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Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years.
Friday,2016-04-01 10:27 America/Los_Angeles — zdrager
| Title | Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years. |
| Publication Type | Journal Article |
| Year of Publication | 2016 |
| Authors | Kuller, LH, Lopez, OL, Mackey, RH, Rosano, C, Edmundowicz, D, Becker, JT, Newman, AB |
| Journal | J Am Coll Cardiol |
| Volume | 67 |
| Issue | 9 |
| Pagination | 1013-22 |
| Date Published | 2016 Mar 8 |
| ISSN | 1558-3597 |
| Keywords | Age Factors, Aged, 80 and over, Cause of Death, Coronary Artery Disease, Dementia, Female, Humans, Incidence, Male, Pennsylvania, Retrospective Studies, Risk Factors, Survival Rate |
| Abstract | <p><b>BACKGROUND: </b>The successful prevention and treatment of coronary heart disease (CHD) and stroke has resulted in a substantial increase in longevity, with subsequent growth in the population of older people at risk for dementia.</p><p><b>OBJECTIVES: </b>The authors evaluated the relationship of coronary and other peripheral atherosclerosis to risk of death, dementia, and CHD in the very elderly. Because the extent of vascular disease differs substantially between men and women, sex- and race-specific analyses were included, with a specific focus on women with low coronary artery calcium (CAC) Agatston scores.</p><p><b>METHODS: </b>We evaluated the relationship between measures of subclinical cardiovascular disease (CAC, carotid intimal medial thickness, stenosis, and ankle brachial index) and risk of dementia, CHD, and total mortality in 532 participants of the Cardiovascular Health Study-Cognition Study from 1998/1999 (mean age, 80 years) to 2012/2013 (mean age, 93 years).</p><p><b>RESULTS: </b>Thirty-six percent of participants had CAC scores >400. Women and African-Americans had lower CAC scores. Few men had low CAC scores. CAC score and number of coronary calcifications were directly related to age-adjusted total mortality and CHD. The age-specific incidence of dementia was higher than for CHD. Only about 25% of deaths were caused by CHD and 16% by dementia. Approximately 64% of those who died had a prior diagnosis of dementia. White women with low CAC scores had a significantly decreased incidence of dementia.</p><p><b>CONCLUSIONS: </b>In subjects 80+ years of age, there is a greater incidence of dementia than of CHD. CAC, as a marker of atherosclerosis, is a determinant of mortality, and risk of CHD and myocardial infarction. White women with low CAC scores had a significantly decreased risk of dementia. A very important unanswered question, especially in the very elderly, is whether prevention of atherosclerosis and its complications is associated with less Alzheimer disease pathology and dementia. (Cardiovascular Health Study [CHS]; NCT00005133).</p> |
| DOI | 10.1016/j.jacc.2015.12.034 |
| Alternate Journal | J. Am. Coll. Cardiol. |
| PubMed ID | 26940919 |
| Grant List | AG05133 / AG / NIA NIH HHS / United States AG15928 / AG / NIA NIH HHS / United States AG20098 / AG / NIA NIH HHS / United States HHSN268200800007C / / PHS HHS / United States HHSN268201200036C / / PHS HHS / United States N01HC55222 / HC / NHLBI NIH HHS / United States N01HC85079 / HC / NHLBI NIH HHS / United States N01HC85080 / HC / NHLBI NIH HHS / United States N01HC85081 / HC / NHLBI NIH HHS / United States N01HC85082 / HC / NHLBI NIH HHS / United States N01HC85083 / HC / NHLBI NIH HHS / United States N01HC85086 / HC / NHLBI NIH HHS / United States R01AG023629 / AG / NIA NIH HHS / United States U01HL080295 / HL / NHLBI NIH HHS / United States |