The new Sheffield risk and benefit tables for the elderly

Apathy in Older Persons With Depression: Course and Predictors: The NESDO Study

OBJECTIVES

Apathy is a common behavioral syndrome, influencing different areas of daily functioning and often seen in depression. Little is known about the course of apathy in depression. In this study, we examine the course and predicting factors of apathy in older persons with depression.

METHOD

Data of 266 older persons with depression participating in the Netherlands Study of Depression in Older Persons, all aged at least 60 years with complete Apathy Scale scores at baseline and 2-year follow-up, were included in this study. Associations between several baseline variables and severity, incidence, and persistence of apathy were examined using regression analyses.

RESULTS

At 2-year follow-up, the severity of apathy was predicted by the severity of apathy at baseline, and incidence rate of apathy was 36%, with a lower baseline Mini-Mental State Examination score being an independent predictor. Older persons with incident apathy did not differ in remission rate of depression compared to those without apathy at follow-up. Persistence rate of apathy was 80% and was independently predicted by a higher baseline Apathy Scale score and, surprisingly, by less use of benzodiazepines. Persons with persistent apathy were less likely to recover from depression than those who remitted from apathy.

CONCLUSION

Severity of apathy at baseline, but not depression, predicted apathy at follow-up. Incident apathy was predicted by poorer cognitive function, whereas severe apathy at baseline predicted its persistence. Remarkably, new apathy was not associated with worse outcome of depression whereas persistent apathy was.

Personalized prediction of lifetime benefits with statin therapy for asymptomatic individuals: a modeling study

BACKGROUND

Physicians need to inform asymptomatic individuals about personalized outcomes of statin therapy for primary prevention of cardiovascular disease (CVD). However, current prediction models focus on short-term outcomes and ignore the competing risk of death due to other causes. We aimed to predict the potential lifetime benefits with statin therapy, taking into account competing risks.

METHODS AND FINDINGS

A microsimulation model based on 5-y follow-up data from the Rotterdam Study, a population-based cohort of individuals aged 55 y and older living in the Ommoord district of Rotterdam, the Netherlands, was used to estimate lifetime outcomes with and without statin therapy. The model was validated in-sample using 10-y follow-up data. We used baseline variables and model output to construct (1) a web-based calculator for gains in total and CVD-free life expectancy and (2) color charts for comparing these gains to the Systematic Coronary Risk Evaluation (SCORE) charts. In 2,428 participants (mean age 67.7 y, 35.5% men), statin therapy increased total life expectancy by 0.3 y (SD 0.2) and CVD-free life expectancy by 0.7 y (SD 0.4). Age, sex, smoking, blood pressure, hypertension, lipids, diabetes, glucose, body mass index, waist-to-hip ratio, and creatinine were included in the calculator. Gains in total and CVD-free life expectancy increased with blood pressure, unfavorable lipid levels, and body mass index after multivariable adjustment. Gains decreased considerably with advancing age, while SCORE 10-y CVD mortality risk increased with age. Twenty-five percent of participants with a low SCORE risk achieved equal or larger gains in CVD-free life expectancy than the median gain in participants with a high SCORE risk.

CONCLUSIONS

We developed tools to predict personalized increases in total and CVD-free life expectancy with statin therapy. The predicted gains we found are small. If the underlying model is validated in an independent cohort, the tools may be useful in discussing with patients their individual outcomes with statin therapy.

Cardiovascular risk management in community-dwelling elderly: opportunities for prevention

BACKGROUND

There is little information on the prevalence of hypertension and other modifiable cardiovascular risk factors in community-dwelling elderly in the Netherlands and the potential impact of improving antihypertensive treatment on major cardiovascular events.

DESIGN

Cross-sectional analysis of Dutch community-dwelling subjects aged 70-78 years without dementia who were included in the cluster randomized preDIVA trial (Prevention of Dementia by Intensive Vascular care).

METHODS

The prevalence of hypertension and other cardiovascular risk factors are described for participants with and without a history of cardiovascular disease (CVD). Projected benefits of blood pressure decrease are calculated using data from a meta-analysis and a large national registry.

RESULTS

Of 3534 subjects, more than one-third (n = 1230, 35.2%) have a history of cardiovascular disease. Overall, 63% of subjects have two or more cardiovascular risk factors amenable to treatment. Systolic blood pressure (SBP) is ≥160 mmHg in 37% of patients with CVD, of which 28% is untreated. In subjects without a history of CVD, 41% have a SBP ≥ 160 mmHg of which 52% is untreated. A 5-15 mmHg decrease in SBP is projected to prevent 12-32% of coronary heart disease and 16-41% of strokes, respectively. This corresponds with 14-38 prevented cases within 2 years in our intervention group (n = 1895).

CONCLUSIONS

Hypertension and other cardiovascular risk factors are very common in elderly subjects. Current (primary and secondary) prevention programmes appear insufficient. Improved antihypertensive treatment has the potential to prevent a substantial proportion of strokes and coronary heart disease in this population.