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Yu Y, Yan P, Cheng G, Liu D, Xu L, Yang M, Xu H, Cheng X, Lian P, Zeng Y. Correlation between serum lipid profiles and cognitive impairment in old age: a cross-sectional study. Gen Psychiatr 2023; 36:e101009. [PMID: 37144157 PMCID: PMC10151832 DOI: 10.1136/gpsych-2023-101009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
Background The correlation between cognitive function and lipid profiles, including total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides, is inconsistent. Aims This cross-sectional study investigated the association between serum lipid levels and the prevalence of cognitive impairment among community-dwelling older adults and explored this difference in association by gender and urban-rural residency. Methods Participants aged 65 and above in urban and rural areas were recruited between 2018 and 2020, selected from the Hubei Memory and Aging Cohort Study. Detailed neuropsychological evaluations, clinical examinations and laboratory tests were conducted in community health service centres. Multivariate logistic regression was used to analyse the correlation between serum lipid profiles and the prevalence of cognitive impairment. Results We identified 1 336 cognitively impaired adults (≥65 years)-1 066 with mild cognitive impairment and 270 with dementia-from 4 746 participants. Triglycerides level was correlated with cognitive impairment in the total sample (χ2=6.420, p=0.011). In gender-stratified multivariate analysis, high triglycerides in males reduced the risk of cognitive impairment (OR: 0.785, 95% CI: 0.623 to 0.989, p=0.040), and high LDL-C in females increased the risk of cognitive impairment (OR: 1.282, 95% CI: 1.040 to 1.581, p=0.020). In both gender-stratified and urban-rural stratified multivariate analyses, high triglycerides reduced the risk of cognitive impairment in older urban men (OR: 0.734, 95% CI: 0.551 to 0.977, p=0.034), and high LDL-C increased the risk of cognitive impairment in older rural women (OR: 1.830, 95% CI: 1.119 to 2.991, p=0.016). Conclusions There are gender and urban-rural differences in the correlation of serum lipids with cognitive impairment. High triglycerides levels may be a protective factor for cognitive function in older urban men, while high LDL-C levels may be a risk factor for cognitive function in older rural women.
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Affiliation(s)
- Yafu Yu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China
| | - Pingting Yan
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China
- Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei, China
| | - Guirong Cheng
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Dan Liu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Lang Xu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Mengliu Yang
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China
| | - Heng Xu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China
| | - Xi Cheng
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China
| | - Pengfei Lian
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China
| | - Yan Zeng
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
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2
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Fu J, Liu Q, Du Y, Zhu Y, Sun C, Lin H, Jin M, Ma F, Li W, Liu H, Zhang X, Chen Y, Sun Z, Wang G, Huang G. Age- and Sex-Specific Prevalence and Modifiable Risk Factors of Mild Cognitive Impairment Among Older Adults in China: A Population-Based Observational Study. Front Aging Neurosci 2020; 12:578742. [PMID: 33192471 PMCID: PMC7662098 DOI: 10.3389/fnagi.2020.578742] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background Minimal data are available on the prevalence of mild cognitive impairment (MCI) in older Chinese adults. Moreover, the current information on MCI shows important geographical variations. Objective We aimed to assess the prevalence and risk factors for MCI by age and sex among older adults in a North Chinese population. Methods In this population-based cross-sectional study, we enrolled a random sample of 4,943 adults aged ≥ 60 years between March 2018 and June 2019 in Tianjin, China. Of these, 312 individuals were excluded due to a lack of data (e.g., fasting blood test). As a result, 4,631 subjects were assessed. Individuals with MCI were identified using neuropsychological assessments, including the Mini-Mental State Examination and Activities of Daily Living scale, based on a modified version of the Petersen’s criteria. Results The mean (SD) age of the 4,631 participants was 67.6 (4.89) years, and 2,579 (55.7%) were female. The overall age- and sex-standardized prevalence of MCI in our study population was 10.7%. There were significant associations of MCI with age [65–69 vs. 60–64 years, OR = 0.74; 95% confidence interval (CI): 0.58, 0.96], physical activity (≥23.0 vs. <23.0 MET-hours/week, OR = 0.79; 95% CI: 0.64, 0.96), body mass index (BMI) (OR = 0.92; 95% CI: 0.89, 0.95), grip strength (OR = 0.50; 95% CI: 0.38, 0.67), hypertension (yes vs. no, OR = 1.44; 95% CI: 1.18, 1.77), higher levels of sleepiness (OR = 1.80; 95% CI: 1.36, 2.37), and longer sleep duration (OR = 1.40; 95% CI: 1.14, 1.72). The inverse association between BMI and MCI was stronger in older age groups (P for heterogeneity = 0.003). Moreover, the magnitude of association between triglycerides and MCI was different between the sexes (P for heterogeneity = 0.029). Conclusion The age- and sex-standardized prevalence of MCI was 10.7% in the study sample. Physical activity, BMI, grip strength, sleepiness, sleep duration, and hypertension were associated with the prevalence of MCI. Additionally, triglycerides and BMI might be differently associated with the presence of MCI for different sexes and age stages, respectively.
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Affiliation(s)
- Jingzhu Fu
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Qian Liu
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Yue Du
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yun Zhu
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Changqing Sun
- Neurosurgical Department of Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Hongyan Lin
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Mengdi Jin
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Fei Ma
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Wen Li
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Huan Liu
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Xumei Zhang
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Yongjie Chen
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhuoyu Sun
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Guangshun Wang
- Department of Tumor, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Guowei Huang
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
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3
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Guo Y, Li P, Ma X, Huang X, Liu Z, Ren X, Yang Y, Halm-Lutterodt NV, Yuan L. Association of Circulating Cholesterol Level with Cognitive Function and Mild Cognitive Impairment in the Elderly: A Community-based Population Study. Curr Alzheimer Res 2020; 17:556-565. [DOI: 10.2174/1567205017666200810165758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022]
Abstract
Background:
The present study was designed to examine the association of circulating cholesterol
with cognitive function in non-demented community aging adults.
Methods:
This was a cross-sectional study including 1754 Chinese adults aged 55-80 years. The association
between serum cholesterol levels and cognitive function was examined. Participants were categorized
into four groups according to the quartile of circulating TC (total cholesterol), High Density
Lipoprotein Cholesterol (HDL-c), Low Density Lipoprotein Cholesterol (LDL-c) levels and HDLc/
LDL-c ratio. The difference in cognitive performance among the groups was compared. Logistic regression
model was used to determine the association of circulating cholesterol level with the risk of
Mild Cognitive Impairment (MCI).
Results:
Mild increase of serum LDL-c level correlated with better visual and executive, language,
memory and delayed recall abilities. Higher circulating TC and HDL-c levels were found to be associated
with poorer cognitive function, especially in aging female subjects. Higher circulating TC, HDL-c
and HDL/LDL ratio indicated an increased risk of MCI, especially in female subjects.
Conclusion:
Slight increase in circulating LDL-c level might benefit cognitive function in aging adults.
However, higher circulating TC and HDL-c levels might indicate a decline of cognitive function, especially
in aging female subjects.
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Affiliation(s)
- Yujie Guo
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Pengfei Li
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Xiaojun Ma
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Xiaochen Huang
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Zhuoheng Liu
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Xiuwen Ren
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yuhui Yang
- School of Public Health, Capital Medical University, Beijing 100069, China
| | | | - Linhong Yuan
- School of Public Health, Capital Medical University, Beijing 100069, China
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4
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Yi S, Karabin NB, Zhu J, Bobbala S, Lyu H, Li S, Liu Y, Frey M, Vincent M, Scott EA. An Injectable Hydrogel Platform for Sustained Delivery of Anti-inflammatory Nanocarriers and Induction of Regulatory T Cells in Atherosclerosis. Front Bioeng Biotechnol 2020; 8:542. [PMID: 32582667 PMCID: PMC7289959 DOI: 10.3389/fbioe.2020.00542] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/05/2020] [Indexed: 01/09/2023] Open
Abstract
Chronic unresolved vascular inflammation is a critical factor in the development of atherosclerosis. Cardiovascular immunotherapy has therefore become a recent focus for treatment, with the objective to develop approaches that can suppress excessive inflammatory responses by modulating specific immune cell populations. A benefit of such immunomodulatory strategies is that low dosage stimulation of key immune cell populations, like antigen presenting cells, can subsequently propagate strong proliferation and therapeutic responses from effector cells. We have previously demonstrated that intravenous injections of anti-inflammatory nanocarriers provided atheroprotection that was mediated by regulatory T cells (Tregs) upregulated in lymphoid organs and atherosclerotic lesions. Here, we demonstrate an injectable filamentous hydrogel depot (FM-depot) engineered for low dosage, sustained delivery of anti-inflammatory nanocarriers. The bioactive form of vitamin D (aVD; 1, 25-Dihydroxyvitamin D3), which inhibits pro-inflammatory transcription factor NF-κB via the intracellular nuclear hormone receptor vitamin D receptor (VDR), was stably loaded into poly(ethylene glycol)-block-poly(propylene sulfide) (PEG-b-PPS) filomicelles. These aVD-loaded filaments underwent morphological transitions to release monodisperse drug-loaded micelles upon oxidation. This cylinder-to-micelle transition was characterized in vitro by cryogenic transmission electron microscopy (CryoTEM) and small angle X-ray scattering (SAXS). Following crosslinking with multi-arm PEG for in situ gelation, aVD-loaded FM-depots maintained high levels of Foxp3+ Tregs in both lymphoid organs and atherosclerotic lesions for weeks following a single subcutaneous injection into ApoE-/- mice. FM-depots therefore present a customizable delivery platform to both develop and test nanomedicine-based approaches for anti-inflammatory cardiovascular immunotherapy.
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Affiliation(s)
- Sijia Yi
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Nicholas B Karabin
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Jennifer Zhu
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Sharan Bobbala
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Huijue Lyu
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Sophia Li
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Yugang Liu
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Molly Frey
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Michael Vincent
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Evan A Scott
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
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5
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Seidu S, Kunutsor SK, Khunti K. Serum albumin, cardiometabolic and other adverse outcomes: systematic review and meta-analyses of 48 published observational cohort studies involving 1,492,237 participants. SCAND CARDIOVASC J 2020; 54:280-293. [PMID: 32378436 DOI: 10.1080/14017431.2020.1762918] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives. A general body of evidence suggests that low serum albumin might be associated with increased risk of adverse cardiometabolic outcomes, but findings are divergent. We aimed to quantify associations of serum albumin with the risk of type 2 diabetes (T2D), cardiovascular disease (CVD), all-cause mortality, and other adverse outcomes using a systematic review and meta-analyses of published observational cohort studies. Design. MEDLINE, Embase, Web of Science, and manual search of relevant bibliographies were systematically searched to January 2020. Relative risks (RRs) with 95% confidence intervals (CIs) comparing top versus bottom thirds of serum albumin levels were pooled. Results. Fifty-four articles based on 48 unique observational cohort studies comprising of 1,492,237 participants were eligible. Multivariable adjusted RRs (95% CIs) comparing the top vs bottom third of serum albumin levels were: 1.03 (0.86-1.22) for T2D; 0.60 (0.53-0.67) for CVD; 0.74 (0.66-0.84) for coronary heart disease (CHD); 0.57 (0.36-0.91) for CHD death; 0.76 (0.65-0.87) for myocardial infarction; 0.66 (0.55-0.77) for all-cause mortality; 0.71 (0.61-0.83) for venous thromboembolism; 0.65 (0.48-0.88) for cancer mortality; and 0.62 (0.46-0.84) for fracture. Heterogeneity between contributing studies of T2D was partly explained by sample sizes of studies (p for meta-regression = .035). Conclusions. Elevated levels of serum albumin are associated with reduced risk of vascular outcomes, all-cause mortality, certain cancers, and fracture. Inconsistent findings for T2D may be attributed to selective reporting by studies. Further research is needed to assess any potential causal relevance to these findings and the role of serum albumin concentrations in disease prevention.Systematic review registration: PROSPERO 2019: CRD42019125869.
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Affiliation(s)
- Samuel Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
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6
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McFarlane O, Kędziora-Kornatowska K. Cholesterol and Dementia: A Long and Complicated Relationship. Curr Aging Sci 2020; 13:42-51. [PMID: 31530269 PMCID: PMC7403650 DOI: 10.2174/1874609812666190917155400] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/09/2019] [Accepted: 08/16/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a huge demand for efficient strategies for maintaining cognitive wellbeing with age, especially in the context of population aging. Dementia constitutes the main reason for disability and dependency in the elderly. Identification of potential risk and protective factors, as well as determinants of conversion from MCI to dementia, is therefore crucial. In case of Alzheimer's disease, the most prevalent dementia syndrome amongst the members of modern societies, neurodegenerative processes in the brain can begin many years before first clinical symptoms appear. First functional changes typically mean advanced neuron loss, therefore, the earliest possible diagnosis is critical for implementation of promising early pharmaceutical interventions. OBJECTIVE The study aimed to discuss the relationships between both circulating and brain cholesterol with cognition, and explore its potential role in early diagnosis of cognitive disorders. METHODS Literature review. RESULTS The causal role of high cholesterol levels in AD or MCI has not been confirmed. It has been postulated that plasma levels of 24(S)-OHC can potentially be used as an early biochemical marker of altered cholesterol homeostasis in the CNS. Some studies brought conflicting results, finding normal or lowered levels of 24(S)-OHC in dementia patients compared to controls. In spite of decades of research on the relationship between cholesterol and dementia, so far, no single trusted indicator of an early cognitive deterioration has been identified. CONCLUSION The current state of knowledge makes the use of cholesterol markers of cognitive decline in clinical practice impossible.
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Affiliation(s)
- Oliwia McFarlane
- Address correspondence to this author at the Department of Public Health, Faculty of Health Sciences, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, P.O. Box: 85-830, Bydgoszcz, Poland; Tel/Fax: ++48-52-585-5408; E-mail:
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7
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The gender- and age- dependent relationships between serum lipids and cognitive impairment: a cross-sectional study in a rural area of Xi'an, China. Lipids Health Dis 2019; 18:4. [PMID: 30611281 PMCID: PMC6320576 DOI: 10.1186/s12944-018-0956-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 12/27/2018] [Indexed: 01/23/2023] Open
Abstract
Background Serum lipids [total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG)] are risk factors for stroke, but the relationships between serum lipids and cognitive impairment have not been verified completely. In this study, we studied the relationships between serum lipids and cognitive impairment and explored whether gender and age had effects on the relationships. Methods In this cross-sectional study, we collected serum lipids and cognitive function information from 1762 participants (aged 40–85). Univariate analysis, multivariate analysis, and both gender- and age-based stratified multivariate analysis were used. Results In the entire sample set, there was no significant correlation between serum lipid parameters (TC, LDL-C, HDL-C and TG) and cognitive impairment. In both gender- and age-based stratified multivariate analysis, high serum TC was positively associated with cognitive impairment in the elderly (> 55) male participants (OR = 4.404, 95% CI = 1.264–15.344, p = 0.02), and high serum LDL-C was positively correlated with cognitive impairment in the elderly female subjects (OR = 2.496, 95% CI = 1.057–5.896, p = 0.037), while high serum TG was negatively associated with cognitive impairment in the middle-aged (≤ 55) male participants (OR = 0.157, 95% CI = 0.051–0.484, p = 0.001). Conclusions The relationships between serum lipids and cognitive impairment are gender- and age- dependent, with high serum TC and LDL-C may be risk factors of cognitive impairment in the elderly male and female subjects respectively, while high serum TG may be protector of cognitive impairment in the middle-aged male participants.
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8
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Zhou F, Deng W, Ding D, Zhao Q, Liang X, Wang F, Luo J, Zheng L, Guo Q, Hong Z. High Low-Density Lipoprotein Cholesterol Inversely Relates to Dementia in Community-Dwelling Older Adults: The Shanghai Aging Study. Front Neurol 2018; 9:952. [PMID: 30483213 PMCID: PMC6240682 DOI: 10.3389/fneur.2018.00952] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background: The relationship between cholesterol and cognitive function is unclear from the previous studies. This study was conducted to explore this association in older Chinese adults. Methods: Data were from the Shanghai Aging Study, comprising 3,836 residents aged 50 years or over in an urban community. Diagnoses of dementia and mild cognitive impairment were established according to the fourth edition of diagnostic and statistical manual of mental disorders (DSM-IV) and Petersen criteria. Multivariate logistic regression models, non-matched and propensity score (PS) matched, were used to examine the association between cholesterol levels and cognitive function. Results: There was a significantly higher proportion of participants with low levels of total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) in the dementia group than in groups without dementia (P < 0.05). High LDL-C level was inversely associated with dementia, with a negative trend in the PS matched model. TC and high density lipoprotein cholesterol (HDL-C) were not significantly related to dementia in either non-matched models or PS matched models. Conclusion: Our result indicates that high level of LDL-C is inversely associated with dementia. High level of LDL-C may be considered as a potential protective factor against cognition decline.
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Affiliation(s)
- Fen Zhou
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China (Fudan University), Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education (Fudan University), Shanghai, China
| | - Wei Deng
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China (Fudan University), Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education (Fudan University), Shanghai, China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoniu Liang
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Fei Wang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China (Fudan University), Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education (Fudan University), Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China (Fudan University), Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education (Fudan University), Shanghai, China
| | - Li Zheng
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qihao Guo
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhen Hong
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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9
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Lv YB, Yin ZX, Chei CL, Brasher MS, Zhang J, Kraus VB, Qian F, Shi XM, Matchar DB, Zeng Y. Serum Cholesterol Levels within the High Normal Range Are Associated with Better Cognitive Performance among Chinese Elderly. J Nutr Health Aging 2017. [PMID: 26892577 DOI: 10.1007/s12603-016-0701-6.] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The association between cognitive function and cholesterol levels is poorly understood and inconsistent results exist among the elderly. The purpose of this study is to investigate the association of cholesterol level with cognitive performance among Chinese elderly. DESIGN A cross-sectional study was implemented in 2012 and data were analyzed using generalized additive models, linear regression models and logistic regression models. SETTING Community-based setting in eight longevity areas in China. SUBJECTS A total of 2000 elderly aged 65 years and over (mean 85.8±12.0 years) participated in this study. MEASUREMENTS Total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) concentration were determined and cognitive impairment was defined as Mini-Mental State Examination (MMSE) score ≤23. RESULTS There was a significant positive linear association between TC, TG, LDL-C, HDL-C and MMSE score in linear regression models. Each 1 mmol/L increase in TC, TG, LDL-C and HDL-C corresponded to a decreased risk of cognitive impairment in logistic regression models. Compared with the lowest tertile, the highest tertile of TC, LDL-C and HDL-C had a lower risk of cognitive impairment. The adjusted odds ratios and 95% CI were 0.73(0.62-0.84) for TC, 0.81(0.70-0.94) for LDL-C and 0.81(0.70-0.94) for HDL-C. There was no gender difference in the protective effects of high TC and LDL-C levels on cognitive impairment. However, for high HDL-C levels the effect was only observed in women. High TC, LDL-C and HDL-C levels were associated with lower risk of cognitive impairment in the oldest old (aged 80 and older), but not in the younger elderly (aged 65 to 79 years). CONCLUSIONS These findings suggest that cholesterol levels within the high normal range are associated with better cognitive performance in Chinese elderly, specifically in the oldest old. With further validation, low cholesterol may serve a clinical indicator of risk for cognitive impairment in the elderly.
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Affiliation(s)
- Y-B Lv
- Dr. Xiaoming Shi, No. 7 Pan Jia Yuan Nan Li, Chaoyang District, Beijing 100021, China. Telephone: (+86) 1050930101, Fax:(+86)1050930115, E-mail:
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Lv YB, Yin ZX, Chei CL, Brasher MS, Zhang J, Kraus VB, Qian F, Shi XM, Matchar DB, Zeng Y. Serum cholesterol levels within the high normal range are associated with better cognitive performance among Chinese elderly. J Nutr Health Aging 2016; 20:280-7. [PMID: 26892577 DOI: 10.1007/s12603-016-0701-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Y-B Lv
- Dr. Xiaoming Shi, No. 7 Pan Jia Yuan Nan Li, Chaoyang District, Beijing 100021, China. Telephone: (+86) 1050930101, Fax:(+86)1050930115, E-mail:
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Ramos–Estebanez C, Moral–Arce I, Rojo F, Gonzalez–Macias J, Hernandez JL. Vascular Cognitive Impairment and Dementia Expenditures: 7–Year Inpatient Cost Description in Community Dwellers. Postgrad Med 2015; 124:91-100. [DOI: 10.3810/pgm.2012.09.2597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ancelin ML, Ripoche E, Dupuy AM, Samieri C, Rouaud O, Berr C, Carrière I, Ritchie K. Gender-specific associations between lipids and cognitive decline in the elderly. Eur Neuropsychopharmacol 2014; 24:1056-66. [PMID: 24721317 DOI: 10.1016/j.euroneuro.2014.02.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 02/07/2014] [Accepted: 02/09/2014] [Indexed: 12/14/2022]
Abstract
The aim of this study was to examine the associations between serum lipid levels and cognitive function in a community-based sample of non-demented subjects aged 65 years and over. Participants were 2737 men and 4118 women from a population-based cohort recruited from three French cities. Visual memory, verbal fluency, psychomotor speed, and executive abilities were evaluated at baseline, and after 2, 4, and 7 years of follow-up. Lipid levels were evaluated at baseline. Multiadjusted Cox models stratified by gender were adjusted for sociodemographic and lifestyle characteristics, mental and physical health, and genetic vulnerability to dyslipidemia (apolipoprotein E and A, and cholesteryl ester transfer protein) and taking into account baseline vascular pathologies. In men, a hypercholesterolemic pattern in late-life (high total cholesterol (T-C), low HDL-C, high LDL-C levels) was associated with a 25 to 50% increased risk of decline over 7 years in psychomotor speed, executive abilities, and verbal fluency. Specific associations with low T-C and low LDL-C levels were also observed which may depend on genetic vulnerability to dyslipidemia (related to apolipoprotein A5 and cholesteryl exchange transfer protein). In contrast, in women, a 30% higher rate of decline was found in psychomotor speed with high HDL-C levels and in executive abilities with low levels of LDL-C and triglycerides, in interaction with hormonal treatment. For men and women, vascular pathologies only slightly outweighed the risk related to lipids. This suggests a complex gender-specific pattern of cognitive decline involving genetic vulnerability in men and hormonal status in women.
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Affiliation(s)
- Marie-Laure Ancelin
- Inserm, U1061, Montpellier, F-34093, France; Univ Montpellier 1, U1061, Montpellier, France.
| | - Emmanuelle Ripoche
- Inserm, U1061, Montpellier, F-34093, France; Univ Montpellier 1, U1061, Montpellier, France
| | - Anne-Marie Dupuy
- Inserm, U1061, Montpellier, F-34093, France; Univ Montpellier 1, U1061, Montpellier, France; CHRU Montpellier, Hop Lapeyronie, Laboratoire de Biochimie, Montpellier, France
| | - Cécilia Samieri
- Univ Bordeaux, ISPED, U897-Epidemiologie-Biostatistique, Bordeaux, France; Insem, U897, Bordeaux, France
| | - Olivier Rouaud
- CHRU Dijon, Centre Mémoire Ressources et Recherche, Dijon, France
| | - Claudine Berr
- Inserm, U1061, Montpellier, F-34093, France; Univ Montpellier 1, U1061, Montpellier, France
| | - Isabelle Carrière
- Inserm, U1061, Montpellier, F-34093, France; Univ Montpellier 1, U1061, Montpellier, France
| | - Karen Ritchie
- Inserm, U1061, Montpellier, F-34093, France; Univ Montpellier 1, U1061, Montpellier, France; Faculty of Medicine, Imperial College, London, UK
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Takata Y, Ansai T, Soh I, Awano S, Nakamichi I, Akifusa S, Goto K, Yoshida A, Fujii H, Fujisawa R, Sonoki K. Serum total cholesterol concentration and 10-year mortality in an 85-year-old population. Clin Interv Aging 2014; 9:293-300. [PMID: 24611005 PMCID: PMC3928456 DOI: 10.2147/cia.s53754] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Little is known about the association between total cholesterol (TC) and all-cause mortality in the elderly (especially the very elderly). Here we examined the association between TC and all-cause mortality in 207 very elderly (85-year-old) participants. In 2003, we performed a baseline laboratory blood examination, and blood pressure (BP) and body mass index (BMI) measurements, and lifestyle questionnaires were completed by the participants. The participants were followed for the subsequent 10 years. As of 2013, of the 207 participants in 2003, 70 participants had survived, 120 individuals had died, and 17 were lost to follow up. The TC values were divided into high-TC (≥209 mg/dL), intermediate-TC (176-208 mg/dL), and low-TC (≤175 mg/dL) categories. With the Kaplan-Meier method, we found that both the high-TC and intermediate-TC participants survived longer than the low-TC participants. The men with high TC survived longer than those with low TC, but no corresponding difference was found for the women. A multivariate Cox proportional hazards regression model, with adjustment for gender, smoking, alcohol intake, history of stroke or heart disease, serum albumin concentration, BMI, and systolic BP, revealed that the total mortality in the low-TC group was 1.7-fold higher than that in the high-TC group. Mortality, adjusted for the same factors, decreased 0.9% with each 1 mg/dL increase in the serum TC concentration and decreased 0.8% with each 1 mg/dL increase in the serum (low-density lipoprotein) LDL-cholesterol (LDL-C) concentration. Our results indicate an association between lower serum TC concentrations and increased all-cause mortality in a community-dwelling, very elderly population. Mortality decreased with the increases in both TC and LDL-C concentrations, after adjustment for various confounding factors. These findings suggest that low TC and low LDL-C may be independent predictors of high mortality in the very elderly.
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Affiliation(s)
- Yutaka Takata
- Division of General Internal Medicine, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
| | - Toshihiro Ansai
- Division of Community Oral health Development, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
| | - Inho Soh
- Division of Community Oral health Development, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
| | - Shuji Awano
- Division of Community Oral health Development, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
| | - Ikuo Nakamichi
- Division of General Internal Medicine, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
| | - Sumio Akifusa
- Department of Oral Health and Environment, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
| | - Kenichi Goto
- Division of General Internal Medicine, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
| | - Akihiro Yoshida
- Division of Community Oral health Development, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
| | - Hiroki Fujii
- Division of General Internal Medicine, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
| | - Ritsuko Fujisawa
- Division of General Internal Medicine, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
| | - Kazuo Sonoki
- Department of Oral Health and Environment, School of Oral Health Science, Kyushu Dental College, Kitakyushu, Japan
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Owens CD, Kim JM, Hevelone ND, Gasper WJ, Belkin M, Creager MA, Conte MS. An integrated biochemical prediction model of all-cause mortality in patients undergoing lower extremity bypass surgery for advanced peripheral artery disease. J Vasc Surg 2012; 56:686-95. [PMID: 22554422 DOI: 10.1016/j.jvs.2012.02.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 02/02/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patients with advanced peripheral artery disease (PAD) have a high prevalence of cardiovascular (CV) risk factors and shortened life expectancy. However, CV risk factors poorly predict midterm (<5 years) mortality in this population. This study tested the hypothesis that baseline biochemical parameters would add clinically meaningful predictive information in patients undergoing lower extremity bypass operations. METHODS This was a prospective cohort study of patients with clinically advanced PAD undergoing lower extremity bypass surgery. The Cox proportional hazard model was used to assess the main outcome of all-cause mortality. A clinical model was constructed with known CV risk factors, and the incremental value of the addition of clinical chemistry, lipid assessment, and a panel of 11 inflammatory parameters was investigated using the C statistic, the integrated discrimination improvement index, and Akaike information criterion. RESULTS The study monitored 225 patients for a median of 893 days (interquartile range, 539-1315 days). In this study, 50 patients (22.22%) died during the follow-up period. By life-table analysis (expressed as percent surviving ± standard error), survival at 1, 2, 3, 4, and 5 years, respectively, was 90.5% ± 1.9%, 83.4% ± 2.5%, 77.5% ± 3.1%, 71.0% ± 3.8%, and 65.3% ± 6.5%. Compared with survivors, decedents were older, diabetic, had extant coronary artery disease, and were more likely to present with critical limb ischemia as their indication for bypass surgery (P < .05). After adjustment for the above, clinical chemistry and inflammatory parameters significant (hazard ratio [95% confidence interval]) for all-cause mortality were albumin (0.43 [0.26-0.71]; P = .001), estimated glomerular filtration rate (0.98 [0.97-0.99]; P = .023), high-sensitivity C-reactive protein (hsCRP; 3.21 [1.21-8.55]; P = .019), and soluble vascular cell adhesion molecule (1.74 [1.04-2.91]; P = .034). Of the inflammatory molecules investigated, hsCRP proved most robust and representative of the integrated inflammatory response. Albumin, eGFR, and hsCRP improved the C statistic and integrated discrimination improvement index beyond that of the clinical model and produced a final C statistic of 0.82. CONCLUSIONS A risk prediction model including traditional risk factors and parameters of inflammation, renal function, and nutrition had excellent discriminatory ability in predicting all-cause mortality in patients with clinically advanced PAD undergoing bypass surgery.
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Affiliation(s)
- Christopher D Owens
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif 94148, USA.
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Formiga F, Ferrer A, Chivite D, Rubio-Rivas M, Cuerpo S, Pujol R. Predictors of long-term survival in nonagenarians: the NonaSantfeliu study. Age Ageing 2011; 40:111-6. [PMID: 20823123 DOI: 10.1093/ageing/afq127] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND few studies have prospectively evaluated long-term predictors of mortality in nonagenarians. OBJECTIVE to determine predictors of death in a nonagenarian cohort after 5 years of follow-up. DESIGN a prospective community-based study. SETTING a community-based study. SUBJECTS one hundred and eighty-six nonagenarians both living in the community and institutionalised. METHODS functional status was determined by the Lawton-Brody and Barthel Indexes (BI) and cognition by the Spanish version of the mental state examination (MEC). The Charlson Index was used to measure comorbidity. Nutritional status was evaluated by the short version of the Mini-Nutritional Assessment questionnaire. RESULTS mortality after 5 years was 75.53%. Patients who did not survive were significantly older, with lower cognitive and functional performance, with diminished visual acuity, higher comorbidity, high risk of malnutrition, higher number of drugs taken and a higher percentage of patients with the diagnosis of dyslipidaemia, heart failure or previous stroke. Cox regression analysis, identified the Charlson Index (hazard ratio 1.23, 95% CI 1.09-1.37) and MEC (hazard ratio 0.98, 95% CI 0.97-0.99) as independent predictors of mortality after 5 years. CONCLUSIONS better cognitive status and lesser comorbidity at baseline are the best predictors to identify which nonagenarians survived after a 5-year follow-up period.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
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Interpreting routine biochemistry in those aged over 65 years: a time for change. Maturitas 2010; 66:39-45. [PMID: 20197224 DOI: 10.1016/j.maturitas.2010.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 02/02/2010] [Accepted: 02/02/2010] [Indexed: 01/24/2023]
Abstract
In clinical practice, routine biochemistry tests are often performed for diagnostic or screening purposes. We reviewed papers that have reported reference values for people older than 65 years with or without overt health problems. Wider intervals have generally been reported for sodium, potassium, calcium and C-reactive protein (CRP) in the elderly. Higher levels of creatinine and lower levels of total cholesterol (TC) and serum albumin (SA) are observed with ageing. Elderly people have been found to be at greater risk for overt abnormalities in sodium, potassium, creatinine, TC, SA and CRP. The consequences of these abnormalities could be severe. For instance, even mild hyponatremia was associated with increased risk of mortality, disability and myocardial infarction. Mild hypernatremia was associated with severe disability. Mild increases in CRP levels were associated with an increased risk of sarcopenia, disability, cardiovascular disease and cognitive decline. Mild decreases in TC levels were associated with an increased risk of disability or mortality, and mild decreases in SA were associated with an increased risk of mortality, disability, sarcopenia and frailty. Nutritional factors could not wholly explain these effects. Modified biochemical reference values are required for elderly patients, as biochemical results can serve as markers of vulnerability to age-related diseases, linked to metabolism. Careful diagnosis and corrective interventions are needed for patients in this age group.
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Cesari M, Onder G, Zamboni V, Capoluongo E, Russo A, Bernabei R, Pahor M, Landi F. C-reactive protein and lipid parameters in older persons aged 80 years and older. J Nutr Health Aging 2009; 13:587-93. [PMID: 19621193 PMCID: PMC4386631 DOI: 10.1007/s12603-009-0168-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Aims of the study were 1) to investigate the association of C-reactive protein (CRP) with lipid (i.e. total, LDL, and HDL cholesterol, triglycerides) concentrations, and to evaluate their predictive value for mortality in very old subjects. DESIGN Cross-sectional and longitudinal analyses in a prospective cohort study. SETTING Participants. Data are from 336 community-dwelling subjects aged > or = 80 years old enrolled in the "Invecchiamento e Longevità nel Sirente" (ilSIRENTE) study. MEASUREMENTS High sensitivity CRP and lipid concentrations were measured at the baseline clinical visit. High sensitivity CRP concentrations were measured by ELISA assessment. Mortality outcome was evaluated over a 24-month follow-up. RESULTS Participants had a mean age of 85.8 (SD 4.8) years old. Spearman's correlations showed significant (p values < 0.01) inverse correlations between CRP and lipid parameters (except triglycerides). Adjusted linear regressions between CRP and lipid parameters concentrations showed no significant association in participants aged lower than 85 years old (all p values > 0.5). In the older age group, significant inverse associations of CRP with total (p=0.002), LDL (p=0.007), and HDL cholesterol (p=0.002) were found, even after adjustment for potential confounders. Adjusted Cox proportional hazard models demonstrated that CRP was the only biomarker significantly predictive of mortality, independently of age and lipid parameters. CONCLUSION An inverse relationship of total, LDL, and HDL cholesterol with CRP is present in very old persons. The prognostic value of CRP is particularly important among very old persons whereas lipid parameters tend to lose their capacity to predict events.
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Affiliation(s)
- M Cesari
- Department of Aging and Geriatric Research, University of Florida-Institute on Aging, Gainesville, FL 32611, USA.
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Carriere I, Dupuy AM, Lacroux A, Cristol JP, Delcourt C. Biomarkers of inflammation and malnutrition associated with early death in healthy elderly people. J Am Geriatr Soc 2008; 56:840-6. [PMID: 18410327 DOI: 10.1111/j.1532-5415.2008.01677.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether malnutrition and biomarkers of inflammation predict all-cause, cancer, and cardiovascular mortality in healthy elderly subjects. DESIGN Population-based study, prospective cohort. SETTING Sète, on the French Mediterranean coast. PARTICIPANTS Five hundred and fifty-three men and 888 women aged 60 and older from the Pathologies Oculaires Liées à l'Age cohort free of known comorbidities. MEASUREMENTS Plasma levels of cholesterol, albumin, transthyretin (TTR), C-reactive protein (CRP), and alpha 1-acid glycoprotein (AAG) were measured at baseline. To investigate the risks of 5-year (early) and 5- to 9-year (late) mortality, hazard ratios (HR) were evaluated using Cox models. RESULTS In men, early death was associated with high CRP and AAG and low albumin and TTR. In women, early death was associated with high AAG, low TTR and low cholesterol. For late death, the only significant association was with CRP in men. A synergistic effect was observed between biomarkers of inflammation and malnutrition. In men, the adjusted HR of early death was 4.98 (95% confidence interval (CI)=2.25-11.01) for both CRP in the highest quartile and albumin in the lowest. In men, this risk was greatest for both AAG in the highest quartile and TTR in the lowest (HR=6.86, 95% CI=3.20-14.71). In women, this risk was greatest for both AAG in the highest quartile and TTR in the lowest (HR=4.64, 95% CI=1.79-12.05). Cancer mortality was greater for high CRP and AAG and for low albumin and TTR in men but not in women. CONCLUSION Biomarkers of inflammation and malnutrition together predict early mortality. In healthy elderly subjects, TTR and AAG could be helpful in identifying elderly subjects at higher risk of death.
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Abstract
The prevalence of type 2 diabetes is increasing among older adults as is their diabetes-related mortality rate. Studies suggest that tighter glucose control reduces complications in elderly patients. However, too low a glycosylated hemoglobin (HbA1c) value is associated with increased hypoglycemia. Moreover, the appropriateness of most clinical trial data and standards of care related to diabetes management in elderly patients is questionable given their heterogeneity. Having guidelines to safely achieve glycemic control in elderly patients is crucial. One of the biggest challenges in achieving tighter control is predicting when peak insulin action will occur. The clinician’s options have increased with new insulin analogs that physiologically match the insulin peaks of the normal glycemic state, enabling patients to achieve the tighter diabetes control in a potentially safer way. We discuss the function of insulin in managing diabetes and how the new insulin analogs modify that state. We offer some practical considerations for individualizing treatment for elderly patients with diabetes, including how to incorporate these agents into current regimens using several methods to help match carbohydrate intake with insulin requirements. Summarizing guidelines that focus on elderly patients hopefully will help reduce crises and complications in this growing segment of the population.
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Affiliation(s)
- Scott K Ober
- Case Western Reserve University, Louis Stokes Cleveland VAMC, 10701 East Blvd, Cleveland, OH 44106, USA.
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Horwich TB, Fonarow GC. CARDIOVASCULAR AND SURVIVAL PARADOXES IN DIALYSIS PATIENTS: Reverse Epidemiology beyond Dialysis Patients: Chronic Heart Failure, Geriatrics, Rheumatoid Arthritis, COPD, and AIDS. Semin Dial 2007; 20:549-53. [DOI: 10.1111/j.1525-139x.2007.00346.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lehtimäki T, Ojala P, Rontu R, Goebeler S, Karhunen PJ, Jylhä M, Mattila K, Metso S, Jokela H, Nikkilä M, Wuolijoki E, Hervonen A, Hurme M. Interleukin-6 modulates plasma cholesterol and C-reactive protein concentrations in nonagenarians. J Am Geriatr Soc 2005; 53:1552-8. [PMID: 16137286 DOI: 10.1111/j.1532-5415.2005.53484.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To establish whether the relationship between interleukin-6 (IL-6) and plasma lipid and C-reactive protein (CRP) concentrations is different in Finnish nonagenarians than in middle-aged subjects with lower inflammatory status. DESIGN Cross-sectional. SETTING Observational cohort study concentrating on the oldest old. PARTICIPANTS Nonagenarians (n=291, mean age+/-standard deviation 90+/-1; 68 men, 223 women) who lived in the Tampere municipality in southern Finland and a middle-aged control population from the same area (n=227, aged 44+/-8). MEASUREMENTS Plasma high sensitive CRP and lipid concentrations were analyzed using an automatic analyzer and IL-6 levels using enzyme-linked immunosorbent assay. RESULTS Plasma concentrations of IL-6 (4.39+/-5.25 vs 1.88+/-1.98 pg/mL) and CRP (3.54+/-4.98 vs 1.53+/-1.91 mg/L) were significantly higher in nonagenarians than in middle-aged subjects (P<.001). In nonagenarians, plasma CRP levels increased (P<.001) and plasma total cholesterol (P=.006), low-density lipoprotein cholesterol (P=.02), and high-density lipoprotein cholesterol (P=.002) levels decreased according to IL-6 quartiles. In middle-aged subjects, similar associations were not found. CONCLUSION The relationship between IL-6 and plasma CRP and cholesterol levels in nonagenarians with enhanced systemic inflammation differs from that of middle-aged subjects.
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Affiliation(s)
- Terho Lehtimäki
- Laboratory of Atherosclerosis Genetics, Tampere University Hospital, Tampere, Finland.
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Abstract
The elderly differ from younger people in the relation of cholesterol to heart disease and mortality. Clinical trial evidence supports epidemiological findings in showing that high cholesterol weakens in its relationship to heart disease with age and loses (and in older age reverses) its relation to mortality. Randomised trial data confirm that lowering cholesterol no longer extends life in the elderly, even those at high risk of heart disease, and no evidence supports the presumption that the impact on all-cause morbidity is any more favourable. These findings increase the importance of statin adverse effects (AEs) in this group. Furthermore, the elderly may be more vulnerable to known AEs, and evidence provides cause for concern that new risks may supervene, including cancer, neurodegenerative disease and heart failure. Physiological evidence regarding the impact of statins on mitochondrial function, and mitochondrial function on ageing, support these concerns. Additionally, the impact of statin AEs (e.g., muscle and cognitive problems) may be amplified in this group. Effects may be misattributed to ageing. Even modestly lower cognitive and physical function in older elderly prognosticates increased disability, hospitalisation, institutionalisation, and mortality. Disability, once present, is less likely to recover. Because the risk for AEs is unattended by evidence of net benefit to the person, the use of statins in the elderly should be undertaken, if at all, with circumspection and close scrutiny for adverse effects.
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Huang T, Chen J. Cholesterol And Lipids In Depression: Stress, Hypothalamo‐Pituitary‐Adrenocortical Axis, And Inflammation/Immunity. Adv Clin Chem 2005. [DOI: 10.1016/s0065-2423(04)39003-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Royall DR, Chiodo LK, Polk MJ. Misclassification Is Likely in the Assessment of Mild Cognitive Impairment. Neuroepidemiology 2004; 23:185-91. [PMID: 15272221 DOI: 10.1159/000078504] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We estimated the relative frequency of isolated memory impairment versus isolated and comorbid impairment in executive control function (ECF). One hundred and ninety-three noninstitutionalized residents of a single Comprehensive Care Retirement Community (mean age 79.2 years) were investigated. The subjects were tested with multiple measures of memory and ECF. Test scores were standardized to minimize scaling effects. 'Impairment' was defined as performance < or =1.5 standard deviations below the mean for the entire sample (i.e., a z score < or =-1.5). Disability was estimated as the sum of self-reported activities of daily living and instrumental activities of daily living. The cognitive test performance was significantly associated with functional impairment, independently of age. ECF and memory measures were significantly intercorrelated. Both were significantly and independently associated with disability ratings. 6-10% of the subjects had memory impairment; 25-35% of the memory-impaired subjects had comorbid ECF impairments. An additional 4-7% of the subjects had isolated ECF impairment. A significant fraction of the cases otherwise meeting the criteria for 'mild cognitive impairment' may have comorbid ECF impairment. This raises the issue of whether they might be more properly classified as 'demented'. In addition, isolated ECF impairment may affect almost as many persons as isolated memory impairment. Isolated ECF impairment is not consistent with the natural history of preclinical Alzheimer's disease, suggests other conditions, and can be disabling, independently of age and/or memory loss.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, South Texas Veterans' Health System Audie L. Murphy Division GRECC and University of Texas Health Science Center, San Antonio, TX 78284, USA.
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Rozzini R, Sabatini T, Franzoni S, Trabucchi M. Cholesterol and Mortality in Elderly Patients. J Am Geriatr Soc 2004; 52:469-70; author reply 471. [PMID: 14962171 DOI: 10.1111/j.1532-5415.2004.52125_4.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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