin AM, McNeil JJ. Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults. JAMA Cardiol 2023; 8:268-272. [PMID: 36652261 PMCID: PMC9857824 DOI: 10.1001/jamacardio.2022.5124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Increased levels of high-density lipoprotein cholesterol (HDL-C) have been associated with osteoporosis. Preclinical studies have reported that HDL-C reduces bone mineral density by reducing osteoblast number and function. However, the clinical significance of these findings is unclear. Objective To determine whether higher HDL-C levels are predictive of an increased fracture risk in healthy older adults. Design, Setting, and Participants This cohort study is a post hoc analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial and the ASPREE-Fracture substudy. ASPREE was a double-blind, randomized, placebo-controlled primary prevention trial of aspirin that recruited participants between 2010 and 2014. These comprised community-based older adults (16 703 Australians aged ≥70 years, 2411 US participants ≥65 years) without evident cardiovascular disease, dementia, physical disability, and life-limiting chronic illness. The ASPREE-Fracture substudy collected data on fractures reported postrandomization from Australian participants. Cox regression was used to calculate hazard ratio (HR) and 95% CI. Data analysis for this study was performed from April to August 2022. Exposure Plasma HDL-C. Main Outcomes and Measures Fractures included were confirmed by medical imaging and included both traumatic and minimal trauma fractures. Fractures were adjudicated by an expert review panel. Results Of the 16 262 participants who had a plasma HDL-C measurement at baseline (8945 female participants [55%] and 7319 male [45%]), 1659 experienced at least 1 fracture over a median (IQR) of 4.0 years (0.02-7.0 years). In a fully adjusted model, each 1-SD increment in HDL-C level was associated with a 14% higher risk of fractures (HR, 1.14; 95% CI, 1.08-1.20). The results remained similar when these analyses were stratified by sex. Sensitivity and stratified analyses demonstrated that these associations persisted when the analyses were repeated to include only (1) minimal trauma fractures, (2) participants not taking osteoporosis medications, (3) participants who were never smokers and reported that they did not drink alcohol, and (4) participants who walked outside for less than 30 minutes per day and reported no participation in moderate/vigorous physical activity and to examine only (5) statin use. No association was observed between non-HDL-C levels and fractures. Conclusions and Relevance This study suggests that higher levels of HDL-C are associated with an increased fracture risk. This association was independent of common risk factors for fractures.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter R. Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Anna L. Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,Silverchain, Melbourne, Victoria, Australia
| | - Lawrence J. Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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24
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Eikelboom JW, Bosch J, Connolly SJ, Tyrwitt J, Fox KAA, Muehlhofer E, Neumann C, Tasto C, Bangdiwala SI, Diaz R, Alings M, Dagenais GR, Leong DP, Lonn EM, Avezum A, Piegas LS, Widimsky P, Parkhomenko AN, Bhatt DL, Branch KRH, Probstfield JL, Lopez-Jaramillo P, Rydén L, Pogosova N, Keltai K, Keltai M, Ertl G, Stoerk S, Dans AL, Lanas F, Liang Y, Zhu J, Torp-Pedersen C, Maggioni AP, Commerford PJ, Guzik TJ, Vanassche T, Verhamme P, O'Donnell M, Tonkin AM, Varigos JD, Vinereanu D, Felix C, Kim JH, Ibrahim KS, Lewis BS, Metsarinne KP, Aboyans V, Steg PG, Hori M, Kakkar A, Anand SS, Lamy A, Sharma M, Yusuf S. Long-Term Treatment with the Combination of Rivaroxaban and Aspirin in Patients with Chronic Coronary or Peripheral Artery Disease: Outcomes During the Open Label Extension of the COMPASS trial. Eur Heart J Cardiovasc Pharmacother 2022; 8:786-795. [PMID: 35383832 DOI: 10.1093/ehjcvp/pvac023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/13/2022] [Accepted: 03/31/2022] [Indexed: 12/29/2022]
Abstract
AIMS To describe outcomes of patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD) enrolled in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) randomized trial who were treated with the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily during long-term open-label extension (LTOLE). METHODS AND RESULTS Of the 27 395 patients enrolled in COMPASS, 12 964 (mean age at baseline 67.2 years) from 455 sites in 32 countries were enrolled in LTOLE and treated with the combination of rivaroxaban and aspirin for a median of 374 additional days (range 1-1191 days). During LTOLE, the incident events per 100 patient years were as follows: for the primary outcome [cardiovascular death, stroke, or myocardial infarction (MI)] 2.35 [95% confidence interval (CI) 2.11-2.61], mortality 1.87 (1.65-2.10), stroke 0.62 (0.50-0.76), and MI 1.02 (0.86-1.19), with CIs that overlapped those seen during the randomized treatment phase with the combination of rivaroxaban and aspirin. The incidence rates for major and minor bleeding were 1.01 (0.86-1.19) and 2.49 (2.24-2.75), compared with 1.67 (1.48-1.87) and 5.11 (95% CI 4.77-5.47), respectively, during the randomized treatment phase with the combination. CONCLUSION In patients with chronic CAD and/or PAD, extended combination treatment for a median of 1 year and a maximum of 3 years was associated with incidence rates for efficacy and bleeding that were similar to or lower than those seen during the randomized treatment phase, without any new safety signals.
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Affiliation(s)
- John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Jacqueline Bosch
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Jessica Tyrwitt
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Eva Muehlhofer
- Bayer AG Pharmaceuticals, Research & Development, Wuppertal, Germany
| | - Christoph Neumann
- Bayer AG Pharmaceuticals, Research & Development, Wuppertal, Germany
| | - Christoph Tasto
- Bayer AG Pharmaceuticals, Research & Development, Wuppertal, Germany
| | - Shrikant I Bangdiwala
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Rafael Diaz
- Estudios Clínicos Latino América and Instituto Cardiovascular de Rosario, Rosaria, Argentina
| | - Marco Alings
- Division of Cardiology, Amphia ziekenhuis, Breda, Netherlands and Werkgroep Cardiologische centra Nederland (WCN), Utrecht, the Netherlands
| | - Gilles R Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - Darryl P Leong
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Eva M Lonn
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | - Petr Widimsky
- Cardiocenter, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander N Parkhomenko
- Emergency Cardiology Dept., National Scientific Center Institute of Cardiology, Kyiv, Ukraine
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelley R H Branch
- University of Washington Medical Centre, Division of Cardiology, Seattle, WA, USA
| | - Jeffrey L Probstfield
- University of Washington SOM, Division of Cardiology/Department of Medicine, Seattle WA, USA
| | - Patricio Lopez-Jaramillo
- Research Institute, Fundación Oftalmológica de Santander (FOSCAL)-Bucaramanga, Bucaramanga, Colombia
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Katalin Keltai
- Hungarian Cardiovascular Institute, Semmelweis University, Budapest, Hungary
| | - Matyas Keltai
- Hungarian Cardiovascular Institute, Semmelweis University, Budapest, Hungary
| | - Georg Ertl
- Deutsches Zentrum für Herzinsuffizienz, Medizinische Klinik I, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Stefan Stoerk
- Deutsches Zentrum für Herzinsuffizienz, Medizinische Klinik I, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Antonio L Dans
- College of Medicine, University of Philippines, Manila, Philippines
| | - Fernando Lanas
- Universidad de La Frontera, Division of Cardiology, Internal Medicine Department, Temuco, Chile
| | - Yan Liang
- Fuwai Hospital, CAMS & PUMC, Beijing, China
| | - Jun Zhu
- Dept of Clinical Medicine, University of Aalborg, Copenhagen, Denmark
| | | | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Patrick J Commerford
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa
| | - Tomasz J Guzik
- Department of Medicine, Jagiellonian University Medical College Krakow, Poland.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | | | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John D Varigos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila; University and Emergency Hospital, Bucharest, Romania
| | - Camillo Felix
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Jae-Hyung Kim
- Catholic University of Korea, Department of Medicine, Seoul, South Korea
| | | | - Basil S Lewis
- Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Kaj P Metsarinne
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital & INSERM 1094, Limoges, France
| | - Phillippe Gabriel Steg
- Université de Paris, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Masatsugu Hori
- Department of Oncocardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Ajay Kakkar
- Thrombosis Research Institute and University College London, London, UK
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Andre Lamy
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Mukul Sharma
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton Canada
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25
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Lacaze P, Bakshi A, Riaz M, Polekhina G, Owen A, Bhatia HS, Natarajan P, Wolfe R, Beilin L, Nicholls SJ, Watts GF, McNeil JJ, Tonkin AM, Tsimikas S. Aspirin for Primary Prevention of Cardiovascular Events in Relation to Lipoprotein(a) Genotypes. J Am Coll Cardiol 2022; 80:1287-1298. [PMID: 36175048 PMCID: PMC10025998 DOI: 10.1016/j.jacc.2022.07.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The role of aspirin in reducing lipoprotein(a)-mediated atherothrombotic events in primary prevention is not established. OBJECTIVES This study sought to assess whether low-dose aspirin benefits individuals with elevated plasma lipoprotein(a)-associated genotypes in the setting of primary prevention. METHODS The study analyzed 12,815 genotyped individuals ≥70 years of age of European ancestry and without prior cardiovascular disease events enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) randomized controlled trial of 100 mg/d aspirin. We defined lipoprotein(a)-associated genotypes using rs3798220-C carrier status and quintiles of a lipoprotein(a) genomic risk score (LPA-GRS). We tested for interaction between genotypes and aspirin allocation in Cox proportional hazards models for incidence of major adverse cardiovascular events (MACE) and clinically significant bleeding. We also examined associations in the aspirin and placebo arms of the trial separately. RESULTS During a median 4.7 years (IQR: 3.6-5.7 years) of follow-up, 435 MACE occurred, with an interaction observed between rs3798220-C and aspirin allocation (P = 0.049). rs3798220-C carrier status was associated with increased MACE risk in the placebo group (HR: 1.90; 95% CI: 1.11-3.24) but not in the aspirin group (HR: 0.54; 95% CI: 0.17-1.70). High LPA-GRS (vs low) was associated with increased MACE risk in the placebo group (HR: 1.70; 95% CI: 1.14-2.55), with risk attenuated in the aspirin group (HR: 1.41; 95% CI: 0.90-2.23), but the interaction was not statistically significant. In all participants, aspirin reduced MACE by 1.7 events per 1,000 person-years and increased clinically significant bleeding by 1.7 events per 1,000 person-years. However, in the rs3798220-C and high LPA-GRS subgroups, aspirin reduced MACE by 11.4 and 3.3 events per 1,000 person-years respectively, without significantly increased bleeding risk. CONCLUSIONS Aspirin may benefit older individuals with elevated lipoprotein(a) genotypes in primary prevention.
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Affiliation(s)
- Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Andrew Bakshi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Moeen Riaz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Galina Polekhina
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Pradeep Natarajan
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lawrence Beilin
- Medical School Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Stephen J Nicholls
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia; Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Victoria Square, Perth, Western Australia, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sotirios Tsimikas
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
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26
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Hussain SM, Ernst ME, Barker AL, Margolis KL, Reid CM, Neumann JT, Tonkin AM, Phuong TLT, Beilin LJ, Pham T, Chowdhury EK, Cicuttini FM, Gilmartin-Thomas JFM, Carr PR, McNeil JJ. Variation in Mean Arterial Pressure Increases Falls Risk in Elderly Physically Frail and Prefrail Individuals Treated With Antihypertensive Medication. Hypertension 2022; 79:2051-2061. [PMID: 35722878 PMCID: PMC9378722 DOI: 10.1161/hypertensionaha.122.19356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Impaired cerebral blood flow has been associated with an increased risk of falls. Mean arterial pressure (MAP) and variability in MAP have been reported to affect cerebral blood flow but their relationships to the risk of falls have not previously been reported. METHODS Utilising data from the Aspirin in Reducing Events in the Elderly trial participants, we estimated MAP and variability in MAP, defined as within-individual SD of MAP from baseline and first 2 annual visits. The relationship with MAP was studied in 16 703 participants amongst whom 1539 falls were recorded over 7.3 years. Variability in MAP was studied in 14 818 of these participants who experienced 974 falls over 4.1 years. Falls were confined to those involving hospital presentation. Cox regression was used to calculate hazard ratio and 95% CI for associations with falls. RESULTS Long-term variability in MAP was not associated with falls except amongst frail or prefrail participants using antihypertensive medications. Within this group each 5 mm Hg increase in long-term variability in MAP increased the risk of falls by 16% (hazard ratio, 1.16 [95% CI, 1.02-1.33]). Amongst the antihypertensive drugs studied, beta-blocker monotherapy (hazard ratio, 1.93 [95% CI, 1.17-3.18]) was associated with an increased risk of falls compared with calcium channel blockers. CONCLUSIONS Higher levels of long-term variability in MAP increase the risk of serious falls in older frail and prefrail individuals taking antihypertensive medications. The observation that the relationship was limited to frail and prefrail individuals might explain some of the variability of previous studies linking blood pressure indices and falls.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria 3010 Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine. The University of Iowa, Iowa City, Iowa. USA
| | - Anna L Barker
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | | | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- Department of Cardiology, University Heart & Vascular Center Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Thao Le Thi Phuong
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Lawrence J Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Thao Pham
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Enayet K Chowdhury
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Julia FM Gilmartin-Thomas
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- College of Health and Biomedicine, and Institute for Health & Sport, Victoria University, Victoria, Australia
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
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Stewart RAH, Kirby A, White HD, Marschner SL, West M, Thompson PL, Sullivan D, Janus E, Hunt D, Kritharides L, Keech A, Simes J, Tonkin AM. B-Type Natriuretic Peptide and Long-Term Cardiovascular Mortality in Patients With Coronary Heart Disease. J Am Heart Assoc 2022; 11:e024616. [PMID: 35766272 PMCID: PMC9333402 DOI: 10.1161/jaha.121.024616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The plasma concentration of B‐type natriuretic peptide (BNP) is a strong predictor of adverse cardiovascular events. The aim of this study was to determine whether the association between plasma BNP concentration and cardiovascular mortality is sustained or diminishes with increasing time after BNP is measured. Methods and Results Six thousand seven hundred forty patients with a history of myocardial infarction or unstable angina who participated in the LIPID (Long‐Term Intervention with Pravastatin in Ischemic Disease) trial had plasma BNP concentration measured at baseline and after 1 year. Associations with cardiovascular mortality were evaluated in landmark analyses 1 to <5, 5 to <10, and 10 to 16 years after randomization. There were 1640 cardiovascular deaths. The cardiovascular mortality rate increased progressively from 10.2 to 19.1 to 26.3/1000 patient‐years from 1 to <5, 5 to <10, and 10 to 16 years after baseline, respectively. The average of baseline and 1‐year BNP concentration was more strongly associated with cardiovascular mortality compared with baseline or 1‐year BNP only. The hazard ratio (HR) for cardiovascular death associated with each doubling of average BNP concentration was similar during years 1 to <5 (HR, 1.53 [95% CI, 1.44–1.63]), years 5 to <10 (HR, 1.52 [95% CI, 1.44–1.60]), and years 10–16 (HR, 1.43 [95% CI, 1.36–1.50]), P<0.0001 for all. Conclusions BNP concentration remains an independent predictor of cardiovascular mortality more than a decade after it is measured. Because of random variation in plasma concentrations, the average of >1 BNP measurement improves long‐term risk prediction.
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Affiliation(s)
- Ralph A H Stewart
- Green Lane Cardiovascular Service Auckland City Hospital Auckland New Zealand
| | - Adrienne Kirby
- National Health and Medical Research Council Clinical Trials Centre University of Sydney Camperdown Australia
| | - Harvey D White
- Green Lane Cardiovascular Service Auckland City Hospital Auckland New Zealand
| | - Simone L Marschner
- National Health and Medical Research Council Clinical Trials Centre University of Sydney Camperdown Australia
| | - Malcolm West
- Department of Medicine University of Queensland Brisbane Australia
| | - Peter L Thompson
- School of Population Health University of Western Australia Perth Australia
| | - David Sullivan
- Department of Clinical Biochemistry Royal Prince Alfred Hospital Sydney Australia
| | - Edward Janus
- Western Health Chronic Disease Alliance and Department of Medicine, Western Health - Melbourne Medical School The University of Melbourne Melbourne Australia
| | - David Hunt
- Department of Medicine University of Melbourne Melbourne Australia
| | | | - Anthony Keech
- National Health and Medical Research Council Clinical Trials Centre University of Sydney Camperdown Australia
| | - John Simes
- National Health and Medical Research Council Clinical Trials Centre University of Sydney Camperdown Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
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28
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Nelson MR, Polekhina G, Woods RL, Reid CM, Tonkin AM, Wolfe R, Murray AM, Kirpach B, Ernst ME, Lockery JE, Shah RC, Stocks N, Orchard SG, Zhou Z. Safety of Ceasing Aspirin Used Without a Clinical Indication After Age 70 Years: A Subgroup Analysis of the ASPREE Randomized Trial. Ann Intern Med 2022; 175:761-764. [PMID: 35286146 PMCID: PMC9434500 DOI: 10.7326/m21-3823] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Galina Polekhina
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, and School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes & Clinical Research, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, and Division of Geriatrics, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota
| | - Brenda Kirpach
- Berman Center for Outcomes & Clinical Research, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, and Translational Immunology and Nanotechnology Research Program, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Nigel Stocks
- Discipline of General Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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29
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Neumann JT, Thao LTP, Murray AM, Callander E, Carr PR, Nelson MR, Wolfe R, Woods RL, Reid CM, Shah RC, Newman AB, Williamson JD, Tonkin AM, McNeil JJ. Prediction of disability-free survival in healthy older people. GeroScience 2022; 44:1641-1655. [PMID: 35420334 PMCID: PMC9213595 DOI: 10.1007/s11357-022-00547-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/16/2022] [Indexed: 11/04/2022] Open
Abstract
Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and without prior cardiovascular events, dementia or persistent physical disability. Disability-free survival outcome was defined as absence of dementia, persistent disability or death. Selection of potential predictors from amongst 25 biomedical, psychosocial and lifestyle variables including recognized geriatric risk factors, utilizing a machine-learning approach. Separate models were developed for men and women. The selected predictors were evaluated in a multivariable Cox proportional hazards model and validated internally by bootstrapping. We included 19,114 Australian and US participants aged ≥65 years (median 74 years, IQR 71.6-77.7). Common predictors of a worse prognosis in both sexes included higher age, lower Modified Mini-Mental State Examination score, lower gait speed, lower grip strength and abnormal (low or elevated) body mass index. Additional risk factors for men included current smoking, and abnormal eGFR. In women, diabetes and depression were additional predictors. The biased-corrected areas under the receiver operating characteristic curves for the final prognostic models at 5 years were 0.72 for men and 0.75 for women. Final models showed good calibration between the observed and predicted risks. We developed a prediction model in which age, cognitive function and gait speed were the strongest predictors of disability-free survival in healthy older people.Trial registration Clinicaltrials.gov (NCT01038583).
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Affiliation(s)
- Johannes Tobias Neumann
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Department of Cardiology, University Heart & Vascular Centre Hamburg, Hamburg, Germany. .,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
| | - Le T P Thao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Anne M Murray
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare, and Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, USA
| | - Emily Callander
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Prudence R Carr
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Mark R Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.,Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Centre, Rush University Medical Centre, Chicago, IL, USA
| | - Anne B Newman
- Centre for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, USA
| | - Jeff D Williamson
- Sticht Centre on Health Aging and Alzheimer's Prevention, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
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30
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Thompson PL, Hui J, Beilby J, Palmer LJ, Watts GF, West MJ, Kirby A, Marschner S, Simes RJ, Sullivan DR, White HD, Stewart R, Tonkin AM. Common genetic variants do not predict recurrent events in coronary heart disease patients. BMC Cardiovasc Disord 2022; 22:96. [PMID: 35264114 PMCID: PMC8908687 DOI: 10.1186/s12872-022-02520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background It is unclear whether genetic variants identified from single nucleotide polymorphisms (SNPs) strongly associated with coronary heart disease (CHD) in genome-wide association studies (GWAS), or a genetic risk score (GRS) derived from them, can help stratify risk of recurrent events in patients with CHD. Methods Study subjects were enrolled at the close-out of the LIPID randomised controlled trial of pravastatin vs placebo. Entry to the trial had required a history of acute coronary syndrome 3–36 months previously, and patients were in the trial for a mean of 36 months. Patients who consented to a blood sample were genotyped with a custom designed array chip with SNPs chosen from known CHD-associated loci identified in previous GWAS. We evaluated outcomes in these patients over the following 10 years. Results Over the 10-year follow-up of the cohort of 4932 patients, 1558 deaths, 898 cardiovascular deaths, 727 CHD deaths and 375 cancer deaths occurred. There were no significant associations between individual SNPs and outcomes before or after adjustment for confounding variables and for multiple testing. A previously validated 27 SNP GRS derived from SNPs with the strongest associations with CHD also did not show any independent association with recurrent major cardiovascular events. Conclusions Genetic variants based on individual single nucleotide polymorphisms strongly associated with coronary heart disease in genome wide association studies or an abbreviated genetic risk score derived from them did not help risk profiling in this well-characterised cohort with 10-year follow-up. Other approaches will be needed to incorporate genetic profiling into clinically relevant stratification of long-term risk of recurrent events in CHD patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02520-0.
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Affiliation(s)
- P L Thompson
- Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Faculty of Health and Medical Sciences, Sir Charles Gairdner Hospital, University of Western Australia, Hospital Ave, Perth, Nedlands, WA, 6009, Australia.
| | - J Hui
- Health Department of Western Australia, PathWest, Perth, Australia.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - J Beilby
- Health Department of Western Australia, PathWest, Perth, Australia.,School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - L J Palmer
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - G F Watts
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - M J West
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - A Kirby
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - S Marschner
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - R J Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - D R Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - H D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - R Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - A M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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31
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West M, Kirby A, Stewart RA, Blankenberg S, Sullivan D, White HD, Hunt D, Marschner I, Janus E, Kritharides L, Watts GF, Simes J, Tonkin AM. Circulating Cystatin C Is an Independent Risk Marker for Cardiovascular Outcomes, Development of Renal Impairment, and Long-Term Mortality in Patients With Stable Coronary Heart Disease: The LIPID Study. J Am Heart Assoc 2022; 11:e020745. [PMID: 35179040 PMCID: PMC9075058 DOI: 10.1161/jaha.121.020745] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Elevated plasma cystatin C levels reflect reduced renal function and increased cardiovascular risk. Less is known about whether the increased risk persists long‐term or is independent of renal function and other important biomarkers. Methods and Results Cystatin C and other biomarkers were measured at baseline (in 7863 patients) and 1 year later (in 6106 patients) in participants in the LIPID (Long‐Term Intervention with Pravastatin in Ischemic Disease) study, who had a previous acute coronary syndrome. Outcomes were ascertained during the study (median follow‐up, 6 years) and long‐term (median follow‐up, 16 years). Glomerular filtration rate (GFR) was estimated using Chronic Kidney Disease Epidemiology Collaboration equations (first GFR‐creatinine, then GFR‐creatinine‐cystatin C). Over 6 years, in fully adjusted multivariable time‐to‐event models, with respect to the primary end point of coronary heart disease mortality or nonfatal myocardial infarction, for comparison of Quartile 4 versus 1 of baseline cystatin C, the hazard ratio was 1.37 (95% CI, 1.07–1.74; P=0.01), and for major cardiovascular events was 1.47 (95% CI, 1.19–1.82; P<0.001). Over 16 years, the association of baseline cystatin C with coronary heart disease, cardiovascular, and all‐cause mortality persisted (each P<0.001) and remained significant after adjustment for estimated GFR‐creatinine‐cystatin C. Cystatin C also predicted the development of chronic kidney disease for 6 years (odds ratio, 6.61; 95% CI, 4.28–10.20) independently of estimated GFR‐creatinine and other risk factors. However, this association was no longer significant after adjustment for estimated GFR‐creatinine‐cystatin C. Conclusions Cystatin C independently predicted major cardiovascular events, development of chronic kidney disease, and cardiovascular and all‐cause mortality. Prediction of long‐term mortality was independent of improved estimation of GFR. Registration URL: https://anzctr.org.au; Unique identifier: ACTRN12616000535471.
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Affiliation(s)
- Malcolm West
- Department of MedicineUniversity of QueenslandBrisbaneAustralia
| | - Adrienne Kirby
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyAustralia
| | - Ralph A. Stewart
- Green Lane Cardiovascular ServiceAuckland City HospitalUniversity of AucklandAucklandNew Zealand
| | | | - David Sullivan
- Department of Chemical PathologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Harvey D. White
- Green Lane Cardiovascular ServiceAuckland City HospitalUniversity of AucklandAucklandNew Zealand
| | - David Hunt
- Cardiology DepartmentRoyal Melbourne HospitalMelbourneAustralia
| | - Ian Marschner
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyAustralia
| | - Edward Janus
- Department of MedicineWestern Health Chronic Disease AllianceWestern HealthMelbourne Medical SchoolUniversity of MelbourneMelbourneAustralia
| | - Leonard Kritharides
- Department of CardiologyConcord Repatriation General HospitalSydney Local Health DistrictSydneyAustralia
- ANZAC Medical Research InstituteFaculty of MedicineUniversity of SydneySydneyAustralia
| | - Gerald F. Watts
- School of MedicineFaculty of Health and Medical SciencesUniversity of Western AustraliaPerthAustralia
| | - John Simes
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyAustralia
| | - Andrew M. Tonkin
- School of Public Health and Preventive MedicineMonash UniversityPerthAustralia
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Neumann JT, Riaz M, Bakshi A, Polekhina G, Thao LTP, Nelson MR, Woods RL, Abraham G, Inouye M, Reid CM, Tonkin AM, McNeil J, Lacaze P. Prognostic Value of a Polygenic Risk Score for Coronary Heart Disease in Individuals Aged 70 Years and Older. Circ Genom Precis Med 2022; 15:e003429. [PMID: 34949098 PMCID: PMC8847323 DOI: 10.1161/circgen.121.003429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The use of a polygenic risk score (PRS) to improve risk prediction of coronary heart disease (CHD) events has been demonstrated to have clinical utility in the general adult population. However, the prognostic value of a PRS for CHD has not been examined specifically in older populations of individuals aged ≥70 years, who comprise a distinct high-risk subgroup. The objective of this study was to evaluate the predictive value of a PRS for incident CHD events in a prospective cohort of older individuals without a history of cardiovascular events. METHODS We used data from 12 792 genotyped, healthy older individuals enrolled into the ASPREE trial (Aspirin in Reducing Events in the Elderly), a randomized double-blind placebo-controlled clinical trial investigating the effect of daily 100 mg aspirin on disability-free survival. Participants had no previous history of diagnosed atherothrombotic cardiovascular events, dementia, or persistent physical disability at enrollment. We calculated a PRS (meta-genomic risk score) consisting of 1.7 million genetic variants. The primary outcome was a composite of incident myocardial infarction or CHD death over 5 years. RESULTS At baseline, the median population age was 73.9 years, and 54.9% were female. In total, 254 incident CHD events occurred. When the PRS was added to conventional risk factors, it was independently associated with CHD (hazard ratio, 1.24 [95% CI, 1.08-1.42], P=0.002). The area under the curve of the conventional model was 70.53 (95% CI, 67.00-74.06), and after inclusion of the PRS increased to 71.78 (95% CI, 68.32-75.24, P=0.019), demonstrating improved prediction. Reclassification was also improved, as the continuous net reclassification index after adding PRS to the conventional model was 0.25 (95% CI, 0.15-0.28). CONCLUSION A PRS for CHD performs well in older people and improves prediction over conventional cardiovascular risk factors. Our study provides evidence that genomic risk prediction for CHD has clinical utility in individuals aged 70 years and older. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583.
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Affiliation(s)
- Johannes T. Neumann
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;,Department of Cardiology, University Heart & Vascular Centre, Hamburg, Hamburg, Germany;,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Moeen Riaz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Bakshi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Galina Polekhina
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Le T. P. Thao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark R. Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Robyn L. Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gad Abraham
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia;,Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Christopher M. Reid
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;,School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrew M. Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Neumann JT, Thao LTP, Callander E, Chowdhury E, Williamson JD, Nelson MR, Donnan G, Woods RL, Reid CM, Poppe KK, Jackson R, Tonkin AM, McNeil JJ. Cardiovascular risk prediction in healthy older people. GeroScience 2022; 44:403-413. [PMID: 34762275 PMCID: PMC8810999 DOI: 10.1007/s11357-021-00486-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/02/2021] [Indexed: 12/02/2022] Open
Abstract
Identification of individuals with increased risk of major adverse cardiovascular events (MACE) is important. However, algorithms specific to the elderly are lacking. Data were analysed from a randomised trial involving 18,548 participants ≥ 70 years old (mean age 75.4 years), without prior cardiovascular disease events, dementia or physical disability. MACE included coronary heart disease death, fatal or nonfatal ischaemic stroke or myocardial infarction. Potential predictors tested were based on prior evidence and using a machine-learning approach. Cox regression analyses were used to calculate 5-year predicted risk, and discrimination evaluated from receiver operating characteristic curves. Calibration was also assessed, and the findings internally validated using bootstrapping. External validation was performed in 25,138 healthy, elderly individuals in the primary care environment. During median follow-up of 4.7 years, 594 MACE occurred. Predictors in the final model included age, sex, smoking, systolic blood pressure, high-density lipoprotein cholesterol (HDL-c), non-HDL-c, serum creatinine, diabetes and intake of antihypertensive agents. With variable selection based on machine-learning, age, sex and creatinine were the most important predictors. The final model resulted in an area under the curve (AUC) of 68.1 (95% confidence intervals 65.9; 70.4). The model had an AUC of 67.5 in internal and 64.2 in external validation. The model rank-ordered risk well but underestimated absolute risk in the external validation cohort. A model predicting incident MACE in healthy, elderly individuals includes well-recognised, potentially reversible risk factors and notably, renal function. Calibration would be necessary when used in other populations.
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Affiliation(s)
- Johannes T Neumann
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.
- Department of Cardiology, University Heart & Vascular Centre, Hamburg, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
| | - Le T P Thao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Emily Callander
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Enayet Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Jeff D Williamson
- Sticht Centre On Aging and Alzheimer's Prevention, Section On Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark R Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Geoffrey Donnan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Katrina K Poppe
- Epidemiology & Biostatistics, University of Auckland, Auckland, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- Epidemiology & Biostatistics, University of Auckland, Auckland, New Zealand
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
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34
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Islam RM, Bell RJ, Handelsman DJ, McNeil JJ, Nelson MR, Reid CM, Tonkin AM, Wolfe RS, Woods RL, Davis SR. Associations between blood sex steroid concentrations and risk of major adverse cardiovascular events in healthy older women in Australia: a prospective cohort substudy of the ASPREE trial. Lancet Healthy Longev 2022; 3:e109-e118. [PMID: 35252940 PMCID: PMC8896500 DOI: 10.1016/s2666-7568(22)00001-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Blood testosterone concentrations in women decline during the reproductive years and reach a nadir in the seventh decade, after which concentrations increase and are restored to those of reproductive-aged women early in the eighth decade. We aimed to establish the association between the concentration of testosterone in the blood and risk of major adverse cardiovascular events (MACE) and all-cause mortality in healthy older women. METHODS SHOW was a prospective cohort substudy of the longitudinal randomised ASPREE trial. Eligible participants were women aged at least 70 years from Australia with unimpaired cognition, no previous MACE, and a life expectancy of at least 5 years. Participants who were receiving hormonal or steroid therapy were ineligible for inclusion. We measured serum concentrations of sex steroids with liquid chromatography-tandem mass spectrometry and of SHBG with immunoassay. We compared lower concentrations of sex hormones with higher concentrations using four quartiles. Primary endpoints were risk of MACE and all-cause mortality, the associations of which with sex steroid concentrations were assessed using Cox proportional hazards regression that included age, body-mass index, smoking status, alcohol consumption, diabetes, hypertension, dyslipidaemia, impaired renal function, and treatment allocation in the ASPREE trial (aspirin vs placebo). ASPREE is registered with ClinicalTrials.gov, NCT01038583. FINDINGS Of the 9180 women recruited to the ASPREE trial between March 10, 2010, and Dec 31 2014, 6358 participants provided sufficient biobank samples at baseline and 5535 were included in the final analysis. Median age at entry was 74·0 years (IQR 71·7-77·7). During a median 4·4 years of follow-up (24 553 person-years), 144 (2·6%) women had a first MACE (incidence 5·9 per 1000 person-years). During a median 4·6 years of follow-up (3·8-5·6), 200 women died (7·9 per 1000 person-years). In the fully adjusted models, higher concentrations of testosterone were associated with a lower incidence of MACE (quartile 4 vs quartile 1: hazard ratio 0·57 [95% CI 0·36-0·91]; p=0·02), as were higher concentrations of DHEA (quartile 4 vs quartile 1: 0·61 [0·38-0·97]; p=0·04). For oestrone, a lower risk of MACE was seen for concentrations in quartile 2 only, compared with quartile 1 (0·55 [0·33-0·92]; p=0·02). In fully adjusted models, no association was seen between SHBG and MACE, or between any hormone or SHBG and all-cause mortality. INTERPRETATION Blood concentrations of testosterone and DHEA above the lowest quartile in older women were associated with a reduced risk of a first-ever MACE. Given that the physiological effects of DHEA are mediated through its steroid metabolites, if the current findings were to be replicated, trials investigating testosterone therapy for the primary prevention of ischaemic cardiovascular disease events in older women would be warranted. FUNDING The National Health and Medical Research Council of Australia, US National Institute on Aging, the Victorian Cancer Agency, the Commonwealth Scientific and Industrial Research Organisation, and Monash University.
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Affiliation(s)
- Rakibul M Islam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (R M Islam PhD, Prof R J Bell MBBS, Prof J J McNeil MBBS, Prof M R Nelson MBBS, Prof C M Reid PhD, Prof R S Wolfe PhD, R L Woods PhD, Prof S R Davis MBBS); ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia (Prof D J Handelsman MBBS); Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Prof M R Nelson); School of Population Health, Curtin University, Bentley, WA, Australia (Prof C M Reid)
| | - Robin J Bell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (R M Islam PhD, Prof R J Bell MBBS, Prof J J McNeil MBBS, Prof M R Nelson MBBS, Prof C M Reid PhD, Prof R S Wolfe PhD, R L Woods PhD, Prof S R Davis MBBS); ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia (Prof D J Handelsman MBBS); Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Prof M R Nelson); School of Population Health, Curtin University, Bentley, WA, Australia (Prof C M Reid)
| | - David J Handelsman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (R M Islam PhD, Prof R J Bell MBBS, Prof J J McNeil MBBS, Prof M R Nelson MBBS, Prof C M Reid PhD, Prof R S Wolfe PhD, R L Woods PhD, Prof S R Davis MBBS); ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia (Prof D J Handelsman MBBS); Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Prof M R Nelson); School of Population Health, Curtin University, Bentley, WA, Australia (Prof C M Reid)
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (R M Islam PhD, Prof R J Bell MBBS, Prof J J McNeil MBBS, Prof M R Nelson MBBS, Prof C M Reid PhD, Prof R S Wolfe PhD, R L Woods PhD, Prof S R Davis MBBS); ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia (Prof D J Handelsman MBBS); Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Prof M R Nelson); School of Population Health, Curtin University, Bentley, WA, Australia (Prof C M Reid)
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (R M Islam PhD, Prof R J Bell MBBS, Prof J J McNeil MBBS, Prof M R Nelson MBBS, Prof C M Reid PhD, Prof R S Wolfe PhD, R L Woods PhD, Prof S R Davis MBBS); ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia (Prof D J Handelsman MBBS); Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Prof M R Nelson); School of Population Health, Curtin University, Bentley, WA, Australia (Prof C M Reid)
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (R M Islam PhD, Prof R J Bell MBBS, Prof J J McNeil MBBS, Prof M R Nelson MBBS, Prof C M Reid PhD, Prof R S Wolfe PhD, R L Woods PhD, Prof S R Davis MBBS); ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia (Prof D J Handelsman MBBS); Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Prof M R Nelson); School of Population Health, Curtin University, Bentley, WA, Australia (Prof C M Reid)
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (R M Islam PhD, Prof R J Bell MBBS, Prof J J McNeil MBBS, Prof M R Nelson MBBS, Prof C M Reid PhD, Prof R S Wolfe PhD, R L Woods PhD, Prof S R Davis MBBS); ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia (Prof D J Handelsman MBBS); Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Prof M R Nelson); School of Population Health, Curtin University, Bentley, WA, Australia (Prof C M Reid)
| | - Rory S Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (R M Islam PhD, Prof R J Bell MBBS, Prof J J McNeil MBBS, Prof M R Nelson MBBS, Prof C M Reid PhD, Prof R S Wolfe PhD, R L Woods PhD, Prof S R Davis MBBS); ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia (Prof D J Handelsman MBBS); Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Prof M R Nelson); School of Population Health, Curtin University, Bentley, WA, Australia (Prof C M Reid)
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (R M Islam PhD, Prof R J Bell MBBS, Prof J J McNeil MBBS, Prof M R Nelson MBBS, Prof C M Reid PhD, Prof R S Wolfe PhD, R L Woods PhD, Prof S R Davis MBBS); ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia (Prof D J Handelsman MBBS); Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Prof M R Nelson); School of Population Health, Curtin University, Bentley, WA, Australia (Prof C M Reid)
| | - Susan R Davis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (R M Islam PhD, Prof R J Bell MBBS, Prof J J McNeil MBBS, Prof M R Nelson MBBS, Prof C M Reid PhD, Prof R S Wolfe PhD, R L Woods PhD, Prof S R Davis MBBS); ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia (Prof D J Handelsman MBBS); Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Prof M R Nelson); School of Population Health, Curtin University, Bentley, WA, Australia (Prof C M Reid)
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Neumann JT, Thao LTP, Callander E, Carr PR, Qaderi V, Nelson MR, Reid CM, Woods RL, Orchard SG, Wolfe R, Polekhina G, Williamson JD, Trauer JM, Newman AB, Murray AM, Ernst ME, Tonkin AM, McNeil JJ. A multistate model of health transitions in older people: a secondary analysis of ASPREE clinical trial data. The Lancet Healthy Longevity 2022; 3:e89-e97. [PMID: 35224525 PMCID: PMC8880962 DOI: 10.1016/s2666-7568(21)00308-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Phyo AZZ, Gonzalez-Chica DA, Stocks NP, Woods RL, Tran T, Reid CM, Tonkin AM, Nelson MR, McNeil JJ, Murray AM, Gasevic D, Freak-Poli R, Ryan J. Trajectories of physical health-related quality of life and the risk of incident cardiovascular disease events and all-cause mortality in older people. Am Heart J Plus 2022; 13:100117. [PMID: 36959831 PMCID: PMC10031654 DOI: 10.1016/j.ahjo.2022.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Study objective The aim of this study was to identify whether physical component score (PCS) of health-related quality of life trajectories over 4.7-years predicted subsequent risk of incident fatal and non-fatal CVD events, and all-cause mortality. Methods This study included 16,871 community-dwelling people aged ≥65 years enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) trial. PCS was assessed annually using the SF-12 (version-2) over a median 4.7-years (i.e. from baseline (2010-2014) till June 2017). Incident CVD events and all-cause mortality occurring after June 2017 until the second-year after the end of the trial were considered. Growth mixture and logistic regression modelling were used. Results Four PCS trajectories were identified: high (66.5%), intermediate (13.3%), decline (13.8%), and low (6.5%), and there was subsequently a total of 406 (2.50%) incident CVD events, 197 (1.17%) fatal CVD, and 751 (4.45%) deaths. The declining PCS trajectory group had the highest risk of incident CVD (adjusted OR, 1.51; 95% CI 1.14, 1.99), while the low PCS trajectory group had the greatest risk of fatal CVD (adjusted OR, 1.74; 95%CI 1.06, 2.85) and all-cause mortality (adjusted OR, 1.83; 95%CI 1.40, 2.40). After further adjustment for the baseline PCS score, only the association between declining PCS trajectory and incident CVD (adjusted OR, 1.51; 95%CI 1.11, 2.07) remained. Conclusion Our study strengthens the importance of PCS as a predictive measure of CVD and all-cause mortality in older people and also highlights that a declining PCS trajectory could be considered an early predictor of future CVD events.
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Affiliation(s)
- Aung Zaw Zaw Phyo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - David A. Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Nigel P. Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- School of Public Health, Curtin University, Perth, WA 6102, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Mark R. Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Hennepin HealthCare Research Institute, Hennepin HealthCare, Minneapolis, MN 55415, United States
- Division of Geriatrics, Department of Medicine, Hennepin HealthCare and University of Minnesota, Minneapolis, MN 55415, United States
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Corresponding author at: School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC 3004, Australia., (J. Ryan)
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Hussain SM, Ernst M, Reid C, Tonkin AM, Neumann J, Le Thao TP, Barker A, McNeil J. Mean Arterial Pressure and Risk of Falls Resulting in Hospital Presentation in Older Adults. Innov Aging 2021. [PMCID: PMC8969989 DOI: 10.1093/geroni/igab046.1727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Utilising data from the ASPirin in Reducing Events in the Elderly trial participants aged 70-years, we estimated MAP and variation in MAP defined as within-individual SD of MAP from baseline and first 2 annual visits. Falls were confined to those involving presentation to a hospital. Cox proportional hazards regression was used to calculate hazard ratio (HR) and 95% confidence interval (CI) for associations with falls. Amongst 16,703 participants (1,540 falls), MAP was not associated with falls irrespective of antihypertensive medication status (all: HR 1.00, 95% CI 0.99-1.01, not on antihypertensive: HR 1.01, 95% CI 0.99, 1.02, on antihypertensive: HR 1.01, 95% CI 0.99-1.02). Amongst 14,818 participants who remained in the study up to year 2 without falls, 1 unit escalation in MAP variability increased the risk (HR 1.01, 95% CI 1.00-1.03). Compared with those in the lowest tercile of variability, those in the middle or highest tercile of variability experienced an increased risk of falling (middle: HR 1.32, 95% CI 1.06-1.65; highest: HR 1.25, 95% CI 1.01-1.55). When stratified for antihypertensive medication status, those receiving diuretics (HR 1.18, 95% CI 1.00-1.39) or beta-blockers (HR 1.37, 95% CI 1.08-1.73) were at increased risk compared to those receiving renin-angiotensin-system acting agents. All results persisted after adjustment for multiple covariates. The association of diuretics and beta-blockers with falls remained significant even after excluding those with history of heart failure. Older community-dwelling adults with high variability in MAP are at increases risk of falls, particularly amongst those receiving beta-blockers or diuretics.
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Affiliation(s)
| | | | | | | | | | | | - Anna Barker
- Silver Chain, Melbourne, Victoria, Australia
| | - John McNeil
- Monash University, Melbourne, Victoria, Australia
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Phyo AZZ, Ryan J, Gonzalez-Chica DA, Stocks NP, Reid CM, Tonkin AM, Woods R, Freak-Poli R. Using Health-Related Quality of Life to Identify the Incident Cardiovascular Disease Risk. Innov Aging 2021. [PMCID: PMC8968281 DOI: 10.1093/geroni/igab046.2335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous studies have revealed that poor health-related quality of life (HRQoL) is associated with a higher risk of hospital readmission and mortality in patients with cardiovascular disease (CVD). The association between HRQoL and incident CVD is still limited for general older people. This study explored the associations between baseline HRQoL and incident and fatal CVD in community-dwelling Australian and the United States older people enrolled in ASPREE clinical trial. A cohort of 19,106 individuals aged 65 to 98 years, who were initially free of CVD, dementia, or disability, were followed between March 2010 and June 2017. The SF-12 questionnaire was used to assess HRQoL, and the physical (PCS) and mental component scores (MCS) of SF-12 were derived using norm-based methods. Incident major adverse CVD events included fatal CVD (death due to atherothrombotic CVD), hospitalizations for heart failure, myocardial infarction or stroke. Analyses were performed using Cox proportional-hazard regression. Over a median 4.7 follow-up years, there were 922 incident CVD events, 203 fatal CVD events, 171 hospitalizations for heart failure, 355 fatal or nonfatal myocardial infarction and 403 fatal or nonfatal strokes. A 10-unit higher PCS, but not MCS, was associated with a lower risk of incident CVD (HR=0.86, 95%CI 0.79-0.92), hospitalization for heart failure (HR=0.72, 95%CI 0.60-0.85), and myocardial infarction (HR=0.85, 95%CI 0.75-0.96). Neither PCS nor MCS was associated with fatal CVD events or stroke. Physical HRQoL can be used in combination with clinical data to identify the incident CVD risk among community-dwelling older people.
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Affiliation(s)
- Aung Zaw Zaw Phyo
- Monash University, Melbourne, Australia, Melbourne, Victoria, Australia
| | - Joanne Ryan
- Monash University, Melbourne, Victoria, Australia
| | | | - Nigel P Stocks
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - Robyn Woods
- Monash University, Melbourne, Victoria, Australia
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Neumann JT, Freak-Poli R, Orchard SG, Wolfe R, Reid CM, Tonkin AM, Beilin LJ, McNeil JJ, Ryan J, Woods RL. Alcohol consumption and risks of cardiovascular disease and all-cause mortality in healthy older adults. Eur J Prev Cardiol 2021; 29:e230-e232. [PMID: 34718513 DOI: 10.1093/eurjpc/zwab177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.,Department of Cardiology, University Heart & Vascular Centre, Hamburg, Martinistraße 52, 20246 Hamburg, Hamburg, Germany
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.,School of Population Health, Curtin University, Kent St, Bentley, 6102, Western Australia, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, GPO Box X2213, 6847 Perth, Western Australia, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia
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Qaderi V, Ball J, Nehme Z, Neumann JT, Wolfe R, Woods R, Tonkin AM, Smith K, McNeil JJ. Out-of-hospital cardiac arrest in elderly individuals. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Out-of-hospital cardiac arrest (OHCA) is associated with poor outcome, particularly in elderly people. Due to the shift in global demographics towards an ageing population, understanding risk factors for OHCA is essential for the development of primary prevention strategies. Thus, we aimed to identify predictors for OHCA in a large, community-dwelling cohort of elderly individuals.
Methods
We analyzed data from 11,156 participants enrolled in a randomized, placebo-controlled primary prevention trial, investigating the effect of low-dose aspirin in individuals aged 70 years or above. At baseline all participants had no prior cardiovascular disease events, dementia or major physical disability. OHCA events occurring within 5 years were identified by probabilistic data-linkage with a state-wide out-of-hospital cardiac arrest registry. Possible predictors included age, sex, anthropometric measures, conventional cardiovascular risk factors, renal function and frailty. To evaluate the association with OHCA, we performed univariable and multivariable Cox regression analyses. In exploratory analyses we also evaluated the effect of low-dose aspirin on OHCA events.
Results
In the cohort 54.7% were female and median age was 74.1 years (Interquartile Range [IQR] 71.8–77.7). During a median follow up time of 4.7 years (IQR 3.4–6.0) we recorded 67 OHCA events with presumed cardiac cause. The incidence rate was 1.07 per 1,000 person-years (95% Confidence-Interval [CI] 0.80–1.40). The mortality rate following OHCA was 91.2% (n=62). Univariable Cox regression analyses identified age, sex, weight, abdominal circumference, serum creatinine, diabetes, arterial hypertension, intake of antihypertensive medication and pre-frailty as predictors for the outcome. In multivariable Cox regression analyses we identified age (Hazard Ratio [HR] 1.06, CI 1.00–1.13), female sex (HR 0.49, CI 0.26–0.94) and pre-frailty (HR 1.92, CI 1.03–3.58) to be independent predictors (Table). In exploratory analyses there was no effect of low-dose aspirin on OHCA (HR 1.52, CI 0.87–2.70).
Conclusion
In a large, contemporary cohort of healthy, elderly individuals we describe a significant incidence of OHCA events associated with a very high mortality. We identified age, sex and pre-frailty, but interestingly not conventional cardiovascular risk factors as independent predictors of OHCA. We could not show a benefit of low-dose aspirin treatment, although the number of events was small. Our findings emphasize the importance of preventive strategies for pre-frailty in elderly individuals.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The ASPREE study was primarily funded by the National Institute of Aging and National Cancer Institute at the National Institutes of Health (grant number U01AG029824), the Australian National Health & Medical Research Council (grants 334047 & 1127060), Monash University (Australia) and the Victorian Cancer Agency (Australia). Multivariable Cox regression analyses
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Affiliation(s)
- V Qaderi
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - J Ball
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - Z Nehme
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - J T Neumann
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - R Wolfe
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - R Woods
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - A M Tonkin
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - K Smith
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - J J McNeil
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
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Haller PM, Beer BN, Tonkin AM, Blankenberg S, Neumann JT. Role of Cardiac Biomarkers in Epidemiology and Risk Outcomes. Clin Chem 2021; 67:96-106. [PMID: 33225348 DOI: 10.1093/clinchem/hvaa228] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/01/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of biomarkers associated with cardiovascular disease (CVD) is established for diagnostic purposes. Cardiac troponins, as specific markers of myocardial injury, and natriuretic peptides, reflecting myocardial dilation, are routinely used for diagnosis in clinical practice. In addition, a substantial body of research has shed light on the ability of biomarkers to reflect the risk of future major cardiovascular events. Among biomarkers, troponin and members of the natriuretic peptide family have been investigated extensively in the general population, in those at higher risk, and in patients with known CVD. Both biomarkers have been shown to contribute substantially to statistical models describing cardiovascular risk, in addition to and independently of important clinical characteristics. The more precise identification of individuals at risk by appropriate use of biomarkers might lead to an earlier initiation of preventive therapies and potentially avoid significant events. CONTENT We summarize the current evidence concerning risk prediction using cardiac biomarkers at different stages in the development of CVD and provide examples of observational studies and large-scale clinical trials testing such application. Beyond the focus on troponin and natriuretic peptides, we also discuss other important and emerging biomarkers in the field with potential for such application, including growth differentiation factor-15, soluble ST2 (alias for IL1RL1 [interleukin 1 receptor like 1), and galectin-3. SUMMARY Incorporating biomarkers in risk prediction models might allow more precise identification of individuals at risk. Among the various biomarkers, cardiac troponin appears to be the most promising for prediction of future cardiovascular events in a wide variety of patient populations.
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Affiliation(s)
- Paul M Haller
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Benedikt N Beer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Andrew M Tonkin
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Johannes T Neumann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
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42
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Ernst ME, Ryan J, Chowdhury EK, Margolis KL, Beilin LJ, Reid CM, Nelson MR, Woods RL, Shah RC, Orchard SG, Wolfe R, Storey E, Tonkin AM, Brodtmann A, McNeil JJ, Murray AM. Long-Term Blood Pressure Variability and Risk of Cognitive Decline and Dementia Among Older Adults. J Am Heart Assoc 2021; 10:e019613. [PMID: 34176293 PMCID: PMC8403315 DOI: 10.1161/jaha.120.019613] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Blood pressure variability (BPV) in midlife increases risk of late‐life dementia, but the impact of BPV on the cognition of adults who have already reached older ages free of major cognitive deficits is unknown. We examined the risk of incident dementia and cognitive decline associated with long‐term, visit‐to‐visit BPV in a post hoc analysis of the ASPREE (Aspirin in Reducing Events in the Elderly) trial. Methods and Results ASPREE participants (N=19 114) were free of dementia and significant cognitive impairment at enrollment. Measurement of BP and administration of a standardized cognitive battery evaluating global cognition, delayed episodic memory, verbal fluency, and processing speed and attention occurred at baseline and follow‐up visits. Time‐to‐event analysis using Cox proportional hazards regression models were used to calculate hazard ratios (HR) and corresponding 95% CI for incident dementia and cognitive decline, according to tertile of SD of systolic BPV. Individuals in the highest BPV tertile compared with the lowest had an increased risk of incident dementia and cognitive decline, independent of average BP and use of antihypertensive drugs. There was evidence that sex modified the association with incident dementia (interaction P=0.02), with increased risk in men (HR, 1.68; 95% CI, 1.19–2.39) but not women (HR, 1.01; 95% CI, 0.72–1.42). For cognitive decline, similar increased risks were observed for men and women (interaction P=0.15; men: HR, 1.36; 95% CI, 1.16–1.59; women: HR, 1.14; 95% CI, 0.98–1.32). Conclusions High BPV in older adults without major cognitive impairment, particularly men, is associated with increased risks of dementia and cognitive decline. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583; isrctn.com. Identifier: ISRCTN83772183.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science College of Pharmacy The University of Iowa Iowa City IA.,Department of Family Medicine Carver College of Medicine The University of Iowa Iowa City IA
| | - Joanne Ryan
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Enayet K Chowdhury
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia.,School of Public Health Curtin University Perth Western Australia Australia
| | | | - Lawrence J Beilin
- Medical School Royal Perth HospitalUniversity of Western Australia Perth Western Australia Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia.,School of Public Health Curtin University Perth Western Australia Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Raj C Shah
- Department of Family Medicine Rush University Medical Center Chicago IL.,Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health Melbourne Victoria Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research Hennepin-Health Research InstituteHennepin Healthcare Minneapolis MN.,Division of Geriatrics Department of Medicine Hennepin Healthcare Minneapolis MN
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Zhou Z, Ryan J, Ernst ME, Zoungas S, Tonkin AM, Woods RL, McNeil JJ, Reid CM, Curtis AJ, Wolfe R, Wrigglesworth J, Shah RC, Storey E, Murray A, Orchard SG, Nelson MR. Effect of Statin Therapy on Cognitive Decline and Incident Dementia in Older Adults. J Am Coll Cardiol 2021; 77:3145-3156. [PMID: 34167639 DOI: 10.1016/j.jacc.2021.04.075] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The neurocognitive effect of statins in older adults remain uncertain. OBJECTIVES The aim of this study was to investigate the associations of statin use with cognitive decline and incident dementia among older adults. METHODS This analysis included 18,846 participants ≥65 years of age in a randomized trial of aspirin, who had no prior cardiovascular events, major physical disability, or dementia initially and were followed for 4.7 years. Outcome measures included incident dementia and its subclassifications (probable Alzheimer's disease, mixed presentations); mild cognitive impairment (MCI) and its subclassifications (MCI consistent with Alzheimer's disease, other MCI); and changes in domain-specific cognition, including global cognition, memory, language and executive function, psychomotor speed, and the composite of these domains. Associations of baseline statin use versus nonuse with dementia and MCI outcomes were examined using Cox proportional hazards models and with cognitive change using linear mixed-effects models, adjusting for potential confounders. The impact of statin lipophilicity on these associations was further examined, and effect modifiers were identified. RESULTS Statin use versus nonuse was not associated with dementia, MCI, or their subclassifications or with changes in cognitive function scores over time (p > 0.05 for all). No differences were found in any outcomes between hydrophilic and lipophilic statin users. Baseline neurocognitive ability was an effect modifier for the associations of statins with dementia (p for interaction < 0.001) and memory change (p for interaction = 0.02). CONCLUSIONS In adults ≥65 years of age, statin therapy was not associated with incident dementia, MCI, or declines in individual cognition domains. These findings await confirmation from ongoing randomized trials.
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Affiliation(s)
- Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Andrea J Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jo Wrigglesworth
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anne Murray
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA; Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, Minnesota, USA; University of Minnesota, Minneapolis, Minnesota, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Neumann JT, Riaz M, Bakshi A, Polekhina G, Thao LTP, Nelson MR, Woods RL, Abraham G, Inouye M, Reid CM, Tonkin AM, Williamson JD, Donnan GA, Brodtmann A, Cloud GC, McNeil JJ, Lacaze P. Predictive Performance of a Polygenic Risk Score for Incident Ischemic Stroke in a Healthy Older Population. Stroke 2021; 52:2882-2891. [PMID: 34039031 DOI: 10.1161/strokeaha.120.033670] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Johannes T Neumann
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia.,Department of Cardiology, University Heart and Vascular Centre, Hamburg, Germany (J.T.N.).,German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Germany (J.T.N.)
| | - Moeen Riaz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia
| | - Andrew Bakshi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia
| | - Galina Polekhina
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia
| | - Le T P Thao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia
| | - Mark R Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart (M.R.N.)
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia
| | - Gad Abraham
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (G.A., M.I.)
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (G.A., M.I.).,Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M.I.)
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia (C.M.R.)
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia
| | - Jeff D Williamson
- Department of Internal Medicine, Sticht Center on Aging and Alzheimer's Prevention, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC (J.D.W.)
| | - Geoffrey A Donnan
- Melbourne Brain Centre, Royal Melbourne Hospital (G.A.D., A. Brodtmann), University of Melbourne, Australia
| | - Amy Brodtmann
- Melbourne Brain Centre, Royal Melbourne Hospital (G.A.D., A. Brodtmann), University of Melbourne, Australia.,The Florey Institute of Neuroscience and Mental Health (A. Brodtmann), University of Melbourne, Australia
| | - Geoffrey C Cloud
- Department of Neuroscience, Central Clinical School (G.C.C.), Monash University, Melbourne, Australia.,Department of Neurology, Alfred Hospital, Melbourne, Australia (G.C.C.)
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (J.T.N., M.R., A. Bakshi, G.P., L.T.P.T., M.R.N., R.L.W., C.M.R., A.M.T., J.J.M., P.L.), Monash University, Melbourne, Australia
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45
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Neumann JT, Tonkin AM. Assessing and modifying cardiovascular risk in people who present to a chest pain clinic with non-cardiac causes. Med J Aust 2021; 214:263-264. [PMID: 33684967 DOI: 10.5694/mja2.50984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Johannes T Neumann
- Monash University, Melbourne, VIC.,University Heart and Vascular Center Hamburg, Hamburg, Germany
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Hilvo M, Meikle PJ, Pedersen ER, Tell GS, Dhar I, Brenner H, Schöttker B, Lääperi M, Kauhanen D, Koistinen KM, Jylhä A, Huynh K, Mellett NA, Tonkin AM, Sullivan DR, Simes J, Nestel P, Koenig W, Rothenbacher D, Nygård O, Laaksonen R. Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients. Eur Heart J 2021; 41:371-380. [PMID: 31209498 DOI: 10.1093/eurheartj/ehz387] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/13/2019] [Accepted: 05/20/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS Distinct ceramide lipids have been shown to predict the risk for cardiovascular disease (CVD) events, especially cardiovascular death. As phospholipids have also been linked with CVD risk, we investigated whether the combination of ceramides with phosphatidylcholines (PCs) would be synergistic in the prediction of CVD events in patients with atherosclerotic coronary heart disease in three independent cohort studies. METHODS AND RESULTS Ceramides and PCs were analysed using liquid chromatography-mass spectrometry (LC-MS) in three studies: WECAC (The Western Norway Coronary Angiography Cohort) (N = 3789), LIPID (Long-Term Intervention with Pravastatin in Ischaemic Disease) trial (N = 5991), and KAROLA (Langzeiterfolge der KARdiOLogischen Anschlussheilbehandlung) (N = 1023). A simple risk score, based on the ceramides and PCs showing the best prognostic features, was developed in the WECAC study and validated in the two other cohorts. This score was highly significant in predicting CVD mortality [multiadjusted hazard ratios (HRs; 95% confidence interval) per standard deviation were 1.44 (1.28-1.63) in WECAC, 1.47 (1.34-1.61) in the LIPID trial, and 1.69 (1.31-2.17) in KAROLA]. In addition, a combination of the risk score with high-sensitivity troponin T increased the HRs to 1.63 (1.44-1.85) and 2.04 (1.57-2.64) in WECAC and KAROLA cohorts, respectively. The C-statistics in WECAC for the risk score combined with sex and age was 0.76 for CVD death. The ceramide-phospholipid risk score showed comparable and synergistic predictive performance with previously published CVD risk models for secondary prevention. CONCLUSION A simple ceramide- and phospholipid-based risk score can efficiently predict residual CVD event risk in patients with coronary artery disease.
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Affiliation(s)
- Mika Hilvo
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | - Peter J Meikle
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC 3004, Australia.,Department of Diabetes, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
| | - Eva Ringdal Pedersen
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies veg 65, 5021 Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5020 Bergen, Norway
| | - Indu Dhar
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120 Heidelberg, Germany.,Network Ageing Research, University of Heidelberg, Bergheimer Straße 20, D-69115 Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120 Heidelberg, Germany.,Network Ageing Research, University of Heidelberg, Bergheimer Straße 20, D-69115 Heidelberg, Germany
| | - Mitja Lääperi
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | | | | | - Antti Jylhä
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | - Kevin Huynh
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC 3004, Australia
| | - Natalie A Mellett
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC 3004, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3004, Australia
| | - David R Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown NSW 2050, Sydney, Australia
| | - John Simes
- The NHMRC Clinical Trials Centre, University of Sydney, 92-94 Parramatta Rd, Camperdown NSW 2050, Sydney, Australia
| | - Paul Nestel
- Heart Centre, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC 3004, Australia
| | - Wolfgang Koenig
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Lazarettstr. 36, D-80636 Munich, Germany.,Institute of Epidemiology and Medical Biometry, Helmholtzstr. 22, D-89081 Ulm University, Ulm, Germany
| | - Dietrich Rothenbacher
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120 Heidelberg, Germany.,Institute of Epidemiology and Medical Biometry, Helmholtzstr. 22, D-89081 Ulm University, Ulm, Germany
| | - Ottar Nygård
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies veg 65, 5021 Bergen, Norway.,Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Reijo Laaksonen
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland.,Finnish Cardiovascular Research Center, University of Tampere, Arvo Ylpön katu 34, 33520 Tampere, Finland.,Finnish Clinical Biobank Tampere, Tampere University Hospital, Biokatu 12, 33520 Tampere, Finland
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47
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Zhou Z, Ofori-Asenso R, Curtis AJ, Breslin M, Wolfe R, McNeil JJ, Murray AM, Ernst ME, Reid CM, Lockery JE, Woods RL, Tonkin AM, Nelson MR. Association of Statin Use With Disability-Free Survival and Cardiovascular Disease Among Healthy Older Adults. J Am Coll Cardiol 2021; 76:17-27. [PMID: 32616158 DOI: 10.1016/j.jacc.2020.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is clinical uncertainty regarding the benefits and harms of prescribing statins in healthy subjects ≥70 years of age. OBJECTIVES The aim of this study was to examine the association among statins, dementia-free and disability-free survival, and cardiovascular disease (CVD) among healthy older adults using data from the ASPREE (Aspirin in Reducing Events in the Elderly) trial. METHODS ASPREE was a randomized trial of 19,114 community-dwelling persons in Australia and the United States ≥65 years of age and free of documented CVD, dementia, and disability. Data were collected for those ≥70 years of age, and participants who took statins at baseline were compared with those who did not using Cox proportional hazards regression with inverse probability weighting. The primary outcome, referred to as "disability-free survival," was a composite of all-cause mortality, dementia, or persistent physical disability. Other outcomes included the individual components of the composite outcome, major adverse cardiovascular events, fatal CVD, myocardial infarction, and stroke. RESULTS Of the 18,096 included participants (median age 74.2 years, 56.0% women), 5,629 took statins at baseline. Over a median follow-up period of 4.7 years, baseline statin use was not associated with disability-free survival or with the risk for all-cause mortality or dementia. However, it was associated with lower risks for physical disability and all cardiovascular outcomes. CONCLUSIONS Among healthy community-dwelling adults ≥70 years of age, statin use may be beneficial for preventing physical disability and CVD but not beneficial for prolonging disability-free survival or avoiding death or dementia. Future clinical trials are needed to confirm these findings.
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Affiliation(s)
- Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrea J Curtis
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine, Hennepin HealthCare, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Jessica E Lockery
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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48
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Ernst ME, Chowdhury EK, Beilin LJ, Margolis KL, Nelson MR, Wolfe R, Tonkin AM, Ryan J, Woods RL, McNeil JJ, Reid CM. Long-Term Blood Pressure Variability and Risk of Cardiovascular Disease Events Among Community-Dwelling Elderly. Hypertension 2020; 76:1945-1952. [PMID: 33131315 DOI: 10.1161/hypertensionaha.120.16209] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
High office blood pressure variability (OBPV) in midlife increases the risk of cardiovascular disease (CVD), but the impact of OBPV in older adults without previous CVD is unknown. We conducted a post hoc analysis of ASPREE trial (Aspirin in Reducing Events in the Elderly) participants aged 70-years and older (65 for US minorities) without history of CVD events at baseline, to examine risk of incident CVD associated with long-term, visit-to-visit OBPV. CVD was a prespecified, adjudicated secondary end point in ASPREE. We estimated OBPV using within-individual SD of mean systolic BP from baseline and first 2 annual visits. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% CI for associations with CVD events. In 16 475 participants who survived to year 2 without events, those in the highest tertile of OBPV had increased risk of CVD events after adjustment for multiple covariates, when compared with participants in the lowest tertile (HR, 1.36 [95% CI, 1.08-1.70]; P=0.01). Similar increased risk was observed for ischemic stroke (HR, 1.56 [95% CI, 1.04-2.33]; P=0.03), heart failure hospitalization, or death (HR, 1.73 [95% CI, 1.07-2.79]; P=0.02), and all-cause mortality (HR, 1.27 [95% CI, 1.04-1.54]; P=0.02). Findings were consistent when stratifying participants by use of antihypertensive drugs, while sensitivity analyses suggested the increased risk was especially for individuals whose BP was uncontrolled during the OBPV estimation period. Our findings support increased OBPV as a risk factor for CVD events in healthy older adults with, or without hypertension, who have not had such events previously. Registration- URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01038583; URL: https://www.isrctn.com; Unique identifiers: ISRCTN83772183.
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Affiliation(s)
- Michael E Ernst
- From the Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City (M.E.E.)
| | - Enayet K Chowdhury
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.).,School of Public Health, Curtin University, Perth, WA, Australia (E.K.C., C.M.R.)
| | - Lawrence J Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Australia (L.J.B.)
| | | | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmani, Hobart, Australia (M.R.N.)
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.).,School of Public Health, Curtin University, Perth, WA, Australia (E.K.C., C.M.R.)
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49
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Sharma M, Hart RG, Smith EE, Bosch J, Eikelboom JW, Connolly SJ, Dyal L, Reeh KW, Casanova A, Diaz R, Lopez-Jaramillo P, Ertl G, Störk S, Dagenais GR, Lonn EM, Ryden L, Tonkin AM, Varigos JD, Bhatt DL, Branch KR, Probstfield JL, Kim JH, O’Donnell M, Vinereanu D, A.A. Fox K, Liang Y, Liu L, Zhu J, Pogosova N, Maggioni AP, Avezum A, Piegas LS, Keltai K, Keltai M, Berkowitz SD, Yusuf S. Rivaroxaban for Prevention of Covert Brain Infarcts and Cognitive Decline. Stroke 2020; 51:2901-2909. [DOI: 10.1161/strokeaha.120.029762] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background and Purpose:
Covert brain infarcts are associated with cognitive decline. It is not known whether therapies that prevent symptomatic stroke prevent covert infarcts. COMPASS compared rivaroxaban with and without aspirin with aspirin for the prevention of stroke, myocardial infarction, and vascular death in participants with stable vascular disease and was terminated early because of benefits of rivaroxaban 2.5 mg twice daily plus aspirin over aspirin. We obtained serial magnetic resonance imagings and cognitive tests in a consenting subgroup of COMPASS patients to examine treatment effects on infarcts, cerebral microbleeds, and white matter hyperintensities.
Methods:
Baseline and follow-up magnetic resonance imagings were completed in 1445 participants with a mean (SD) interval of 2.0 (0.7) years. Whole-brain T1, T2 fluid-attenuated inversion recovery, T2* sequences were centrally interpreted by blinded, trained readers. Participants had serial measurements of cognition and function. The primary end point was the proportion of participants with incident covert infarcts. Secondary end points were the composite of clinical stroke and covert brain infarcts, cerebral microbleeds, and white matter hyperintensities.
Results:
At baseline, 493 (34.1%) participants had infarcts. Incident covert infarcts occurred in 55 (3.8%) participants. In the overall trial rivaroxaban plus aspirin reduced ischemic stroke by 49% (0.7% versus 1.4%; hazard ratio [95% CI], 0.51 [0.38–0.68]). In the magnetic resonance imaging substudy the effects of rivaroxaban+aspirin versus aspirin were: covert infarcts: 2.7% versus 3.5% (odds ratio [95% CI], 0.77 [0.37–1.60]); Covert infarcts or ischemic stroke: 2.9% versus 5.3% (odds ratio [95% CI], 0.53 [0.27–1.03]). Incident microbleeds occurred in 6.6% of participants and 65.7% of participants had an increase in white matter hyperintensities volume with no effect of treatment for either end point. There was no effect on cognitive tests.
Conclusions:
Covert infarcts were not significantly reduced by treatment with rivaroxaban and aspirin but estimates for the combination of ischemic stroke and covert infarcts were consistent with the effect on ischemic stroke in the overall trial.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01776424.
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Affiliation(s)
- Mukul Sharma
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Robert G. Hart
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Eric E. Smith
- Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.)
| | - Jacqueline Bosch
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada (J.B.)
| | - John W. Eikelboom
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Stuart J. Connolly
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Leanne Dyal
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Kevin W Reeh
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Amparo Casanova
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Rafael Diaz
- Estudios Clinicos Latino America and Instituto Cardiovascular de Rosario, Argentina (R.D.)
| | | | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg, Germany (G.E., S.S.)
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg, Germany (G.E., S.S.)
| | - Gilles R. Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Quebec, Quebec City, Canada (G.R.D.)
| | - Eva M. Lonn
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Lars Ryden
- Karolinska Institutet, Stockholm, Sweden (L.R.)
| | | | | | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard, Medical School, Boston, MA (D.L.B.)
| | - Kelley R.H. Branch
- University of Washington Medical Centre, Seattle (K.R.H.B.)
- University of Washington, Seattle (K.R.H.B., J.L.P.)
| | | | - Jae-Hyung Kim
- The Catholic University of Korea, Seoul, Korea (J.-H.K.)
| | | | - Dragos Vinereanu
- University of Medicine and Pharmacology Carol Davila University and Emergency Hospital, Bucharest, Romania (D.V.)
| | - Keith A.A. Fox
- Centre for Cardiovascular Science, University of Edinburgh, Scotland, United Kingdom (K.A.A.F.)
| | - Yan Liang
- FuWai Hospital, Beijing, China (Y.L., L.L., J.Z.)
| | - Lisheng Liu
- FuWai Hospital, Beijing, China (Y.L., L.L., J.Z.)
| | - Jun Zhu
- FuWai Hospital, Beijing, China (Y.L., L.L., J.Z.)
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia (N.P.)
| | | | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil (A.A.)
| | | | | | - Matyas Keltai
- Semmelweis University, Budapest, Hungary (K.K., M.K.)
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
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50
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Wolfe R, Wetmore JB, Woods RL, McNeil JJ, Gallagher H, Roderick P, Walker R, Nelson MR, Reid CM, Shah RC, Ernst ME, Lockery JE, Tonkin AM, Abhayaratna WP, Gibbs P, Wood EM, Mahady SE, Williamson JD, Donnan GA, Cloud GC, Murray AM, Polkinghorne KR. Subgroup analysis of the ASPirin in Reducing Events in the Elderly randomized clinical trial suggests aspirin did not improve outcomes in older adults with chronic kidney disease. Kidney Int 2020; 99:466-474. [PMID: 32920022 DOI: 10.1016/j.kint.2020.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/22/2020] [Accepted: 08/13/2020] [Indexed: 01/09/2023]
Abstract
The role of aspirin for primary prevention in older adults with chronic kidney disease (CKD) is unclear. Therefore, post hoc analysis of the randomized controlled trial ASPirin in Reducing Events in the Elderly (ASPREE) was undertaken comparing 100 mg of enteric-coated aspirin daily against matching placebo. Participants were community dwelling adults aged 70 years and older in Australia, 65 years and older in the United States, all free of a history of dementia or cardiovascular disease and of any disease expected to lead to death within five years. CKD was defined as present at baseline if either eGFR under 60mL/min/1.73m2 or urine albumin to creatinine ratio 3 mg/mmol or more. In 4758 participants with and 13004 without CKD, the rates of a composite endpoint (dementia, persistent physical disability or death), major adverse cardiovascular events and clinically significant bleeding in the CKD participants were almost double those without CKD. Aspirin's effects as estimated by hazard ratios were generally similar between CKD and non-CKD groups for dementia, persistent physical disability or death, major adverse cardiovascular events and clinically significant bleeding. Thus, in our analysis aspirin did not improve outcomes in older people while increasing the risk of bleeding, with mostly consistent effects in participants with and without CKD.
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Affiliation(s)
- Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - James B Wetmore
- Department of Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota, USA; Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hugh Gallagher
- Renal Services, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Paul Roderick
- School of Primary Care, Population Sciences and Medical Education, University of Southampton and Southampton General Hospital, Hampshire, UK
| | - Rowan Walker
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Jessica E Lockery
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Walter P Abhayaratna
- College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Erica M Wood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne E Mahady
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jeff D Williamson
- Sticht Center on Healthy Aging and Alzheimer's Prevention, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Geoffrey A Donnan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey C Cloud
- Department of Clinical Neurosciences, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Victoria, Australia
| | - Anne M Murray
- Department of Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota, USA
| | - Kevan R Polkinghorne
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.
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