Risk Factors In Middle Age Research Articles

Review on Alzheimers Disease

Abstract: Loss of Abstract Thinking Someone with Alzheimer’s disease may lose the ability to draw conclusions and solve problems. It may become difficult to balance a checkbook, for example, because the patient has forgotten what to do with the numbers. About 29.8 million people worldwide had been diagnosed with Alzheimer’s disease (AD) in 2015, And the number is projected to triple by 2050. In 2018, AD was the fifth leading cause of death in Americans with 65 years of age or older, but the progress of AD drug research is very limited. It is Helpful to identify the key factors and research trends of AD for guiding further more effective Studies. Alzheimer’s disease is a degenerative disease of the brain, the most common cause of dementia in the geriatric population, and a major cause of death. Alzheimer’s disease is one of the fastest growing risk factors in middle age, which Increases the risk of Alzheimer’s disease in coronary weddings and higher levels of Homocysteine, which can lead to withdrawal due to lifestyle changes. Cigarettes prevent Alzheimer’s disease by recalling memories. Also, despite the fact that there is no Definitive cure for Alzheimer’s, the ability to increase acetylcholine levels and reduce Ameloid beta deposition and your medications such as Donepezil has proven to be very Effective when treating Alzheimer’s disease (AD) is a progressive neurodegenerative disease. It Is characterized by progressive cognitive deterioration together with Declining activities of daily living and behavioral changes. It is the Most common type of pre-senile and senile dementia. Alzheimer disease (AD) is a heterogeneous disease with a complex pathobiology. The presence Extracellular b-amyloid deposition as neuritic plaques and intracellular accumulation of hyperphos . Phorylated tau as neurofibrillary tangles remains the primary neuropathologic criteria for AD diagnosis. However, a number of recent fundamental discoveries highlight important pathological roles For other critical cellular and molecular processes. Despite this, no disease-modifying treatment Currently exists, and numerous phase 3 clinical trials have failed to demonstrate benefits. Here ,We review recent advances in our understanding of AD pathobiology and discuss current treatment Strategies, highlighting recent clinical trials and opportunities for developing future disease modifying therapies.

Cardiovascular health metrics from mid‐ to late‐life and risk of dementia: A population‐based study

AbstractBackgroundCardiometabolic risk factors in middle age have been associated with late‐life risk of dementia. The associations of cardiovascular health (CVH) metrics in midlife and old age with late‐life risk of dementia need to be clarified in cohort studies. We sought to examine the associations of CVH metrics from mid‐ to late‐life with risk of incident dementia in late‐life.MethodThis population‐based cohort study used data from the Finnish Cardiovascular Risk Factors, Aging and Dementia study. A total of 1449 participants were followed from midlife (1972 to 1987, mean baseline age 50.4 years) to late‐life (1998 to 2005‐2009, mean baseline age 70.2 years, N=744). We defined six CVH metrics (smoking, blood pressure, physical activity, body mass index, fasting plasma glucose, and serum total cholesterol) following the modified American Heart Association’s recommendations. Dementia diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria. Data were analysed with Cox regression models.ResultDuring the follow‐up examinations, dementia was diagnosed in 61 persons in 1998 and additional 47 persons during 2005 to 2008. The incidence of dementia (per 1000 person‐years) was 7.27, 3.76, and 2.00 for those with poor (score ≤5), intermediate (6‐7), and ideal (≥8) levels of CVH metrics in midlife, respectively. Compared with people with poor CVH metrics, those with ideal CVH metrics in midlife had a 48% lower risk of dementia in late‐life (fully‐adjusted hazard ratios, 0.52; 95% CI, 0.20‐0.92). The incidence rate of dementia (per 1000 person‐years) was 9.5, 5.5, and 8.7 for those with poor, intermediate, and ideal levels of CVH metrics in late‐life, respectively. No significant association was found between late‐life CVH metrics and risk of dementia. Compared with poor CVH metrics in both midlife and late‐life, the fully‐adjusted hazard ratio of dementia was 0.24 (95% CI, 0.06‐0.94) for having intermediate or ideal CVH metrics in either midlife or late‐life and 0.29 (0.10‐0.86) for intermediate or ideal CVH metrics in both midlife and late‐life.ConclusionHaving an intermediate or ideal level of CVH metrics in either midlife or late‐life is associated with a decreased risk of dementia.

Self-Reported Diet Quality Differentiates Nutrient Intake, Blood Nutrient Status, Mood, and Cognition: Implications for Identifying Nutritional Neurocognitive Risk Factors in Middle Age.

Evidence for diet quality representing a modifiable risk factor for age-related cognitive decline and mood disturbances has typically come from retrospective, cross-sectional analyses. Here a diet screening tool (DST) was used to categorize healthy middle-aged volunteers (n = 141, 40–65 years) into “optimal” or “sub-optimal” diet groups to investigate cross-sectional associations between diet quality, cognitive function, and mood. The DST distinguished levels of nutrient intake as assessed by Automated Self-Administered 24-h dietary recall and nutrient status, as assessed by blood biomarker measures. Compared with the “sub-optimal” group, the “optimal” diet group showed significantly higher intake of vitamin E (p = 0.007), magnesium (p = 0.001), zinc (p = 0.043) and fiber (p = 0.015), higher circulating levels of vitamin B6 (p = 0.030) and red blood cell folate (p = 0.026) and lower saturated fatty acids (p = 0.012). Regarding psychological outcomes, the “optimal” diet group had significantly better Stroop processing than those with a “sub-optimal” diet (p = 0.013). Regression analysis revealed that higher DST scores were associated with fewer mood disturbances (p = 0.002) and lower perceived stress (p = 0.031), although these differences were not significant when comparing “optimal” versus “sub-optimal” as discrete groups. This study demonstrates the potential of a 20-item diet screen to identify both nutritional and psychological status in an Australian setting.

Medicine in small doses.

Stroke – now a disorder of middle age – so act FAST It is now just on 8 years since I sustained my stroke in May 2010, at the age of 61 years. I was due to fly out to the United States the following morning, when I was bending down in the floor of my car when it happened. First my right hand would not respond and then my right leg would not support my weight. I tried to call out to my wife, but could only grunt. I crawled to the front door and my intensivist wife called 000 and the ambulance was there in 3 min. The paramedics recognized the four classic signs incorporated in the acronym FAST. This acronym was developed in the UK in 1998 by a group of stroke physicians, ambulance personnel and an emergency room physician, and was designed to be an integral part of a training package for ambulance staff (Harbison et al. Stroke 2003; 34: 71–6), and is now used throughout the world including Australia and New Zealand. The acronym stands for: F Facial drooping. A section of the face, usually on one side that is drooping and hard to move. This can be recognized by a crooked smile. A Arm weakness: the inability to raise one’s arms fully. S Speech difficulties and inability or difficulty understanding or producing speech. T Time. If any of these symptoms are showing, time is of the essence and the importance of calling emergency services or go straight to hospital. The other message from the FAST campaign is not only time, but also the importance of education of the public to the recognition of the early signs of stroke. Mine was a ‘stroke of luck’, as I was taken by ambulance to a metropolitan hospital with a stroke unit, received thrombolysis and made an excellent recovery. The cause of my stroke was a patent foramen ovale and probably, therefore, a paradoxical embolus caused by my bending down in the car, with a Valsalva effect (Waxman. MJA 2010; 193: 468). My experience with a rapid hospital assessment and early intervention with thrombolysis after sustaining an acute ischaemic stroke with full recovery emphasizes that time is critical. In February 2018, Public Health England released new estimates of the incidence of first stroke in England, and relaunched its FAST campaign (https://www.gov.uk/government/news/new-figures-show-larger-proportion-of-strokes-in-the-middle-aged). The new estimates show that about 57 000 new strokes and 32 000 stroke-related deaths occur every year in England. Of those who have experienced a stroke, about one-quarter leave hospital with moderate or severe disability. While overall stroke incidence increases with age, 38.2% of all strokes are now in the 40–60-year age group, compared with 33% in 2007. Stroke is increasingly becoming a more common problem for the middle-aged individuals. Many middle-aged individuals might not be aware that they may have important risk factors, including hypertension and atrial fibrillation, or, as in my case, an unrecognized patent foramen ovale. The other important risk factors in middle age include obesity, alcohol use and physical inactivity. Treatment and prevention of risk factors for stroke are equally crucial and need to be acted upon fast, or else the stroke burden will shift further to younger age groups (Lancet 2018; 391: 514). The Stroke Foundation in Australia released their updated clinical guidelines for stroke management in 2017, using the best available evidence, updating and superseding those for 2010, and where approved by the National Health and Medical Research Council on 25 July 2017 (https://informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Management-2017). These guidelines provide a series of recommendations to assist decision-making in the management of stroke and transient ischaemic attacks in adults. Telemedicine is also having an impact for patients who may not necessarily be close to a metropolitan stroke unit. The implementation of the Victorian Stroke Telemedicine (VST) programme across rural centres in Victoria has had a significant impact on the early treatment of patients with stroke symptoms with a telemedicine link to a consultant neurologist from emergency departments throughout rural Victoria (www.vst.org.au). In the initial 12-month implementation of VST, 62 patients arrived within 4.5 h with stroke thrombolysis use increased from 17% to 26% and more patients who received thrombolysis were discharged to home or rehabilitation with significant fewer transfers to other acute care services (Bladin et al. Intern. Med. J. 2015; 45: 951–6). The programme now services 16 regional hospitals and to date, 3000 consultations have been provided. So, what is my take-home message? Consider lifestyle changes to reduce your chances of stroke, and be aware that stroke may affect individuals of any age, particularly those in middle age and some at the height of their surgical careers and act FAST.

Hypertension, Obesity, Diabetes, and Heart Failure–Free Survival: The Cardiovascular Disease Lifetime Risk Pooling Project

ObjectivesThis study was designed to quantify the relationship between the absence of heart failure risk factors in middle age and incident heart failure, heart failure-free survival, and overall survival. BackgroundQuantification of years lived free from heart failure in the context of risk factor burden in mid-life may improve risk communication and prevention efforts. MethodsWe conducted a pooled, individual-level analysis sampling from communities across the United States as part of 4 cohort studies: the Framingham Heart, Framingham Offspring, Chicago Heart Association Detection Project in Industry, and ARIC (Atherosclerosis Risk In Communities) studies. Participants with and without hypertension (blood pressure ≥140/90 mm Hg or treatment), obesity (body mass index ≥30 kg/m2), or diabetes (fasting glucose ≥126 mg/dl or treatment), and combinations of these factors, at index ages of 45 years and 55 years through 95 years. Competing risk-adjusted Cox models, a modified Kaplan-Meier estimator, and Irwin’s restricted mean were used to estimate the association between the absence of risk factors at mid-life and incident heart failure, heart failure-free survival, and overall survival. ResultsFor participants at age 45 years, over 516,537 person-years of follow-up, 1,677 incident heart failure events occurred. Men and women with no risk factors, compared to those with all 3, had 73% to 85% lower risks of incident heart failure. Men and women without hypertension, obesity, or diabetes at age 45 years lived on average 34.7 years and 38.0 years without incident heart failure, and they lived on average an additional 3 years to 15 years longer free of heart failure than those with 1, 2, or 3 risk factors. Similar trends were seen when stratified by race and at index age 55 years. ConclusionsPrevention of hypertension, obesity, and diabetes by ages 45 years and 55 years may substantially prolong heart failure-free survival, decrease heart failure-related morbidity, and reduce the public health impact of heart failure.

Gout in Older Adults: The Atherosclerosis Risk in Communities Study.

It is unclear whether traditional and genetic risk factors in middle age predict the onset of gout in older age. We studied the incidence of gout in older adults using the Atherosclerosis Risk in Communities study, a prospective U.S. population-based cohort of middle-aged adults enrolled between 1987 and 1989 with ongoing follow-up. A genetic urate score was formed from common urate-associated single nucleotide polymorphisms for eight genes. The adjusted hazard ratio and 95% confidence interval of incident gout by traditional and genetic risk factors in middle age were estimated using a Cox proportional hazards model. The cumulative incidence from middle age to age 65 was 8.6% in men and 2.5% in women; by age 75 the cumulative incidence was 11.8% and 5.0%. In middle age, increased adiposity, beer intake, protein intake, smoking status, hypertension, diuretic use, and kidney function (but not sex) were associated with an increased gout risk in older age. In addition, a 100 µmol/L increase in genetic urate score was associated with a 3.29-fold (95% confidence interval: 1.63-6.63) increased gout risk in older age. These findings suggest that traditional and genetic risk factors in middle age may be useful for identifying those at risk of gout in older age.

Anthropometric measurements in childhood and prediction of cardiovascular risk factors in adulthood: Kaunas cardiovascular risk cohort study.

BackgroundThis study aimed to examine the associations between anthropometric measurements in childhood and adulthood as well as the effect of childhood body mass index (BMI) and skinfold thickness in the prediction of adult cardiovascular risk factors.MethodsThe Study subjects were participants of the Kaunas Cardiovascular Risk Cohort study. They were 12–13 years old at the time of the baseline survey (1977) and 48–49 years old in the 35-year follow-up survey (2012, n = 506). In childhood, height, weight, subscapular and triceps skinfold thickness measurements were taken. In 2012, health examination involved measurements of blood pressure (BP), BMI, waist circumference, glucose, lipids, and high-sensitivity C-reactive protein (CRP) levels. Logistic regression models were fitted to assess the associations of childhood BMI and skinfold thicknesses as well as BMI gain with cardiovascular risk factors in middle age. All logistic regression models were adjusted for sex, physical activity level, alcohol consumption, smoking and family history of obesity.ResultsOver 35 years of follow-up, BMI gain was greater in men than in women. Anthropometric measurements in childhood significantly correlated with values measured in adulthood. The highest correlation coefficients were defined for weight and BMI measurements (in girls r = 0.56 and r = 0.51 respectively; in boys r = 0.45 and r = 0.41 respectively, P < 0.001). Mean values of change in BMI were similar in all quintiles of childhood BMI; however, prevalence of adult obesity increased considerably with increasing quintiles. The risk of adult obesity, metabolic syndrome, hyperglycaemia or type 2 diabetes, and elevated level of high-sensitivity CRP increased with a rise in childhood BMI and skinfold thicknesses, irrespectively of BMI gain from childhood to adulthood. No relationship was found between childhood anthropometric measurements and arterial hypertension, raised level of triglycerides or reduced level of HDL cholesterol. Gain in BMI from childhood to adulthood was associated with increased odds of all above-mentioned risk factors independently of childhood BMI.ConclusionsRisk of metabolic syndrome, hyperglycaemia and diabetes, and elevated high-sensitivity CRP may be affected by childhood BMI and skinfold thickness, while risk of hypertension, raised triglycerides and reduced HDL cholesterol is associated more strongly with BMI gain from childhood to adulthood.

Predicting the risk of physical disability in old age using modifiable mid-life risk factors

BackgroundWe aimed to investigate the relationship between potentially modifiable risk factors in middle age and disability after 13 years using the Framingham Offspring Study (FOS). We further aimed to develop...

Abstract P341: Associations between Middle-age Risk Factors and Risk of Asymptomatic Abdominal Aortic Aneurysm: the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Abdominal aortic aneurysm (AAA) is an important cardiovascular disease in older adults and rupture of an AAA is associated with high mortality. Although traditional cardiovascular risk factors have been associated with the risk of AAA, their importance in the etiology of AAA is not well established, partly due to limited data for asymptomatic AAA from large prospective studies with a long follow up. The objective of this study was to prospectively assess the association between mid-life atherosclerotic disease risk factors and later-life asymptomatic AAA in the ARIC Study, a large, community-based cohort. Methods: Risk factors were measured at baseline, at 45-64 years of age, in 1987-1989. Abdominal aortic ultrasound was conducted in 2011-2013. Ultrasound images with maximal infrarenal abdominal aortic diameter (IAD) ≥ 28 mm were over-read by radiologists. Diagnosis of asymptomatic AAA was made in the over-reading based on IAD ≥ 30 mm. Participants who had a history of repair for abdominal aorta or were identified as clinical AAAs via previous hospital discharge diagnoses were excluded. Multivariable logistic regression models were used to estimate the association of baseline risk factors with AAA risk. Results: A total of 113 asymptomatic AAAs were ascertained in 5,904 participants (78% whites) who had an abdominal ultrasound exam (prevalence=1.9%). Age, male gender, white race, smoking, height, total, HDL, and LDL cholesterols, triglycerides, white blood cell count, and fibrinogen were risk factors for asymptomatic AAA (Table). BMI, diabetes, alcohol consumption, hypertension, and peripheral artery disease were not associated with AAA. In multivariable adjustment that included the significant risk factors, age, smoking, height, LDL or total cholesterol, white blood cell count, and fibrinogen remained independently associated with AAA risk (p&lt;0.05). Conclusions: Several lifestyle and clinical variables measured in middle-age were associated with risk of asymptomatic AAA during a long follow up.

Abstract 032: Associations between Middle-age Risk Factors and Future Risk of Abdominal Aortic Aneurysm: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Abdominal aortic aneurysm (AAA) is an important manifestation of vascular disease in older age and rupture of an AAA is a life threatening condition. Traditional atherosclerotic disease risk factors, particularly male sex, smoking and hypertension, are known to contribute to the etiology of AAA. However, epidemiologic studies of AAA have often been cross-sectional, and few have employed a prospective cohort design, especially with long follow-up. The objective of this study was to prospectively assess the association between atherosclerotic disease risk factors and hospitalized AAA in 15,722 participants (68% whites) of the ARIC study, a large, community-based cohort. Methods: Risk factors were measured at baseline at 45-64 year of age. Clinical AAAs were ascertained through hospital discharge diagnoses or death certificates. Over 15 years of follow-up, a total of 265 AAAs (85.3% whites) were identified, including repair procedures, AAA rupture or dissection, and incidental detection. Multivariable Cox proportional hazard models were used to estimate the association of risk factors with the risk of future AAA. Results: Consistent with the literature from prospective studies, we identified age, male gender, white race, smoking, height, total and HDL cholesterols, triglycerides, white blood cell count, and hypertension as risk factors for AAA (Table). In addition, LDL-C, fibrinogen, and peripheral artery disease that were previously reported only in cross-sectional case-control studies were also strongly associated with AAA (Table). Body mass index, diabetes, and alcohol consumption were not associated with AAA occurrence. Conclusions: Several lifestyle and clinical variables measured in middle-age were strong risk factors for future AAA during a long follow-up.

Lifetime Risk and Years Lived Free of Total Cardiovascular Disease

Estimates of lifetime risk for total cardiovascular disease (CVD) may provide projections of the future population burden of CVD and may assist in clinician-patient risk communication. To date, no lifetime risk estimates of total CVD have been reported. To calculate lifetime risk estimates of total CVD by index age (45, 55, 65, 75 years) and risk factor strata and to estimate years lived free of CVD across risk factor strata. Pooled survival analysis of as many as 905,115 person-years of data from 1964 through 2008 from 5 National Heart, Lung, and Blood Institute-funded community-based cohorts: Framingham Heart Study, Framingham Offspring Study, Atherosclerosis Risk in Communities Study, Chicago Heart Association Detection Project in Industry Study, and Cardiovascular Health Study. All participants were free of CVD at baseline with risk factor data (blood pressure [BP], total cholesterol [TC], diabetes, and smoking status) and total CVD outcome data. Any total CVD event (including fatal and nonfatal coronary heart disease, all forms of stroke, congestive heart failure, and other CVD deaths). At an index age of 45 years, overall lifetime risk for total CVD was 60.3% (95% CI, 59.3%-61.2%) for men and 55.6% (95% CI, 54.5%-56.7%) for women. Men had higher lifetime risk estimates than women across all index ages. At index ages 55 and 65 years, men and women with at least 1 elevated risk factor (BP, 140-149/90-99 mm Hg; or TC, 200-239 mg/dL; but no diabetes or smoking), 1 major risk factor, or at least 2 major risk factors (BP, ≥160/100 mm Hg or receiving treatment; TC, ≥240 mg/dL or receiving treatment; diabetes mellitus; or current smoking) had lifetime risk estimates to age 95 years that exceeded 50%. Despite an optimal risk factor profile (BP, <120/80 mm Hg; TC, <180 mg/dL; and no smoking or diabetes), men and women at the index age of 55 years had lifetime risks (through 85 years of age) for total CVD of greater than 40% and 30%, respectively. Compared with participants with at least 2 major risk factors, those with an optimal risk factor profile lived up to 14 years longer free of total CVD. Lifetime risk estimates for total CVD were high (>30%) for all individuals, even those with optimal risk factors in middle age. However, maintenance of optimal risk factor levels in middle age was associated with substantially longer morbidity-free survival.

Abstract A90: The attribution of lifestyle related risk factors in middle age on breast cancer incidence in The Netherlands: Preliminary results

Abstract Background: Breast cancer, especially postmenopausal, is one of the most common cancers in Western women. Although therapeutic options have improved, there still is a high mortality rate. Several of the known risk factors for breast cancer are lifestyle related and modifiable, providing an opportunity for primary prevention. Middle-aged women still have the chance to modify these factors to lower nearby breast cancer risk. We estimated the fraction of postmenopausal breast cancer cases that is attributable to lifestyle factors as currently present in middle-aged Dutch women. Methods: We estimated population attributable fractions (PAFs) of five potentially modifiable risk factors for Dutch women aged 45-54 years. Risk factors included overweight and obesity, alcohol use, physical inactivity, current use of hormone replacement therapy (HRT) and oral contraceptives. We based relative risks on literature search including meta-analyses and expert group consensus. Current prevalence rates of the risk factors were derived from several Dutch registration databases and national surveys (2009-2011). Results: Of all 45-54 year old contemporary Dutch women, 46% are estimated to be physically inactive, 43% to be overweight or obese, 42% to drink alcohol, 1% to use HRT and 17% to use contraceptives. These risk factors jointly account for an estimated 20.2% of all future breast cancer cases in these women. Physical inactivity and alcohol use are responsible for the highest population attributable fraction (PAF of 7.0% and 6.8% respectively), followed by overweight and obesity (4.3%), oral contraceptive use (3.4%) and hormone replacement therapy (0.6%). Conclusion: On a population level, lifestyle related factors play an important role in the development of postmenopausal breast cancer. Considering current prevalence rates in the Netherlands, our findings imply that modifiable risk factors present at middle-age are jointly responsible for 1 out of every 5 future breast cancer cases. This is in concordance with other studies in European countries. Our findings thus suggest that incidence rates can be lowered substantially by changing lifestyle habits, even in a woman's later life. Citation Format: WAM van Gemert, SG Elias, RA Bausch-Goldbohm, PA van den Brandt, HG Grooters, E Kampman, LALM Kiemeney, FE van Leeuwen, EM Monninkhof, E De Vries, PHM Peeters. The attribution of lifestyle related risk factors in middle age on breast cancer incidence in The Netherlands: Preliminary results. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A90.

Associations of Pregnancy Complications With Calculated Cardiovascular Disease Risk and Cardiovascular Risk Factors in Middle Age

Background— The nature and contribution of different pregnancy-related complications to future cardiovascular disease (CVD) and its risk factors and the mechanisms underlying these associations remain unclear. Methods and Results— We studied associations of pregnancy diabetes mellitus, hypertensive disorders of pregnancy, preterm delivery, and size for gestational age with calculated 10-year CVD risk (based on the Framingham score) and a wide range of cardiovascular risk factors measured 18 years after pregnancy (mean age at outcome assessment, 48 years) in a prospective cohort of 3416 women. Gestational diabetes mellitus was positively associated with fasting glucose and insulin, even after adjustment for potential confounders, whereas hypertensive disorders of pregnancy were associated with body mass index, waist circumference, blood pressure, lipids, and insulin. Large for gestational age was associated with greater waist circumference and glucose concentrations, whereas small for gestational age and preterm delivery were associated with higher blood pressure. The association with the calculated 10-year CVD risk based on the Framingham prediction score was odds ratio 1.31 (95 confidence interval, 1.11–1.53) for preeclampsia and 1.26 (95 confidence interval, 0.95–1.68) for gestational diabetes mellitus compared with women without preeclampsia and without gestational diabetes mellitus, respectively. Conclusions— Hypertensive disorders of pregnancy and pregnancy diabetes mellitus are independently associated with an increased calculated 10-year CVD risk. Preeclampsia may be the better predictor of future CVD because it was associated with a wider range of cardiovascular risk factors. Our results suggest that pregnancy may be an important opportunity for early identification of women at increased risk of CVD later in life.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Abstract P250: Incidence of Hospitalized Peripheral Arterial Disease and Critical Limb Ischemia: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Lower extremity peripheral arterial disease (PAD) affects between 12% and 20% of Americans over the age of 65. PAD compromises quality of life, contributes a high burden of disability and its related health care costs exceed $4 billion/year, yet this preventable CVD outcome remains understudied. Aims: Assess the incidence of hospitalized PAD, and of the most severe form of PAD, critical limb ischemia (CLI), in middle-aged men and women, and evaluate their risk factors in a bi-ethnic, population-based cohort. We hypothesized that incidence of hospitalized PAD and CLI are higher in African Americans, and that modifiable atherosclerosis risk factors in middle age predict these sequelae of PAD. Methods: We analyzed data from 13,865 participants from the Atherosclerosis Risk in Communities Study aged 45–64 without PAD at baseline (1987–89). Incident PAD and CLI events were identified using ICD-9 codes from active surveillance of all hospitalizations among cohort participants from 1987 through 2008. All estimates are incidence rates per 10,000 person-years; nominal statistical significance was achieved for all baseline characteristic comparisons reported. Results: There were 707 incident hospitalized PAD during a median of 18 years of follow-up (249,570 person-years). The overall age-adjusted incidence of PAD and limb-threatening CLI were 26.0 and 9.6 per 10,000 person-years, respectively. Incidence of hospitalized PAD was higher in African Americans than whites (34.7 vs. 23.2) and in men compared to women (32.4 vs. 26.7). Baseline characteristics associated with age-adjusted incident PAD (per 10,000 person-years) compared to their referent groups were diabetes (91.2 vs. 19.0), history of smoking (33.6 vs. 16.2), hypertension (42.6 vs. 18.6), coronary heart disease (81.4 vs. 24.1), and obesity (41.5 vs. 20.2). Incidence of CLI also was higher among African Americans (21.0 vs. 5.9) and in men (10.5 vs. 8.9 per 10,000 person-years). Baseline characteristics associated with incident CLI were similar to those for PAD. Conclusions: The absolute risk of hospitalized lower extremity PAD in this community-based cohort is of a magnitude similar to that of heart failure and of stroke. As modifiable factors are strongly predictive of the long-term risk of hospitalized PAD and CLI, particularly among African Americans, our results highlight the need for effective risk factor prevention and control.

IQ in late adolescence/early adulthood, risk factors in middle age, and later cancer mortality in men: the Vietnam Experience Study

(i) examine the relation, if any, of pre-morbid IQ scores at 20 years of age with the risk of later cancer mortality; and (ii) explore the role, if any, of potential mediating factors (e.g. smoking, obesity), assessed in middle age, in explaining the IQ-cancer relation. Cohort study of 14, 491 male, Vietnam-era, former US army personnel with IQ test scores at around 20 years of age (1965-71), who participated in a risk factor survey at around age 38 years of age (1985-6), who were then followed up for mortality experience for 15 years. There were 176 cancer deaths during mortality surveillance. We found an inverse association of IQ with later mortality from all cancers combined (age-adjusted HR(per one SD decrease in IQ); 95% confidence interval: 1.27; 1.10, 1.46) and smoking-related malignancies (1.37; 1.14, 1.64). There was some attenuation following control for mediating variables, particularly smoking and income, but the gradients generally held at conventional levels of statistical significance. Higher scores on pre-morbid IQ tests are associated with lower risk of later cancer morality. The strength of the relation was partially mediated by established risk factors.

IQ in late adolescence/early adulthood, risk factors in middle age and later all-cause mortality in men: the Vietnam Experience Study

Objective:To examine the role of potential mediating factors in explaining the IQ–mortality relation.Design, setting and participants:A total of 4316 male former Vietnam-era US army personnel with IQ test results at...

Risk Factor Burden in Middle Age and Lifetime Risks for Cardiovascular and Non-Cardiovascular Death (Chicago Heart Association Detection Project in Industry)

Few data exist regarding the association of risk factor burden in middle age with lifetime risks for cardiovascular disease (CVD) and non-CVD death. In this study, participants in the Chicago Heart Association Detection Project in Industry aged 40 to 59 years in 1967 to 1973 were stratified into 5 groups on the basis of risk factor burden: favorable risk factor profile (untreated blood pressure <or=120/<or=80 mm Hg, total cholesterol <200 mg/dl, nonsmoking, and body mass index <25 kg/m2); 0 elevated but >or=1 unfavorable; or any 1, any 2, or >or=3 elevated (systolic >or=140 mm Hg or diastolic >or=90 mm Hg or treated hypertension; total cholesterol >or=240 mg/dl; current smoking; or body mass index >or=30 kg/m2). Remaining lifetime risks for CVD and non-CVD death were estimated through the age of 85 years. Eight thousand thirty-three men and 6,493 women were followed for 409,987 person-years; 2,582 died of CVD, and 3,955 died of non-CVD causes. A greater risk factor burden was associated with a higher incidence of CVD and non-CVD death. Compared with participants with >or=3 risk factors, those with favorable profiles had substantially lower lifetime risks for CVD death (20.5% vs 35.2% in men, 6.7% vs 31.9% in women) and markedly longer median Kaplan-Meier survival (>35 vs 26 years in men, >35 vs 28 years in women). In conclusion, having favorable risk factors in middle age is associated with a lower lifetime risk for CVD death and markedly longer survival. These results should encourage efforts aimed at preventing the development of risk factors in younger subjects to decrease CVD mortality and promote longevity.

Cardiovascular Risk Factors Predictive for Survival and Morbidity‐Free Survival in the Oldest‐Old Framingham Heart Study Participants

To examine whether midlife cardiovascular risk factors predict survival and survival free of major comorbidities to the age of 85. Prospective community-based cohort study. Framingham Heart Study, Massachusetts. Two thousand five hundred thirty-one individuals (1,422 women) who attended at least two examinations between the ages of 40 and 50. Risk factors were classified at routine examinations performed between the ages of 40 and 50. Stepwise sex-adjusted logistic regression models predicting the outcomes of survival and survival free of morbidity to age 85 were selected from the following risk factors: systolic and diastolic blood pressure, total serum cholesterol, glucose intolerance, cigarette smoking, education, body mass index, physical activity index, pulse pressure, antihypertensive medication, and electrocardiographic left ventricular hypertrophy. More than one-third of the study sample survived to age 85, and 22% of the original study sample survived free of morbidity. Lower midlife blood pressure and total cholesterol levels, absence of glucose intolerance, nonsmoking status, higher educational attainment, and female sex predicted overall and morbidity-free survival. The predicted probability of survival to age 85 fell in the presence of accumulating risk factors: 37% for men with no risk factors to 2% with all five risk factors and 65% for women with no risk factors to 14% with all five risk factors. Lower levels of key cardiovascular risk factors in middle age predicted overall survival and major morbidity-free survival to age 85. Recognizing and modifying these factors may delay, if not prevent, age-related morbidity and mortality.

Vascular dementia.

Vascular dementia (VaD) is a term used to describe a particular constellation of cognitive and functional impairment, and is now generally seen as a subset of the larger syndrome of vascular cognitive impairment (VCI). The latter is seen as cognitive impairment in the face of cerebrovascular disease. VCI can be classified clinically by whether patients meet criteria for dementia, and whether the syndrome is distinct or overlaps with primary neurodegenerative diseases, such as Alzheimer's disease. This clinical classification can be further classified by neuroimaging, with subgroups that show cortical infarction, subcortical infarction and white matter changes, each alone or in combination. Understood in this way, VCI is likely the most common form of cognitive impairment in the population. Attempts to treat VaD had varying degrees of success, but it now appears that many forms of VCI might be preventable, especially with good control of vascular risk factors in middle age.