Coronary Heart Disease In Older Adults Research Articles

Adiponectin and Risk of Coronary Heart Disease in Older Men and Women

Despite established insulin-sensitizing and antiatherogenic preclinical effects, epidemiological investigations of adiponectin have yielded conflicting findings, and its relationship with coronary heart disease (CHD) remains uncertain. Our objective was to investigate the relationship between adiponectin and CHD in older adults. This was a case-control study (n = 1386) nested within the population-based Cardiovascular Health Study from 1992--2001. Controls were frequency-matched to cases by age, sex, race, subclinical cardiovascular disease, and center. Incident CHD was defined as angina pectoris, percutaneous or surgical revascularization, nonfatal myocardial infarction (MI), or CHD death. A more restrictive CHD endpoint was limited to nonfatal MI and CHD death. Adiponectin exhibited significant negative correlations with baseline adiposity, insulin resistance, dyslipidemia, inflammatory markers, and leptin. After controlling for matching factors, adjustment for waist to hip ratio, hypertension, smoking, alcohol, low-density lipoprotein cholesterol, creatinine, and leptin revealed a modestly increased risk of incident CHD with adiponectin concentrations at the upper end [odds ratio = 1.37 (quintile 5 vs. 1-4), 95% confidence interval 1.02-1.84]. This association was stronger when the outcome was limited to nonfatal MI and fatal CHD (odds ratio = 1.69, 95% confidence interval 1.23-2.32). The findings were not influenced by additional adjustment for weight change, health status, or cystatin C, nor were they abolished by adjustment for potential mediators. This study shows an association between adiponectin and increased risk of first-ever CHD in older adults. Further research is needed to elucidate the basis for the concurrent beneficial and detrimental aspects of this relationship, and under what circumstances one or the other may predominate.

Lifetime Major Depression is Associated With Coronary Heart Disease in Older Adults: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

To examine the association between mood and anxiety disorders and coronary heart disease (CHD) in a nationally representative sample of older adults. Data from the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed with 10,573 adults aged > or = 60 years surveyed. A total of 13.30% of older adults reported diagnoses of CHD. Age (odds ratio (OR) = 1.04), morbid obesity (OR = 1.60), hypertension (OR = 2.29), lifetime nicotine dependence (OR = 1.41), and lifetime drug use disorders (OR = 2.19) were all significantly related to CHD. Being female (OR = 0.73) relative to male and a lifetime social drinker (OR = 0.71) compared with alcohol abstainers decreased the odds of CHD. After controlling for these characteristics, the presence of a lifetime major depressive episode was significantly associated with increased risk of CHD (OR = 2.05), but the lifetime anxiety disorders assessed were not. The association between lifetime mood disorders and CHD was similar for both genders, and single versus multiple depressive episodes conferred equal risk of CHD. These data demonstrate that a lifetime major depressive episode increases the risk of CHD in older adults.

DSM-IV Personality Disorders and Coronary Heart Disease in Older Adults: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

We evaluated the relationship between seven personality disorders listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders and coronary heart disease (CHD) in a nationally representative sample of U.S. older adults. We analyzed data on 10,573 adults aged 60 or older from the National Epidemiologic Survey on Alcohol and Related Conditions. In our results, we found that 13.30% of older adults reported a diagnosis of CHD confirmed by a health professional. Age (odds ratio or OR = 1.04), morbid obesity (OR = 1.59), hypertension (OR = 2.30), nicotine dependence (OR = 1.39), any drug use disorder (OR = 2.13), and any mood disorder (OR = 1.87) increased the odds of having CHD. Female gender (OR = 0.72) and social drinking (OR = 0.71) decreased the odds of having CHD. Controlling for these variables, we found that avoidant (OR = 1.80), schizoid (OR = 1.63), and obsessive-compulsive (OR = 1.37) personality disorders increased the odds of having CHD. Personality disorders may increase the risk of CHD in older adults. Putative mechanisms and directions for future research are proposed.

Physical activity and coronary heart disease in older adults. A systematic review of epidemiological studies.

While there is good evidence to suggest an inverse relation of physical activity and cardiorespiratory fitness with coronary heart disease (CHD) in middle-aged men and women, much less is known about this association in older adults. The purpose of this paper was to explore the relation of physical activity and cardiorespiratory fitness with CHD in older adults by reviewing relevant studies. Publications were identified in two ways: i) conducting a PUBMED search from its inception in 1966 until January 2001; and ii) scrutinizing the reference sections of identified papers. Ten studies relating physical activity and two relating cardiorespiratory fitness in older people to CHD met the inclusion criteria. With one exception, the studies were observational in nature and the majority of these were of prospective cohort design. Most studies featured men only. Of the eleven studies that presented data on older men, eight reported an inverse relation between physical activity or cardiorespiratory fitness and CHD, and statistical significance was seen in five of these. There were too few data on older women to draw clear conclusions regarding the association in this group. This review suggests that, in older adult men, physical activity and cardiorespiratory fitness are inversely related to CHD risk. This association is unlikely to be attributable to reverse causality or confounding. Except where such advice is contraindicated, older adult men may benefit from physical activity in terms of reduced CHD risk.