Cardiovascular Outcomes In Elderly Patients Research Articles

Wearable equipment-based telemedical management via multiparameter monitoring on cardiovascular outcomes in elderly patients with chronic coronary heart disease: an open-labelled, randomised, controlled trial

BackgroundThe prevalence of chronic coronary heart diseases (CHDs) increases with age in the elderly, which represents one of the top-ranked causes of death and disease burden.MethodsThis study aimed to investigate...

The impact of patient-reported frailty on cardiovascular outcomes in elderly patients after non-ST-acute coronary syndrome

BackgroundAs life expectancy increases, the population of older individuals with coronary artery disease and frailty is growing. We aimed to assess the impact of patient-reported frailty on the treatment and prognosis of elderly early survivors of non-ST-elevation acute coronary syndrome (NSTE-ACS). MethodsFrailty data were obtained from two prospective trials, POPular Age and the POPular Age Registry, which both assessed elderly NSTE-ACS patients. Frailty was assessed one month after admission with the Groningen Frailty Indicator (GFI) and was defined as a GFI-score of 4 or higher. In these early survivors of NSTE-ACS, we assessed differences in treatment and 1-year outcomes between frail and non-frail patients, considering major adverse cardiovascular events (MACE, including cardiovascular mortality, myocardial infarction, and stroke) and major bleeding. ResultsThe total study population consisted of 2192 NSTE-ACS patients, aged ≥70 years. The GFI-score was available in 1320 patients (79 ± 5 years, 37% women), of whom 712 (54%) were considered frail. Frail patients were at higher risk for MACE than non-frail patients (9.7% vs. 5.1%, adjusted hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.01–2.43, p = 0.04), but not for major bleeding (3.7% vs. 2.8%, adjusted HR 1.23, 95% CI 0.65–2.32, p = 0.53). Cubic spline analysis showed a gradual increase of the risk for clinical outcomes with higher GFI-scores. ConclusionsIn elderly NSTE-ACS patients who survived 1-month follow-up, patient-reported frailty was independently associated with a higher risk for 1-year MACE, but not with major bleeding. These findings emphasize the importance of frailty screening for risk stratification in elderly NSTE-ACS patients.

Impact of patient-reported frailty on cardiovascular outcomes in elderly patients with non-ST-elevation myocardial infarction

Abstract Background Due to the increasing life expectancy, more older people will be affected by coronary artery disease (CAD). The evaluation of frailty and comorbidity is crucial when elderly patients with non–ST-segment elevation myocardial infarction (NSTEMI) are treated, as frailty can increase the risk of adverse clinical outcomes. Purpose The aim of this registry was to assess the predictive value of patient-reported frailty on the treatment and prognosis of elderly non-ST-elevation myocardial infarction (NSTEMI) patients. Methods A post-hoc analysis was performed in patients included in the POPular Age trial and POPular Age egistry, which both enrolled elderly patients with NSTEMI. Frailty was assessed within one month after admission using the Groningen Frailty Indicator (GFI), which is a widely-used questionnaire that includes both physical, cognitive, social and psychological domains. Missing data was imputed by predictive mean matching when at least one item for the questionnaire was registered. Patients with a GFI score of 4 or higher were defined as frail. We evaluated the impact of frailty on both major adverse cardiovascular events (MACE, consisting of cardiovascular mortality, myocardial infarction and stroke) and major or clinically-relevant non-major bleeding (BARC 2, 3 or 5) at one year. Outcomes were then evaluated by stratifying the population in invasively managed patients, who underwent coronary angiography (CAG), versus conservatively-managed patients. Results The total included population consisted of 2229 patients ≥70 years presenting with NSTEMI. The GFI score was available in 1320 patients (mean age 79 years, 51% women), of whom 712 were considered frail (54%, mean GFI score 4.3 ± 2.8). In total, 1027 patients (78%) were invasively-managed. Frail patients were at higher risk for MACE than non-frail patients (9.7% vs. 5.1%, adjusted hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.05-2.51), but not for major or clinically-relevant non-major bleeding (12.5% vs. 14.5%, HR 0.93, 95% CI 0.69-1.28). In frail patients, invasive management was strongly associated with a lower incidence of MACE (6.7% vs. 17.0%, adjusted HR 0.40, 95% CI: 0.24-0.66, p < 0.001). Yet, in non-frail patients, invasive management was not associated with a lower risk for MACE (4.8% vs. 6.9%, adjusted HR 0.81, 95% CI: 0.32-2.06, p = 0.66). This difference in outcomes could not be primarily explained by frailty status (p-value for interaction = 0.19). Conclusions Patient-reported frailty was independently associated with higher risk for MACE but not for major or clinically relevant nonmajor bleeding in elderly patients presenting with NSTEMI. The results may consolidate the importance of frailty screening in risk stratification in elderly patients presenting with NSTEMI.Figure 1.KM MACE in frail vs. nonfrailFigure 2.Forest plot inv vs. consv

Nationwide Trends in Hospitalizations with Heart Failure Preserved Ejection Fraction and Subsequent Cardiovascular Outcomes in Elderly Patients with Leukemia [2016-2019]

Background: Leukemia and the therapeutic treatments for leukemia are both associated with cardiovascular side effects. Heart failure is one of the most identified side effects related to cancer or cancer-related therapies. Evidence suggests a higher risk of HFrEF (heart failure with reduced ejection fraction) and its consequences, there is limited data on the trends of HFpEF admissions in Leukemia patients. In this study, we are using a nationally representative population to study the trends in HFpEF-related admissions and outcomes in elderly Leukemia patients. Methods: A retrospective analysis was conducted using the National Inpatient Sample from the 2016-2019 dataset. Elderly patients older than 65 years with leukemia were selected and the trends of HFpEF were studied over these 4 years. In this study, we used both univariable and multivariable regression analysis to adjust the odds ratio and compared and followed the trends over 4 years. Co-primary outcomes were major adverse cardiac and cerebrovascular events [MACCE - all-cause mortality, acute myocardial infarction (AMI), acute ischemic stroke (AIS), and cardiac arrest] in HFpEF patients among the leukemia cohort. Results: There was a significantly higher prevalence and increasing trends of HFpEF admissions in cohort with leukemia vs non-leukemia between 2016 to 2019 (from 11.6% to 14.4% in leukemia vs. from 10.3% to 13.0%, p trend <0.001). A total of 66,345 admissions with HFpEF in leukemia patients were studied over a period of 4 years, with a median age of 81 [Table 1]. The majority of the patients studied were whites (87%), Medicare patients (93.6%), and urban teaching locations (66.5%). The baseline characteristics trends were matched in all the cohorts and significant comorbidities observed over a period of 2016-2019 were hypertension (75.8% and 70.2%), diabetes (35.8% and 38.7%), hyperlipidemia (46% and 52.1%), prior MI (9.5% and 9.9%), prior PCI (8.3% and 9.7%), prior CABG (10.8% and 9.5%%), alcohol use (0.9% and 1.4%), drug use (0.3% and 0.9%), chronic pulmonary disease (35.5% and 37.9%), obesity (14.5% and 18.1%), prior chemotherapy (4.4.% and 5.1%), prior radiotherapy (1.9% and 2.7%), and CKD (44.6% and 47.8%). On following the trends from 2016 to 2019 we established that Leukemia patients with HFpEF had no significant improvement in in-hospital outcomes of MACCE including all-cause mortality, myocardial Ischemia, acute ischemic stroke, and cardiac arrest between 2016 and 2019 when potential confounders were adjusted. The univariate and multivariable-adjusted odds ratios for all-cause mortality, AMI, cardiac arrest, AIS, and MACCE were 0.97 and 1.04, 1.16 and 1.21, 0.99 and 1.00, 1.49 and 1.49, and 1.06 and 1.12, respectively when compared for Leukemia-HFpEF cohort of 2019 vs. 2016 (p>0.05). Median hospital stay and cost were stable during the study duration without any significantly increasing or decreasing trends. Conclusion: There were significantly increasing trends in hospitalizations with HFpEF in elderly leukemia patients without any substantial improvement in acute cardiovascular events between 2016 and 2019. It has been established that cardiovascular outcomes are closely associated with leukemia and related chemotherapy, there is no standardized risk stratification or assessment tool to assess the management of MACEE in Leukemia patients. Furthermore, prospective studies are required to better understand and address the association of leukemia-related treatments and their impact on HFpEF risk and MACCE in the long term.

Association between corrected QT interval and long-term cardiovascular outcomes in elderly patients who had undergone endovascular therapy for lower extremity arterial disease.

Population-based studies have reported the association between prolonged corrected QT (QTc) intervals and an increased risk of adverse cardiovascular events. Data regarding the association between longer QTc intervals and incident cardiovascular outcomes in patients with lower extremity arterial disease (LEAD) are scarce. To examine the impact of QTc interval on long-term cardiovascular outcomes in elderly patients with symptomatic LEAD. This cohort study extracted data from the Tzu-chi Registry of ENDovascular Intervention for Peripheral Artery Disease (TRENDPAD) and enrolled 504 patients aged ≥ 70 treated with endovascular therapy for atherosclerotic LEAD from July 1, 2005, to December 31, 2019. The main outcomes of interest were all-cause mortality and major adverse cardiovascular events (MACE). Multivariate analysis was conducted using the Cox proportional hazard model to determine independent variables. We performed interaction analysis between corrected QT and other covariates and Kaplan-Meier analysis to compare the outcome of interest among the groups stratified by the tercile of QTc intervals. A total of 504 patients [235 men (46.6%); mean age, 79.9 ± 6.2 years; mean QTc interval, 459 ± 33 msec] entered the final data analysis. We categorized the baseline patient characteristics according to terciles of QTc intervals. During the median follow-up time of 3.15 (interquartile ranges, 1.65-5.42) years, we noted 264 deaths and 145 MACEs. The 5-year rates of freedom from all-cause mortality (71% vs. 57% vs. 31%, P < 0.001) and MACEs (83% vs. 67% vs. 46%, P < 0.001) were significantly different among the tercile groups. Multivariate analysis showed that a 1-SD increase in the QTc interval increased the risk of all-cause mortality [hazard ratio (HR) 1.49, P < 0.001] and MACEs (HR 1.59, P < 0.001) after adjusting for other covariates. The interaction analysis showed that QTc interval and C-reactive protein levels were most strongly associated with death (HR = 4.88, 95% CI 3.09-7.73, interaction P < 0.001) and MACEs (HR = 7.83, 95% CI 4.14-14.79, interaction P < 0.001). In elderly patients with symptomatic atherosclerotic LEAD, a prolonged QTc interval is associated with advanced limb ischemia, multiple medical comorbidities, increased risk of MACEs, and all-cause mortality.

Intensive Blood Pressure Control and Cardiovascular Outcomes in Elderly Patients: A Secondary Analysis of SPRINT Study Based on a 60-Year Age Cutoff.

In the original SPRINT article, age was categorized at 75 years, which was contrary to many previous clinical trials which is at 60 years. The SPRINT trial randomized 9,361 hypertensive patients to a target blood pressure of <120 vs. <140 mm Hg (intensive vs. standard treatment, respectively). Age was re-categorized as <60 and ≥60 years and hazard ratios (HRs) were calculated with 95% confidence intervals (CIs) for outcomes and adverse events. Intensive treatment reduced primary outcome significantly in both <60 and ≥60 years of age subgroups with a relative risk reduction (RRR) of 36% and 22%, respectively, and HR of 0.58 [95% CI, 0.36-0.94] and 0.78 [95% CI, 0.65-0.93], respectively. Although the intensive treatment rendered no effect on myocardial infarction (MI) in the overall comparison, it significantly reduced MI in patients <60 years of age with an RRR of 58% and HR of 0.39 [95% CI, 0.17-0.91]. In the ≥60-year age subgroup, reduced heart failure incidence was noted after intensive treatment, including death from other cardiovascular causes; however, these were not observed in the <60-year age subgroup. Intensive treatment resulted in significant hypotension, syncope, acute renal failure, or acute kidney injury in the ≥60-year age group; conversely, the risk of these adverse effects in patients <60 years of age did not increase. Intensive blood pressure control is beneficial for elderly patients (age ≥60 years), albeit with increased risk of adverse events.

Effects of sodium-glucose cotransporter 2 inhibitors on cardiovascular outcomes in elderly patients with comorbid coronary heart disease and diabetes mellitus.

OBJECTIVETo investigate the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular outcomes in elderly Chinese patients with comorbid coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM).METHODSA retrospective cohort study was conducted on 501 elderly inpatients (≥ 60 years) with comorbid CHD/T2DM in Department of Cardiovascular Medicine and Endocrinology, Chinese PLA General Hospital from January 2018 to December 2019. These patients were divided into two groups according to the administration of SGLT2i. All the demographic characteristics and clinical data were collected. Cardiovascular outcomes, including all-cause mortality, major adverse cardiovascular events (MACE), and hospitalization for heart failure (HHF), were followed up.RESULTSIn the cohort, there were 167 patients in the SGLT2i group and 334 patients in the control group. In the efficacy analyses, the incidence of MACE was lower in the SGLT2i group than in the control group: 3.6% vs. 9.3% (P = 0.022). A lower risk of MACE was observed in the SGLT2i group [hazard ratio (HR) = 0.40, 95% CI: 0.17–0.95]. There was no significant difference in the incidence of all-cause mortality or HHF between the two groups. No significant difference of HR was observed for all-cause mortality (HR = 0.41, 95% CI: 0.12–1.41) or HHF (HR = 0.58, 95% CI: 0.12–2.81). CONCLUSIONSSGLT2i treatment exhibited benefits for elderly patients with comorbid CHD/T2DM with a lower risk for MACE.

Use of statin for the primary prevention of cardiovascular outcomes in elderly patients: A propensity-matched cohort study

Background and aimsHerein, we investigate whether statin treatment as primary prevention reduces cardiovascular outcomes in elderly Asian patients. MethodsData were obtained from the Korean National Health Insurance Service-Senior Cohort database (n = 558,147). A total of 81,729 elderly patients (≥75 years) without clinically recognized atherosclerotic cardiovascular disease (CVD) were included. The patients who did not have a history of statin use in year 2003 were followed from January 2004 to the end of 2012. New statin users (n = 3670) were matched on the basis of the propensity score in a 1:2 ratio with non-users. Incidences of myocardial infarction, ischemic stroke, and death from CVD were compared using the Cox proportional hazards model. ResultsThe risk of cardiovascular death was significantly reduced in the statin treatment group compared with the non-user group (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.29 to 0.40; p < 0.001). This effect was observed in both patient groups with and without diabetes. In patients with diabetes, the HR for statin use was 0.85 (95% CI 0.55 to 1.33) for myocardial infarction and 0.75 (95% CI 0.60 to 0.93) for ischemic stroke. In participants without diabetes, the HR of statin use was 0.95 (95% CI 0.73 to 1.24) for myocardial infarction and 1.13 (95% CI 1.01 to 1.26) for ischemic stroke. The presence of hypertension was also a significant factor in the prevention of ischemic stroke by statin treatment. ConclusionsIn elderly patients without clinically recognized atherosclerotic CVD, the risk of cardiovascular mortality was significantly reduced with statin treatment than with non-users. In participants with type 2 diabetes, statin treatment was associated with a reduction in ischemic stroke.

Efficacy of statin treatment based on cardiovascular outcomes in elderly patients: a standard meta-analysis and Bayesian network analysis.

ObjectiveStatins have been shown to be beneficial for the prevention of cardiovascular events. In elderly individuals, the efficacy of statins remains controversial and the comparative effect of statins has not been assessed.MethodsMEDLINE, Embase, and the Cochrane Central database were searched for randomized controlled trials that assessed statins in older patients.ResultsSeventeen trials were analyzed. When used for secondary prevention, statins were associated with reduced risk of cardiovascular events, all-cause mortality, cardiovascular mortality, revascularization, and stroke. When used for primary prevention, statins reduced the risk of myocardial infarction and revascularization, but did not significantly affect other outcomes. A modest difference between pharmaceutical statin products was found, and high-quality evidence indicated that intensive atorvastatin had the greatest benefits for secondary prevention.ConclusionsIn secondary prevention, evidence strongly suggests that statins are associated with a reduction in the risk of all-cause mortality, cardiovascular events, cardiovascular mortality, and revascularization. However, differences in the effects of various statins do not appear to have significant effects on therapy in secondary prevention for the elderly.

MACHINE LEARNING TECHNIQUES TO PREDICT IN-HOSPITAL CARDIOVASCULAR OUTCOMES IN ELDERLY PATIENTS PRESENTING WITH ACUTE MYOCARDIAL INFARCTION

The ability to predict the cardiovascular outcomes in elderly patients presenting with acute myocardial infarction can aid in clinical decision-making. We sought to determine whether machine learning techniques can be used to predict in-hospital cardiovascular mortality and major bleeding after the

MON-LB029 The Influence of SGLT-2 Inhibitors and Other Glucose-Lowering Therapies on All-Cause Mortality Risk and Cardiovascular Outcomes in Older Patients with Newly Treated Type 2 Diabetes: A Population-Based Cohort Study

Background: SGLT-2 inhibitors (SGLT-2i) have been associated with decreased all-cause mortality and cardiovascular (CV) morbidity in patients with type 2 diabetes (T2DM) and established CV disease in randomized trials. The objective of this study was to evaluate exposure time to SGLT-2i and other diabetic therapies on all-cause mortality and cardiovascular outcomes in elderly patients with newly diagnosed T2DM. Methods: We conducted a retrospective analysis of patients > 67 years of age who were started on a glucose lowering drug (GLD) between August 1, 2015 and January 1, 2017 using population-based health administrative data. The primary outcome was time to death from any cause. Exposure to all drugs was captured as time-dependent covariates. Secondary outcomes included time to admission to hospital for a cardiovascular outcome. Results: During the study, 36,021 individuals started an GLD. The prevalence of MI and CHF at baseline were low (6.4% vs 9.2% respectively). SGLT-2i were first-line treatment in 3.5% of patients and 7.1% of patients were exposed at any time during the study period. The SGLT-2i group was younger (71.9+/-4.6 yrs vs 74.7+/- 6.2 yrs) with a higher prevalence of MI at baseline. In contrast to other GLDs, death risk decreased as the proportion of observation exposed to SGLT-2i and biguanides increased. The association between individual drug exposures and cardiovascular outcomes was similar. Discussion: In contrast to previous cohort studies, this study examined the independent influence of both SGLT-2i and all other possible GLD individually on mortality and CV risk and based on exposure time. This study suggests that SGLT-2i and biguanides are associated with a decreased risk of all-cause mortality and CV outcomes in patients newly diagnosed with T2DM. Further research is needed to elucidate the mechanism by which SGLT-2i improves mortality and CV outcomes. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Effect of liraglutide on cardiovascular outcomes in elderly patients: A post hoc analysis of a randomized controlled trial

Effect of liraglutide on cardiovascular outcomes in elderly patients: A post hoc analysis of a randomized controlled trial

Effect of Liraglutide on Cardiovascular Outcomes in Elderly Patients: A Post Hoc Analysis of a Randomized Controlled Trial.

Effect of Liraglutide on Cardiovascular Outcomes in Elderly Patients: A Post Hoc Analysis of a Randomized Controlled Trial.

Association of systolic blood pressure with cardiovascular outcomes in elderly patients with hypertension in Northern China.

The aim of this study was to investigate the association of systolic blood pressure (SBP) with cardiovascular disease and all-cause mortality among elderly hypertensive patients in northern China. In this prospective cohort study, 9655 elderly hypertensive patients from Kailuan study were followed up with the incidence of primary outcomes (composite outcomes including myocardial infarction, stroke, and all-cause death) and the incidence of secondary outcomes (stroke, myocardial infarction, and all-cause death). Patients were categorized into five groups on the basis of SBP levels: Q1 (SBP<130 mmHg), Q2 (130≤SBP<140 mmHg), Q3 (140≤SBP<150 mmHg), Q4 (150≤SBP<160 mmHg), and Q5 (SBP≥160 mmHg). During an average of 7.2±1.6 years of follow-up, patients in the group Q2 had the lowest incidence rates of composite outcomes. Q1 was not associated with a decreased risk of composite outcomes. Interestingly, compared with reference group Q2, the risk of composite outcomes [hazard ratio (HR): 1.36; 95% confidence interval (CI): 1.06-1.75] was significantly increased in the Q3 subgroup with high risk+very high risk for the incidence of ischemic cardiovascular disease (ICVD). Similarly, the risk of composite outcomes (HR: 1.25; 95% CI: 1.01-1.53 and HR: 1.35; 95% CI: 1.04-1.75) was significantly increased in Q4 subgroups, with both intermediate risk and high risk+very high risk for 10-year ICVD. Elderly hypertensive patients with a high risk of 10-year ICVD were still at a higher risk of developing adverse outcomes even with 140≤SBP<150 mmHg. SBP of less than 130 mmHg was not associated significantly with a reduced risk of developing adverse outcomes.

Clustering of ABCB1 and CYP2C19 Genetic Variants Predicts Risk of Major Bleeding and Thrombotic Events in Elderly Patients with Acute Coronary Syndrome Receiving Dual Antiplatelet Therapy with Aspirin and Clopidogrel.

ObjectiveThe clinical efficacy of clopidogrel in secondary prevention of vascular events is hampered by marked inter-patient variability in drug response, which partially depends on genetic make-up. The aim of this pilot prospective study was to evaluate 12-month cardiovascular outcomes in elderly patients with acute coronary syndrome (ACS) receiving dual antiplatelet therapy (aspirin and clopidogrel) according to the clustering of CYP2C19 and ABCB1 genetic variants.MethodsParticipants were 100 consecutive ACS patients who were genotyped for CYP2C19 (G681A and C-806T) and ABCB1 (C3435T) polymorphisms, which affect clopidogrel metabolism and bioavailability, using PCR-restriction fragment length polymorphism. They were then grouped as poor, extensive and ultra-rapid metabolisers based on the combination of CYP2C19 loss-of-function (CYP2C19*2) and gain-of-function (CYP2C19*17) alleles and ABCB1 alleles. The predictive value of each phenotype for acute vascular events was estimated based on 12-month cardiovascular outcomes.ResultsThe poor metabolisers were at an increased risk of thrombotic events (OR 1.26; 95% CI 1.099–1.45; χ2 = 5.676; p = 0.027), whereas the ultra-rapid metabolisers had a 1.31-fold increased risk of bleeding events compared with the poor and extensive metabolisers (OR 1.31; 95% CI 1.033–1.67; χ2 = 5.676; p = 0.048). Logistic regression model, including age, sex, BMI and smoking habit, confirmed the differential risk of major events in low and ultra-rapid metabolisers.ConclusionsOur findings suggest that ACS patients classified as ‘poor or ultra-rapid’ metabolisers based on CYP2C19 and ABCB1 genotypes should receive alternative antiplatelet therapies to clopidogrel.Electronic supplementary materialThe online version of this article (10.1007/s40266-018-0555-1) contains supplementary material, which is available to authorized users.

Prediction of 14-year cardiovascular outcomes by dobutamine stress 99mTc-tetrofosmin myocardial perfusion SPECT in elderly patients unable to perform exercise testing

BackgroundDobutamine stress myocardial perfusion imaging (MPI) is a useful alternative for the evaluation of coronary artery disease (CAD) in elderly patients who are unable to perform an exercise stress test. However, data on the long-term prognostic value of stress MPI in elderly patients are lacking. Therefore, this study evaluated the long-term prognostic value of dobutamine stress MPI in elderly patients unable to perform an exercise test. MethodsThe study population consisted of 247 elderly patients (mean age 71 ± 5 years) who underwent dobutamine stress single-photon emission computed tomography (SPECT) MPI. An abnormal SPECT study was defined as the presence of fixed and/or reversible perfusion defects. A summed stress score (SSS) was obtained to estimate the extent and severity of perfusion defects. End points during follow-up were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction (MI). ResultsDuring a median follow-up of 14 years (range 12-16), 168 (68%) patients died (all-cause mortality), of which 56 (23%) were due to cardiac causes. Nonfatal MI occurred in 19 (8%) patients. Kaplan-Meier survival curves showed that MPI provided optimal risk stratification in patients with normal and abnormal MPI. Multivariable analysis identified an abnormal MPI as a strong significant predictor of all-cause mortality and cardiac events. A multivariable analysis also revealed that a reversible defect and SSS were strong long-term predictors of cardiac mortality and hard cardiac events. ConclusionDobutamine stress 99mTc-tetrofosmin SPECT provides incremental prognostic information for the prediction of long-term cardiovascular outcomes in elderly patients, unable to perform exercise testing. Dobutamine stress MPI is useful in risk classifying elderly patients.

Obstructive Sleep Apnea-Hypopnea and Cardiovascular Diseases in Adults

Cardiovascular diseases (CVD) are the main cause of death worldwide representing 30% of all global deaths. Obstructive sleep apnea hypopnea (OSAH) has been associated with several serious cardiovascular comorbidities. OSAH occurs in 17% to 24% of North American American adults that increase the risk of sudden cardiac deaths between 12 midnight and 6 a.m. OSAH is considered as an independent risk factor for CVD such as systemic hypertension, pulmonary arterial hypertension, coronary artery disease, stroke, cardiac arrhythmias, heart failure, which raise both cardiovascular morbidity and mortality and the increase demand for healthcare resources. Several mechanisms have been suggested to link OSAH and vascular diseases including increases in sympathetic activation, oxidative stress, inflammation, endothelial dysfunction, coagulation, and metabolic dysregulation. This review will provide insights on mechanisms by which OSAH might contribute to pathogenesis of cardiovascular disease. Continuous positive airway pressure (CPAP) is considered the gold standard in the treatment of OSAH with improved metabolic and CV endpoints. To a lesser extent oral appliance therapy and upper airway or mandibular advancement surgery are palliative measures that leave the patient with significant residual apnea hypopnea. There is increasing evidence that adequate CPAP therapy leads to a significant reduction in cardiovascular morbidity. Moderate to severe OSAH not treated with CPAP was an independent risk factor for relapse of a CVD event, and adequate CPAP treatment improved cardiovascular outcomes in elderly patients.

Role of bone mineral density in the inverse relationship between body size and aortic calcification: Results from the Baltimore Longitudinal Study of Aging

ObjectiveThere is a J-shaped relationship between body mass index (BMI) and cardiovascular outcomes in elderly patients (obesity paradox). Whether low BMI correlates with aortic calcification (AC) and whether this association is accounted for by bone demineralization is uncertain. MethodsPresence of AC was evaluated in 687 community-dwelling individuals (49% male, mean age 67 ± 13 years) using CT images of the thoracic, upper and lower abdominal aorta, and scored from 0 to 3 according to number of sites that showed any calcification. Whole-body bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry. Predictors of AC were assessed by logistic regression, and the role of BMD using mediation analysis. ResultsAge and cardiovascular risk factors were positively associated while both BMI (r = −0.11, p < 0.01) and BMD (r = −0.17, p < 0.0001) were negatively associated with AC severity. In multivariate models, lower BMI (OR 0.96, 95%CI 0.92–0.99, p = 0.01), older age, higher systolic blood pressure, use of lipid-lowering drugs and smoking were independent predictors of AC. A nonlinear relationship between BMI and AC was noticed (p = 0.03), with decreased AC severity among overweight participants. After adjusting for BMD, the coefficient relating BMI to AC was reduced by 14% and was no longer significant, whereas BMD remained negatively associated with AC (OR 0.82, 95%CI 0.069–0.96, p = 0.01), with a trend for a stronger relationship in older participants. ConclusionLow BMI is associated with increased AC, possibly through calcium mobilization from bone, resulting in low BMD. Prevention of weight loss and bone demineralization with aging may help reducing AC.

Continuous positive airway pressure treatment improves cardiovascular outcomes in elderly patients with cardiovascular disease and obstructive sleep apnea

Obstructive sleep apnea (OSA) is associated with the progression of cardiovascular disease (CVD), particularly in the middle-aged population. However, the clinical importance of OSA as a risk for CVD in the elderly population remains controversial. Moreover, evidence for the effectiveness of continuous positive airway pressure (CPAP) treatment for the secondary prevention of CVD in elderly patients is lacking. We assessed whether CPAP treatment improves cardiovascular outcomes in elderly patients with OSA and CVD. In this retrospective cohort study, we enrolled 130 elderly patients aged 65-86 years with moderate to severe OSA (apnea-hypopnea index ≥15/h) and a history of hospitalization due to CVD, who underwent polysomnography between November 2004 and July 2011. Patients were divided into the CPAP group (n = 64) or untreated OSA group (n = 66). The main outcome measures were cardiovascular death and hospitalization due to CVD. During the mean follow-up period of 32.9 ± 23.8 (standard deviation) months, 28 (21.5 %) patients either died or were hospitalized. The Kaplan-Meier curves indicated that event-free survival was significantly lower in the untreated OSA group than in the CPAP group (P < 0.005). A multivariate analysis showed that the risk was significantly increased in the untreated OSA group (hazard ratio 5.13; 95 % confidence interval 1.01-42.0; P < 0.05). Moderate to severe OSA not treated with CPAP was an independent risk factor for relapse of a CVD event, and adequate CPAP treatment improved cardiovascular outcomes in elderly patients.

Abstract 9437: Impact of Positive Airway Pressure Therapy in Elderly Patients with Cardiovascular Disease and Sleep-disordered Breathing

Introduction: Many studies have identified an association between sleep-disordered breathing (SDB) and cardiovascular disease (CVD). Recent studies have showed that SDB is an independent predictor of poor prognosis and continuous positive airway pressure (PAP) therapy contributes to reduce the risk. However, whether SDB is a risk factor for CVD in elderly patients and whether PAP therapy improves long-term cardiovascular outcomes are unknown. Hypothesis: We assessed the hypothesis that PAP therapy improved long-term cardiovascular outcomes in elderly patients with CVD and moderate to severe SDB. Methods: We studied 1693 patients who underwent polysomnography between November 2004 and July 2011, and enrolled 131 elderly patients (age ≥65 years old) with SDB (apnea-hypopnea index ≥15 per hour), who had been admitted to hospital due to CVD before polysomnography. They were divided into two groups; a PAP-treated group (n=64; treated with continuous positive airway pressure or adaptive servo ventilation) and an untreated SDB group (n=67; untreated with PAP devices). The frequency of death and hospitalization due to cardiovascular events (acute coronary syndrome, heart failure, stroke, fatal arrhythmias, and aortic dissection) between the groups was analyzed using multivariate analysis. Results: The mean follow-up period was 31.8 ± 23.4 months and 34 patients (26.0%) died or were re-admitted to hospital due to cardiovascular events. Kaplan-Meier survival curves indicated that event-free survival was significantly higher in the PAP-treated group than in the untreated SDB group (Figure). Multivariate analysis showed that the risk for death and re-admission due to cardiovascular events was significantly higher in the untreated SDB group than in the PAP-treated group (hazard ratio, 3.21; 95% confidence interval, 1.05 to 10.9; p &lt;0.05). Conclusions: PAP therapy improves cardiovascular outcomes in elderly patients with CVD and moderate to severe SDB.