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1.
Lancet Neurol ; 20(5): 335-336, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33894188
2.
Stroke ; : STROKEAHA120030226, 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33840227

RESUMO

BACKGROUND AND PURPOSE: The general cardiovascular Framingham risk score (FRS) identifies adults at increased risk for stroke. We tested the hypothesis that baseline FRS is associated with the presence of postmortem cerebrovascular disease (CVD) pathologies. METHODS: We studied the brains of 1672 older decedents with baseline FRS and measured CVD pathologies including macroinfarcts, microinfarcts, atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy. We employed a series of logistic regressions to examine the association of baseline FRS with each of the 5 CVD pathologies. RESULTS: Average age at baseline was 80.5±7.0 years and average age at death was 89.2±6.7 years. A higher baseline FRS was associated with higher odds of macroinfarcts (odds ratio, 1.10 [95% CI, 1.07-1.13], P<0.001), microinfarcts (odds ratio, 1.04 [95% CI, 1.01-1.07], P=0.009), atherosclerosis (odds ratio, 1.07 [95% CI, 1.04-1.11], P<0.001), and arteriolosclerosis (odds ratio, 1.04 [95% CI, 1.01-1.07], P=0.005). C statistics for these models ranged from 0.537 to 0.595 indicating low accuracy for predicting CVD pathologies. FRS was not associated with the presence of cerebral amyloid angiopathy. CONCLUSIONS: A higher FRS score in older adults is associated with higher odds of some, but not all, CVD pathologies, with low discrimination at the individual level. Further work is needed to develop a more robust risk score to identify adults at risk for accumulating CVD pathologies.

3.
Neurology ; 2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33853892

RESUMO

OBJECTIVE: We tested the hypothesis that an inverse association exists between diabetes mellitus (DM) and hemoglobin A1C (A1C) with Transactive response DNA binding protein 43 (TDP-43) levels in older adults. METHODS: We leveraged antemortem and postmortem data of decedents from three community-based clinical-pathological studies. DM status, A1C levels, and medications for DM were documented annually. TDP-43 cytoplasmic inclusions, evaluated in 6 brain regions using immunohistochemistry, were used to obtain a semiquantitative TDP-43 score (0-5) in each region, and scores were averaged across regions to obtain a TDP-43 severity score. We used linear regressions to test the association of DM and A1C with the TDP-43 severity score. RESULTS: On average, participants (n=817) were 90 years old at the time of death, three fourth were women, and one fourth had DM. The mean A1C was 6.0% (SD=0.6). TDP-43 was observed in 54% of participants, and the mean TDP-43 score was 0.7 (range 0-4.5). A higher level of A1C was associated with a lower TDP-43 score (estimate=-0.156, S.E.=0.060, p=0.009) while DM had a borderline inverse association with the TDP-43 score (estimate=-0.163, S.E.=0.087, p=0.060). The association of higher levels of A1C with lower TDP-43 scores persisted after further adjustment by Apolipoprotein ε4, vascular risk factors, stroke, and hypoglycemic medications. Exclusion of the oldest old participants did not change the results. CONCLUSION: Overall, the results suggest that a high level of A1C is associated with less TDP-43 proteinopathy in older persons while the relationship of DM with TDP-43 needs further study.

4.
PLoS One ; 16(2): e0246206, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33534811

RESUMO

BACKGROUND: Mobility disability and parkinsonism are associated with decreased survival in older adults. This study examined the transition from no motor impairment to mobility disability and parkinsonism and their associations with death. METHODS: 867 community-dwelling older adults without mobility disability or parkinsonism at baseline were examined annually. Mobility disability was based on annual measured gait speed. Parkinsonism was based on the annual assessment of 26 items from the motor portion of the Unified Parkinson's Disease Rating Scale. A multistate Cox model simultaneously examined the incidences of mobility disability and parkinsonism and their associations with death. RESULTS: Average age at baseline was 75 years old and 318 (37%) died during 10 years of follow-up. Mobility disability was almost 2-fold more common than parkinsonism. Some participants developed mobility disability alone (42%), or parkinsonism alone (5%), while many developed both (41%). Individuals with mobility disability or parkinsonism alone had an increased risk of death, but their risk was less than the risk in individuals with both impairments. The risk of death did not depend on the order in which impairments occurred. CONCLUSION: The varied patterns of transitions from no motor impairment to motor impairment highlights the heterogeneity of late-life motor impairment and its contribution to survival. Further studies are needed to elucidate the underlying biology of these different transitions and how they might impact survival.

5.
Heart ; 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33318082

RESUMO

OBJECTIVE: Hypertension is the most important modifiable risk factor for stroke globally. We hypothesised that country-income level variations in knowledge, detection and treatment of hypertension may contribute to variations in the association of blood pressure with stroke. METHODS: We undertook a standardised case-control study in 32 countries (INTERSTROKE). Cases were patients with acute first stroke (n=13 462) who were matched by age, sex and site to controls (n=13 483). We evaluated the associations of knowledge, awareness and treatment of hypertension with risk of stroke and its subtypes and whether this varied by gross national income (GNI) of country. We estimated OR and population attributable risk (PAR) associated with treated and untreated hypertension. RESULTS: Hypertension was associated with a graded increase in OR by reducing GNI, ranging from OR 1.92 (99% CI 1.48 to 2.49) to OR 3.27 (2.72 to 3.93) for highest to lowest country-level GNI (p-heterogeneity<0.0001). Untreated hypertension was associated with a higher OR for stroke (OR 5.25; 4.53 to 6.10) than treated hypertension (OR 2.60; 2.32 to 2.91) and younger age of first stroke (61.4 vs 65.4 years; p<0.01). Untreated hypertension was associated with a greater risk of intracerebral haemorrhage (OR 6.95; 5.61 to 8.60) than ischaemic stroke (OR 4.76; 3.99 to 5.68). The PAR associated with untreated hypertension was higher in lower-income regions, PAR 36.3%, 26.3%, 19.8% to 10.4% by increasing GNI of countries. Lifetime non-measurement of blood pressure was associated with stroke (OR 1.80; 1.32 to 2.46). CONCLUSIONS: Deficits in knowledge, detection and treatment of hypertension contribute to higher risk of stroke, younger age of onset and larger proportion of intracerebral haemorrhage in lower-income countries.

6.
Am J Hypertens ; 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33197265

RESUMO

BACKGROUND: Although low sodium intake (<2g/day) and high potassium intake (>3·5g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke and its subtypes. METHODS: We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls (8,761 matched pairs for conditional analysis) from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes. RESULTS: The mean estimated 24-hour sodium and potassium urinary excretion was 3·29g/day and 1·57g/day, with 0·01% of participants having both low sodium (<2·0g/day) and high potassium excretion (>3·5g/day). There was a moderate positive correlation between sodium and potassium excretion (r=0·4435, P<0.001) and between sodium excretion and blood pressure (P<0.001). Compared with an estimated urinary sodium excretion of 2·8-3·5g/day (second quartile, reference), higher (>4·26g/day) (OR 1.81;95%CI,1.65-2.00) and lower (<2·8g/day) sodium excretion (OR 1.39;95%CI,1.26-1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4·26g/day) was significantly greater (P<0.001) for intracerebral haemorrhage (ICH) (OR 2.38;95%CI,1.93-2.92) than for ischemic stroke (OR 1.67;95%CI,1.50-1.87), and greater for large vessel and small vessel ischemic stroke than for cardioembolic ischemic stroke. Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P=0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1·58g/day) and moderate sodium intake (2.8-3.5 g/day) was associated with the lowest risk of stroke. CONCLUSION: The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for intracerebral haemorrhage than ischemic stroke. Our data suggest that moderate sodium intake - rather than low sodium intake - combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target.

7.
J Alzheimers Dis ; 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33185594

RESUMO

BACKGROUND: Vascular mechanisms may contribute to the accumulation of AD pathology. OBJECTIVE: We examined whether the burden of vascular risk factors proximate to death is associated with amyloid-ß and tau levels or modified their known association. METHODS: We examined the brains of 1, 585 participants from two longitudinal community-based studies of older adults. Amyloid-ß and tau were quantified by postmortem examination. The burden of vascular risk factors was summarized by calculating the Framingham general cardiovascular risk score (FRS) proximate to death. Using linear regressions, we examined the association of the FRS with the amyloid-ß and tau levels and examined if the FRS modified the association of the amyloid-ß with tau. RESULTS: On average, participants were nearly 90 years old and two-thirds were women. The FRS was not associated with amyloid-ß (Spearman r  = -0.00, p  = 0.918) or tau (r = 0.01, p = 0.701). However, the FRS as a whole (estimate = -0.022, SE = 0.008, p = 0.009), and specifically the systolic blood pressure (SBP) component (estimate = -0.033, SE = 0.012, p = 0.009), modified the association of the amyloid-ß with tau. Further analysis showed that the association between amyloid-ß and tau was stronger at lower levels of SBP. CONCLUSION: Late-life vascular risk scores were not related to postmortem levels of amyloid-ß or tau. However, lower levels of vascular risk scores and SBP were associated with a stronger association between amyloid-ß and tau. These data suggest that vascular risk factors may modify the relation of AD pathology markers to one another.

8.
J Res Med Sci ; 25: 51, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32765621

RESUMO

Background: Considering the role of Vitamin D in cardiovascular disease (CVD) and the relationship between coronary artery calcification (CAC) and CVD, we aimed to investigate the association between the serum level of Vitamin D and CAC. Materials and Methods: This was a cross-sectional study on 67 consecutive patients who were referred for performing computed tomography angiography. We used Spearman correlation to evaluate the relationship between Vitamin D and CAC and then linear regressions to control for demographics and vascular risk factors. Results: There was no association between CAC and Vitamin D levels (Spearman coefficient = -0.03, P = 0.805). After controlling for age, sex, hypertension, hyperlipidemia, diabetes mellitus, and smoking, there was still no association between Vitamin D and CAC score (estimate = 0.001, S. E. = 0.020, P = 0.942). Conclusion: We did not find the association between the serum level of Vitamin D and coronary artery calcification.

9.
Alzheimers Dement ; 16(11): 1596-1599, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32729966

RESUMO

INTRODUCTION: Few biomarkers exist for early detection of vascular cognitive impairment. We examined whether the Hachinski Ischemic Scale (HIS) can predict dementia in elderly. METHODS: We leveraged data of the Canadian Study of Health and Aging. First, we examined the association of HIS with incident dementia. Next, we compared HIS to apolipoprotein E (APOE ɛ4) in prediction of dementia. We trained the HIS and APOE ɛ4 models in the training dataset and used the trained models for dementia prediction in the validation dataset. RESULTS: A higher HIS level was associated with a higher odds of dementia (odds ratio = 1.64, 95% confidence interval [CI]: 1.41 to 1.90, P < .001). Dementia discrimination of the HIS model was not different from the APOE ɛ4 model (area under the curve difference = 0.002, 95% CI: -0.024 to 0.029, P = .857). The calibration of the HIS model was 13.7 (P = .091) and of the APOE ɛ4 model was 13.3 (P = .100). DISCUSSION: HIS may be used as a simple, inexpensive test to identify older adults at risk of developing dementia.

10.
Artigo em Inglês | MEDLINE | ID: mdl-32720690

RESUMO

OBJECTIVE: Mixed-brain pathologies are the most common cause of progressive parkinsonism in older adults. We tested the hypothesis that the impact of individual pathologies associated with progressive parkinsonism, differ among older adults. METHODS: Data was from 1089 decedents who had undergone annual clinical testing and autopsy. Parkinsonism was based on a modified United Parkinson's Disease Rating Scale. Linear mixed-effects models were employed, to investigate the combinations of nine pathologies related to progressive parkinsonism. Then we estimated the person-specific contributions of each pathology for progressive parkinsonism. RESULTS: The average participant showed three pathologies. Parkinson's disease (PD) and four cerebrovascular pathologies [macroinfarcts, atherosclerosis, arteriolosclerosis and cerebral amyloid angiopathy (CAA)] but not AD, TDP-43, hippocampal sclerosis and microinfarcts, were independently associated with progressive parkinsonism. These pathologies accounted for 13% of additional variance of progressive parkinsonism. Thirty-one different combinations of these five pathologies were observed to be associated with progressive parkinsonism observed. On average, PD and CAA accounted respectively for 66% and 65% of person-specific progression of parkinsonism, while macroinfarcts, atherosclerosis and arteriolosclerosis accounted for 41%-48%. CONCLUSION: There is much greater heterogeneity in the comorbidity and relative impact of individual brain pathologies affecting progressive parkinsonism than previously recognized and this may account in part for its phenotypic heterogeneity in older adults.

11.
JAMA Neurol ; 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32597941

RESUMO

Importance: Indicators of early-life cognitive enrichment (ELCE) have been associated with slower cognitive decline and decreased dementia in late life. However, the mechanisms underlying this association have not been elucidated. Objective: To examine the association of ELCE with late-life Alzheimer disease (AD) and other common dementia-related pathological changes. Design, Setting, and Participants: This clinical-pathological community-based cohort study, the Rush Memory and Aging Project, followed up participants before death for a mean (SD) of 7.0 (3.8) years with annual cognitive and clinical assessments. From January 1, 1997, through June 30, 2019, 2044 participants enrolled, of whom 1018 died. Postmortem data were leveraged from 813 participants. Data were analyzed from April 12, 2019, to February 20, 2020. Exposures: Four indicators of ELCE (early-life socioeconomic status, availability of cognitive resources at 12 years of age, frequency of participation in cognitively stimulating activities, and early-life foreign language instruction) were obtained by self-report at the study baseline, from which a composite measure of ELCE was derived. Main Outcomes and Measures: A continuous global AD pathology score derived from counts of diffuse plaques, neuritic plaques, and neurofibrillary tangles. Results: The 813 participants included in the analysis had a mean (SD) age of 90.1 (6.3) years at the time of death, and 562 (69%) were women. In a linear regression model controlled for age at death, sex, and educational level, a higher level of ELCE was associated with a lower global AD pathology score (estimate, -0.057; standard error, 0.022; P = .01). However, ELCE was not associated with any other dementia-related pathological changes. In addition, a higher level of ELCE was associated with less cognitive decline (mean [SD], -0.13 [0.19] units per year; range, -1.74 to 0.85). An indirect effect through AD pathological changes constituted 20% of the association between ELCE and the rate of late-life cognitive decline, and 80% was a direct association. Conclusions and Relevance: These findings suggest that ELCE was associated with better late-life cognitive health, in part through an association with fewer AD pathological changes.

12.
PLoS One ; 15(4): e0232404, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348372

RESUMO

OBJECTIVE: We examined the association of physical activity, postmortem brain pathologies, and parkinsonism proximate to death in older adults. METHODS: We studied the brains of 447 older decedents participating in a clinical-autopsy cohort study. We deployed a wrist worn activity monitor to record total daily physical activity during everyday living in the community-setting. Parkinsonism was assessed with 26 items of a modified motor portion of Unified Parkinson's Disease Rating Scale (UPDRS). We used linear regression models, controlling for age and sex, to examine the association of physical activity with parkinsonism with and without indices of Alzheimer's disease and related disorders (ADRD) pathologies. In separate models, we added interaction terms to examine if physical activity modified the associations of brain pathologies with parkinsonism. RESULTS: Mean age at death was 90.9 (SD, 6.2), mean severity of parkinsonism was 14.1 (SD, 9.2, Range 0-59.4), and 350 (77%) had evidence of more than one ADRD pathologies. Higher total daily physical activity was associated with less severe parkinsonism (Estimate, -0.315, S.E., 0.052, p<0.001). The association of more physical activity with less severe parkinsonism persisted after adding terms for ten brain pathologies (Estimate, -0.283, S.E., 0.052, p<0.001). The associations of brain pathologies with more severe parkinsonism did not vary with the level of physical activity. CONCLUSION: The association of higher physical activity with less severe parkinsonism may be independent of the presence of ADRD brain pathologies. Further work is needed to identify mechanisms through which physical activity may maintain motor function in older adults.


Assuntos
Encéfalo/patologia , Transtornos Parkinsonianos/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Exercício Físico , Feminino , Humanos , Masculino , Transtornos Parkinsonianos/complicações , Transtornos Parkinsonianos/etiologia , Fatores Sexuais
13.
J Gerontol A Biol Sci Med Sci ; 75(4): 702-711, 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-31046115

RESUMO

BACKGROUND: Physical activity is a modifiable risk factor associated with health benefits. We hypothesized that a more active lifestyle in older adults is associated with a reduced risk of incident parkinsonism and a slower rate of its progression. METHODS: Total daily physical activity was recorded with an activity monitor in 889 community-dwelling older adults participating in the Rush Memory and Aging Project. Four parkinsonian signs were assessed with a modified motor portion of the Unified Parkinson's Disease Rating Scale and summarized as a categorical measure and continuous global parkinsonian score. We used Cox models to determine whether physical activity was associated with incident parkinsonism and linear mixed-effects models to examine if physical activity was associated with the rate of progressive parkinsonism. RESULTS: During an average follow-up of 4 years, 233 of 682 (34%) participants, without parkinsonism, developed incident parkinsonism. In Cox models controlling for age, sex, and education, a higher level of physical activity was associated with a reduced risk of developing parkinsonism (hazard ratio = 0.79; 95% CI = 0.70-0.88, p < .001). This association was not attenuated when controlling for cognition, depressive symptoms, Apolipoprotein E ℇ4 allele, and chronic health conditions. In a linear mixed-effects model including all participants (N = 889) which controlled for age, sex, and education, a 1 SD total daily physical activity was associated with a 20% slower rate of progression of parkinsonism. CONCLUSION: Older adults with a more active lifestyle have a reduced risk for parkinsonism and a slower rate of its progression.

14.
Iran J Neurol ; 18(2): 57-63, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-31565201

RESUMO

Background: Transcranial direct current stimulation (tDCS) of the primary motor cortex of the lower limb has been exploited in the treatment of patients with stroke and spastic lower limb paresis. We examined this stimulation efficacy in the treatment of multiple sclerosis (MS)-related walking disability. Methods: In a single-center randomized double-blind clinical trial study, 13 patients with MS and walking disability and Expanded Disability Status Scale (EDSS) score of 3 to 6 were randomized to the real and sham stimulation groups. In the real tDCS stimulation, 7 patients received anodal 2.5 mA stimulation at 1 cm anterior to the Cz point for 30-minute daily sessions in 7 consecutive days. The other group received sham stimulation with the same protocol. The primary outcome of the trial was change in the Timed 25-Foot Walk (T25-FW) from before to after the stimulation. We also assessed the Multiple Sclerosis Walking Scale-12 (MSWS-12). We employed linear mixed effects model to examine the efficacy of tDCS stimulation on changing the outcomes. Results: On average, patients who received real tDCS stimulation walked faster after 7 sessions of stimulation [Estimate = -2.7, standard error (SE) = 1.3, P = 0.049], while walking speed of sham stimulation recipients did not change. For every session of stimulation, recipients of real tDCS stimulation spent 2.7 seconds less for walking the 25 feet. Real tDCS stimulation was not effective in improving MSWS-12 scores. Conclusion: tDCS stimulation of the lower limb motor cortex speeded up patients with MS in walking, but without improvement in patients' mobility in daily activities.

15.
J Stroke Cerebrovasc Dis ; 28(11): 104296, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31395425

RESUMO

OBJECTIVES: This study was designed to investigate the effect of prism adaptation (PA) combined with continuous theta-burst transcranial magnetic stimulation (cTBS) on the neglect recovery of stroke patients with unilateral neglect. METHODS: A total of 14 stroke patients with unilateral neglect were randomly assigned to 2 groups including an intervention group undergone PA combined with cTBS over the left intact parietal cortex and a control group. PA combined with sham cTBS was perfomed for 2 weeks in 10 daily sessions. Before and after the intervention, patients were evaluated for visuospatial neglect measured using the Star Cancellation Test (SCT), Line Bisection Task (LBT), Figure Copying Test, and Clock Drawing Task. Neurological function was evaluated using the Modified Rankin Scale (MRS). RESULTS: Both groups (PA alone and PA+ cTBS) showed improvement in their neglected symptoms (measured by SCT, LBT, Figure Copying Test, and Clock Drawing Task), and in their disability in the neurological function (measured by MRS) (P< .05). CONCLUSIONS: The results of the present study showed that, transcranial magnetic stimulation did not increase the effect of PA on neglect symptoms in stroke patients.


Assuntos
Agnosia/reabilitação , Ritmo beta , Encéfalo/fisiopatologia , Óculos , Reabilitação do Acidente Vascular Cerebral/instrumentação , Acidente Vascular Cerebral/terapia , Estimulação Magnética Transcraniana , Visão Ocular , Percepção Visual , Idoso , Agnosia/diagnóstico , Agnosia/fisiopatologia , Agnosia/psicologia , Terapia Combinada , Avaliação da Deficiência , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Projetos Piloto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Fatores de Tempo , Estimulação Magnética Transcraniana/efeitos adversos , Resultado do Tratamento
16.
Anatol J Cardiol ; 22(1): 33-43, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31264654

RESUMO

OBJECTIVE: The aim of the present study was to assess different obesity indices, as well as their best cut-off point, to predict the occurrence of hypertension (HTN) in an Iranian population. METHODS: In a population-based study, subjects aged 35 years and older were followed for 7 years. Blood pressure was measured at baseline and after the follow-up. Anthropometry indices included body mass index (BMI), body adiposity index (BAI), the waist-to-height ratio (WHtR), the waist-to-hip ratio (WHpR), and waist and hip circumferences (WC and HC). Logistic regression was employed to calculate the odds ratio (OR) and 95% confidence intervals (CI) per standard deviation (SD) increment. The operating characteristic analysis was used to derive the best cut-off value for each index. RESULTS: Among original 6504 participants, 2450 subjects who had no cardiovascular diseases (CVD) and HTN at baseline were revisited, and 542 (22.1%) new cases of HTN were detected. There were minimal differences between most indices in the adjusted models; however, the best HTN predictors were BMI (OR per SD 1.32; 95% CI 1.12-1.56) and almost equally WC (1.35; 1.13-1.60) in men and WC (1.20; 1.04-1.39) in women. As a binary predictor, BMI with a cut-off point of 24.9 kg/m2 in men (1.91; 1.40-2.62) and WC with a cut-off point of 98 cm in women (1.57; 1.17-2.10) were the best in adjusted models. WC, WHpR, and WHtR were significantly associated with an increased risk of HTN only in participants whose weight was normal (BMI, 18.5-24.9 kg/m2). CONCLUSION: Therefore, BMI in men and WC in women were the best predictors of HTN, both as continuous and binary factors at their appropriate cut-off points.


Assuntos
Hipertensão/epidemiologia , Obesidade/complicações , Adiposidade , Adulto , Antropometria , Determinação da Pressão Arterial , Índice de Massa Corporal , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hipertensão/etiologia , Incidência , Entrevistas como Assunto , Irã (Geográfico)/epidemiologia , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Exame Físico , Curva ROC , Inquéritos e Questionários , Circunferência da Cintura , Razão Cintura-Estatura , Relação Cintura-Quadril
17.
Eur J Nutr ; 58(1): 163-171, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29151136

RESUMO

BACKGROUND: The association between milk intake and cardiovascular disease (CVD) and mortality risk is still controversial but data from Middle-Eastern populations are scarce. We aimed to study these associations in an Iranian population. METHODS: We used the Isfahan Cohort Study, a population-based prospective study of 6504 adult Iranians. In this analysis, we included 5432 participants free of CVD at baseline with at least one follow-up. Data on whole milk intake and other dietary factors were collected by a food frequency questionnaire at baseline. Cox proportional hazard regression was used to predict risk of CVD events, comprising coronary heart disease (CHD) and stroke, and mortality according to frequency of whole milk intake with adjustment for other potential confounders. RESULTS: During a median 10.9 years of follow-up, we documented 705 new cases of CVD comprising 564 CHD and 141 stroke cases. Compared with non-consumers, less than daily intake of whole milk was significantly associated with lower risk of CVD (HR 0.80, 95% CI 0.65-0.97), CHD (HR 0.81, 95% CI 0.65-0.99), and a non-significant lower risk of stroke (HR 0.79, 95% CI 0.50-1.27). Daily intake of whole milk was not significantly associated with CVD (HR 1.25, 95% CI 0.89-1.75), CHD, and stroke, but was associated with higher risk of all-cause mortality (HR 1.54, 95% CI 1.04-2.29). CONCLUSIONS: Less than daily intake of whole milk was associated with a statistically significant, although modest, lower risk of CVD compared with non-consumption, but this potential benefit may not extend to daily intake in this population.


Assuntos
Doenças Cardiovasculares/epidemiologia , Leite , Animais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
18.
J Hum Hypertens ; 33(11): 807-816, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30385824

RESUMO

A 10-year longitudinal population-based study entitled Isfahan Cohort Study (ICS) was conducted in 2001-2011 with cardiovascular disease (CVD) as the primary outcome. We considered ICS as a master plan for a multi-level non-communicable disease (NCD) study named Isfahan Cohort Study 2 (ICS2). ICS2 is a multi-generation 10-year cohort study with new goals and outcomes that have been started in 2013, recruiting a sub-sample of ICS (n = 1487) and a new recruited sample (n = 1355) aged 35 years and over, all living in urban and rural areas of two counties in central Iran. In addition, 2500 of participant's adult children were selected randomly, as well as 1000 of their grandchildren. The aim of ICS2 is to detect the incidence of some NCDs including CVD, cancers, and diabetes and to identify the impact of their behavioral, metabolic, environmental, and genetic risk factors. In addition, studying lifestyle behaviors in three generations in a hierarchical manner of parents, their children and grandchildren in ICS2 will improve our knowledge on other determinants such as epigenetics of NCDs.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/genética , Hereditariedade , Doenças não Transmissíveis/epidemiologia , Linhagem , Projetos de Pesquisa , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Epigênese Genética , Feminino , Interação Gene-Ambiente , Predisposição Genética para Doença , Nível de Saúde , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Estilo de Vida , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/mortalidade , Fenótipo , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
19.
Acta Neuropathol ; 136(6): 887-900, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30334074

RESUMO

Alzheimer's dementia is significantly more common in women than in men. However, few pathological studies have addressed sex difference in Alzheimer's disease (AD) and other brain pathologies. We leveraged postmortem data from 1453 persons who participated in one of two longitudinal community-based studies of older adults, the Religious Orders Study and the Rush Memory and Aging Project. Postmortem examination identified AD pathologies, neocortical Lewy bodies, DNA-binding protein 43 (TDP-43), hippocampal sclerosis, gross and micro infarcts, atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy. Linear and logistic regressions examined the association of sex with each of the pathologic measures. Two-thirds of subjects were women (n = 971; 67%), with a mean age at death of 89.8 (SD = 6.6) years in women and 87.3 (SD = 6.6) in men. Adjusted for age and education, women had higher levels on a global measure of AD pathology (estimate = 0.102, SE = 0.022, p < 0.001), and tau tangle density in particular (estimate = 0.334, SE = 0.074, p < 0.001), and there was a borderline difference between women and men in amyloid-ß load (estimate = 0.124, SE = 0.065, p = 0.056). In addition, compared to men, women were more likely to have more severe arteriolosclerosis (OR = 1.28, 95% CI:1.04-1.58, p = 0.018), and less likely to have gross infarcts (OR = 0.78, 95% CI:0.61-0.98, p = 0.037), although the association with gross infarct was attenuated after controlling for vascular risk factors. These data help elucidate the neuropathologic footprint of sex difference in AD and other common brain pathologies of aging.


Assuntos
Envelhecimento/patologia , Doença de Alzheimer/patologia , Encéfalo/patologia , Caracteres Sexuais , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/genética , Doença de Alzheimer/complicações , Doença de Alzheimer/genética , Doença de Alzheimer/metabolismo , Apolipoproteína E4/genética , Arteriolosclerose/complicações , Arteriolosclerose/patologia , Autopsia , Encéfalo/metabolismo , Distribuição de Qui-Quadrado , Estudos Transversais , Proteínas de Ligação a DNA/metabolismo , Feminino , Humanos , Estudos Longitudinais , Masculino , alfa-Sinucleína/metabolismo , Proteínas tau/metabolismo
20.
Lancet ; 391(10134): 2019-2027, 2018 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-29864018

RESUMO

BACKGROUND: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels. METHODS: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month. FINDINGS: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14-1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12-1·72) irrespective of other patient and service characteristics. INTERPRETATION: Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes. FUNDING: Chest, Heart and Stroke Scotland.


Assuntos
Padrões de Prática Médica , Acidente Vascular Cerebral/terapia , Idoso , Estudos de Casos e Controles , Países Desenvolvidos , Países em Desenvolvimento , Medicina Baseada em Evidências , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Pobreza , Inquéritos e Questionários , Análise de Sobrevida , Resultado do Tratamento
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