Community-dwelling Elderly Chinese Research Articles

Healthy vascular ageing protects community dwelling elderly from all-cause mortality: 5-year evidence from the North Shanghai Study

Abstract Background Healthy vascular ageing (HVA) defined by normal pulse wave velocity (PWV) has been recognized as a valuable indicator of vascular status. And HVA strongly correlates with preclinical targeted organ damage (TOD). While the long-term benefit of HVA remains to be investigated. Aims To investigate the long-term outcome of population with HVA based on large registered North Shanghai Study. Methods Since Jun. 2014, 3363 community-dwelling elderly Chinese (age ≥65 years) were enrolled in the Northern Shanghai Study. HVA was defined as normal carotid femoral PWV that stratified by age and blood pressure. TOD was measured and categorized as vascular TOD indicated by carotid-femoral PWV and ankle-brachial index, cardiac TOD indicated by left ventricular hypertrophy and diastolic dysfunction, and renal TOD indicated by estimated glomerular filtration rate and urinary albumin/creatinine ratio. Follow-up outcome including all-cause mortality, cardiovascular and non-cardiovascular mortalities were evaluated. Results 1016 participants (30.2%) with HVA were identified. Compared with non-HVA group, although no gender difference, HVA group had younger age, lower blood pressure, lower body mass index (BMI), and milder TODs. Through a follow-up period of 5.7±1.8 years, 233 (6.9%) all-cause deaths, including 94 (2.8%) cardiovascular deaths were observed. Participants with HVA showed significantly higher survival from all-cause deaths (Log-rank P=0.002) and cardiovascular deaths (Log-rank P=0.003), but statistically non-significant survival from non-cardiovascular deaths (Log-rank P=0.098).Subgroup analysis showed that HVA was a significant protective factor in female (HR 0.412 (0.245, 0.692), P=0.002), participants aged 65-70 (HR 0.417 (0.194, 0.897), P=0.025), participants with BMI<25 (0.570 (0.386, 0.842) P=0.005), and participants with at least 1 TOD (HR 0.634 (0.444, 0.907), P=0.013). Moreover, the protective value of HVA was only significant in participants without cardiac TOD (0.681, (0.464, 0.998), P=0.049), participants with renal TOD (0.547, (0.354, 0.844), P=0.006), and participants with vascular TOD (0.461 (0.251, 0.848), P=0.013). Conclusion In community-dwelling elderly, HVA could be a significant protective factor for all-cause deaths, especially in subpopulation of female, age 65-70, BMI<25 and with renal and/or vascular TOD.

IS IT REASONABLE TO DECREASE THE DEFINITION OF DIASTOLIC HYPERTENSION FROM 90 MMHG TO 80 MMHG IN THE ELDERLY? THE NORTHERN SHANGHAI STUDY

Objective: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines decreased the definition of diastolic hypertension to 80 mmHg from 90 mmHg. However, this action may not be appropriate in the elderly, considering the limited value of increased DBP in predicting future cardiovascular risk and the worse prognosis associated with significant lower DBP in the elderly. Design and method: A total of 1178 participants with SBP<130 mmHg derived from the Northern Shanghai Study, a prospective study focusing on the cardiovascular risk of the community-dwelling elderly Chinese in the northern Shanghai, China, were included. Study participants were divided into Group 1 (DBP<80 mmHg) and Group 2 (80<DBP<90 mmHg) according to DBP level. Survival analysis and Cox proportional hazard regression were used to study the future cardiovascular risk of the two groups. Results: After 5.8 years of follow-up, a total of 172 events were observed. Survival analysis showed no significant difference in the rates of the primary endpoints between two groups (14.9%vs14.0%, P = 0.80). In multiple COX proportional hazard regression, after adjusted for covariates, participants in Group 2 showed similar future cardiovascular risk (Hazard Ratio 1.05, 95% Confidence Interval 0.75-1.48, P = 0.78), as compared with Group 1. Conclusions: No increased cardiovascular risk observed in the elderly with SBP<130 mmHg and DBP between 80-90 mmHg, compared with those with DBP<80 mmHg. Therefore, it is maybe unreasonable to downregulate the definition of the diastolic hypertension in the elderly.

HEALTHY VASCULAR AGEING PROTECTS COMMUNITY DWELLING ELDERLY FROM ALL-CAUSE MORTALITY: 5-YEAR EVIDENCE FROM THE NORTH SHANGHAI STUDY

Objective: Healthy vascular ageing (HVA) defined by normal pulse wave velocity (PWV) has been recognized as a valuable indicator of vascular status. And HVA strongly correlates with preclinical targeted organ damage (TOD). While the long-term benefit of HVA remains to be investigated. The study aims to investigate the long-term outcome of population with HVA based on large registered North Shanghai Study. Design and method: Since Jun. 2014, 3363 community-dwelling elderly Chinese (age larger than 65 years) were enrolled in the Northern Shanghai Study. HVA was defined as normal carotid femoral PWV that stratified by age and blood pressure. TOD was measured and categorized as vascular TOD indicated by carotid-femoral PWV and ankle-brachial index, cardiac TOD indicated by left ventricular hypertrophy and diastolic dysfunction, and renal TOD indicated by estimated glomerular filtration rate and urinary albumin/creatinine ratio. Follow-up outcome including all-cause mortality, cardiovascular and non-cardiovascular mortalities were evaluated. Results: 1016 participants (30.2%) with HVA were identified. Compared with non-HVA group, although no gender difference, HVA group had younger age, lower blood pressure, lower body mass index (BMI), and milder TODs. Through a follow-up period of 5.7±1.8 years, 233 (6.9%) all-cause deaths, including 94 (2.8%) cardiovascular deaths were observed. Participants with HVA showed significantly higher survival from all-cause deaths (Log-rank P = 0.002) and cardiovascular deaths (Log-rank P = 0.003), but statistically non-significant survival from non-cardiovascular deaths (Log-rank P = 0.098). Subgroup analysis showed that HVA was a significant protective factor in female (HR 0.412 (0.245, 0.692), P = 0.002), participants aged 65-70 (HR 0.417 (0.194, 0.897), P = 0.025), participants with BMI<25 (0.570 (0.386, 0.842) P = 0.005), and participants with at least 1 TOD (HR 0.634 (0.444, 0.907), P = 0.013). Moreover, the protective value of HVA was only significant in participants without cardiac TOD (0.681, (0.464, 0.998), P = 0.049), participants with renal TOD (0.547, (0.354, 0.844), P = 0.006), and participants with vascular TOD (0.461 (0.251, 0.848), P = 0.013). Conclusions: In community-dwelling elderly, HVA could be a significant protective factor for all-cause deaths, especially in subpopulation of female, age 65-70, BMI<25 and with renal and/or vascular TOD.

Urinary antibiotic exposure and low grip strength risk in community-dwelling elderly Chinese by gender and age.

Emerging studies have shown that environmental contaminants were related to decreased handgrip strength. Nevertheless, no prior research has investigated the relationship of exposure to environmental antibiotics with grip strength. Thus, we explored the relationship between urinary antibiotic burden and grip strength among the elderly in China. This study consisted of 451 men and 539 women from the baseline survey of a cohort study. Commonly used antibiotics for humans and animals were detected in 990 urine samples through a biomonitoring method. Grip strength was measured by an electronic dynamometer. We examined the associations of antibiotic exposure with low grip strength (LGS), grip strength, and grip strength index, respectively. Results suggested that 34.9% of participants developed LGS, and 93.0% of individuals were exposed to 1-10 antibiotics. Among women, oxytetracycline (Quartile 2: odds ratio: 2.97, 95% confidence interval: 1.36-6.50), florfenicol (Quartile 3: 2.60 [1.28-5.27]), fluoroquinolones (Quartile 4: 1.88 [1.07-3.30]), and chloramphenicols (Quartile 3: 2.73 [1.35-5.51]) could enhance LGS risk. Among men, ofloxacin (Quartile 2: 3.32 [1.45-7.59]) increased LGS risk, whereas tetracycline (Quartile 2: 0.31 [0.11-0.88]) was implicated in reduced LGS risk. In participants < 70years, ofloxacin (Quartile 2: 3.00 [1.40-6.42]) could increase LGS risk. For participants who were 70years of age or older, veterinary antibiotics (Quartile 3: 1.73 [1.02-2.94]) were linked to a 73% increased risk of LGS. Our findings suggested that antibiotics mainly pertained to LGS, and there were gender and age disparities in associations between antibiotic exposure and muscle strength indicators in the elderly Chinese population.

Associations of Walking Activity With Hypertensive Mediated Organ Damage in Community-Dwelling Elderly Chinese: The Northern Shanghai Study.

Background: Walking, as the most common campaign in older people, is recommended to improve their cardiovascular health. However, the direct association between weekly walking activity and asymptomatic hypertensive mediated organ damage (HMOD) remains unclear.Methods: 2,830 community-dwelling elderly subjects (over 65 years) in northern Shanghai were recruited from 2014 to 2018. Weekly walking activity was assessed by International Physical Activity Questionnaires (IPAQ). Within the framework of comprehensive cardiovascular examinations, HMOD, including left ventricular mass index, peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity, creatinine clearance rate, urinary albumin–creatinine ratio, carotid-femoral pulse wave velocity (cf-PWV), carotid intima–media thickness (CIMT), arterial plaque, and ankle-brachial index (ABI), were all evaluated.Results: 1,862 (65.8%) participants with weekly walking activity showed lower CIMT, lower cf-PWV, fewer abnormal ABI, and lower prevalence of hypertension and coronary heart disease (p < 0.05). Walking activity was negatively correlated with age and smokers (correlation coefficient: −0.066, −0.042; both p < 0.05). After adjusting for cardiovascular risk factors and concomitant diseases, walking activity was significantly associated with better indicator of most vascular HMOD in multivariate logistic regressions, including arterial stiffness [odds ratio (OR) = 0.75, p = 0.01], increased CIMT (OR = 0.70, p = 0.03), and peripheral artery disease (OR = 0.72, p = 0.005), but not cardiac or renal HMOD. Subgroup analysis further showed that walking duration ≥1 h/day was significantly associated with decreased risk of most vascular HMOD after adjustment for confounders and moderate-to-vigorous physical activity based on IPAQ (all p < 0.05).Conclusions: In the community-dwelling elderly Chinese, there was a significant negative association of weekly walking activity with vascular HMOD, but not cardiac or renal HMOD. Increased daily walking duration, but not walking frequency, was significantly associated with improved vascular HMOD. Hence, increasing daily walking duration seems to encourage a healthy lifestyle in terms of vascular protection.Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT02368938.

BENEFICIAL EFFECTS OF WEEKLY WALKING ACTIVITY ON HYPERTENSIVE MEDIATED ORGAN DAMAGE IN THE COMMUNITY-DWELLING ELDERLY CHINESE: THE NORTHERN SHANGHAI STUDY

Objective: To investigate the effects of weekly walking activity on the asymptomatic hypertensive mediated organ damage (HMOD) remains unclear. Design and method: 2830 community-dwelling elderly subjects (over 65 years) in northern Shanghai were recruited from June 2014 to June 2018. Weekly walking activity was evaluated by standard questionnaire based on the International Physical Activity Questionnaires-short form (including walking duration per time and walking days per week). Within the framework of comprehensive cardiovascular examinations, HMOD, including left ventricular mass index (LVMI), peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea), carotid intima-media thickness (CIMT), arterial plaque, creatinine clearance rate (CCR), urinary albumin-creatinine ratio (UACR), carotid-femoral pulse wave velocity (cf-PWV) and ankle-brachial index (ABI), were all evaluated. Results: There were 1862 (65.8%) participants enrolled in weekly walking activity, with 56.8 ± 36.8 min/day and a median of 6.71 days/week walking. Young elderly, fewer smokers, lower CIMT, lower cf-PWV, fewer abnormal ABI, lower prevalence of hypertension and coronary heart disease were observed in walking activity group (P &lt; 0.05). Similarly, Pearson's correlation analysis revealed that weekly walking activity was significantly correlated with elderly (age 70 years or more) and smoker (both P &lt; 0.05). To further investigate the association of weekly walking activity with HMOD, logistic regression analysis was conducted. Interestingly, weekly walking activity was only significantly associated with peripheral artery diseases (P &lt; 0.05), together with cardiovascular risk factors. Subsequently, subgroup analysis about weekly walking activity was performed and the results revealed that only walking duration more than 30 min per time was related to arterial plaque (OR: 1.048, 95% CI: 1.002–1.095, P = 0.038). Conclusions: Taken together, in the community-dwelling elderly Chinese, weekly walking activity played a protective role in HMOD, especially vascular HMOD, regardless of walking duration per time and walking days per week.

NOVEL ANTHROPOMETRIC INDICES WERE BETTER ASSOCIATED WITH HYPERTENSIVE TARGET ORGAN DAMAGES IN THE COMMUNITY-DWELLING ELDERLY CHINESE: THE NORTHERN SHANGHAI STUDY

Objective: Body mass index (BMI), the most commonly used body composition assessing indice, has recently been challenged by two novel anthropometric indices, a body shape index (ABSI) and body roundness index (BRI), in arterial stiffness predicting capacity[1,2]. The purpose of this study was to detect and compare the different predictive capacities of the four anthropometric indices (ABSI, BRI, waist-hip ratio (WHR) and BMI) in predicting hypertensive target organ damages (HTODs). Design and method: Overall, 3077 community-dwelling elderly Chinese (age &gt; 65 years, 1329 men and 1748 women) in northern Shanghai were enrolled prospectively from June 2014 to August 2019. ABSI and BRI were calculated with validated formula. HTODs were defined as three levels: (1) left ventricular hypertrophy (LVH), (2) arterial stiffness (AS) and lower limb atherosclerosis (LLA), (3) micro-albuminuria (MAU). Multivariate linear and logistic regression were performed to detect the relations between anthropometric indices and HTODs. Results: Spearman correlation analysis revealed that all anthropometric indices were correlated with HTODs indices (all P &lt; 0.001). In multivariate logistic regression models, compared to the lowest quartiles, participants with the highest quartiles of ABSI, BRI and WHR all exhibited a significantly higher risk of LVH, AS and MAU independent of confounders and BMI (all P for trend &lt; 0.01). Results of receiver operator characteristic (ROC) analysis performed within the female subgroup demonstrated that BRI and WHR were the better anthropometric indices in predicting HTODs compared to BMI. However, similar trend disappeared in the male subgroup. Further comparison analysis about the predictive priorities in the female subgroup were tested with stepwise logistic regression, after all anthropometric indices were put into models, only BRI stayed and was significantly associated higher prevalence of LVH (OR = 1.42, 95%CI 1.30∼1.55) and LLA (OR = 1.48, 95%CI 1.23∼1.77) together with WHR stayed to predict higher risks of AS (OR = 1.30, 95%CI 1.18∼1.43) and MAU (OR = 1.48, 95%CI 1.28∼1.72, all P &lt; 0.01). Conclusions: Novel anthropometric indices, especially BRI and WHR, compared to the conventional indice BMI, have the superior capacities in predicting HTODs in the elderly female Chinese population.

Peripheral artery disease impairs myocardial perfusion through increasing pulse wave reflection: the Northern Shanghai study

Abstract Background Peripheral artery disease (PAD) is prevalent and substantially contributes to cardiovascular mortality particularly in the elderly, although the pathophysiological impact of PAD on heart itself still needs further investigation. In theory, PAD can increase pulse wave reflection which is an important determinant of subendocardial viability ratio (SEVR), a valuable estimate of myocardial perfusion as indicated by previous invasive studies. Thus, we hypothesize that PAD impairs myocardial perfusion through increasing pulse wave reflection. In this study, we aim to test this hypothesis in a large cohort from the Northern Shanghai Study. Methods A total of 2947 community-dwelling elderly Chinese (43.6% male, mean age: 71.3±5.9 years) were recruited. Ankle-brachial index were measured with the VP1000 device and used to diagnose PAD. Pulse wave reflection was estimated as aortic augmentation pressure (AP). Aortic BP, AP and SEVR were assessed by radial applanation tonometry. Multiple linear regression with SEVR and AP as dependent variable and PAD as independent variable, meanwhile adjusted for other covariates, were performed, respectively. Results 375 (12.7%) participants presented PAD. Compared to subjects without PAD, those with PAD showed significantly lower SEVR (126 vs. 132, P&amp;lt;0.001) but higher AP (19 vs. 17 mmHg, P&amp;lt;0.001). Multiple regression analysis revealed that both SEVR (regression coefficient [B] = −1.69, P=0.04, R2=0.61) and AP (B=1.19, P=0.04, R2=0.56) significantly associated with PAD, respectively. However, the association between SEVR and PAD was abolished when further adjusted for AP (B=−0.49, P=0.52). Similar results were obtained when inter-leg systolic BP difference was used to diagnose PAD. Conclusions PAD significantly and independently associates with myocardial perfusion; moreover, this association is mediated by increased pulse wave reflection. These findings provide a new dimension for understanding the pathophysiological mechanisms of cardiac damage of PAD. Funding Acknowledgement Type of funding source: None

Effects of different living conditions on the risk of osteoporosis in Chinese community-dwelling elderly: a 3-year cohort study.

ObjectiveOsteoporosis can lead to bone fragility and an increased risk of bone fracture with resultant high morbidity and mortality. Living alone has been associated with various mental and physical health problems. However, the risk of osteoporosis among individuals with different living conditions and changing living conditions is unclear. We examined the risk of osteoporosis in different living conditions over a 3-year period in community-dwelling suburban elderly Chinese.MethodsThis study involved 288 elderly Chinese suburb-dwelling participants with no documented history of osteoporosis. All were aged ≥60 years (mean, 65.6±3.75 years; 157 men). A quantitative ultrasound scan of the calcaneus with a T score of <−2.5 was used to identify a high risk of osteoporosis.ResultsIn total, 54.2% of participants were determined to have a high risk of osteoporosis (male, 51.6%; female, 57.3%). People who had always lived alone had a significantly higher risk of osteoporosis, even after adjusting for potential confounders. A change from living alone to living with others had no significant impact on the risk of osteoporosis.ConclusionOur results indicate that living alone is associated with a high risk of osteoporosis. Thus, people who live alone may need regular bone tests to avoid adverse events.

Renal functional impairment in the elderly, the importance of fasting plasma glucose: the Northern Shanghai Study.

Chronic kidney disease is a global health problem that is closely related to the aging population. Although plasma glucose levels have been shown to be related to renal dysfunction, risk factors for renal functional impairment in the geriatric population are unknown. The authors therefore aimed to investigate the determinants of renal functional impairment in an elderly population. From June 2014 to August 2015, 912 participants (aged > 65years) were recruited. Renal function was assessed at baseline; follow-up was conducted in 2016. Within the framework of comprehensive cardiovascular examinations, all conventional cardiovascular risk factors, fasting plasma glucose (FPG), and renal function were assessed. Renal function was evaluated by the estimated glomerular filtration rate (e-GFR) using a modified Modification of Diet in Renal Disease formula. Rapid decline in e-GFR was defined as an e-GFR slope > 5mL/min per 1.73m2 per year. We observed that FPG levels were significantly higher in participants with (6.15 ± 2.76mmol/L) than in those without (5.56 ± 1.61mmol/L) a rapid decline in e-GFR (p = 0.02). The average decline in e-GFR was 0.149mL/min/1.73m2 per year in this elderly population, and the increasing risk of having rapid decline in e-GFR was 0.44-fold each year. In the full adjustment model, decline in e-GFR (p = 0.02) and rapid decline in e-GFR (OR1.33, 95% CI 1.03-1.72) were significantly associated with FPG, independent of other conventional cardiovascular risk factors. Using the same models, decline in e-GFR (p = 0.04) and rapid decline in e-GFR (OR 1.57, 95% CI 1.05-2.35) were also significantly associated with FPG in diabetic population, but they were not in non-diabetic population. In community-dwelling elderly Chinese, the average decline in e-GFR was 0.149mL/min/1.73m2 per year. FPG control is important for delaying renal functional impairment in elderly population. Trial registration NSS, NCT02368938.

A0504 The Prevalence of Central Hypertension and Its Association with Target Organ Damage in Community-Dwelling Elderly Chinese

Objectives: We aimed to investigate the prevalence of central hypertension and its association with target organ damage (TOD). Methods: 1983 community-dwelling elderly Chinese were recruited for this analysis. Brachial and central blood pressure (BP) were measured by a oscillometric device and SphygmoCor, respectively. Brachial hypertension was defined by brachial systolic (SBP)/diastolic BP (DBP) ≥140/90 mmHg or using antihypertensive medications. Central hypertension was defined by central SBP/DBP ≥130/90 mmHg or using antihypertensive medications. TOD including left ventricular hypertrophy (LVH) and diastolic dysfunction (LVDD), carotid-femoral pulse wave velocity (CF-PWV) and urinary albumin-creatinine ratio (UACR), were evaluated by standardized methods. Results: In this cohort, there were 563(28.4%) brachial and central consistent normotension (BCCN), 46 (2.3%) isolated brachial hypertension (IBH), 27 (1.4%) isolated central hypertension (ICH), and 1347 (67.9%) brachial and central combined hypertension (BCCH). In ANOVA, BCCH showed significantly higher levels in all TOD than BCCN. In multiple logistic regression, all TOD were significantly associated with BCCH (LVH: adjusted OR[95%CI] = 2.03[1.55, 2.68]; LVDD:2.29[1.53, 3.43]; CF-PWV > 10m/s: 3.41[2.55, 4.58]; UACR > 30 mg/g: 1.97[1.58, 2.44]), rather than IBH or ICH. Conclusion: Central hypertension was prevalent (69.3%) in this elderly cohort. BCCH was independently and significantly associated with cardiac, arterial and renal damage. This finding implies that both brachial and central BPs need to be considered for managing hypertension.

A11075 Association of hypertensive target organ damage with serum uric acid in the community-dwelling elderly Chinese

Objectives: To survey the correlation between hypertensive target organ damage (TOD) and serum uric acid in the elderly. Methods: 1599 participants aged over 65 years (mean age 72.72 ± 5.97 years) were recruited in ten communities located in northern Shanghai from July 2014 and August 2015. Hypertensive TOD were assessed for each participant, including carotid-femoral pulse wave velocity (CF-PWV), carotid intima-media thickness (CIMT), left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR) and urinary microalbumin/creatinine (UMC). Results: Mean serum uric acid was 338.9 ± 84.6 μmol/L. sUA was positively correlated with age, body mass index and systolic blood pressure (BP) (p < 0.001). In the univariate linear regression, sUA was significantly associated with CF-PWV (r = 0.16, p < 0.001), UMC (r = 0.11, p < 0.05) and eGFR (r = −0.23, p < 0.001) in high sUA level. After adjustment for confounders, sUA in the high level also showed significant and negative association with eGFR (r = −0.22, p < 0.001) and CF-PWV (r = 0.13, p = 0.05). Conclusion: In the elderly, sUA is significantly correlated with renal function and arterial stiffening, especially in the high level.

DETERMINANTS OF RENAL FUNCTIONAL IMPAIRMENT, THE IMPORTANCE OF FASTING PLASMA GLUCOSE CONTROL

Objective: Chronic kidney disease is a global health problem. However, the causes of renal functional impairment in the general elderly population remains unclear. The aim of this study was to investigate the determinants of renal functional impairment, within a framework of cardiovascular (CV) risk assessment in a community-dwelling elderly cohort. Design and method: From June 2014 to August 2015, a total of 912 community-dwelling elderly subjects (aged > = 65 years) from the northern Shanghai were recruited. CV risk factors were assessed, and renal function was evaluated by estimated glomerular filtration rate (e-GFR) at baseline and during 2-year follow-up. Rapid decline in e-GFR was defined as an e-GFR slope (decline in e-GFR) > 5 ml/min per 1.73 m2 per year. Results: The average decline in e-GFR was 0.104 ml/min/1.73m2 per year, while the increasing risk of having rapid decline in e-GFR was 1.25-fold every additional year. Decline in e-GFR was significantly different between diabetics and non-diabetics (p = 0.03). In full adjustment model, decline in e-GFR (p = 0.03) and rapid decline in e-GFR (OR 1.37, CI 1.07–1.75) were both significantly associated with fasting plasma glucose. Similar result of the association of rapid decline in e-GFR with fasting plasma glucose was obtained in the diabetes (full adjustment, OR 1.57, CI 1.05–2.34). Conclusions: In the community-dwelling elderly Chinese, the average decline in e-GFR was 0.104 ml/min/1.73m2 per year, and renal functional impairment was significantly associated with hyperglycemia in the old Chinese.

The prevalence of central hypertension defined by a central blood pressure type I device and its association with target organ damage in the community-dwelling elderly Chinese: The Northern Shanghai Study

We aimed to investigate the prevalence of central hypertension and its association with target organ damage (TOD). 1983 community-dwelling elderly Chinese people were recruited for this analysis. Brachial and central blood pressure (BP) were measured by an oscillometric device and SphygmoCor (type I device), respectively. Brachial hypertension was defined by brachial systolic BP/diastolic BP ≥140/90 mmHg or using antihypertensive medications. Central hypertension was defined by central systolic BP/diastolic BP ≥130/90 mmHg or using antihypertensive medications. TOD included left ventricular hypertrophy and diastolic dysfunction, carotid-femoral pulse wave velocity, and urinary albumin-creatinine ratio. In this cohort, there were 563 (28.4%) brachial and central consistent normotension, 46 (2.3%) isolated brachial hypertension, 27 (1.4%) isolated central hypertension, and 1347 (67.9%) brachial and central combined hypertension (BCCH). In analysis of variance, BCCH showed significantly higher levels in all TOD than brachial and central consistent normotension. In multiple logistic regression, all TOD were significantly associated with BCCH (left ventricular hypertrophy: adjusted odds ratios [95% confidence interval] = 2.03 [1.55, 2.68]; left ventricular diastolic dysfunction: 2.29 [1.53, 3.43]; carotid-femoral pulse wave velocity >10 m/s: 3.41 [2.55, 4.58]; urinary albumin-creatinine ratio >30 mg/g: 1.97 [1.58, 2.44]), rather than isolated brachial hypertension or isolated central hypertension. In conclusion, central hypertension was prevalent (69.3%) in this elderly cohort. BCCH was independently and significantly associated with cardiac, arterial, and renal damage. This finding implies that both brachial and central BPs need to be considered for managing hypertension.

PP.19.18] ASSOCIATION OF ARTERIOSCLEROSIS AND/OR ATHEROSCLEROSIS WITH HYPERTENSIVE TARGET ORGAN DAMAGES IN THE COMMUNITY-DWELLING ELDERLY CHINESE

Objective: Cardiovascular events and mortality are tightly associated with vascular abnormalities. There are two types of modifications in vascular structure, namely arteriosclerosis and atherosclerosis, which coexist in many patients with cardiovascular diseases. However, it remains unclear whether their combination may lead to worse status in those patients. We therefore aimed to investigate the association of arteriosclerosis and/or atherosclerosis with hypertensive target organ damages (TODs), within a framework of cardiovascular risk assessment in a community-dwelling elderly cohort. Design and method: From June 2014 to August 2015, a total of 1599 community- dwelling elderly subjects (age >65 years old) located in the northern Shanghai were recruited. Vascular measurements, such as carotid-femoral pulse wave velocity (cf-PWV), ankle-brachial index (ABI) and carotid plaque, were conducted on each participant, and arteriosclerosis was defined as cf-PWV > 12 m/s, while atherosclerosis was defined as with carotid plaque or ABI < 0.9. Within the framework of comprehensive cardiovascular examinations, risk factors were assessed, and asymptomatic TODs were evaluated by measuring participants’ left ventricular mass index (LVMI), peak transmitral pulsed Doppler velocity / early diastolic tissue Doppler velocity (E/Ea), urinary albumine-creatinine rate (UACR), evaluate glomerular filtration rate (eGFR). Results: Age, body mass index, smoking status, systolic blood pressure and fasting plasma glucose were significantly different among participants with or without arteriosclerosis and/or atherosclerosis (p < 0.02). Although LVMI, E/Ea and eGFR were significantly different among subjects with or without arteriosclerosis and/or atherosclerosis (P for trend < 0.02), in full adjustment model, only E/Ea significantly differed among subjects with or without arteriosclerosis and/or atherosclerosis (P for trend = 0.023). Moreover, E/Ea was significantly different between participants with arteriosclerosis or atherosclerosis and those without (P = 0.045), while there was no significant difference between participants with arteriosclerosis and atherosclerosis and those without (P = 0.28). Similar results were obtained in the multivariate logistic regression of left ventricular diastolic dysfunction (LVDD). With similar adjustment, LVDD was significantly associated with atherosclerosis (P = 0.01) but not with arteriosclerosis (P = 0.99). Conclusions: In the community-dwelling elderly Chinese, among hypertensive target organ damages, LVDD was significantly associated with atherosclerosis but not with arteriosclerosis, and their combination does not worsen patients’ LV diastolic function.

EGFRs from Asian-modified CKD-EPI and Chinese-modified CKD-EPI equations were associated better with hypertensive target organ damage in the community-dwelling elderly Chinese: the Northern Shanghai Study.

BackgroundWith increasing age, estimated glomerular filtration rate (eGFR) decline is a frequent manifestation and is strongly associated with other preclinical target organ damage (TOD). In literature, many equations exist in assessing patients’ eGFR. However, these equations were mainly derived and validated in the population from Western countries, which equation should be used for risk stratification in the Chinese population remains unclear, as well as their comparison. Considering that TOD is a good marker for risk stratification in the elderly, in this analysis, we aimed to investigate whether the recent eGFR equations derived from Asian and Chinese are better associated with preclinical TOD than the other equations in elderly Chinese.MethodsA total of 1,599 community-dwelling elderly participants (age >65 years) in northern Shanghai were prospectively recruited from June 2014 to August 2015. Conventional cardiovascular risk factors were assessed, and hypertensive TOD including left ventricular mass index (LVMI), carotid–femoral pulse wave velocity (cf-PWV), carotid intima-media thickness (IMT), ankle–brachial index (ABI) and urine albumin to creatinine ratio (UACR) was evaluated for each participant. Participant’s eGFR was calculated from the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Chinese-abbreviated MDRD (c-aMDRD), Asian-modified CKD-EPI (aCKD-EPI) equation and Chinese-modified CKD-EPI (cCKD-EPI) equation.ResultsIn multivariate regression analysis, only eGFRs from aCKD-EPI were significantly and inversely associated with carotid IMT (P=0.005). In multivariate logistic models, decreased eGFR from all the equations were significantly associated with lower ABI (P<0.001), microalbuminuria (P=0.02 to P<0.001) and increased cf-PWV (P<0.001). Only decreased eGFRs from aCKD-EPI and cCKD-EPI equations were significantly associated with increased IMT (both crude P<0.05). In the receiver operator characteristic (ROC) analysis, only aCKD-EPI and cCKD-EPI equations presented significant associations with all the listed preclinical TODs (P-value from <0.05 to <0.001).ConclusionIn community-dwelling elderly Chinese, eGFRs from aCKD-EPI and cCKD-EPI equations are better associated with preclinical TOD. aCKD-EPI and cCKD-EPI equations should be preferred when making risk assessment.

Association of arteriosclerosis and/or atherosclerosis with hypertensive target organ damage in the community-dwelling elderly Chinese: the Northern Shanghai Study.

ObjectiveVascular abnormality includes two forms, arteriosclerosis (ARS) and atherosclerosis (ATS), which coexist in patients with cardiovascular (CV) diseases. However, whether their combination may lead to a worsening status in those patients remains unclear. We therefore aimed to investigate the association of ARS and/or ATS with hypertensive target organ damage (TOD).MethodsFrom June 2014 to August 2015, a total of 1,599 community-dwelling elderly subjects (aged >65 years) from northern Shanghai were recruited. Vascular measurements, such as carotid–femoral pulse wave velocity (cf-PWV), ankle–brachial index (ABI) and carotid plaque, were conducted on each participant, and ARS was defined as cf-PWV >12 m/s, while ATS was defined as participants who have carotid plaque or ABI <0.9. Within the framework of comprehensive CV examinations, CV risk factors were assessed, and asymptomatic TOD was evaluated by measuring participants’ left ventricular mass index (LVMI), peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea), urinary albumin–creatinine rate (UACR) and estimated glomerular filtration rate (eGFR).ResultsAlthough LVMI, E/Ea and eGFR were significantly different among subjects with or without ARS and/or ATS (P<0.02), in full adjustment model, only E/Ea showed the independent and significant difference (P=0.023). Moreover, E/Ea was significantly different between participants with ARS or ATS and those without ARS or ATS (P=0.045), while there was no significant difference between participants with ARS and ATS and those without ARS or ATS (P=0.28). Similar results were obtained in the multivariate logistic regression of left ventricular diastolic dysfunction (LVDD). With similar adjustment, LVDD was significantly associated with ATS (P=0.01) but not with ARS (P=0.99).ConclusionIn the community-dwelling elderly Chinese, among hypertensive TOD, LVDD was significantly associated with ATS but not with ARS. The proportion of patients with LVDD was not significantly different despite the presence of both ATS and ARS, when compared to patients with ATS alone.

Exploratory serum fatty acid patterns associated with blood pressure in community-dwelling middle-aged and elderly Chinese

BackgroundEpidemiological studies have assessed relationships between circulating levels of fatty acid (FA) and blood pressure (BP), and their results remain controversial. Nevertheless, data are sparse on serum FA as biomarker and BP in China. The aim of the study was to investigate the association between serum FA and BP in Chinese populations.MethodsWe conducted a cross-sectional study nested within a community-based cohort of 2447 Chinese participants aged 35–79 years who completed a baseline assessment between October 2012 and April 2013. Baseline assessment included the collection of fasting blood samples, anthropometric measurements and a personal interview using a validated questionnaire. Serum FA was determined by gas-liquid chromatography. Exploratory factor analyses were employed to identify FA-factor as a reflection of serum FA pattern. A multiple regression model was conducted to estimate adjusted mean of BP with 95 % confidence interval (CI) by tertile groups of the generated FA-factor scores.ResultsHypertensive patients have significantly higher serum 14:0, 16:0, 16:1n-7, 18:3n-6, 20:3n-6 and Δ6-desaturase index (18:3n-6/18:2n-6) as well as lower 18:2n-6, 22:6n-3 and Δ5-desaturase index (20:4n-6/20:3n-6) compared with normotensive participants. Factor 1 (low linoleic acid/high saturated FA pattern: 14:0, 16:0, 16:1n-7, 18:2n-6, 18:3n-6, 20:3n-6) and Factor 2 (n-3 PUFA pattern: 20:5n-3, 22:5n-3, 22:6n-3, 18:1n-9) were identified as indicators of the serum FA pattern. After adjustment for age, gender, body mass index, hypertension treatment, smoking, alcohol intake, education, profession, exercise habit, salt intake, family history of hypertension, heart rate, blood lipids and fasting blood-glucose levels, per a standard deviation (SD) increment of Factor 1 scores was associated with an increment of 2.44 (95 % CI: 1.73, 3.15) mm Hg for systolic BP, whereas per a SD increment of Factor 2 scores was associated with a reduction of 1.40 (95 % CI: 0.80, 2.04) mm Hg for diastolic BP.ConclusionsThe serum FA pattern characterized by low proportions of 14:0, 16:0, 16:1n-7 and 18:3n-6 as well as high 18:2n-6 and 22:6n-3 was beneficially associated with BP levels in this Chinese population. This evidence well supports the current dietary recommendations in the communities to replace saturated fat with polyunsaturated fat.Electronic supplementary materialThe online version of this article (doi:10.1186/s12944-016-0226-3) contains supplementary material, which is available to authorized users.

Health-promoting lifestyles and depression in urban elderly Chinese.

ObjectiveTo explore health-promoting lifestyles, depression and provide further insight into the relationship between health-promoting lifestyles and depression in an urban community sample of elderly Chinese people.MethodsA cross-sectional descriptive and correlational study of 954 community-dwelling urban elderly Chinese (aged ≥ 60) was conducted from July to December 2010. Lifestyles and depression were assessed using the revised Chinese Version of the Health-Promoting Lifestyle Profile (HPLP-C) and the Geriatric Depression Scale (GDS), respectively.ResultsIn this cohort, 15.8% of elderly urban adults met the criteria for depression. Over half of the sample (62.1%) scored greater than 100 on the HPLP-C, with range of score sum from 55 to 160. There were significant correlations between self-actualization (OR = 1.167, 95%CI: 1.111–1.226), nutrition (OR = 1.118, 95%CI: 1.033–1.209), physical activity (OR = 1.111, 95%CI: 1.015–1.216) and depression among community-dwelling elderly Chinese.LimitationsThis was a cross-sectional study. The significant associations found do not represent directional causation. Further longitudinal follow-up is recommended to investigate the specific causal relationship between lifestyles and depression.ConclusionsDepression was common with medium to high levels of health-promoting lifestyles among urban elderly Chinese people. Lifestyle behaviors such as self-actualization, good nutrition habits and frequent physical activity were correlated to fewer depressive symptoms. Healthy lifestyles should be further developed in this population and measures should be taken for improving their depression.

Physical activity and cognitive function of community Chinese elderly in Hong Kong (HK) and Guangzhou (GZ).

Some studies demonstrated that physical activity may have beneficial effect on cognitive function. The objective of the study was to estimate the association between physical activity and cognitive function in community-dwelling elderly Chinese in Hong Kong (HK) and Guangzhou (GZ). In the neighborhood of HK and GZ, a convenience sample of 557 (260 in HK and 297 in GZ) older persons without dementia aged over 60 years (73.4 ± 6.5) was recruited. Physical activity was measured using a checklist. Information on physical activity participation, cognitive function, and other variables were collected. Multivariate linear regression analyses were performed to evaluate the association between physical activity and cognitive function. Total number of physical activities showed significant association with the delayed recall test (p 0.05) CONCLUSION: Physical activity may not be associated with better cognitive function among elderly Chinese independently of other factors.