Association between level of brachial-ankle pulse wave velocity and onset of activities of daily living impairment in community-dwelling older individuals.

AIM: The purpose of the present study was to clarify the longitudinal association between brachial-ankle pulse wave velocity (baPWV) and the onset of impairment in activities of daily living (ADL) among community-dwelling individuals. METHODS: Deaths and the onsets of ADL impairment during 3 years were followed for 450 individuals without ADL impairment at entry who were aged 65 years or older (men : women 181:269; mean age 77 years). They were dichotomized on the median baPWV value at entry. RESULTS: Within 3 years, 28 died and 60 had an onset of ADL impairment. The high baPWV group had a higher incidence of deaths (high baPWV group vs low baPWV group, 9.3% vs 3.1%) and ADL impairment (high baPWV group vs low baPWV group, 20.7% vs 9.3%). After adjustment for age, sex and systolic blood pressure, as compared with the low baPWV group, the high baPWV group had increased risk for mortality (adjusted odds ratio 3.22; 95% confidence interval 1.26-8.22) and the onset of ADL impairment (adjusted odds ratio 1.94; 95% confidence interval 1.03-3.63). When the onset of ADL impairment was grouped according to medical conditions that preceded/accompanied the onset of ADL impairment, elevated baPWV was associated with increased risk for the onset of ADL impairment after/accompanying fall/fracture. CONCLUSIONS: The assessment of arterial stiffness by baPWV contributes to identifying functionally independent community-dwelling older individuals at risk for ADL impairment, in particular ADL impairment associated with fall/fracture, as well as for mortality. Geriatr Gerontol Int 2015; 15: 840-847.

Significant association between hypolipoproteinemia(a) and lifetime risk of cancer: an autopsy study from a community-based Geriatric Hospital.

BACKGROUND: Our recent study showed that a low lipoproteinemia(a) [Lp(a)] level was a risk factor for cancer and all-cause deaths. The purpose of this study was to verify the role of the Lp(a) level on cancer among consecutive autopsy cases. METHODS: The subjects consisted of 1354 cases (775 men and 579 women). The average age at death was 79.9 years. Hypolipoproteinemia(a) was defined as an Lp(a) level of below 80 mg/L. Overall, 62.3% of the subjects had suffered from at least one to a maximum of five malignancies throughout their lives. The most frequent type of malignancy was gastric cancer, followed by leukemia, lung cancer, and colon cancer. RESULTS: The cancer-bearing status decreased linearly according to the Lp(a) level in both men and women (P=0.01 and P<0.001, respectively). The median Lp(a) level was significantly lower among the cases with hepato-biliary-pancreatic cancers or hematopoietic malignancy, but was higher among cases with lung cancer, especially lung adenocarcinoma. Hypolipoproteinemia(a) was a significant risk factor for any origins of cancer, with an odds ratio of 1.94 (95% CI, 1.45-2.60; P<0.001). It was also a risk factor for hepato-biliary cancers and leukemia, but it was a protective factor for lung cancer. CONCLUSIONS: Our findings suggested hypolipoproteinemia(a) would be a significant risk factor for cancer except lung cancer. This study complements our previous study showing that hypolipoproteinemia(a) would increase the lifetime risk of cancer other than lung cancer.

Age is a major pathobiological determinant of aortic dilatation: a large autopsy study of community deaths.

AIM: Aortic dilatation is a well-known phenomenon in the elderly. We therefore aimed to study the pathobiological determinants of aortic dilatation. METHODS: Retrospective chart review. The subjects were 833 consecutive autopsy cases (616 men and 217 women) of community deaths. The age at death ranged from 20 to 94 years, with an average of 59.2 years. We measured the internal circumference of the aortic root, arch, descending portion, abdominal portion, and bifurcation in unfixed opened aorta at the time of autopsy. RESULTS: The simple correlation between age and aortic circumference was strongest for the descending portion, followed by the arch, abdominal portion, root, and bifurcation. The simple correlation coefficient reached 0.836 for the descending portion (p < 0.001). The circumference of the descending portion increased significantly as the severity of aortic atherosclerosis increased (p for trend < 0.001). Multiple regression analysis showed that age, sex, and body height were significantly correlated with the aortic circumference at all five measurement sites, while severe atherosclerosis was correlated with the aortic circumference at the root, and descending and abdominal portions. Six contributing factors (age, sex, body height, smoking history, hypertension, and severe atherosclerosis) explained 68.5% of the variance in circumference in the descending portion; age explained 57.5%; sex 8.4%; body height 1%; and severe atherosclerosis 0.8%. CONCLUSION: The contribution of atherosclerosis to aortic dilation was very weak, representing less than one seventieth of the contribution of age. The aortic circumference, especially in the descending portion, serves as an excellent age-related marker.

Association between brachial-ankle pulse wave velocity and 3-year mortality in community-dwelling older adults.

With aging, arterial stiffness increases and results in cardiovascular diseases. Recently, high brachial-ankle pulse wave velocity (baPWV), measured using a new noninvasive device to estimate arterial stiffness, was reported to be associated with the prevalence of cardiovascular diseases. The purpose of this study was to clarify the association between baPWV with 3-year mortality in community-dwelling older adults and to determine the cutoff value of baPWV in terms of mortality. A total of 530 subjects aged 65 years or older (men/women, 207:323; mean age, 76 years) participated. They were dichotomized by the median value of baPWV. Within 3 years, 30 deaths occurred, including 11 cardiovascular deaths. The high-baPWV group had a higher incidence of total deaths (high-baPWV group vs. low-baPWV group, 8.3 vs. 3.0%, respectively) and cardiovascular deaths (high-baPWV group vs. low-baPWV group, 3.8 vs. 0.4%, respectively). A high-baPWV level was associated with an increased risk of 3-year total mortality after adjustment for age, sex and systolic blood pressure (hazard ratio for high baPWV vs. low baPWV=2.98, 95% CI=1.25-7.07) and with an increased risk of 3-year cardiovascular mortality (hazard ratio for high baPWV vs. low baPWV=10.01, 95% CI=1.21-82.49). A receiver-operating characteristic curve showed that the optimal cutoff value of baPWV for total mortality was 19.63 m s(-1), and for cardiovascular mortality it was 19.63 m s(-1). This study provides a preliminary finding that assessment of arterial stiffness by baPWV might be a useful method to predict mortality risk in community-dwelling older adults. Large longitudinal studies for extended periods of time are necessary to confirm the association.

B-type natriuretic peptide is predictive of hospitalization in community-dwelling elderly without heart diseases.

AIM: To examine prospectively the relationship between plasma B-type natriuretic peptide (BNP) levels in community-dwelling elderly and their hospitalization. METHODS: A total number of 644 subjects aged 65 years or older were recruited from the annual community health examinations. Those with a history of stroke or neurological findings were not included. After excluding those with old myocardial infarction, left ventricular dysfunction, moderate or severe valvular disorders, atrial fibrillation, renal insufficiency, and history of hospitalization within 1 year, 602 participants (226 men, 376 women; mean age, 80.3 +/- 6.2 years) remained eligible for this study. Antihypertensive medications, activities of daily living (ADL) score and history of hospitalization were assessed by annual interview. Measurement of casual blood pressure, Mini-Mental State Examination, electrocardiography and echocardiography were performed. Plasma BNP, serum creatinine, total cholesterol, albumin and hemoglobin A1c levels were also examined. A follow-up survey was performed for the occurrence and reasons for hospitalization. RESULTS: During a median follow up of 37 months, 112 subjects were hospitalized. After adjustment for conventional risk factors of hospitalization using the Cox proportional hazard model, each increment of 1 standard deviation in log BNP levels was associated with a 36% increase in the risk of hospitalization (P = 0.02). Plasma BNP levels were significantly higher in the hospitalized subjects due to stroke, heart diseases, dementia, pneumonia and also difficulty to live alone than those of the subjects without hospitalization. CONCLUSION: Plasma BNP level is a very useful biochemical marker predictive of future hospitalization in community-dwelling independent elderly people without apparent heart diseases.

Comparison between carotid-femoral and brachial-ankle pulse wave velocity as measures of arterial stiffness.

BACKGROUND: Arterial stiffness is an important risk factor for cardiovascular disease. Carotid-femoral pulse wave velocity (cfPWV) is the most recognized and established index of arterial stiffness. An emerging automatic measure of PWV primarily used in the Asian countries is brachial-ankle PWV (baPWV). METHOD: To systematically compare these two methodologies, we conducted a multicenter study involving a total of 2287 patients. RESULTS: There was a significant positive relation between baPWV and cfPWV (r = 0.73). Average baPWV was approximately 20% higher than cfPWV. Both cfPWV and baPWV were significantly and positively associated with age (r = 0.56 and 0.64), systolic blood pressure (r = 0.49 and 0.61), and the Framingham risk score (r = 0.48 and 0.63). The areas under the receiver operating curves (ROCs) of PWV to predict the presence of both stroke and coronary artery disease were comparable between cfPWV and baPWV. CONCLUSION: Collectively, these results indicate that cfPWV and baPWV are indices of arterial stiffness that exhibit similar extent of associations with cardiovascular disease risk factors and clinical events.

Elderly patients with minimal common carotid atherosclerosis not infrequently have severe coronary atherosclerosis and myocardial infarction.

BACKGROUND: The presence of discordances between common carotid and coronary atherosclerosis in the same individual has not been previously reported. METHODS AND RESULTS: The subjects of the present study were 1,518 consecutive autopsy cases at a general geriatric hospital. All were aged 60 years or older (821 men, 697 women) with an average age of 80 years. The atherosclerotic index of the common carotid artery (CC-AI) and coronary stenotic index (CSI) were semi-quantitatively evaluated. The simple correlation coefficient between the CC-AI and CSI was 0.456 (p<0.0001). Among 689 cases with minimal common carotid atherosclerosis (CC-AI < or =2), 74 (11%) had severe coronary atherosclerosis (CSI > or =12), 68 (10%) had coronary heart disease, and 80 (12%) had pathologically-verified myocardial infarction (MI). Among those with minimal common carotid atherosclerosis, the serum total cholesterol level, diabetes mellitus, and history of smoking were significantly higher or more frequent in cases with a CSI > or =12 than in the patients with a CSI <12. CONCLUSIONS: A considerable proportion of cases with minimal common carotid atherosclerosis had severe coronary atherosclerosis and MI. This discordance can potentially lead to an underestimation of coronary risks if normal common carotid morphology is obtained by ultrasound.

Sustained progression and loss of the gender-related difference in atherosclerosis in the very old: a pathological study of 1074 consecutive autopsy cases.

INTRODUCTION: Epidemiological surveys show decrease or reversal of male predominance in cardiovascular mortality in the very old, but the actual condition of atherosclerosis in the very old is largely unknown. The objective of this paper is to reveal whether the atherosclerosis continues to progress, or the gender-related difference exists in the very old. METHODS: The subjects were 1074 consecutive autopsy cases of in-hospital death. The male:female ratio was 1.1:1 and the average age was 80 years. Macroscopic evaluation was performed on the degree of atherosclerosis in 10 arteries including the intracranial arteries, carotid artery, aorta, coronary artery, and femoral artery. RESULTS: The severity of atherosclerosis differed greatly among arteries. The age-related increase of the atherosclerotic degree was evident, even after 80 years of age. The atherosclerosis was more severe in males than in females in their 60s, but this male predominance decreased with ageing and finally disappeared in their 90s. CONCLUSION: The sustained progression of atherosclerosis and loss of the gender-related difference probably account for the increase of cardiovascular mortality in very old females. They also suggest that the prevention of the atherosclerotic progression is still important in the seventh and eighth decade of life.

Aortic pulse wave velocity and the degree of atherosclerosis in the elderly: a pathological study based on 304 autopsy cases.

INTRODUCTION: Studies examining the correlation between aortic pulse wave velocity (PWV) and atherosclerosis have reported conflicting results. The present paper verifies this correlation by conducting autopsy examination of elderly subjects. METHODS: A total of 3456 PWV examinations had been performed on 1538 elderly people, as a part of routine physical check-up. During long-term follow-up, many of these subjects died, and autopsy study could be conducted on 304 of these subjects. The average age at death of the subjects was 83 years and the male: female ratio was 6:5. The pathological atherosclerotic index (PAI) was defined as the average pathological degree of atherosclerosis in eight large arteries, including aorta. RESULTS: Significant positive correlations were observed between the age and PWV (gamma=0.273, P<0.001), and between the systolic blood pressure and PWV (gamma=0.478, P<0.001). There was a significantly positive correlation between the aortic atherosclerotic degree and mean PWV (rho=0.239, P<0.005), and between the PAI and mean PWV (gamma=0.323, P<0.001). The partial regression coefficient between the PAI and mean PWV was 0.209, after adjusting for the mean systolic blood pressure and age at death. CONCLUSION: The present study proved a weak correlation between the PWV and the pathologically verified degree of the aortic and systemic atherosclerosis.

High morning home blood pressure is associated with a loss of functional independence in the community-dwelling elderly aged 75 years or older.

To elucidate the relationship between home systolic blood pressure (SBP) and functional impairment in the elderly 75 years or older, 461 community-dwelling subjects (192 men, 269 women, mean age: 80 years) were studied. Home blood pressure was measured twice in the morning and twice in the evening for 5 consecutive days with an automatic cuff-oscillometric device. Total/high-density lipoprotein cholesterol and several functional assessments were evaluated. A subject was determined to exhibit a loss of independence according to the activities of daily living (ADL) score in a study conducted in 2001. Based on the mean home SBPs (mSBP) and morning-evening SBP differences (dSBP), the subjects were classified into 4 groups as follows: hypertensive/morning-dominant (HM; mSBP > or = 135 mmHg, dSBP > or = 15 mmHg), hypertensive/sustained (HS; mSBP > or = 135 mmHg, dSBP<15 mmHg), normotensive/morning-dominant (NM; mSBP<135 mmHg, dSBP > or = 15 mmHg), and normotensive/controlled (NC; mSBP<135 mmHg, dSBP<15 mmHg). There were no differences in sex, cholesterol levels, history of stroke, other cardiovascular diseases (CVDs), and cognitive function, but there were significant differences in age, antihypertensive medications, the neurobehavioral test scores, and ADL scores. There were no significant differences in terms of mortality and CVD events. In the survivors, HM and HS were independent risk factors for a loss of independence, after adjustments were made for onset of stroke, age, antihypertensive therapy, history of CVD, as well as neurobehavioral test scores and ADL scores (odds ratio [OR]: 12.2 and 3.78, respectively). After the same adjustments as those mentioned above were made, HM and HS were found to be negative determinants of survival and maintenance of independence (OR: 0.082, 0.270, respectively). In conclusion, high home SBP (> or = 135 mmHg) and high dSBP (> or = 15 mmHg) were found to be important in determining the levels of disability for the very elderly.