Homocysteine, hypertension, and risks of cardiovascular events and all-cause death in the Chinese elderly population: a prospective study.

BACKGROUND: Increased homocysteine levels are associated with the risk of cardiovascular disease (CVD) and death. However, their prevention has not been effective in decreasing CVD risk. This study investigated the individual and combined associations of hyperhomocysteinemia and hypertension with incident CVD events and all-cause death in the Chinese elderly population without a history of CVD. METHODS: This prospective study was conducted among 1,257 elderly participants (mean age: 69 years). A questionnaire survey, physical examinations, and laboratory tests were conducted to collect baseline data. Hyperhomocysteinemia was defined as homocysteine level ≥ 15 µmol/L. H-type hypertension was defined as concomitant hypertension and hyperhomocysteinemia. Multivariate Cox regression analysis was used to evaluate individual and combined associations of hyperhomocysteinemia and hypertension with the risks of incident CVD events and all-cause death. RESULTS: Over a median of 4.84-year follow-up, hyperhomocysteinemia was independently associated with incident CVD events and all-cause death. The hazard ratios (HRs) were 1.45 (95% CI: 1.01-2.08) for incident CVD events and 1.55 (95% CI: 1.04-2.30) for all-cause death. After adjustment for confounding factors, H-type hypertension had the highest HRs for incident CVD events and all-cause death. The fully adjusted HRs were 2.44 for incident CVD events (95% CI: 1.28-4.65), 2.07 for stroke events (95% CI: 1.01-4.29), 8.33 for coronary events (95% CI: 1.10-63.11), and 2.31 for all-cause death (95% CI: 1.15-4.62). CONCLUSIONS: Hyperhomocysteinemia was an independent risk factor, and when accompanied by hypertension, it contributed to incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.

Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm.

INTRODUCTION: The aneurysm wall has been reported to play a critical role in the formation, development, and even rupture of an aneurysm. We used high-resolution magnetic resonance imaging (HRMRI) to investigate the aneurysm wall in an effort to identify evidence of inflammation invasion and define its relationship with aneurysm behavior. METHODS: Patients with intracranial aneurysms who were prospectively evaluated using HRMRI between July 2013 and June 2014 were enrolled in this study. The aneurysm's wall enhancement and evidence of inflammation invasion were determined. In addition, the relationship between aneurysm wall enhancement and aneurysm size and symptoms, including ruptured aneurysms, giant unruputred intracranial aneurysms (UIAs) presenting as mass effect, progressively growing aneurysms, and aneurysms associated with neurological symptoms, was statistically analyzed. RESULTS: Twenty-five patients with 30 aneurysms were available for the current study. Fourteen aneurysms showed wall enhancement, including 6 ruptured and 8 unruptured aneurysms. Evidence of inflammation was identified directly through histological studies and indirectly through intraoperative investigations and clinical courses. The statistical analysis indicated no significant correlation between aneurysm wall enhancement and aneurysm size. However, there was a strong correlation between wall enhancement and aneurysm symptoms, with a kappa value of 0.86 (95 % CI 0.68-1). CONCLUSIONS: Aneurysm wall enhancement on HRMRI might be a sign of inflammatory change. Symptomatic aneurysms exhibited wall enhancement on HRMRI. Wall enhancement had a high consistent correlation of symptomatic aneurysms. Therefore, wall enhancement on HRMRI might predict an unsteady state of an intracranial saccular aneurysm.

[A cohort study on mortality and risk of death among population diagnosis as dementia, at base-line survey, in Beijing].

OBJECTIVE: To study the mortality and risk of death on dementia among ageing population. METHODS: A random sample including 2788 elderly residents was studied. Dementia was diagnosed under the two-phase procedure in 1997. In phase 1, questionnaire was administered, including the Mini-Mental State Examination (MMSE) tested. In phase 2, all the elderly who showed low MMSE score and some with normal MMSE score, were examined by neurologists. The clinical diagnosis of dementia was set up by two neurologists according to the criteria of DSM-III-R and NINCDS-ADRDA. The same sample was followed up in 2000 and 2004 the same way and data on deaths and causes was gathered. The overall time for follow-up was 7.25 years. RESULTS: 171 cases with dementia were diagnosed from 2788 subjects in 1997, with a crude death rate (CDR) of dementia was 7.8 per 1000 person-years and age-standardized CDR as 5.5 per 1000 person-years. The death rate was increased exponentially with age. In the dementia group, the total number of deaths was 133, with the CDR as 236 per 1000 person-years and the age-standardized CDR as 206 per 1000 person-years, in the end of the survey. In the non-dementia group, the total number of deaths was 680, with CDR as 40 per 1000 person-years and the age-standardized CDR as 31 per 1000 person-years. The difference in the two groups was statistically significant. The hazard ratio (HR) of dementia death appeared to be the biggest in the 60 - 74 - year group than the other groups. Data was analyzed with the Cox proportional hazards model after making necessary adjustment on potential covariates with the HR of dementia as 2.181 (95%CI: 1.751 - 2.717). The HRs were 2.524 (95%CI: 1.964 - 3.243) in Alzheimer's disease and 1.859 (95%CI: 1.213 - 2.850) in vascular dementia. CONCLUSION: The CDR and HR of dementia were higher than the non-dementia group in the aging population, showing that dementia was one of the most important risk factors on death in the aging population.

[Study on the incidence and risk factors of dementia in elderly residents from communities in Beijing].

OBJECTIVE: To study the incidence of dementia and its risk factors among the elderly living in the community of Beijing. METHODS: A sample of 2788 elderly residents from Beijing were investigated regarding the incidence of dementia which was diagnosed using two-stage method in 1997. In the first stage, questionnaire was filled, including MMSE checked up. In the second stage, all the elderly who had lower MMSE score and some with normal MMSE score were examined by neurologists. The clinical diagnosis of dementia was set up by two neurologists according to the criteria of DSM-III-R and NINCDS-ADRDA. The same sample was followed up on 2000 and 2004 by the same way, with the overall time for following-up as 7.25 years. RESULTS: 171 dementias cases were diagnosed among the 2788 elderly in 1997. At the end of the survey, another 180 new cases developed. The average weighted incidence was 0.84/100 person year, adjusted by age (it's same followed), with 0.64/100 person year in males and 1.01/100 person years in females. The incidence of vascular dementia was 0.35/100 person years, with male as 0.39/100 person year and female as 0.32/100 person years. The incidence of dementia was increasing with age, but decreasing with time of education by Multinomial Logistic Regression Analysis. Old age and illiterate appeared to be the risk factors for dementia. People with stroke history and elevated systolic blood pressure were risk factors for vascular dementia. CONCLUSION: The incidence of dementia in the elderly in Beijing was higher than in other areas of China. Old age and illiterate were risk factors for dementia. Being male, illiterate, with stroke history and elevated systolic blood pressure were risk factors for vascular dementia.

[Study on the relationship between somatic health and incidence of depression in the elderly].

OBJECTIVE: In order to explore the risk factors of geriatric depression, a longitudinal follow-up study was conducted on elderly population living in the community so as to provide evidence for the development of depression prevention and control. METHODS: A sampled population consisting 2506 elderly was selected from urban and rural communities in Beijing, using well-established sampling techniques as cluster, stratification and random selection. Data was collected by trained staff members, using standard survey instruments in 2000 and 2004. RESULTS: Longitudinal study showed that the four-year cumulative incidence of the geriatric depression in Beijing was 10.58%. Difference on were evident intelligence/education, with the rates for illiteracy (15.2%) and primary school (10.5%) significantly higher than that of junior high school and above (5.1%) (chi2 = 26.587, P = 0.000). Rates also varied substantially with place of residence, individuals living in rural areas had a substantially higher rate of depression (15.4%) than those individuals dwelling in urban district (6.1%) (chi2 = 31.163, P = 0.000). Poor self-rated health condition (chi2 = 23.385, P = 0.000), cognitive impairment (chi2 = 11.947, P = 0.001) and limitations in physical functioning (ADL: chi2 = 15.930, P = 0.000; IADL: chi2 = 9.501, P = 0.002) were related to the worsening of depressive symptoms. Results from logistic regression analysis indicated that education level, dwelling area, self-rated health condition and ADL were the independent risk factors. CONCLUSION: Lower educational level, dwelling situation, poor self-rated health condition as well as ADL damage might increase the incidence of depression, suggesting more attention needs to be paid to improve somatic function of elderly in order to decrease the incidence of geriatric depression and to improve the prognosis of the disease and the quality of life.

[Study on the isolated systolic hypertension and its prognosis among 2866 elderly residents at the community level in Beijing].

OBJECTIVE: We followed a group of community residents above 60 years old to investigate how isolated systolic hypertension (ISH) could influence the prognosis in the long run among the elderly. METHODS: A selected sample of 60 year olds and over from the Beijing residential communities was randomized ascertained to a longitudinal study. Baseline data was collected in 1993 and 11 years later in 2004, the all-cause death, mortality of cardiovascular and cerebrovascular diseases were observed and analyzed. RESULTS: (1) The morbidity of hypertension(HT) was 61.7% and ISH was 27.8% seen in baseline survey while the SBP was increasing with age. (2) The longitudinal study showed that the total mortality and the mortality of cardiovascular and cerebrovascular diseases in HT group were higher than in the normal blood pressure(BP) group. The total mortality in the group ISH was higher than in normal BP group (55.2%: 46.2%; P < 0.01). The mortality OR for group ISH/group normal BP was 1.4 and group DSH/group normal BP was 1.6. The level of SBP was related to prognosis too which showed that the mortality appeared the lowest in 120-139 mm Hg group, and increased when the level of SBP was above 140 mm Hg. CONCLUSION: SBP was an independent risk factor on the all-cause mortality and the mortality of cerebrovascular diseases in eldevly. ISH also appeared a risk factor on the prognosis among the elderly, suggesting that more attention should be paid to it and treatment be carefully addressed.