Biracial Cohort Of Older Adults Research Articles

Cardiovascular health and the risk of Alzheimer’s dementia in a biracial population‐based study

AbstractBackgroundThe cardiovascular health (CVH) index, created by the American Heart Association (AHA) to assess and monitor the risk of cardiovascular disease, has been related to dementia risk. However, evidence is limited, and most studies originate from populations comprised of primarily white participants. We examined the association of the CVH index with the risk of incident Alzheimer’s dementia in a biracial population‐based study.MethodOur study consisted of 1,702 non‐Hispanic Black and white participants of the Chicago Health and Aging Project, a population‐based cohort. CVH was based on seven risk factors: diet, physical activity, body mass index, smoking, dyslipidemia, hypertension, and diabetes. Following AHA recommendations, we assigned points of 0, 1, or 2 based on adherence to each factor, with an overall score ranging from 0 to 14 – a higher score indicates better cardiovascular health. Clinical diagnosis of Alzheimer’s dementia was based on the NINCDS‐ADRDA criteria. Cox proportional hazard models were used to compute the hazard ratio and 95% confidence interval. Models were adjusted for age, sex, race, education, ApoE4 allele, cognitive activities, and cardiovascular disease.ResultThe average baseline age of the study population was 73 years and comprised 62% women and 53% black participants. During 14,226 person‐years of follow‐up, there were 351 incident Alzheimer’s dementia. In a multivariable‐adjusted model, CVH was linearly associated with a lower risk of incident Alzheimer’s dementia. For each additional CVH score, the HR was lower by 0.84 (95% CI 0.76 ‐ 0.94). Compared to individuals with inadequate CVH (score: 0‐6), the HRs (95% CIs) of incident Alzheimer’s dementia in participants with average (7‐9) and optimal CVH (10‐14) was 0.44 (95%CI 0.28 ‐ 0.69) and 0.37 (95%CI 0.21 ‐ 0.65), respectively. We found similar associations between CVH score, per one additional score, and risk of Alzheimer’s dementia in Black (HR 0.84, 95%CI 0.74 ‐ 0.95) and white (HR 0.83, 95%CI 0.7 ‐ 0.98) individuals.ConclusionIn a biracial cohort of older adults, the cardiovascular health burden was higher among Black individuals. However, promoting a better CVH in the general population may help lower dementia risk in Black and white older adults.

Association of Whole Grain Consumption and Cognitive Decline: An Investigation From a Community-Based Biracial Cohort of Older Adults.

To examine the association of whole grain consumption and longitudinal change in global cognition, perceptual speed, and episodic memory by different race/ethnicity. We included 3,326 participants from the Chicago Health and Aging Project who responded to a Food Frequency Questionnaire (FFQ), with 2 or more cognitive assessments. Global cognition was assessed using a composite score of episodic memory, perceptual speed, and the Mini Mental State Examination (MMSE). Diet was assessed by a 144-item FFQ. Linear mixed-effects models were used to estimate the association of intakes of whole grains and cognitive decline. This study involved 3,326 participants (60.1% African American [AA], 63.7% female) with a mean age of 75 years at baseline and a mean follow-up of 6.1 years. Higher consumption of whole grains was associated with a slower rate of global cognitive decline. Among AA participants, those in the highest quintile of whole grain consumption had a slower rate of decline in global cognition (β = 0.024, 95% CI [0.008-0.039], p = 0.004), perceptual speed (β = 0.023, 95% CI [0.007-0.040], p = 0.005), and episodic memory (β = 0.028, 95% CI [0.005-0.050], p = 0.01) compared with those on the lowest quintile. Regarding the amount consumed, in AA participants, those who consumed >3 servings/d vs those who consumed <1 serving/d had a slower rate of decline in global cognition (β = 0.021, 95% CI [0.005-0.036], p = 0.0093). In White participants, with >3 servings/d, we found a suggestive association of whole grains with global cognitive decline when compared with those who consumed <1 serving/d (β = 0.025, 95% CI [-0.003 to 0.053], p = 0.08). Among AA participants, individuals with higher consumption of whole grains and more frequent consumption of whole grain had slower decline in global cognition, perceptual speed, and episodic memory. We did not see a similar trend in White adults.

Association of Performance on Olfactory and Cognitive Screening Tests With Conversion to Dementia in a Biracial Cohort of Older Adults.

Odor identification deficits are associated with transition to dementia, whereas intact odor identification and global cognition test performance may identify lack of transition. The purpose of this study was to examine intact odor identification and global cognition as prognostic indicators of lack of transition to dementia in a biracial (Black and White) cohort. In a community-dwelling sample of older adults from the Health, Aging, and Body Composition study, odor identification was measured using the Brief Smell Identification Test (BSIT), and global cognition was measured using the Teng Modified Mini-Mental State Examination (3MS). Survival analyses for dementia transition over 4 and 8 years of follow-up used Cox proportional hazards models. A total of 2,240 participants had an average age of 75.5 years (SD 2.8). Approximately 52.7% were female individuals. Approximately 36.7% were Black and 63.3% were White individuals. Impaired odor identification (hazard ratio [HR] 2.29, 95% CI 1.79-2.94, p < 0.001) and global cognition (HR 3.31, 95% CI 2.26-4.84, p < 0.001) were each independently associated with transition to dementia (n = 281). Odor identification remained robustly associated with transition to dementia for Black (HR 2.02, 95% CI 1.36-3.00, p < 0.001, n = 821) and White participants (HR 2.45, 95% CI 1.77-3.38, p < 0.001, n = 1,419), whereas global cognition was associated with transition among Black participants only (HR 5.06, 95% CI 3.18-8.07, p < 0.001). ApoE genotype was consistently associated with transition among White participants only (HR 1.75, 95% CI 1.20-2.54, p < 0.01). Among participants with intact performance on both odor identification (BSIT ≥9/12 correct) and global cognition (3MS ≥ 78/100 correct), 8.8% transitioned to dementia over 8 years. Intact performance on both measures had high positive predictive value for identifying individuals who did not transition to dementia over 4 years (0.98 for ages 70-75 years with only 2.3% transitioning, 0.94 for ages 76-82 years with only 5.8% transitioning). Odor identification testing paired with a global cognitive screening test identified individuals at low risk of transition to dementia in a biracial community cohort with a pronounced effect in the eighth decade of life. Identification of such individuals can reduce the need for extensive investigation to establish a diagnosis. Odor identification deficits showed utility in both Black and White participants, unlike the race-dependent utility of a global cognitive test and ApoE genotype.

Associations Between Circulating Levels of Myostatin and Plasma β-Amyloid 42/40 in a Biracial Cohort of Older Adults.

Myostatin, a cytokine produced by skeletal muscle, may influence Alzheimer's disease (AD) pathogenesis, but sparse evidence exists in humans. We assessed the association between circulating levels of myostatin at Year 1 and plasma levels of β-amyloid 42/40 at Year 2, a marker of AD pathology, in a biracial cohort of older adults. We studied 403 community-dwelling older adults enrolled in the Health, Aging and Body Composition Study from Memphis, Tennessee, and Pittsburgh, PA. Mean age was 73.8 ± 3 years; 54% were female; and 52% were Black. Serum myostatin levels were measured at Year 1, plasma β-amyloid 42/40 levels in Year 2 (higher ratio indicating lower amyloid load). Multivariable linear regression analyses tested the association of serum myostatin with plasma levels of β-amyloid 42/40 adjusted for computed-tomography-derived thigh muscle cross-sectional area, demographics, APOe4 allele, and risk factors for dementia. We tested for 2-way.interactions between myostatin and race or sex; results were stratified by race and sex. In multivariable models, myostatin was positively associated with plasma levels of β-amyloid 42/40 (standardized regression coefficient: 0.145, p = .004). Results were significant for white men and women (0.279, p = .009, and 0.221, p = .035, respectively) but not for Black men or women; interactions by race and gender were not statistically significant. Higher serum myostatin was associated with lower amyloid burden, independently of APOe4 alleles, muscle area and other established risk factors for dementia. The role of myostatin in AD pathogenesis and the influence of race should be further investigated.

Cardiac Structure and Function and Diabetes-Related Risk of Death or Heart Failure in Older Adults.

BackgroundWhether cardiac structure and function abnormalities associated with dysglycemia are sufficient to explain the increased risk of death or heart failure (HF) remains unclear.Methods and ResultsWe analyzed 6059 participants (mean age, 75±5 years; 58% women; and 22% Black individuals) who attended the ARIC (Atherosclerosis Risk in Communities) study visit 5 examination (2011–2013). Participants were categorized as no diabetes, pre‐diabetes, and diabetes (on the basis of medical history and glycated hemoglobin values). We assessed whether diabetes modified the association between echocardiographic measures of cardiac structure and function and the composite of all‐cause death or HF hospitalization and then estimated the extent to which the increased risk of the composite outcome associated with diabetes was explained by cardiac structure and function. Diabetes was prevalent in 33.5% of the subjects. Death or HF occurred in 1111 (18%) at a rate of 3.6 per 100 person‐years. Both measures of cardiac structure and function and diabetes status were significantly associated with worse prognosis after accounting for clinical confounders. While diabetes was consistently associated with a higher risk of events, it did not significantly modify the association between cardiac abnormalities and the risk of death or HF, except for subjects with higher left atrial volume who showed higher relative risk of events (P for interaction <0.001). Measures of cardiac structure and function accounted for ≈16% of the increased risk of death or HF associated with diabetes. Similar results were observed analyzing subjects without prevalent heart disease.ConclusionsIn a biracial cohort of older adults, the increased risk of events associated with diabetes was partially explained by cardiac structure and function abnormalities.

Abstract 15085: Association Between Bone Mineral Density and Incident Heart Failure in a Biracial Cohort of Older Adults: The Health, Aging, and Body Composition Study

Background: Osteoporosis and heart failure (HF) are age-related disorders that share some pathogenetic features and may influence each other. Previous studies have suggested an association between bone mineral density (BMD) and HF risk, which may be race-dependent. We sought to further investigate race- and sex-specific associations of BMD with HF in a longitudinal study of older adults. Methods: We evaluated the relationship between BMD and HF in the Health, Aging, and Body Composition study, a sample of community-dwelling adults aged 70-79. BMD was measured by dual-energy X-ray absorptiometry (DXA) of the total hip and femoral neck, and in half the cohort by computed tomography of the spine. Analyses were stratified a priori by sex and race, and Cox models were used to estimate risk after adjustment for potential confounders. Results: Of 2835 participants, 572 (49% women, 42% black) developed HF during a median follow up of 12.2 years. Lower BMD of the total hip by DXA was associated with higher risk of HF in black women (adj. HR 1.84 [95% CI, 1.43 - 2.37] per SD decrement), with suggestion of lower risk in black men that was not significant (adj. HR 0.81 [0.64 - 1.02]). Corresponding analyses failed to reveal significant associations in white women (adj. HR 0.86 [0.71-1.04]) or white men (adj. HR 1.10 [0.93 - 1.30]). There were a significant interaction of total hip BMD by sex among blacks (p=0.002), but not whites (p=0.363), as well as by race among women (p=0.026) and men (p=0.049). Relationships of BMD of the femoral neck were similar in all groups. Likewise, lower volumetric BMD of the spine was associated with higher risk in black women (adj. HR 1.34 [1.02 - 1.77] per SD decrement), but there were no significant associations in black men (adj. HR 0.91 [0.78 - 1.18]), white women (adj. HR 0.83 [0.64 - 1.08]), or white men (adj. HR 1.17 [0.95 - 1.44]). Conclusions: Among a biracial cohort of older adults, lower BMD was associated with higher risk of HF in black women, with no clear evidence of an association in white women or in men of either race. Further research is needed to understand the factors that may account for the particular association in black women, and whether these can be leveraged for therapeutic intervention.

Thyroid dysfunction and incident heart failure phenotypes among older adults: the atherosclerosis risk in communities (aric) study

Abstract Background/Introduction Abnormal thyroid hormone concentrations have been associated with adverse cardiovascular outcomes, but the relationship between thyroid dysfunction and specific heart failure phenotypes is less clear. Purpose To examine the association of thyroid dysfunction with the risk of incident HF in older adults without pre-existing HF. Methods We analyzed participants enrolled in the Atherosclerosis Risk in Communities (ARIC) study who attended the visit 5 examination (2011–2013). Participants with previous HF history, and participants treated with amiodarone, levothyroxine, and antithyroid medication were excluded. We used Cox regression models to assess the associations between serum thyroid indices (free thyroxine [FT4], total triiodothyronine [TT3], or thyroid stimulating hormone [TSH]) and incident adjudicated HF with reduced (HFrEF) and preserved (HFpEF) left ventricular ejection fraction. Continuous associations between TT3 and outcome were further assessed via Cox model using restricted cubic spline. Results Among 3349 participants (mean age 75±5 years, 56% women, 20% black), subclinical hypothyroidism was prevalent in 12% of participants and low T3 syndrome in 3%. Those with overt hypothyroidism (&amp;lt;1%) or hyperthyroidism (&amp;lt;1%) were not included in the analysis given the low prevalence. Over a median follow-up of 5.5 years, incident HF occurred in 198 subjects (5.9%) at a rate of 11.1 per 1000 person-years. Of these, 86 were HFrEF, 83 HFpEF, and 29 were unclassified HF. We observed an inverse association of TT3 level with risk of incident HFpEF, but not overall incident HF or incident HFrEF, after adjustment for clinical confounders and baseline NT-proBNP levels (HR per 1 SD 0.70, 95% CI 0.54–0.92; P 0.010) (Figure). Similar results were observed for the composite endpoint of incident HFpEF or all-cause death. No statistically significant associations were found between TSH or T4 levels and incident HF. Low T3 syndrome was associated with incident HFpEF, but not overall incident HF or incident HFrEF, after adjustment for clinical confounders (HR 2.71, 95% CI 1.08–6.82; P 0.035); however, its association was significantly attenuated after adjustment with NT-proBNP (HR 2.25, 95% CI 0.87–5.79; P 0.09). No statistically significant association was found between subclinical hypothyroidism and incident HF. Conclusions In a contemporary biracial cohort of older adults, serum T3 level was inversely associated with incident HFpEF hospitalization. T3 administration could be considered as a potential target in future clinical trials preventing HFpEF hospitalization. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The Atherosclerosis Risk in Communities Study is performed as a collaborative study supported by National Heart, Lung, and Blood Institute contracts

Catechol-O-Methyltransferase Genotype, Frailty, and Gait Speed in a Biracial Cohort of Older Adults.

To examine whether the association between dopamine-related genotype and gait speed differs according to frailty status or race. Cross-sectional population-based study (Cardiovascular Health Study). Multicenter study, four U.S. sites. Volunteer community-dwelling adults aged 65 years and older, without evidence of Parkinson's disease (N = 3,744; 71 years; 82% White; 39% male). Gait speed (usual pace; m/s), physical frailty (Fried definition), and genetic polymorphism of catechol-O-methyltransferase (COMT; rs4680), an enzyme regulating tonic brain dopamine levels, were assessed. Interaction of COMT by frailty and by race predicting gait speed were tested, and, if significant, analyses were stratified. Multivariable regression models of COMT predicting gait speed were adjusted for demographics and locomotor risk factors. Sensitivity analyses were repeated, stratified by clinical cutoffs of gait speed (0.6 and 1.0 m/s) instead of frailty status. The interaction of COMT by frailty and COMT by race were P = .02 and P = .01, respectively. Compared with Met/Met (higher dopaminergic signaling), the Val/Val group (lower dopaminergic signaling) walked marginally more slowly in the full cohort (0.87 vs 0.89 m/s; P = .2). Gait speed differences were significant for frail (n = 220; 0.55 vs 0.63 m/s; P = .03), but not for prefrail (n = 1,691; 0.81 vs 0.81 m/s; P = .9) or nonfrail (n = 1,833; 0.98 vs 0.97 m/s; P = .7); results were similar in fully adjusted models. Among frail, associations were similar for Whites and Blacks, with statistical significance for Whites only. Associations stratified by clinical cutoffs of gait speed were not significant. The association of dopamine-related genotype with gait speed is stronger among adults with frailty compared with those without frailty. The potential effects of dopaminergic signaling on preserving physical function in biracial cohorts of frail adults should be further examined.

Development and validation of a novel measure of resilience in older adults: a longitudinal cohort study

BackgroundThe concept of resilience has gained increasing attention in ageing research; however, published literature lacks consensus on how to measure resilience. We developed a novel resilience measure based on the degree of mismatch between a person's frailty level and disease burden and examined its ability in predicting adverse outcomes. MethodsWe included white and black older adults (≥70 years) from the Health, Aging, and Body Composition Study. Eligibility criteria were (1) free of life-threatening illness, (2) self-reported ability to walk a quarter of a mile, to climb 10 steps without resting, and to perform basic activities of daily living without assistance, and (3) no intention to move out of the current geographic area for at least 3 years. We constructed the resilience measure as the residual taken from the linear model regressing frailty on age, sex, race or ethnicity, and 14 diseases. We classified participants into three groups—adapters, expected agers, and premature frailers—on the basis of residuals (less than, within, or above 1 SD of the mean). Validation outcomes included years of healthy and able life (YHAL), disability, hospitalisation, and survival. We also examined the association between this new resilience measure and survival after incident cardiovascular events (coronary heart disease, myocardial infarction, and stroke). Findings2457 adults were included in the analysis. The average YHAL was 4·65 for premature frailers, 7·70 for expected agers, and 9·63 years for adapters. Compared with premature frailers and expected agers, adapters had significantly lower disability (p<0·0001), hospitalisation (p<0·0001), and mortality (p<0·0001) and a higher proportion surviving to 90 years (p<0·0001). Among the 371 adults who had incident cardiovascular events, the multivariable-adjusted model showed that each 1-unit increase in the resilience level corresponded with a 10·4% decrease in hazard of death (p=0·0021). We observed similar results when we examined each of the three cardiovascular events separately: hazard ratios were 0·86 for coronary heart disease, 0·92 for myocardial infarction, and 0·90 for stroke. InterpretationWe developed and validated a novel approach for quantifying and classifying physical resilience in a biracial cohort of older adults. People with high physical resilience had a longer healthy life span, lower adverse outcomes, and higher ability of recovering from acute cardiovascular events. FundingNone.

The PPARG Pro12Ala Polymorphism and 20-year Cognitive Decline: Race and Sex Heterogeneity.

Previous reports suggest race/ethnic and sex heterogeneity in the association between the Pro12Ala polymorphism of the peroxisome proliferator-activated receptor gamma (PPARG) gene and cognitive decline. Tests of verbal memory, processing speed, and verbal fluency and a composite global Z-score were used to assess cognitive performance longitudinally in a large (n=11,620) biracial cohort of older adults in the Atherosclerosis Risk in Communities Neurocognitive Study from midlife to older age. Linear mixed models were used to estimate associations between the Ala12 allele and cognitive performance over 20 years of follow-up. Heterogeneity was present for rate of cognitive decline as measured by the global Z-score by race, sex, and Ala12 allele status (P=0.01 for 4-way interaction term: race×sex×time×Ala12 carrier status). Stratified analysis showed a significantly increased rate of global cognitive decline over the 20-year follow-up for carriers of the Ala12 allele compared with noncarriers among black male individuals (-0.92 SD decline vs. -0.57 SD; P=0.02) but not among black female, white male, or white female individuals. Decline in global cognitive function among black male Ala12 carriers was primarily driven by decline in verbal memory. Our data underscore the context-dependent association between the Pro12Ala polymorphism and cognitive decline, specifically race/ethnic background and sex.

Editors' note: Olfaction and risk of dementia in a biracial cohort of older adults

In “Olfaction and risk of dementia in a biracial cohort of older adults,” the authors found an association between worsened olfaction and dementia. Drs. Fuller-Thomson and Jopling suggest the link is cumulative lifetime lead exposure, associated with both deterioration in olfaction and cognitive decline. Older adults, particularly, were exposed to years of airborne lead pollution through leaded gasoline, which was finally phased out in 1991. Authors Freimer and Yaffe agree that continued research into the role of environmental toxins may lead to insights that could help prevent or delay the onset of dementia. In “Olfaction and risk of dementia in a biracial cohort of older adults,” the authors found an association between worsened olfaction and dementia. Drs. Fuller-Thomson and Jopling suggest the link is cumulative lifetime lead exposure, associated with both deterioration in olfaction and cognitive decline.

Editors' note: Standard operating procedures improve acute neurologic care in a sub-Saharan African setting

In “Standard operating procedures improve acute neurologic care in a sub-Saharan African setting,” the authors showed that implementing standard operating procedures (SOPs) in resource-limited countries is possible and potentially valuable. Dr. Chin points out that while SOP utilization increased in the first 2 years, it was under experimental conditions, which likely artificially increased adherence. He also highlights that clinical outcomes did not change significantly but may improve with the addition of postemergency management SOPs as well. Authors Fassbender et al. agree that health care in sub-Saharan Africa is subject to many formidable limitations, including financial, structural, and personnel constraints, but note that the implementation of SOPs is a positive act that can be accomplished quickly and with available resources. They agree that expanding SOPs into postemergency management and prevention may be the next step. In “Olfaction and risk of dementia in a biracial cohort of older adults,” the authors found an association between worsened olfaction and dementia. Drs. Fuller-Thomson and Jopling suggest the link is cumulative lifetime lead exposure, associated with both deterioration in olfaction and cognitive decline.

Reader response: Olfaction and risk of dementia in a biracial cohort of older adults.

We read with great interest the article by Yaffe et al.1 in which a strong association between poorer olfaction and incident dementia was reported. Exposure to airborne lead pollution decades earlier may play a role in this association. In older adults, higher cumulative lifetime exposure to lead, a well-established neurotoxin, was associated with impaired memory and accelerated declines in cognition,2–4 as well as smaller total brain volume, smaller volume of frontal and total gray matter, and more prevalent and serious white matter lesions.4 In primate studies, early life exposure to lead was associated with a greater burden of both β-amyloid plaques and neurofibrillary tangles in later life.2,3 Among older humans, the primary exposure pathway for lead was through inhalation of airborne lead pollution from leaded gasoline; mean blood lead levels declined 78% between 1976 and 1991 with the phase out of leaded gasoline.2 Cumulative lifetime lead exposure is associated with markedly worse olfactory function, and there is a negative dose–response relationship between exposure to vehicle exhaust and olfaction.5 A recent review suggested, “Inhaled Pb is likely able to directly reach olfactory tissues and translocate to the brain, given its strong deleterious neurocognitive effects.”5

Author response: Olfaction and risk of dementia in a biracial cohort of older adults.

We thank Drs. Fuller-Thompson and Jopling for the thoughtful contribution to the discourse of our article.1 While we were unable to assess the potential role of lead in the observed association between poorer olfaction and incident dementia, we agree that such environmental toxins may be important in considering possible mechanistic pathways linking olfaction and dementia. The mechanisms underlying pollution-associated olfactory dysfunction are an important area of future research, particularly to answer the question of whether exposure to environmental toxins—along with other dementia risk factors such as cardiovascular disease and APOE ε4 status—could help identify individuals who would benefit most from early interventions to prevent or delay the onset of dementia.

Associations of obesity and body fat distribution with incident atrial fibrillation in the biracial health aging and body composition cohort of older adults

Obesity is a well-recognized risk factor for atrial fibrillation (AF), yet adiposity measures other than body mass index (BMI) have had limited assessment in relation to AF risk. We examined the associations of adiposity measures with AF in a biracial cohort of older adults. Given established racial differences in obesity and AF, we assessed for differences by black and white race in relating adiposity and AF. We analyzed data from 2,717 participants of the Health, Aging, and Body Composition Study. Adiposity measures were BMI, abdominal circumference, subcutaneous and visceral fat area, and total and percent fat mass. We determined the associations between the adiposity measures and 10-year incidence of AF using Cox proportional hazards models and assessed for their racial differences in these estimates. In multivariable-adjusted models, 1-SD increases in BMI, abdominal circumference, and total fat mass were associated with a 13% to 16% increased AF risk (hazard ratio [HR] 1.14, 95% CI 1.02-1.28; HR 1.16, 95% CI 1.04-1.28; and HR 1.13, 95% CI 1.002-1.27). Subcutaneous and visceral fat areas were not significantly associated with incident AF. We did not identify racial differences in the associations between the adiposity measures and AF. Body mass index, abdominal circumference, and total fat mass are associated with risk of AF for 10years among white and black older adults. Obesity is one of a limited number of modifiable risk factors for AF; future studies are essential to evaluate how obesity reduction can modify the incidence of AF.

Association Between Hypoglycemia and Dementia in a Biracial Cohort of Older Adults With Diabetes Mellitus

Hypoglycemia commonly occurs in patients with diabetes mellitus (DM) and may negatively influence cognitive performance. Cognitive impairment in turn can compromise DM management and lead to hypoglycemia. To prospectively evaluate the association between hypoglycemia and dementia in a biracial cohort of older adults with DM. Prospective population-based study. We studied 783 older adults with DM (mean age, 74.0 years; 47.0% of black race/ethnicity; and 47.6% female) who were participating in the prospective population-based Health, Aging, and Body Composition Study beginning in 1997 and who had baseline Modified Mini-Mental State Examination scores of 80 or higher. Dementia diagnosis was determined during the follow-up period from hospital records indicating an admission associated with dementia or the use of prescribed dementia medications. Hypoglycemic events were determined during the follow-up period by hospital records. During the 12-year follow-up period, 61 participants (7.8%) had a reported hypoglycemic event, and 148 (18.9%) developed dementia. Those who experienced a hypoglycemic event had a 2-fold increased risk for developing dementia compared with those who did not have a hypoglycemic event (34.4% vs 17.6%, P < .001; multivariate-adjusted hazard ratio, 2.1; 95% CI, 1.0-4.4). Similarly, older adults with DM who developed dementia had a greater risk for having a subsequent hypoglycemic event compared with participants who did not develop dementia (14.2% vs 6.3%, P < .001; multivariate-adjusted hazard ratio, 3.1; 95% CI, 1.5-6.6). Further adjustment for stroke, hypertension, myocardial infarction, and cognitive change scores produced similar results. Among older adults with DM, there seems to be a bidirectional association between hypoglycemia and dementia.

Electrocardiographic PR Interval and Adverse Outcomes in Older Adults

Background— The electrocardiographic PR interval increases with aging, differs by race, and is associated with atrial fibrillation (AF), pacemaker implantation, and all-cause mortality. We sought to determine the associations between PR interval and heart failure, AF, and mortality in a biracial cohort of older adults. Methods and Results— The Health, Aging, and Body Composition (Health ABC) Study is a prospective, biracial cohort. We used multivariable Cox proportional hazards models to examine PR interval (hazard ratios expressed per SD increase) and 10-year risks of heart failure, AF, and all-cause mortality. Multivariable models included demographic, anthropometric, and clinical variables in addition to established cardiovascular risk factors. We examined 2722 Health ABC participants (aged 74±3 years, 51.9% women, and 41% black). We did not identify significant effect modification by race for the outcomes studied. After multivariable adjustment, every SD increase (29 ms) in PR interval was associated with a 13% greater 10-year risk of heart failure (95% confidence interval, 1.02–1.25) and a 13% increased risk of incident AF (95% confidence interval, 1.04–1.23). PR interval &gt;200 ms was associated with a 46% increased risk of incident heart failure (95% confidence interval, 1.11–1.93). PR interval was not associated with increased all-cause mortality. Conclusions— We identified significant relationships of PR interval to heart failure and AF in older adults. Our findings extend prior investigations by examining PR interval and associations with adverse outcomes in a biracial cohort of older men and women.

Aortic Pulse Wave Velocity Predicts Focal White Matter Hyperintensities in a Biracial Cohort of Older Adults

Although the cross-sectional relationship of arterial stiffness with cerebral small vessel disease is consistently shown in middle-aged and young-old adults, it is less clear whether these associations remain significant over time in very old adults. We hypothesize that arterial stiffness is longitudinally associated with white matter characteristics, and associations are stronger within watershed areas. Neuroimaging was obtained in 2006-2008 from 303 elderly (mean age 82.9 years, 59% women, 41% black) with pulse wave velocity (PWV) measures in 1997-1998. Multivariable regression models estimated the coefficients for PWV (cm/sec) in relationship to presence, severity, and spatial distribution of white matter hyperintensities (WMH), gray matter volume, and fractional anisotropy from diffusion tensor, adjusting for demographic, cardiovascular risk factors, and diseases from 1997-1998 to 2006-2008. Higher PWV in 1997-1998 was associated with greater WMH volume in 2006-2008 within the left superior longitudinal fasciculus (age and total brain WMH adjusted, P=0.023), but not with WMH in other tracts or with fractional anisotropy or gray matter volume from total brain (P>0.2). Associations were stronger in blacks than in whites, remaining significant in fully adjusted models. Elderly with WMH in tracts related to processing speed and memory are more likely to have had higher PWV values 10 years prior, before neuroimaging data being available. Future studies should address whether arterial stiffness can serve as an early biomarker of covert brain structural abnormalities and whether early arterial stiffness control can promote successful brain aging, especially in black elderly.

Race, Psychosocial Factors, and Aortic Pulse Wave Velocity: The Health, Aging, and Body Composition Study

Increasingly, researchers have begun to explore pathways through which psychosocial factors might influence cardiovascular disease, with some emphasis on early markers. The current study examined the cross-sectional association between psychosocial factors and aortic pulse wave velocity (an early marker of cardiovascular disease) in a biracial cohort of older adults. We were particularly interested in determining whether the association between psychosocial factors and aortic pulse wave velocity differed for older blacks compared with whites. Participants were 2,488 (40% black and 52% female) older adults from the Health, Aging, and Body Composition Study. Carotid-femoral aortic pulse wave velocity was assessed using standard methodologies. Depressive symptoms, anxiety symptoms, negative life events, and inadequate emotional support were assessed, and a summary psychosocial risk index was created. In multivariable linear regression models, psychosocial risk was not associated with aortic pulse wave velocity (Estimate [Est] = .00, p = .83), but there was a significant Race × Psychosocial risk interaction (Est = .07, p = .01), after adjusting for age, race, sex, and education. Further analyses revealed that this association was driven by the inadequate emotional support component of psychosocial risk (Race × Inadequate emotional support, p = .005). In race-stratified analyses, inadequate emotional support was associated with higher levels of arterial stiffness in older blacks (Est = .05, p = .04) but not whites (Est = -.04, p = .13). This association persisted after adjusting for demographics, cardiovascular risk factors, and social network characteristics. Findings suggest that older blacks may be particularly vulnerable to the effects of inadequate emotional support on vascular health. Interventions aimed at increasing social support among this population might be beneficial in reducing cardiovascular disease risk.

P-170: Aromatase gene haplotypes are associated with cognitive function in a biracial cohort of older adults: The health ABC study

P-170: Aromatase gene haplotypes are associated with cognitive function in a biracial cohort of older adults: The health ABC study