Population-based Study Of Older Men Research Articles

A 13-Year Time-Lagged Description of General Cognitive and Functional Abilities in Older Men: A Cross-Lagged Panel Model.

Objectives: The purpose of this study was to evaluate a cross-lagged panel model of general cognition and functional abilities over 13years. The goal was to determine whether general cognitive abilities predict or precede functional decline versus functional abilities predicting cognitive decline. Methods: The sample included 3508 men (71-93years of age at baseline) of the Kuakini Honolulu-Asia Aging Study who were tested repeatedly using a global cognitive test and an assessment of functional capacity. Education and age served as covariates. Cross-lagged models were tested, assessing stationarity of stability and cross-lags. Results: The overall model fit the data well. Cognitive scores had better stability than functional abilities and predicted functional abilities more strongly than functional abilities predicted cognitive scores over time. The strength of all cross-lags increased over time. Discussion: These longitudinal data show that cognitive scores predicted functional decline in a population-based study of older men.

Social relationships and the risk of incident heart failure: results from a prospective population-based study of older men.

AimsLimited social relationships, particularly in older adults, have been implicated as a risk factor for cardiovascular disease. However, little is known about the associations between poor social relationships and heart failure incidence.Methods and resultsProspective study of socially representative men aged 60–79 years drawn from general practices in 24 British towns and followed up for a maximum of 18 years. A total of 3698 participants with no previous diagnosis of heart failure were included. Information on social relationships was based on a combination of marital status, living circumstances, and social contacts with friends and family. These provided information on contact frequency, contact satisfaction, and a social relationship score (low to high) combining frequency and satisfaction with contact. Heart failure included both incidents non-fatal heart failure and death from heart failure. Among 3698 participants, 330 developed heart failure. Men with low compared to high frequency of contact with family and friends had an increased risk of incident heart failure [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.15–2.18]; this remained statistically significant after adjustment for social class, behavioural, and biological risk factors. Low compared to high scores for satisfaction with contacts was associated with increased risk of heart failure (adjusted HR = 1.54; 95% CI 1.14–2.07). Lower social relationship scores (combining frequency and satisfaction with contact) were associated with greater risk of incident heart failure (adjusted HR = 1.38, 95% CI 1.02–1.87). Marital status and living alone were not significantly associated with heart failure.ConclusionWeaker social relationships appear to increase the risk of developing heart failure in older age. Further research is needed to investigate pathways underlying these associations and to test whether interventions to strengthen social relationships can reduce the risk of heart failure.

The relationship between executive dysfunction and post-stroke mortality: a population-based cohort study

ObjectivesTo study the associations of pre-stroke cognitive performance with mortality after first-ever stroke or transient ischaemic attack (TIA).DesignA prospective cohort study.Setting and participantsIn participants having first-ever stroke or TIA during...

Serum uric acid is associated with bone health in older men: A cross-sectional population-based study

Serum uric acid (UA) is a strong endogenous antioxidant. Since oxidative stress has been linked to osteoporosis, we examined the association between serum UA levels and bone mineral density (BMD), prevalent vertebral and nonvertebral fractures, and laboratory measures such as calcitropic hormones and bone turnover marker levels. This cross-sectional analysis consisted of 1705 community-dwelling men aged 70 years or over who participated in the baseline part of the Concord Health and Ageing in Men Project (CHAMP), a population-based study of older men in Sydney, Australia. BMD at all sites was significantly higher among men with serum UA levels above the group median than among men with UA levels below the median. In multiple regression analyses adjusted for potential confounders, serum UA remained associated with BMD at all sites (β = 0.12 to 0.14, p < .001), serum calcium (β = 0.11, p = .001), parathyroid hormone (β = 0.09, p = .002), 25-hydroxyvitamin D (β = 0.09, p = .005), and was negatively associated with urinary excretion amino-terminal cross-linked telopeptide of type 1 collagen (β = -0.09, p = .006). Overall, serum UA accounted for 1.0% to 1.44% of the variances in BMD (R(2) = 0.10 to 0.22). In multiple logistic regression analyses, above-median serum UA levels were associated with a lower prevalence of osteoporosis at the femoral neck [odds ratio (OR) = 0.42, 95% confidence interval (CI) 0.22-0.81, p = .010) and lumbar spine (OR = 0.44, 95% CI 0.23-0.86, p = .016) and a lower prevalence of vertebral (OR = 0.62, 95% CI 0.43-0.91, p = .015) and nonvertebral (OR = 0.51, 95% CI 0.29-0.89, p = .018) fractures. In conclusion, higher serum UA levels are associated with higher BMD at all skeletal sites and with a lower prevalence of vertebral and nonvertebral fractures in older men.

Does leptin predict incident hypertension in older adults?

Leptin is associated with blood pressure (BP) in experimental and cross-sectional studies, but only one previous prospective study of middle-aged men has reported the association between leptin and incident hypertension. We examined the association of leptin levels with incident hypertension in a population-based study of older men and women. Longitudinal cohort study. Participants were 602 community-dwelling older adults with normal baseline BP levels who attended a research clinic visit between 1984 and 1987 and again 4.4 years later (mean age was 66.2 +/- 11.4; 60.6% were men; mean body mass index (BMI) 24.9 +/- 3.4 kg/m(2)). Hypertension was defined as systolic BP > or =140 mmHg and/or diastolic BP > or =90 mmHg and/or antihypertensive drug treatment. Leptin was measured by radioimmunoassay. After an average 4.4-year follow-up (minimum 2-maximum 7 years), 106 (17.6%) new cases of hypertension were identified. At baseline, participants who developed hypertension were older and had higher systolic BP and higher total cholesterol compared to participants who remained normotensive. Baseline serum leptin levels were higher in participants who developed hypertension compared to persistent normotensives [median (25th-75th range)] [8.8(5-16) vs 7(4-11) ng/ml, P = 0.002]. In logistic regression models, leptin (log-transformed) predicted incident hypertension before and after adjustments for baseline age, BMI, systolic BP, total cholesterol, medications, and previous cardiovascular disease (OR 1.75 95% CI 1.17-2.61, P = 0.006). This association persisted after exclusion of 45 obese participants. Higher leptin levels were independently associated with increased odds of incident hypertension in older adults.

Social Engagement and the Risk of Cardiovascular Disease Mortality: Results of a Prospective Population-Based Study of Older Men

To examine the prospective relation of social engagement with cardiovascular disease (CVD) mortality, taking into account behavioral factors (smoking, physical activity, body weight, and alcohol consumption), socioeconomic factors, and presence of comorbidity and disability. A socioeconomically representative cohort of 5925 men aged 52-74 years from 24 British towns was followed up from 1992-2006. A scale from 0-9 was used based on questions reflecting the frequency and extent of social engagement in 1992. CVD mortality risk decreased with increasing social engagement score-age-adjusted hazard ratio (HR) for those with the highest social engagement score of 8-9 was 0.42 (95% confidence interval [95%CI], 0.32-0.53) compared to those with the lowest scores of 0-3 (p for trend < or = 0.0001). Further adjustment for behavioral factors (smoking, alcohol, physical activity, and body weight), disability, comorbidity, and socioeconomic factors reduced the strength of this association, although strong evidence of an association remained: HR 0.70 (95%CI, 0.53-0.93) for highest versus lowest social engagement scores (p for trend = 0.0004). Although the association appeared somewhat stronger in subjects with preexisting CVD (HR 0.59 for highest vs. lowest social engagement scores) than in those without (HR 0.79), there was no evidence of an interaction between social engagement and preexisting CVD (p = 0.61). In our study of older men, social engagement appeared to have a modest protective effect on CVD mortality independent of behavioral factors, socioeconomic conditions, disease, and disability.

Are social inequalities in mortality in Britain narrowing? Time trends from 1978 to 2005 in a population-based study of older men

Objective:To examine whether social inequalities in all-cause and coronary heart disease (CHD) mortality in Britain have reduced between 1978 and 2005.Design:A prospective study of a socioeconomically representative population.Setting:24 British towns.Participants:7735...

Are childhood socio-economic circumstances related to coronary heart disease risk? Findings from a population-based study of older men

The independent influence of childhood social circumstances on health in later life remains uncertain. We examined the extent to which childhood socio-economic circumstances are related to the risk of coronary heart disease (CHD) in older British men, taking account of adult social class and behavioural risk factors. A socio-economically representative sample of 5552 British men (52-74 years) with retrospective assessment of childhood socio-economic circumstances (father's occupation and childhood household amenities) who were followed up for CHD (fatal and non-fatal) for 12 years. Men whose childhood social class was manual had an increased hazard ratio (HR) 1.34 (95% CI 1.11-1.63)-this effect was diminished when adjusted for adult social class and adult behavioural risk factors (cigarette smoking, alcohol, physical activity and body weight) (HR 1.19; 95% CI 0.97-1.46). Men whose family did not own a car in their childhood were at increased CHD risk even after adjustments for adult social class and behaviours (HR 1.35, 95% CI 1.04-1.75). Men with combined exposure to both childhood and adult manual social class had the highest risk of CHD (HR 1.51; 95% CI 1.19-1.91); this was substantially reduced by adjustment for adult behavioural risk factors (adjusted HR 1.28; 95% CI 0.99-1.65). Less affluent socio-economic conditions in childhood may have a modest persisting influence on risk of CHD in later life.

Survival in relation to angina symptoms and diagnosis among men aged 70–90 years: the Whitehall Study

While the excess mortality associated with a diagnosis of angina, myocardial infarction in middle-aged individuals is well established, there is little available evidence on the natural history of angina in population-based studies of older people. We conducted a 5-year follow-up of 6655 older men aged 67-90 years (mean age 77 years) who participated in the Whitehall Study of London Civil Servants. Survival was examined in relation to a diagnosis of angina or myocardial infarction and to angina symptoms in a population-based study of older men living in the United Kingdom in the late 1990s. Compared with men without a diagnosis of myocardial ischaemia (n=5219), a diagnosis of angina alone (n=617), myocardial infarction alone (n=421) or both (n=398) were associated with about a threefold, fourfold and sixfold higher risk of death from coronary heart disease, respectively. Median expectation of life at age 70 years was reduced by about 2, 5 and 6 years for those with angina, myocardial infarction, or both, respectively. Current symptoms of angina among those without previously diagnosed angina, was associated with a 2-fold higher risk of coronary heart disease mortality than those without either diagnosis or symptoms. Both angina symptoms and diagnosis have a significant adverse effect on survival among men aged 70-90 years highlighting the importance of diagnosis and appropriate treatment of angina in old age.

Relationships of inflammatory and haemostatic markers with social class: Results from a population-based study of older men

Haemostatic and inflammatory markers have been hypothesised to mediate the relationship of social class and cardiovascular disease (CVD). We investigated whether a range of inflammatory/haemostatic markers are associated with social class independent of chronic diseases and behavioural risk factors in a population-based sample of 2682 British men aged 60–79 without a physician diagnosis of CVD, diabetes or musculoskeletal disease requiring anti-inflammatory medications. Men in lower social classes had higher mean levels of C-reactive protein, fibrinogen, interleukin-6, white blood cell count, von Willebrand factor (vWF), factor VIII, activated protein C (APC) resistance, plasma viscosity, fibrin D-dimer and platelet count, compared to higher social class groups; but not of tissue plasminogen activator antigen, haematocrit or activated partial prothrombin time. After adjustment for behavioural risk factors (smoking, alcohol, physical activity and body mass), the associations of social class with vWF, factor VIII, APC resistance, plasma viscosity, and platelet count though weakened, remained statistically significant, while those of other markers were considerably attenuated. In this study of older men without CVD, the social gradient in inflammatory and haemostatic markers was substantially explained by behavioural risk factors. The effect of socio-economic gradient on the factor VIII–vWF complex, APC resistance, plasma viscosity and platelet count merits further study.

Vitamin D status and parathyroid hormone levels in relation to blood pressure: a population‐based study in older men and women

Evidence is accumulating that the vitamin D endocrine system has physiological functions beyond bone health including a role in the regulation of blood pressure. Effects of poor vitamin D status on blood pressure may be mediated by elevated parathyroid hormone (PTH) levels. To evaluate whether serum 25-hydroxyvitamin D [25(OH)D] and PTH levels are independently associated with blood pressure in a population-based study of older men and women. Subjects were participants of the Longitudinal Aging Study Amsterdam, aged 65 years and older. In 1205 participants, serum 25(OH)D and PTH levels were determined and diastolic and systolic blood pressure were measured. Linear and logistic regression analyses were performed with adjustments for age, sex, region, season, lifestyle factors (physical activity, smoking, alcohol intake), and waist circumference. Serum 25(OH)D was not significantly associated with diastolic (beta 0.00, P = 0.98) or systolic (beta 0.06, P = 0.11) blood pressure. In contrast, higher ln-PTH levels were significantly associated with higher diastolic (beta 1.93, P = 0.03) and systolic (beta 4.67, P = 0.01) blood pressure. Higher PTH levels were associated with a substantially higher prevalence of hypertension (OR 2.00, 95% CI 1.31-3.06 for the highest versus the lowest quartile), whereas 25(OH)D showed no significant association (OR 0.89, 95% CI 0.47-1.69 for the lowest versus the highest 25(OH)D category). These results indicate that PTH is a potentially modifiable determinant of blood pressure in the general elderly population. Serum 25(OH)D, however, was not associated with blood pressure, possibly due to the relatively high levels in our population.

Quantitative ultrasound predicts hip and non-spine fracture in men: the MrOS study

Quantitative ultrasound (QUS) is associated with fracture risk in women, but there are few data in men. We studied 5,607 older men and found that QUS predicts hip and any non-spine fracture risk nearly as well as BMD. Combined measurements of QUS and BMD are not superior to either measurement alone. Quantitative ultrasound (QUS) predicts fracture risk among older women, but there are few prospective studies among older men. We studied the ability of QUS and BMD measurements to predict hip and other non-spine fractures in a population-based study of older men. Calcaneal QUS and hip BMD were measured in 5,607 men aged > or =65 years recruited from six US centers. At baseline duplicate QUS measurements with repositioning were obtained, and subsequent hip and other non-spine fractures were documented by review of x-rays or x-ray reports. The relationships between QUS and fractures were examined with proportional hazard models adjusted for age and clinic. We used receiver operating characteristic curves and predicted fracture risk models to determine the utility of QUS alone, BMD alone or the combination of QUS+BMD. During a mean follow-up of 4.2 years with 99% complete follow-up, 239 men suffered a non-spine fracture, including 49 hip fractures. Each standard deviation reduction in broadband ultrasonic attenuation (BUA) was associated with an increased risk of hip (relative hazard=2.0, CI: 1.5, 2.8) and any non-spine fracture (relative hazard=1.6, CI: 1.4, 1.8). The area under the receiver operating characteristic curve and the predicted probability of fracture were similar for BUA alone, BMD alone and the combination of BUA+BMD, indicating that once BUA or BMD is known, the other measurement does not add useful information. Other QUS parameters gave similar results. QUS measurements predict the risk of hip and any non-spine fracture in older men, and do so nearly as well as hip BMD measurements. Combined measurements of QUS and BMD are not superior to either measurement alone.