Factors Correlated with Anticoagulation Choice in Primary Care Patients with Atrial Fibrillation and High Stroke Risk.

BACKGROUND: The available data on anticoagulation therapy in real-world primary care settings for atrial fibrillation (AF) patients at high risk of stroke is limited. OBJECTIVE: To evaluate anticoagulation therapy and elucidate the factors associated with the selection between direct oral anticoagulants (DOACs) and warfarin. DESIGN AND PARTICIPANTS: This is a retrospective cohort study that included patients ≥ 18 years old at a large primary care outpatient group, a network of twenty clinics in the northeast United States between January 4, 2021 - January 4, 2023. MAIN MEASURES: Oral anticoagulation therapy in AF patients with high risk of stroke (CHA2DS2-VASc score of ≥ 2 in men or ≥ 3 in women). KEY RESULTS: Among the 3,118 adult patients with AF and high risk of stroke (median age 77.90, IQR 71.66-84.50 years; male 57.6%), we found that older age (aOR 1.40, p = 0.003), greater BMI (25-29.9: aOR 1.32, p = 0.048; ≥ 30 aOR 1.42, p = 0.010), and taking more than five medications (aOR 2.28, p < 0.001) were more likely to be on an oral anticoagulant. Among those taking an OAC, having Medicare as the sole coverage (aOR 0.53, p = 0.032), male gender (aOR 0.69, p = 0.011), worse renal function (aOR 0.80, p = 0.021), and higher CHA2DS2-VASc score (aOR 0.88, p = 0.024) are more likely to be on warfarin than a DOAC. Patients taking more than five medications daily (6-10 medications: aOR 1.92, p = 0.013; ≥ 16: aOR = 2.10, p = 0.006) were more likely to be on an anticoagulant and may receive a DOAC over warfarin. CONCLUSIONS: AF with high stroke risk adult patients are more likely to be on an oral anticoagulant if they are older, having BMI ≥ 25, or taking more than five medications. Medicare as the sole coverage, male gender, worse renal function, and higher CHA2DS2-VASc scores are factors associated with greater warfarin usage, while patients taking over five daily medications are more likely to be prescribed DOACs.

Differential changes and interactions of autonomic functioning and sleep architecture before and after 50 years of age.

We hypothesize that the time when age-related changes in autonomic functioning and in sleep structure occur are different and that autonomic functioning modulates sleep architecture differently before and after 50 years of age. Sixty-eight healthy subjects (aged 20 to 79 years old, 49 of them women) were enrolled. Correlation analysis revealed that wake after sleep onset, the absolute and relative value of stage 1 (S1; S1%), and relative value of stage 2 (S2) were positively correlated with age; however, sleep efficiency, stage 3 (S3), S3%, and rapid-eye-movement latency (REML) were negatively correlated with age. Significant degenerations of sleep during normal aging were occurred after 50 years of age; however, significant declines of autonomic activity were showed before 50 years of age. Before 50 years of age, vagal function during sleep was negatively correlated with arousal index; however, after 50 years of age, it was positively correlated with S1 and S1%. In addition, sympathetic activity during wake stage was positively related to S2% only after 50 years of age. Our results imply that the age-related changes in autonomic functioning decline promptly as individuals leave the younger part of their adult life span and that age-related changes in sleep slowly develop as individuals enter the older part of their adult life span. Furthermore, while various aspects of sleep architecture are modulated by both the sympathetic and vagal nervous systems during adult life span, the sleep quality is mainly correlated with the sympathetic division after 50 years of age.

Relation of heart rate recovery after exercise to insulin resistance and chronic inflammation in otherwise healthy adolescents and adults: results from the National Health and Nutrition Examination Survey (NHANES) 1999-2004.

OBJECTIVE: Insulin resistance (IR) and chronic inflammation are inversely related to heart rate recovery (HRR), a marker of cardiac autonomic function. Little is known, however, about the joint effects of IR and inflammation on HRR. METHODS: The study sample consisted of 2649 healthy individuals aged 12-49 years with measures of submaximal cardiopulmonary fitness testing from the National Health and Nutrition Examination Survey 1999-2004. HRR 1-min (HRR1) and 2-min (HRR2) after recovery were recorded (bpm). IR was defined if homeostasis model assessment (HOMA-IR) was ≥ 2.73. C-reactive protein (CRP) was quantified by latex-enhanced nephelometry. RESULTS: In the fully adjusted model, participants with IR had attenuated HRR compared to those without (mean HRR1 11.8 vs. 12.7, p = 0.011; mean HRR2 31.2 vs. 33.4, p < 0.001). Mean HRR1 for participants with CRP >0.3 mg/dL, CRP 0.1-0.3 mg/dL, and CRP <0.1 mg/dL were 11.6, 12.0, and 12.8 (p for trend 0.002), respectively. Mean HRR2 in the three corresponding groups were 33.0, 32.5, and 31.8 (p for trend 0.033), respectively. Participants with IR and CRP elevation had slower HRR than those without IR and with normal CRP. The mean HRR1 comparing participants with IR/CRP >0.3 mg/dL to those with no IR/CRP <0.1 mg/dL were 10.5 and 13.1 (p < 0.001), while the mean HRR2 for the same comparison were 29.1 and 33.8 (p < 0.001). HRR (especially HRR2) was inversely correlated with various metabolic risks. CONCLUSIONS: Insulin resistance and CRP levels were inversely associated with HRR in healthy adolescents and adults. Participants with IR and elevated CRP had the worst HRR. Our findings suggest a joint effect of IR and inflammation on cardiac autonomic dysfunction.

Sex differences in the impact of diabetes on the risk of geriatric conditions.

AIM: To examine whether sex differences exist in the relationship between diabetes and geriatric conditions. METHODS: This was a cross-sectional analysis of 2629 community-dwelling older adults, drawn from the 2003 wave of the "Survey of Health and Living Status of the Elderly in Taiwan." Selected geriatric conditions included cognitive impairment, depression, falls and urinary incontinence (UI). Diabetes and comorbid conditions (heart disease, hypertension, chronic lung disease, stroke, hip fracture, arthritis, chronic kidney disease and cancer) were assessed using questionnaires. RESULTS: A greater proportion of older women, compared with men, had cognitive impairment (15.8% vs 7.3%), depression (22.6% vs 10.4%), falls (26.7% vs 16.3%), and UI (20.9% vs 15.1%). After adjustment for basic demographics and comorbid conditions, diabetes was associated with increased risk for cognitive impairment (RR 1.85 [CI 1.12-3.05], P=0.017), depression (RR 2.03 [CI 1.39-2.97], P=0.0003) and falls (RR 1.72 [CI 1.2-2.48], P=0.003), but not UI (RR 1.4 [CI 0.9-2.1], P=0.067) among older women. However, we did not find any associations in men. CONCLUSIONS: Diabetes was associated with excessive risk for geriatric conditions among older women, but not men. The effect of sex differences on the relationship between diabetes and geriatric conditions requires further exploration.

Chronic inflammation, albuminuria, and functional disability in older adults with cardiovascular disease: the National Health and Nutrition Examination Survey, 1999-2008.

OBJECTIVE: Although C-reactive protein (CRP) and albuminuria are well-documented cardiovascular risk markers, the functional implications of these biomarkers and their combination on functional disability and metabolic risks in patients with cardiovascular disease (CVD) are unknown. METHODS: Data were from 1403 adults (≥60 years, mean 73.2 years) with CVD, ascertained by self-reported diagnosis of angina, coronary heart disease, congestive heart failure, myocardial infarction or stroke, in the National Health and Nutrition Examination Survey 1999-2008. Disability in activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), general physical activities (GPA), and lower-extremity mobility (LEM) were obtained from self-reports. The urinary albumin-to-creatinine ratio (UACR) was calculated by dividing the urinary albumin value by the urinary creatinine concentration. CRP levels were quantified by latex-enhanced nephelometry. RESULTS: Inflammation and albuminuria were associated with disability. In the full-adjusted models, odds ratios (ORs) (95% confidence intervals [CIs]) of disability in ADL, LSA, and LEM were 1.60 (1.13-2.28), 1.76 (1.22-2.55) and 2.31 (1.62-3.31), respectively, comparing participants in the highest CRP quartile to the lowest (p values for trend across CRP quartiles<0.01). The corresponding ORs (95% CI) for disability in ADL, IADL, LSA, and LEM were 1.71 (1.20-2.45), 1.72 (1.21-2.45), 1.46 (1.01-2.12) and 2.50 (1.73-3.62), respectively, comparing participants in the highest UACR quartile to the lowest. We found combined association of inflammation and albuminuria with disability and with metabolic risks. Based on medians of both UACR and CRP, subjects with both higher levels of both markers had higher odds of disability and a more unfavorable metabolic profile than those with lower levels. CONCLUSIONS: Elevated levels of CRP and UACR independently correlate with disability among older adults with CVD. There is a combined association of inflammation and albuminuria on multiple domains of disability and metabolic risks, suggesting the presence of elevated UACR may amplify the association of inflammation with disability and with metabolic risk in older adults living with CVD.

Medication adherence among geriatric outpatients prescribed multiple medications.

BACKGROUND: Poor medication adherence (PMA) is associated with higher risks of morbidity, hospitalization, and mortality. Polypharmacy is not only a determinant of PMA but is also associated with many adverse health outcomes. OBJECTIVE: We aimed to determine the prevalence and correlates of PMA in an older population with polypharmacy. METHODS: Baseline data from 193 older adults from the Medication Safety Review Clinic Taiwan Study were analyzed. Patients were either prescribed ≥8 long-term medications or visited ≥3 different physicians between August and October 2007. PMA was defined as taking either <80% or >120% of prescribed amounts of a medication. Patients were classified as no (0%), low level (>0 but <25%), and high level (≥25%) PMA depending on what percentage of entire medication regimen taken reached PMA. RESULTS: Mean (SD) age was 76 (6) years, and mean number of medications was 9 (3), with a mean medication class number of 4 (1). Of the 1713 medications reviewed, 19% had PMA. However, at patient level, 34%, 32%, and 34% of patients were classified as no, low level, and high level PMA, respectively. Correlates varied by levels of PMA. Compared with patients without PMA, higher medication class number and use of alimentary tract, psychotropic, and hematologic agents were associated with both low and high level PMA. History of dizziness was associated with low level PMA, and higher Mini Mental Status Examination score was associated with high level PMA. CONCLUSIONS: To enhance medication adherence in older adults prescribed multiple medications, medication class numbers and certain high-risk medication classes should be taken into account. Physicians should also routinely assess systemic (eg, cognition) or drug-specific characteristics (eg, side effects).

Drug-related problems (DRPs) identified from geriatric medication safety review clinics.

Drug-related problems (DRPs) were identified from baseline data of 193 Medication Safety Review Clinic (MSRC) patients. MSRCs enroll older adults (≥ 65 years) with either (1) prescriptions of ≥ 8 chronic medications (drugs prescribed for ≥ 28 days) or (2) a visit to ≥ 3 different physicians at the two participating hospitals in Taipei, Taiwan from August to October 2007. The Pharmaceutical Care Network Europe (PCNE) Classification Version 5.01 was used to report DRPs. Mean age was 76.2 ± 6.2 years and 53% of participants were male. Participants had, on average, 9.0 ± 2.6 chronic conditions and took 8.9 ± 3.1 chronic medications and 1.7 ± 1.8 dietary supplements. Eighty-seven percent had at least one DRP. Being older, having orthostatic hypotension and taking more chronic medications were associated with higher likelihood of having at least one DRP. For the 1713 medications and 331 diet supplements reviewed, 427 DRPs were found, 490 causes (1.1 ± 0.4 per problem) identified and 1067 interventions proposed (2.5 ± 0.6 per problem). The most common DRP category was "drug not taken/administered" (35%), and the most common offending drug category was cardiovascular agents (33%). Prevalence of DRPs was high among geriatric outpatients prescribed multiple medications. Careful medication review is needed in routine clinical practice to improve prescription quality.

Human papillomavirus and cardiovascular disease among U.S. women in the National Health and Nutrition Examination Survey, 2003 to 2006.

OBJECTIVES: The purpose of this study was to examine the association between human papillomavirus (HPV) and cardiovascular disease (CVD) among U.S. women. BACKGROUND: Oncogenic proteins derived from tumor-associated HPV induce the degradation of tumor suppressor protein p53. Inactivation of p53 is associated with accelerated atherosclerotic process. However, the association between HPV infection with CVD remains unclear. METHODS: Data were from 2,450 women (age 20 to 59 years) in the National Health and Nutrition Examination Survey, 2003 to 2006. Self-collected vaginal swab specimens were sent for HPV DNA analysis by L1 consensus polymerase chain reaction followed by type-specific hybridization. CVD was ascertained by self-reported diagnosis of myocardial infarction or stroke. RESULTS: A total of 60 females (39 women were HPV DNA positive, whereas 21 were negative) had coronary artery disease. Presence of vaginal HPV DNA was associated with CVD. Odds ratio (OR) of CVD comparing women with presence of vaginal HPV DNA to those without was 2.30 (95% confidence interval [CI]: 1.27 to 4.16) after controlling for demographics, health/sex behaviors, medical comorbidities, cardiovascular risk factors, and management. At the same level of adjustment, OR of CVD comparing women with cancer-associated HPV types to those with negative HPV was 2.86 (95% CI: 1.43 to 5.70). CONCLUSIONS: HPV infection, especially cancer-associated oncogenic types, is associated with CVD among women.

Potentially inappropriate medications in geriatric outpatients with polypharmacy: application of six sets of published explicit criteria.

AIM: Our aim was to compare the practicability of six different potentially inappropriate medication (PIM) criteria in geriatric outpatients with polypharmacy. METHODS: We analysed baseline data from the Medication Safety Review Clinic in Taiwanese Elders (MSRC-Taiwan) study. The prevalence and correlates of PIMs were determined on the basis of criteria developed in the USA, Canada, France, Norway, Ireland and Thailand. The percentage of PIMs considered as drug-related problems and the problem-solving rate are reported. RESULTS: In the 193 participants, the prevalence of PIM varied from 24 to 73%. Application of the criteria revealed that a high number of chronic medications was a common risk factor for having at least one PIM. Of the 1713 medications reviewed, 5.6-14.8% were considered PIMs. Only 30-40% of the identified PIMs were reported as drug-related problems by the MSRC team experts. Criteria with a higher number of statements and a higher percentage of local market/institution drug availability tended to detect more PIMs. CONCLUSIONS: The prevalence of PIM varied significantly when different criteria were applied. Caution should be exercised in applying PIM criteria developed in other regions when medication availability in the local market is limited.

White blood cell count and psychomotor cognitive performance in the elderly.

BACKGROUND: White blood cell (WBC) count is associated with many inflammatory diseases such as cardiovascular disease, diabetes and hypertension. Research on the relationship of WBC count and cognition in the elderly is relatively sparse. This study examined the association between WBC count and cognitive performance in older adults. METHODS: Data from the National Health and Nutrition Examination Survey (1999-2002) containing 1670 older adults were analysed. Every subject completed a household interview, examination of digit symbol substitution test (DSST) scores, WBC count measurement and a questionnaire regarding personal health. WBC count was restricted to the normal range and divided into quartiles, using a multiple hierarchical regression model to estimate the relationship between WBC counts and DSST scores. Quartile-based analysis with an extended-model approach was used for further covariates adjustment. Trends test examining the associations across increasing quartiles of WBC counts and DSST scores were also conducted. RESULTS: In the multiple hierarchical regression model, the ß coefficient, representing the change of DSST scores for each 1000 cells uL(-1) increase in WBC count, was -0·097 (R(2) = 0·343, P < 0·001). After additional competent covariates adjustment, the negative correlation remained (all P < 0·001). In quartile-based multiple linear regression, the negative trends between DSST scores and WBC count quartiles in the stratified comparison with extended-model approach were all statistically significant (P for trends <0·001). CONCLUSIONS: Higher WBC counts, even within the normal range, were associated with poor psychomotor cognitive performance in the elderly.

Oral health status and self-reported functional dependence in community-dwelling older adults.

OBJECTIVES: To assess the strength of association between graded groups of oral health status and self-reported functional dependence in community-dwelling older adults. DESIGN: Population-based cross-sectional study. SETTING: National Health and Nutritional Examination Survey (NHANES) 1999 to 2004. PARTICIPANTS: Three thousand eight hundred fifty-six participants aged 60 and older (mean age 71.2) without missing values in the examined correlates. MEASUREMENTS: Oral health status was evaluated according to edentulism, severity of periodontal disease, and recommendation of periodontal care and compared with that of healthy controls. Self-reported functional dependence was assessed according to 19 questions in five domains: activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSAs), lower extremity mobility (LEM), and general physical activities (GPAs). RESULTS: After controlling for demographic and dental variables, health-related behaviors, C-reactive protein, and comorbidities, edentulism was significantly associated with disability in IADLs (odds ratio (OR)=1.58), LSAs (OR=1.63), LEM (OR=1.31), and GPAs (OR=1.45) compared with healthy controls. Likewise, severe periodontitis was associated with disability in IADLs (OR=1.58), LSAs (OR=1.70), and LEM (OR=1.63). The trends toward disability in IADLs, LSAs, LEM, and GPAs were statistically significant across increasing severity of oral health problems. CONCLUSION: Poor oral health, specifically edentulism and severe periodontitis, is associated with multiple domains of late-life disability, but a causal relationship cannot be established based on current study design.

Cross-sectional associations of albuminuria and C-reactive protein with functional disability in older adults with diabetes.

OBJECTIVE: To examine the relationship between albuminuria, inflammation, and disability in older adults with diabetes. RESEARCH DESIGN AND METHODS: Data were from 1,729 adults (≥ 60 years) with diabetes in the National Health and Nutrition Examination Survey, 1999-2008. Disability in activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), general physical activities (GPA), and lower-extremity mobility (LEM) was obtained from self-reports. Urinary albumin-to-creatinine ratio (UACR) (mg/g) was categorized into normal (UACR <30 mg/g), microalbuminuria (UACR 30-300 mg/g), and macroalbuminuria (UACR >300 mg/g). C-reactive protein (CRP) levels were quantified by latex-enhanced nephelometry. RESULTS: In the full-adjusted model, microalbuminuria was associated with disability in ADL, LSA, and LEM with corresponding odds ratios (ORs) (95% CIs) of 1.51 (1.16-1.98), 1.62 (1.23-2.14), and 1.34 (1.03-1.74), respectively, compared with participants without albuminuria. Macroalbuminuria was associated with disability in ADL, IADL, and LEM with corresponding ORs (95% CIs) of 1.94 (1.24-3.03), 1.93 (1.23-3.02), and 2.20 (1.38-3.49), respectively, compared with participants without albuminuria. Elevated CRP (>0.3 mg/dL) was associated with increased odds of disability in ADL and LEM, with corresponding ORs (95% CIs) of 1.28 (1.00-1.62) and 1.68 (1.34-2.11), respectively. Subjects with both albuminuria and elevated CRP had higher odds of disability than individuals with no albuminuria and normal CRP. CONCLUSIONS: Albuminuria and inflammation were independent correlates for disability among older adults with diabetes. There was an interaction of albuminuria and elevated CRP on disability, suggesting that the presence of subclinical inflammation may amplify the effect of albuminuria on disability in older adults living with diabetes.

Sarcopenia, cardiopulmonary fitness, and physical disability in community-dwelling elderly people.

BACKGROUND: Sarcopenia refers to the loss of skeletal muscle mass with aging. It is believed to be associated with functional impairment and physical disability. OBJECTIVE: The purposes of this study were: (1) to compare the physical activity, muscle strength (force-generating capacity), cardiopulmonary fitness, and physical disability in community-dwelling elderly people with sarcopenia, borderline sarcopenia, and normal skeletal muscle mass in Taiwan and (2) to test the hypothesis that sarcopenia is associated with physical disability and examine whether the association is mediated by decreased muscle strength or cardiopulmonary fitness. DESIGN: This was a cross-sectional investigation. METHODS: Two hundred seventy-five community-dwelling elderly people (148 men, 127 women) aged > or =65 years participated in the study. The participants were recruited from communities in the district of Zhongzheng, Taipei. Predicted skeletal muscle mass was estimated using a bioelectrical impedance analysis equation. The skeletal muscle mass index (SMI) was calculated by dividing skeletal muscle mass by height squared. Physical disability was assessed using the Groningen Activity Restriction Scale. Physical activity was assessed using a 7-day recall physical activity questionnaire. Cardiopulmonary fitness was assessed using a 3-minute step test, and grip strength was measured to represent muscle strength. RESULTS: Cardiopulmonary fitness was significantly lower in elderly people with sarcopenia than in those with normal SMIs. Grip strength and daily energy expenditure (kcal/kg/day) were not significantly different between the participants with sarcopenia and those with normal SMIs. The odds ratio for physical disability between the participants with sarcopenia and those with normal SMIs was 3.03 (95% confidence interval=1.21-7.61). The odds ratio decreased and the significant difference diminished after controlling for cardiopulmonary fitness. LIMITATIONS: A causal relationship between sarcopenia and physical activity, cardiopulmonary fitness, and physical disability cannot be established because of the cross-sectional nature of study design. CONCLUSIONS: Sarcopenia was associated with physical disability in elderly men. The association between sarcopenia and physical disability was mediated to a large extent by decreased cardiopulmonary fitness.

A family history of diabetes mellitus is associated with poor glycemic control and increased metabolic risks among people with diabetes: data from the National Health and Nutrition Examination Survey 1999-2004.

BACKGROUND: Several lines of evidence from studies involving both general and non-diabetic populations have shown that a family history of diabetes was associated with an increased risk for cardiovascular diseases and metabolic alterations. However, little is known about the relationship of a family history of diabetes to glycemic control and metabolic risks among people with diabetes. METHODS: We conducted a cross-section study of 946 diabetic adults from the National Health and Nutrition Examination Survey between 1999 and 2004. Familial risk of diabetes was classified as average, moderate, or high. Logistic regression analyses were conducted to determine the association between familial risk of diabetes and poor glycemic control, as defined by A1C > or = 8%. According to stratified levels of familial risk of diabetes, adjusted means of various metabolic risks, including A1C, BMI, lipid profiles, and C-reactive protein, were obtained by using multiple linear regression. RESULTS: Independent of basic demographics, health-related behaviors, use of anti-diabetic medications, diabetes duration, cardiovascular co-morbidities, and various metabolic risks, the odds ratio of poor glycemic control comparing participants with a high familial risk of diabetes to those with an average risk was 1.91 (95% confidence interval 1.02-3.58). In the multivariate analysis, the adjusted means of A1C in participants with high, moderate, and averaged familial risk of diabetes were 7.75%, 7.45%, and 7.25%, respectively (p for trend 0.036). Participants with a high familial risk of diabetes also had higher triglycerides and body mass index (p for trend 0.042 and 0.02, respectively). CONCLUSION: Diabetic adults with a higher familial risk of diabetes have a worse glycemic control, higher BMI, and higher triglycerides. Obtaining family history of the disease is crucial in identifying and targeting high risk diabetic patients who may require more stringent lifestyle changes as well as pharmaceutical intervention.

Gender-specific association between self-reported sleep duration and falls in high-functioning older adults.

BACKGROUND: Prior studies have shown that sleep disturbances are related to falling and its risk factors, such as poorer cognition, depression, and physical function. However, little is know about the gender-specific associations between falling and sleep duration. METHODS: Study participants were from the annual Health Examination for the Elderly Program in the National Taiwan University Hospital (135 women and 121 men, mean age 72.2 years). Self-reported sleep duration was grouped into three categories: less than 5, 5-7.9, and 8 or more hours. Short sleep duration was defined as sleep duration less than 5 hours. Falling during the previous 12 months was ascertained by self-report questionnaire. The association of sleep duration with falling was examined by using multiple logistic regression. We approximated risk ratio (RR) of falls from the adjusted odds ratio (OR) after correction of falls incidence in the previous year. RESULTS: Sleep duration was inversely associated with falling among women. After adjusting for multiple confounding factors including use of antihypertensives and psychotropic medications, the OR of falls for each hour decrease in sleep duration was 1.95 (95% confidence interval [CI] 1.24-3.06). Moreover, women with sleep deprivation had a greater odds of falls within the last year than those with longer sleep durations. The estimated RR of falls comparing women with short sleep duration (sleep <5 hours) with those without was 2.98 (95% CI 1.32-4.62). We did not find an association among men. CONCLUSION: Sleep deprivation is independently associated with falls in women but not in men. Short sleep duration may be an indicator to identify women at risk for falling.

Metabolic risks, white matter hyperintensities, and arterial stiffness in high-functioning healthy adults.

BACKGROUND: Arterial stiffness, an age-related feature and measured noninvasively by pulse wave velocity (PWV), is associated with a variety of cardiovascular diseases. Although white matter lesion (WML), representing cerebrovascular micro-angiopathy, is typically considered as a preclinical cardiovascular disease, little is know about the association between PWV and WML. The aim of this study is to examine the association between PWV and WML. METHOD: We examined the extent of white matter lesion on cranial magnetic resonance imaging of 93 participants (mean 72.46 years) from the annual Health Examination for the Elderly Program in the National Taiwan University Hospital. Two subtypes of WML including periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) were graded according to Fazekas et al. The brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV) were measured using an automatic waveform analyzer. RESULTS: PVH and DWHM were found in 71 (76%) and 58 (62%) participants. Various degree of WML was observed in 80 (86%) participants. Hypertension, use of anti-hypertensive medications, and elevated blood pressure were identified as risk factors of WML. The baPWV and haPWV were correlated with many metabolic risks, including systolic blood pressure, pulse pressure, and serum triglycerides. The baPWV and haPWV were greater in participants with higher grades of WML in the multivariate analyses. The receiver operating characteristics analyses demonstrated that area under curves for haPWV to identify moderate-to-severe PVH and DWMH were 0.78 (95% confidence interval [CI] 0.66-0.91) and 0.72 (95% CI 0.59-0.85), respectively. CONCLUSION: Greater PWV is associated with higher grades of WML among high-functioning older adults. Our findings support the notion that measurement of arterial stiffness is useful in clinical practice for detection of preclinical cerebrovascular disease.

Inverse association between insulin resistance and gait speed in nondiabetic older men: results from the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2002.

BACKGROUND: Recent studies have revealed the associations between insulin resistance (IR) and geriatric conditions such as frailty and cognitive impairment. However, little is known about the relation of IR to physical impairment and limitation in the aging process, eg. slow gait speed and poor muscle strength. The aim of this study is to determine the effect of IR in performance-based physical function, specifically gait speed and leg strength, among nondiabetic older adults. METHODS: Cross-sectional data were from the population-based National Health and Nutrition Examination Survey (1999-2002). A total of 1168 nondiabetic adults (> or = 50 years) with nonmissing values in fasting measures of insulin and glucose, habitual gait speed (HGS), and leg strength were analyzed. IR was assessed by homeostasis model assessment (HOMA-IR), whereas HGS and peak leg strength by the 20-foot timed walk test and an isokinetic dynamometer, respectively. We used multiple linear regression to examine the association between IR and performance-based physical function. RESULTS: IR was inversely associated with gait speed among the men. After adjusting demographics, body mass index, alcohol consumption, smoking status, chronic co-morbidities, and markers of nutrition and cardiovascular risk, each increment of 1 standard deviation in the HOMA-IR level was associated with a 0.04 m/sec decrease (p = 0.003) in the HGS in men. We did not find such association among the women. The IR-HGS association was not changed after further adjustment of leg strength. Last, HOMA-IR was not demonstrated in association with peak leg strength. CONCLUSION: IR is inversely associated with HGS among older men without diabetes. The results suggest that IR, an important indicator of gait function among men, could be further investigated as an intervenable target to prevent walking limitation.

Association among acrylamide, blood insulin, and insulin resistance in adults.

OBJECTIVE: Exposure to acrylamide in foodstuffs and smoking has become a worldwide concern. The effect of acrylamide on glucose homeostasis is not known. The goal of the present study was to test the hypothesis that trace acrylamide exposure might be independently associated with both reduced blood insulin and reduced insulin resistance. RESEARCH DESIGN AND METHODS: We examined 1,356 participants with reliable measures of glucose homeostasis and Hb adducts of acrylamide (HbAA) and glycidamide from the National Health and Nutrition Examination Survey, 2003-2004. Glucose homeostasis was assessed by the measurement of plasma glucose, serum insulin, and the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: In a linear regression model, a 1-unit increase in log HbAA was associated with a decrease in serum insulin (beta coefficient = -0.20 +/- 0.05, P = 0.001) and HOMA-IR (beta coefficient = -0.23 +/- 0.05, P < 0.001). After HbAA concentrations were divided into quartiles in the fully adjusted models, the adjusted serum insulin level and HOMA-IR significantly decreased across quartiles of HbAA (P(trend) < 0.001 for both). In subgroup analysis, the association of HbAA levels with HOMA-IR and insulin levels was stronger in subjects who were white or had ever smoked or in subjects with a lower education level or a BMI <25 or >30 kg/m(2). CONCLUSIONS: Acrylamide is associated with reduced serum insulin levels in adults. Further clinical and animal studies are warranted to clarify the putative causal relationship.

Nationwide epidemiological study of severe gallstone disease in Taiwan.

BACKGROUND: Our study aimed to assess the nationwide trends in the incidence of severe gallstone disease in Taiwan among adults aged >or=20. METHODS: A retrospective longitudinal study was conducted using Taiwan National Health Insurance Research Database collected during 1997-2005. Patients with incident severe gallstone disease (acute cholecystitis, biliary pancreatitis, acute cholangitis) and gallstone-related procedures (elective and non-elective cholecystectomy, endoscopic retrograde cholangiopancreatography [ERCP]) that led to hospital admission were identified using ICD-9-CM diagnostic and procedure codes. Annual incidence rates of gallstone-related complications and procedures were calculated and their 95% confidence intervals (CI) were estimated assuming a Poisson distribution. RESULTS: The hospital admission rate for severe gallstone disease increased with advancing age and the age-standardized rate (95% CI) per 1000 population was 0.60 (0.59-0.60) for men and 0.59 (0.59-0.60) for women. Men had a higher rate of acute cholecystitis, probably due to the substantially lower rate of elective cholecystectomy among men than women. For those aged 20-39, hospital admissions for all gallstone-related complications and procedures increased significantly. For those aged >or=60, incidences of biliary pancreatitis, acute cholangitis, and hospital admission for gallstone receiving ERCP increased significantly without substantial change in the incidence of acute cholecystitis and despite a decreased rate of elective cholecystectomy. CONCLUSION: This population-based study found a substantial increase in the rate of admission for severe gallstone disease among those aged 20-39. Concurrently, the incidences of biliary pancreatitis and acute cholangitis have risen among those aged >or=60.

Associations between body mass index and serum levels of C-reactive protein.

BACKGROUND: Obesity leads to increased risk of cardiovascular disease and glucose intolerance, which are phenomena of chronic inflammation. This study was performed to determine whether a higher body mass index (BMI) and central obesity are associated with low-grade inflammation. METHODS: An analysis of 8 453 adults aged > or =20 years was performed. Every subject completed a household interview and a questionnaire regarding personal health, and their BMI and serum C-reactive protein (CRP) level were measured. The BMI data were divided into quintiles, using multiple linear regression to estimate the relationship between CRP level and BMI quintiles. An extended-model approach was used for covariate adjustment. The association between central obesity and CRP level was examined by this method as well. RESULTS: After controlling for demographics, chronic diseases, health behaviours and levels of folate and vitamin B12, the beta coefficient (which represents the change of natural-log-transformed levels of CRP for each kg/m2 increase in BMI) was 0.078 (p < 0.001). The CRP levels also increased across increasing quintiles of BMI (p for trend <0.001). The beta coefficient, representing the change of natural-log-transformed levels of CRP comparing subjects with central obesity to those without, was 0.876 (p < 0.001). CONCLUSION: Higher BMIs as well as central obesity are independently associated with higher levels of CRP.