All-cause Mortality In Older Women Research Articles

0726 Longitudinal Changes in 24-h Sleep-wake Patterns and All-cause Mortality in Older Women

0726 Longitudinal Changes in 24-h Sleep-wake Patterns and All-cause Mortality in Older Women

Longitudinal associations of housework with frailty and mortality in older adults: Singapore Longitudinal Ageing Study 2

BackgroundHousework may provide a sustainable form of physical activity for older adults and improve health and survival outcomes. Longitudinal studies on associations between housework status over time and health outcomes are lacking. We aim to assess the longitudinal association of intensity and duration of housework with frailty and mortality outcomes.MethodsAmong 3270 community-dwelling prospective cohort study participants, aged ≥55 years, data on light housework (N=2996) and heavy housework (N=3022) were available at baseline (March 6, 2009, to June 11, 2013) and follow-up at 3 to 5 years later, (January 16, 2013 to August 24, 2018). Median time spent per week on light (≥420min/week) and heavy (>0min/week) household activities at baseline and follow-up were used to categorise individuals into three groups (i) consistent low levels of housework at both baseline and follow-up, (ii) inconsistent high levels of housework at either baseline or follow-up and (iii) consistent high levels of housework at both baseline and follow-up. Baseline and follow-up frailty index >0.10, and all-cause, cancer and cardiovascular mortality from mean 9.5 years follow-up to March 31, 2021. Effect estimates were adjusted for socio-demographics, nutritional risk, lifestyle and other physical activities.ResultsOverall, participants had mean [SD] age, 66.9 [7.8] years; 1916 [62.7%] were female. Participation in high levels of light and heavy housework consistently over time was associated with decreased odds of prefrailty/frailty at follow-up, [OR,0.61;95%CI,0.40–0.94] and [OR,0.56;95%CI,0.34–0.90] respectively, in the older group aged ≥65, compared to participants with consistent low levels of housework at baseline and follow-up. Sex-stratified analysis revealed an association between regular heavy housework participation and lower prevalence of prefrailty/frailty at follow-up in older men but not women [OR,0.31;95%CI,0.13–0.72]. Regular participation in high levels of light housework was associated with 41% lower risk of all-cause mortality [95%CI,0.36–0.96] in women but not in men, and 54% lower risk of cardiovascular mortality [95%CI,0.22–0.96].ConclusionsRegular participation in above average levels of light housework is associated with decreased odds of prefrailty/frailty in older adults aged ≥65 years, and all-cause mortality in older women. Heavy housework participation is associated with decreased odds of prefrailty/frailty, especially in older men aged ≥65. Housework may be a meaningful occupation for older adults and should be encouraged for health and wellbeing.

Low Diastolic Blood Pressure and Mortality in Older Women. Results From the Women's Health Initiative Long Life Study.

Recommended systolic blood pressure targets often do not consider the relationship of low diastolic blood pressure (DBP) levels with cardiovascular disease (CVD) and all-cause mortality risk, which is especially relevant for older people with concurrent comorbidities. We examined the relationship of DBP levels to CVD and all-cause mortality in older women in the Women's Health Initiative Long Life Study (WHI-LLS). The study sample included 7,875 women (mean age: 79 years) who underwent a blood pressure measurement at an in-person home visit conducted in 2012-2013. CVD and all-cause mortality were centrally adjudicated. Hazard ratios (HRs) were obtained from adjusted Cox proportional hazards models. After 5 years follow-up, all-cause mortality occurred in 18.4% of women. Compared with a DBP of 80 mm Hg, the fully adjusted HR for mortality was 1.33 (95% confidence interval [CI]: 1.04-1.71) for a DBP of 50 mm Hg and 1.67 (95% CI: 1.29-2.16) for a DBP of 100 mm Hg. The HRs for CVD were 1.14 (95% CI: 0.78-1.67) for a DBP of 50 mm Hg and HR 1.50 (95% CI: 1.03-2.17) for a DBP of 100 mm Hg. The nadir DBP associated with lowest mortality risk was 72 mm Hg overall. In older women, consideration should be given to the potential adverse effects of low and high DBP. Low DBP may serve as a risk marker. DBP target levels between 68 and 75 mm Hg may avoid higher mortality risk.

Associations between frailty and cancer-specific mortality among older women with breast cancer.

Frailty is assessed when making treatment decisions among older women with breast cancer (BC), which in turn impacts survival. We evaluated associations between pre-diagnosis frailty and risks of BC-specific and all-cause mortality in older women. We conducted a retrospective cohort study of Medicare beneficiaries ages ≥ 65years with stage I-III BC using the Surveillance, Epidemiology and End Results-Medicare Health Outcome Survey Data Resource. Frailty was measured using the deficit-accumulation frailty index, categorized as robust, pre-frail, or frail, at baseline and during follow-up. Fine and Gray competing risk and Cox proportional hazards models were used to estimate subdistribution hazard ratios (SHR) and hazard ratios (HR) with 95% confidence intervals (CI) for BC-specific and all-cause mortality, respectively. Among 2411 women with a median age of 75years at BC diagnosis, 49.5% were categorized as robust, 29.4% were pre-frail and 21.1% were frail. Fewer frail women compared to robust women received breast-conserving surgery (52.8% vs. 61.5%, frail vs. robust, respectively) and radiation (43.5% vs. 51.8%). In multivariable analyses, degree of frailty was not associated with BC-specific mortality (frail vs robust SHR 1.47, 95% CI 0.97-2.24). However, frail women with BC had higher risks of all-cause mortality compared to robust women with BC (HR 2.32, 95% CI 1.84-2.92). Among a cohort of older women with BC, higher degrees of frailty were associated with higher risk of all-cause mortality, but not BC-specific mortality. Future study should examine if preventing progression of frailty may improve all-cause mortality.

Abstract PS7-13: Associations between frailty and cancer-specific mortality among older women with breast cancer

Abstract PURPOSE Frailty is assessed when making treatment decisions among older women with breast cancer (BC), which in turn impacts survival. We evaluated associations between frailty and risks of BC-specific and all-cause mortality in older women. METHODS We conducted a retrospective cohort study of Medicare beneficiaries ages ≥65 years with stage I-III BC using the Surveillance, Epidemiology and End Results Medicare Health Outcome Survey Data Resource. Frailty was measured using the deficit-accumulation frailty index, categorized as robust, pre-frail or frail, at baseline and during follow-up. Fine and Gray competing risk and Cox proportional hazards models were used to estimate sub-distribution hazard ratios (SHR) and hazard ratios (HR) with 95% confidence intervals (CI) for BC-specific and all-cause mortality, respectively. RESULTS Among 2,411 women with a median age of 75 years at BC diagnosis, 50% were categorized as robust, 29% were pre-frail and 21% were frail. Compared to robust women, fewer frail women received breast-conserving surgery (52% vs. 63%) and radiation (44% vs. 52%). In multivariable analyses, frail women had higher risks of all-cause mortality compared to robust women (HR 2.16, 95% CI 1.80-2.60). CONCLUSION Frail women in our study had a higher cumulative hazard of BC-specific death, but this observed higher risk was not significant after accounting for differences in treatment and competing risks of other-cause death. Measuring frailty may help determine overall life expectancy but not BC-specific death. Table. Risk of Breast Cancer-Specific and All-cause Mortality, using time-varying DAFI measureEventsCrude SHRRobust 95%CIP-valueMinimally Adjusted SHRaRobust 95%CIP-valueFully Adjusted SHRbRobust 95%CIP-valueBreast Cancer-Specific MortalityDAFI CategoriesRobust891.001.001.00Pre-frail691.250.91 – 1.700.161.150.84 – 1.590.381.060.77 – 1.480.72Frail621.531.11 – 2.110.011.371.00 – 1.900.051.190.85 – 1.660.31All-Cause MortalityDAFI CategoriesRobust2721.001.001.00Pre-frail2241.551.30 – 1.84<0.00011.411.19 – 1.68<0.00011.371.15 – 1.63<0.0001Frail2362.32.12 – 3.02<0.00012.331.96 – 2.78<0.00012.161.80 – 2.60<0.0001DAFI = deficit-accumulation frailty index; HR = hazard ratio; SHR = subdistribution hazard ratios; CI = confidence intervalsa adjusted for age categories and breast cancer staging b adjusted for age categories, breast cancer staging, surgery type, radiation, Estrogen/Progestin Receptor, race/ethnicity, marital status, and education Citation Format: Connie H Yan, Chandler Coleman, Nadia A Nabulsi, Brian Chiu, Naomi Y Ko, Kent Hoskins, Gregory S Calip. Associations between frailty and cancer-specific mortality among older women with breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-13.

Gender differences in the impact of metabolic syndrome components on mortality in older people: A systematic review and meta-analysis

Background and aimsThe influence of metabolic syndrome (MetS) on mortality may be influenced by age- and gender-related changes affecting the impact of individual MetS components. We investigated gender differences in the association between MetS components and mortality in community-dwelling older adults. Methods and resultsProspective studies were identified through a systematic literature review up to June 2019. Random-effect meta-analyses were run to estimate the pooled relative risk (RR) and 95% confidence intervals (95% CI) of all-cause and cardiovascular (CV) mortality associated with the presence of MetS components (abdominal obesity, high triglycerides, low HDL cholesterol, high fasting glycemia, and high blood pressure) in older men and women. Meta-analyses considering all-cause (103,859 individuals, 48,830 men, 55,029 women; 10 studies) and CV mortality (94,965 individuals, 44,699 men, 50,266 women; 8 studies) did not reveal any significant association for abdominal obesity and high triglycerides in either gender. Low HDL was associated with increased all-cause (RR = 1.16, 95% CI: 1.02–1.32) and CV mortality (RR = 1.34, 95% CI: 1.03–1.74) among women, while weaker results were found for men. High fasting glycemia was associated with higher all-cause mortality in older women (RR = 1.35, 95% CI: 1.22–1.50) more than in older men (RR = 1.21, 95% CI: 1.13–1.30), and CV mortality only in the former (RR = 1.36, 95% CI: 1.04–1.78). Elevated blood pressure was associated with increased all-cause mortality (RR = 1.16, 95% CI: 1.03–1.32) and showed marginal significant results for CV death only among women. ConclusionsThe impact of MetS components on mortality in older people present some gender differences, with low HDL cholesterol, hyperglycemia, and elevated blood pressure being more strongly associated to all-cause and CV mortality in women.

Association of Step Volume and Intensity With All-Cause Mortality in Older Women

A goal of 10 000 steps/d is commonly believed by the public to be necessary for health, but this number has limited scientific basis. Additionally, it is unknown whether greater stepping intensity is associated with health benefits, independent of steps taken per day. To examine associations of number of steps per day and stepping intensity with all-cause mortality. This prospective cohort study included 18 289 US women from the Women's Health Study who agreed to participate by wearing an accelerometer during waking hours for 7 days between 2011 and 2015. A total of 17 708 women wore and returned their devices; data were downloaded successfully from 17 466 devices. Of these women, 16 741 were compliant wearers (≥10 h/d of wear on ≥4 days) and included in the analyses, which took place between 2018 and 2019. Steps per day and several measures of stepping intensity (ie, peak 1-minute cadence; peak 30-minute cadence; maximum 5-minute cadence; time spent at a stepping rate of ≥40 steps/min, reflecting purposeful steps). All-cause mortality. Of the 16 741 women who met inclusion criteria, the mean (SD) age was 72.0 (5.7) years. Mean step count was 5499 per day, with 51.4%, 45.5%, and 3.1% of time spent at 0, 1 to 39 (incidental steps), and 40 steps/min or greater (purposeful steps), respectively. During a mean follow-up of 4.3 years, 504 women died. Median steps per day across low-to-high quartiles of distribution were 2718, 4363, 5905, and 8442, respectively. The corresponding quartile hazard ratios (HRs) associated with mortality and adjusted for potential confounders were 1.00 (reference), 0.59 (95% CI, 0.47-0.75), 0.54 (95% CI, 0.41-0.72), and 0.42 (95% CI, 0.30-0.60), respectively (P < .01). In spline analysis, HRs were observed to decline progressively with higher mean steps per day until approximately 7500 steps/d, after which they leveled. For measures of stepping intensity, higher intensities were associated with significantly lower mortality rates; however, after adjusting for steps per day, all associations were attenuated, and most were no longer significant (highest vs lowest quartile for peak 1-minute cadence, HR = 0.87 [95% CI, 0.68-1.11]; peak 30-minute cadence, HR = 0.86 [95% CI, 0.65-1.13]; maximum 5-minute cadence, HR = 0.80 [95% CI, 0.62-1.05]; and time spent at a stepping rate of ≥40 steps/min, HR = 1.27 [95% CI, 0.96-1.68]; P > .05). Among older women, as few as approximately 4400 steps/d was significantly related to lower mortality rates compared with approximately 2700 steps/d. With more steps per day, mortality rates progressively decreased before leveling at approximately 7500 steps/d. Stepping intensity was not clearly related to lower mortality rates after accounting for total steps per day.

Mortality in older adults with frequent alcohol consumption and use of drugs with addiction potential - The Nord Trøndelag Health Study 2006-2008 (HUNT3), Norway, a population-based study.

BackgroundThe aim of this study was to investigate whether frequent drinking, use of drugs with addiction potential and the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older adults.MethodsWe used data from the Nord-Trøndelag Health Study (HUNT3 2006–08), a population-based study in Norway. A total of 11,545 (6,084 women) individuals 65 years and older at baseline participated. We assessed frequent drinking (≥ 4 days a week), occasional drinking (i.e. a few times a year), never drinking and non-drinking in the last year. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009. This information was drawn from the Norwegian Prescription Database. The main outcome was all-cause mortality with information drawn from the Norwegian Cause of Death Registry. Follow-up continued until death or latest at 31 December 2013. Logistic regression analyses were used to investigate all-cause mortality since date of study entry and exact age at time of death was unknown.ResultsThe adjusted logistic regression analyses showed that frequent drinking was not associated with all-cause mortality compared to occasional drinking. Men who reported to be never drinkers and non-drinkers in the last year had higher odds of mortality compared to those who drank occasionally. Use of prescribed drugs with addiction potential was associated with increased mortality in men, but not in women. No association was found between the possible combination of frequent drinking and use of prescribed drugs with addiction potential and mortality.ConclusionNeither frequent drinking nor the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older women and men. Use of prescribed drugs with addiction potential was associated with higher odds of mortality in men. This finding should lead to more caution in prescribing drugs with addiction potential to this group.

Associations between superoxide dismutase, malondialdehyde and all-cause mortality in older adults: a community-based cohort study

BackgroundOxidative stress is an important theory of aging but population-based evidence has been lacking. This study aimed to evaluate the associations between biomarkers of oxidative stress, including plasma superoxide dismutase (SOD) activity and malondialdehyde (MDA), with all-cause mortality in older adults.MethodsThis is a community-based cohort study of 2224 participants (women:1227, median age: 86 years). We included individuals aged 65 or above and with plasma SOD activity and/or MDA tests at baseline. We evaluated the hazard ratios (HRs) and 95% confidence intervals (CIs) by multivariable Cox models.ResultsWe documented 858 deaths during six years of follow-up. There was a significant interaction effect of sex with the association between SOD activity and mortality (P < 0.001). Compared with the lowest quintile, the risk of all-cause mortality was inversely associated with increasing quintiles of plasma SOD activity in women(P-trend< 0.001), with adjusted HRs for the second through fifth quintiles of 0.73 (95% CI 0.53–1.02), 0.52(95% CI 0.38–0.72), 0.53(95% CI 0.39–0.73), and 0.48(95% CI 0.35–0.66). There were no significant associations between SOD activity and mortality in men (P-trend = 0.64), and between MDA and mortality in all participants (P-trend = 0.79).ConclusionsIncreased activity of SOD was independently associated with lower all-cause mortality in older women but not in men. This epidemiological study lent support for the free radical/oxidative stress theory of aging.

Increased longevity in older users of postmenopausal estrogen therapy: the Leisure World Cohort Study.

To examine the effect of postmenopausal estrogen therapy (ET), including duration and recency of use, on all-cause mortality in older women. As part of a prospective cohort study of residents of a California retirement community begun in the early 1980s, Leisure World Cohort women (median age, 73 y) completed a postal health survey including details on ET use and were followed up for 22 years (1981-2003). Age- and multivariate-adjusted risk ratios (RR) and 95% CIs were calculated using proportional hazard regression. Of the 8,801 women, 6,626 died during follow-up (median age, 88 y). ET users had an age-adjusted mortality rate of 52.9 per 1,000 person-years compared with 56.5 among lifetime nonusers (RR = 0.91; 95% CI, 0.87-0.96). Risk of death decreased with both increasing duration of ET and decreasing years since last use (P for trend < 0.001). The risk was lowest among long-term (≥15 y) users (RR = 0.83; 95% CI, 0.74-0.93 for 15-19 y and RR = 0.87; 95% CI, 0.80-0.94 for 201 y). For long-term users, the age-adjusted mortality rate was 50.4 per 1,000 person-years. Lower-dose users (≤0.625 mg) had a slightly better survival rate than higher-dose users (RR = 0.84; 95% CI, 0.78-0.91 vs RR = 0.91; 95% CI, 0.83-0.97). Risk did not differ by route of administration (P = 0.56). Further adjustment for potential confounders had little effect on the observed RRs for ET. Long-term ET is associated with lower all-cause mortality in older women.

Associations between Superoxide Dismutase, Malondialdehyde and All-Cause Mortality in Older Adults: A Community-Based Cohort Study

Background: In vitro and in vivo studies have suggested that some biomarkers of oxidative stress, such as superoxide dismutase(SOD), may protect against oxidative damage. This study aimed to evaluate the associations between biomarkers of oxidative stress, including plasma SOD activity and malondialdehyde(MDA), with all-cause mortality in older adults. Methods: This is a community-based cohort study of 2,224 participants(women:1227, median age: 86 years). We included individuals aged 65 or above and with plasma SOD activity and/or MDA tests at baseline. We evaluated the hazard ratios(HRs) and 95% confidence intervals(CIs) by multivariable Cox models Findings: We documented 858 deaths during six years of follow-up. There was a significant interaction effect of sex with the association between SOD activity and mortality(P<0.001). Compared with the lowest quintile, the risk of all-cause mortality was inversely associated with increasing quintiles of plasma SOD activity in women(P-trend<0.001), with adjusted HRs for the second through fifth quintiles of 0.73 (95% CI 0.53-1.02), 0.52(95% CI 0.38-0.72), 0.53(95% CI 0.39 -0.73), and 0.48(95% CI 0.35-0.66). There were no significant associations between SOD activity and mortality in men (P-trend=0.64), and between MDA and mortality in all participants (P-trend=0.79). Interpretation: Increased activity of SOD was independently associated with a lower all-cause mortality in older women but not in men. This epidemiological study lent support for the free radical/oxidative stress theory of aging. Funding: National Natural Sciences Foundation of China, the U.S. National Institute of Aging/United Nations Fund for Population Activities, and Claude D. Pepper Older Americans Independence Centers grant. Declaration of Interest: The authors declare that they have no conflict of interest. Ethical Approval: The study was approved by the Ethics Committee of Peking University and Duke University. Informed consent was obtained from all individual participants included in the study.

Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503).

Tools to estimate survival, such as ePrognosis ( http://eprognosis.ucsf.edu/carey2.php ), were developed for general, not cancer, populations. In older patients with breast cancer, accurate overall survival estimates would facilitate discussions about adjuvant therapies. Secondary analyses were performed of data from two parallel breast cancer studies (CALGB/Alliance 49907/NCT000224102 and CALGB/Alliance 369901/NCT00068328). We included patients (n=971) who were age 70years and older with complete baseline quality of life data (194 from 49907; 777 from 369901). Estimated versus observed all-cause two-year mortality rates were compared. ePrognosis score was calculated based on age, sex, and daily function (derived from EORTC QLQ-C30). ePrognosis scores range from 0 to 10, with higher scores indicating worse prognosis based on mortality of community-dwelling elders and were categorized into three groups (0-2, 3-6, 7-10). Observed mortality rates were estimated using Kaplan-Meier methods. Patient mean age was 75.8years (range 70-91) and 73% had stage I-IIA disease. Most patients were classified by ePrognosis as good prognosis (n=562, 58% 0-2) and few (n=18, 2% 7-10) poor prognosis. Two-year observed mortality rates were significantly lower than ePrognosis estimates for patients scoring 0-2 (2% vs 5%, p=0.001) and 3-6 (8% vs 12%, p=0.01). The same trend was seen with scores of 7-10 (23% vs 36%, p=0.25). ePrognosis tool only modestly overestimates mortality rate in older breast cancer patients enrolled in two cooperative group studies. This tool, which estimates non-cancer mortality risk based on readily available clinical information may inform adjuvant therapy decisions but should be validated in non-clinical trial populations.

Abstract P297: Intensity-specific Physical Activity Measured by Accelerometry and Mortality in Women: The OPACH Study

Background: Associations for cardiovascular disease (CVD) and all-cause mortality with intensity-specific physical activity (PA) exposures assessed by questionnaire may be underestimated by exposure measurement error, especially in older adults. We examined accelerometer measured PA and CVD and all-cause mortality in 6,374 race-ethnically diverse women (White, 49.4%, Black 33.7%, Hispanic 16.9%) ages 63-91 (mean 78.7 years) followed a mean of 2.5 years as part of the Objective Physical Activity and Cardiovascular Health (OPACH) Study. Methods: Vector magnitude counts/15-sec epoch from hip worn Actigraph GT3X+ triaxial accelerometers (required ≥4 of 7 days with ≥10 hr/day wear time) were used to define time spent in low light (LLPA; 19-225 counts/15-sec), high light (HLPA; 226-518), and moderate-to-vigorous (MVPA; ≥519) PA based on cutpoints determined from a calibration study among similarly aged women. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for these associations. Results: There were 270 (4.2%) all-cause deaths and 78 (1.2%) CVD deaths during 14,205 person-years of follow-up. Adjusting for awake-time accelerometer wear-time, age, and race, HRs (CI) for CVD mortality associated with a 30-min/day increment in PA were 0.82 (0.71,0.96) for LLPA; 0.48 (0.38,0.61) for HLPA; and 0.53 (0.38, 0.74) for MVPA; and for all-cause mortality were 0.86 (0.79, 0.93), 0.61 (0.54, 0.69), and 0.57 (0.48, 0.67) respectively. These associations were similar following additional adjustments for smoking, age at menopause, and number of prevalent comorbidities (CVD HRs = 0.83, 0.49, 0.54, respectively, P≤0.01 all; all-cause HRs = 0.86, 0.62, 0.58, respectively, P&lt;0.001 all). Similar results were observed after discarding the first 6 months of follow-up (CVD HRs = 0.84, 0.49, 0.50; all-cause HRs = 0.87, 0.63, 0.59). In a final model mutually adjusting for total light PA (LLPA and HLPA combined) and MVPA, each 30-min increment in light PA and MVPA was associated with HRs for CVD mortality of 0.84 (0.75, 0.93) and 0.67 (0.47, 0.96) respectively; and with all-cause mortality of 0.90 (0.85, 0.95) and 0.66 (0.55, 0.80), respectively. Conclusions: Higher levels of both light intensity PA and MVPA measured by accelerometry are associated with lower CVD and all-cause mortality in older women. Because light intensity PA accounts for the majority of daily PA energy expenditure in older women’s lives, these results could have important public health implications and should be confirmed.

Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503)

Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503)

Urinary Co, Mn and Sr concentrations, cardiovascular disease and all-cause mortality in older Australian Women

Introduction Exposure to metals, specifically cadmium and lead, has been associated with increased risk of cardiovascular disease (CVD) and overall mortality, however, there has been limited investigation of other metals and few studies have focused specifically on women. Methods This study investigated the association between metals exposure, CVD outcomes and all-cause mortality in elderly Australian women. Urinary metal concentrations were measured at baseline in 1359 women, mean age 75.2 ± 2.7 years and 14.5 years of atherosclerotic vascular disease (ASVD) events and deaths were retrieved from the Western Australian Data Linkage System. Urinary metals concentrations were measured using ICPMS and ln-transformed and Cox regression models were adjusted for demographic and CVD risk factors including age, BMI, hypertension, prevalent ASVD, kidney function, low dose aspirin use, smoking history (yes/no) and pack years smoked. Results Concentrations of urinary metals were low: median (IQR) Co 0.07 (0.04-0.13); Mn 0.39 (0.23-0.70); Sr 20.0 (11.7-33.7) µg/L. In multivariable-adjusted analyses, a ln unit (equivalent to 2.7 fold) increase in urinary Co or Mn concentrations was associated with a 32% increase in the Hazard ratio (HR) for death from heart failure (Co HR=1.325, 95% CI 1.09-1.61; Mn HR=1.32, 95% CI 1.07-1.63), a ln-unit increase in Sr was associated with a 70% increase in HR for heart failure death (HR=1.70, 95% CI 1.31-2.22). Increased urinary metals concentrations were also associated with increased HR for ASVD deaths (Co HR=1.19, 95% CI 1.07-1.32; Mn HR=1.13, 95% CI 1.01-1.27; Sr HR=1.26, 95% CI 1.09-1.45) and all-cause mortality (Co HR=1.14, 95% CI 1.06-1.24; Mn HR=1.10, 95% CI 1.01-1.20; Sr HR=1.14, 95% CI 1.03-1.26). Conclusions Despite the low urinary metals concentrations, increased Co, Mn and Sr were associated with increased CVD and all-cause mortality in older women. The relationship between urinary metals concentrations and CVD warrants further research.

Potassium intake and risk of stroke in women with hypertension and nonhypertension in the Women's Health Initiative.

Dietary potassium has been associated with lower risk of stroke, but there are little data on dietary potassium effects on different stroke subtypes or in older women with hypertension and nonhypertension. The study population consisted of 90 137 postmenopausal women aged 50 to 79 at enrollment, free of stroke history at baseline, followed up prospectively for an average of 11 years. Outcome variables were total, ischemic, and hemorrhagic stroke, and all-cause mortality. Incidence was compared across quartiles of dietary potassium intake, and hazard ratios were obtained from Cox proportional hazards models after adjusting for potential confounding variables, and in women with hypertension and nonhypertension separately. Mean dietary potassium intake was 2611 mg/d. Highest quartile of potassium intake was associated with lower incidence of ischemic and hemorrhagic stroke and total mortality. Multivariate analyses comparing highest to lowest quartile of potassium intake indicated a hazard ratio of 0.90 (95% confidence interval, 0.85-0.95) for all-cause mortality, 0.88 (95% confidence interval, 0.79-0.98) for all stroke, and 0.84 (95% confidence interval, 0.74-0.96) for ischemic stroke. The effect on ischemic stroke was more apparent in women with nonhypertension among whom there was a 27% lower risk with hazard ratio of 0.73 (95% confidence interval, 0.60-0.88), interaction P<0.10. There was no association with hemorrhagic stroke. High potassium intake is associated with a lower risk of all stroke and ischemic stroke, as well as all-cause mortality in older women, particularly those who are not hypertensive.

Sitting-time and 9-year all-cause mortality in older women

BackgroundStudies of mid-aged adults provide evidence of a relationship between sitting-time and all-cause mortality, but evidence in older adults is limited. The aim is to examine the relationship between total...

Metabolic syndrome and all‐cause mortality in older men and women

Prevalence of metabolic syndrome (MetS) increases with age, but its association with all-cause mortality in older persons remains uncertain. This study investigated the association of all-cause mortality with MetS and its individual components in older men and women. A total of 917 men and 1043 women aged 65 years and older from two Italian population-based cohorts were included in the study. MetS was defined according to four different definitions: National Cholesterol Education Program (NCEP), NCEP revised according to the American Heart Association and National Heart Lung Blood Institute (NCEP-R), International Diabetes Organization (IDF) and Joint Interim Statement (JIS). All of these definitions include abdominal obesity, hyperglycaemia, hypertriglyceridaemia, low high-density lipoprotein cholesterol and hypertension. Hazard Ratios (HR) and their corresponding 95% confidence interval (95%CI) estimated from multivariable-adjusted Cox regression models were used to investigate the associations of all-cause mortality with baseline MetS status and individual MetS components. After 6·5 ± 1·8 years of follow-up, there were 179 deaths among women and 193 among men. Mortality risk was increased in women with MetS by any definition, regardless of individual components, but limited to age 70-79 years (NCEP, HR = 2·02, 95%CI, 1·16-3·53; NCEP-R, HR = 2·51, 95%CI, 1·45-4·34; IDF, HR = 2·16, 95%CI, 1·26-3·72; JIS, HR = 2·16, 95%CI, 1·26-3·72). Mortality risk of men was associated with hypertriglyceridaemia below age 70 years (HR = 2·50, 95%CI, 1·19-5·25), but unrelated to MetS status. Metabolic Syndrome is associated with all-cause mortality in older women but not in men. The association, however, is limited to a narrow age range.

Fruit and vegetable intake, physical activity, and mortality in older community-dwelling women.

To examine the relationship between fruit and vegetable intake, physical activity, and all-cause mortality in older women. Six Cox proportional hazards models examined independent and additive relationships between physical activity, carotenoids, and all-cause mortality. Additional models tested whether physical activity and carotenoids were conjointly related to mortality. Models were adjusted for age, education, and race and ethnicity. Baltimore, Maryland. Seven hundred thirteen women aged 70 to 79 participating in the Women's Health and Aging Studies. Total serum carotenoids, a marker of fruit and vegetable intake, and physical activity were measured at baseline. Physical activity was measured according to kilocalorie expenditure. During 5 years of follow-up, 82 (11.5%) participants died. Measured continuously, physical activity improved survival (HR = 0.52, 95% CI = 0.41-0.66, P < .001). The most active women were more likely to survive than the least physically active women (HR = 0.28, 95% CI = 0.13-0.59, P < .001). Continuous measures of carotenoids improved survival (HR = 0.67, 95% CI = 0.51-0.89, P = .01). Women in the highest tertile of total carotenoids were more likely to survive those in the lowest (HR = 0.50, 95% CI = 0.27-0.91, P = .03). When examined in the same model, continuous measures of physical activity (HR = 0.54, 95% CI = 0.42-0.68, P < .001) and carotenoids (HR = 0.76, 95% CI = 0.59-0.98, P = .04) predicted survival during follow-up. The combination of low total serum carotenoids and low physical activity, both modifiable risk factors, strongly predicted earlier mortality. These findings provide preliminary support that higher fruit and vegetable intake and exercise improve survival.

Physical activity and all-cause mortality in older women and men

BackgroundRegular physical activity is associated with reduced risk of mortality in middle-aged adults; however, associations between physical activity and mortality in older people have been less well studied. The objective...