A prospective study of risk factors for cardiovascular events among the elderly

High triglyceride/HDL cholesterol ratio is associated with silent brain infarcts in a healthy population

Background

Triglycerides (TG)/high-density lipoprotein (HDL) cholesterol ratio is a marker of small/dense low-density lipoprotein particles, which are closely associated with various metabolic and vascular diseases. However, the role of TG/HDL cholesterol ratio in cerebrovascular diseases has not been well studied. In this study, we evaluated the relationship between TG/HDL cholesterol ratio and the presence of silent brain infarct (SBI) in a neurologically healthy population.

Methods

We retrospectively evaluated consecutive participants in health check-ups between January 2006 and December 2013. SBI was defined as an asymptomatic, well-defined lesion with a diameter of ≥3 mm on T1- or T2-weighted images. TG/HDL cholesterol ratio was calculated after dividing absolute TG levels by absolute HDL cholesterol levels.

Results

Of 3172 healthy participants, 263 (8.3%) had SBI lesions. In multivariate analysis, TG/HDL cholesterol ratio was independently associated with SBI (adjusted odds ratio [aOR] = 1.16, 95% confidence interval [CI] = 1.00 to 1.34, P = 0.047). This association was prominent in males (aOR = 1.23, 95% CI = 1.03 to 1.48, P = 0.021), but not in females. In the analyses of the relationships between lipid parameters and SBI lesion burden, TG/HDL cholesterol ratio was positively correlated, and total cholesterol/TG ratio was negatively correlated with SBI lesion burden, in dose-response manners (P for trend = 0.015 and 0.002, respectively).

Conclusions

The TG/HDL cholesterol ratio was positively associated with the prevalence of SBI in a neurologically healthy population.

Electronic supplementary material

The online version of this article (10.1186/s12883-019-1373-8) contains supplementary material, which is available to authorized users.

Importance rating of risk factors of ischemic stroke in patients over 85 years old in the polish population

INTRODUCTION

The European population is aging and the number of elderly patients suffering from ischemic brain stroke increases. A better knowledge of the correlation between the risk factors and the course of the disease in old people may be useful for planning medical care and prophylactic strategies.

AIM

This prospective study aimed to perform a demographic and clinical analysis of the etiology of ischemic stroke, survival rate and severity of post-stroke disability in patients who developed ischemic stroke at the age of over 85 years in the Polish population.

METHOD

The study group consisted of 159 patients over 85 years old with ischemic stroke. The prevalence of risk factors such as sex, hypertension, hyperlipidemia, atrial fibrillation, heart failure and diabetes was evaluated. The outcome was assessed using the Barthel scale and the National Institutes of Health Stroke Scale.

RESULTS

The most common risk factors of ischemic stroke were hypertension and atrial fibrillation. Patients with atrial fibrillation had a more severe course of ischemic stroke.

CONCLUSION

The course of brain stroke in the Polish population is more severe in patients over 85 years old than in younger ones. The key risk factor in this group is atrial fibrillation.

Association between triglycerides and HDL-cholesterol ratio and cardiovascular risk factors among elderly persons receiving care under the family health strategy of Viçosa, Minas Gerais

Abstract Objective: To evaluate the association between triglycerides and HDL-cholesterol (TG/HDL-c) ratio and cardiovascular risk factors among the elderly. Method: A cross-sectional epidemiological study with a random sample of elderly persons (n=349) of both genders, who received care under the Family Health Strategy in the municipality of Viçosa, in the state of Minas Gerais, was performed. Cardiovascular risk was calculated by the relationship between the TG and the HDL-c levels, with values greater than 3.5 considered a risk. Social and economic variables, lifestyle, noncommunicable chronic diseases, serum glucose levels, waist circumference (WC) and body mass index were evaluated. Multiple linear regression was used to evaluate the association between the TG/HDL-c ratio and other variables. Variables associated with the dependent variable with a level of significance lower than 0.20 in univariate regression analysis were included in the final model (stepwise-forward), applying a significance level of p<0.05. Results: The highest TG/HDL-c ratio values were associated with the presence of hypertension, having been or currently be a smoker, having elevated serum glucose and an increased waist circumference. Conclusion: The findings reflect the importance of studies on cardiovascular risk in the elderly, as health professionals should be familiar with the parameters that classify at risk individuals. The TG/HDL-c ratio is a reliable classification method that is easy to apply and correlates closely with adverse health effects.

Neck Circumference as a Predictive Indicator of CKD for High Cardiovascular Risk Patients

Background. Neck circumference (NC) is an anthropometric measure of obesity for upper subcutaneous adipose tissue distribution which is associated with cardiometabolic risk. This study investigated whether NC is associated with indicators of chronic kidney disease (CKD) for high cardiometabolic risk patients. Methods. A total of 177 consecutive patients who underwent the outpatient departments of cardiology were prospectively enrolled in the study. The patients were aged >20 years with normal renal function or with stages 1–4 CKD. A linear regression was performed using the Enter method to present an unadjusted R², standardized coefficients, and standard error, and the Durbin-Watson test was used to assess residual independence. Results. Most anthropometric measurements from patients aged ≧65 were lower than those from patients aged <65, except for women's waist circumference (WC) and waist hip ratio. Female NC obtained the highest R² values for 24 hr CCR, uric acid, microalbuminuria, hsCRP, triglycerides, and HDL compared to BMI, WC, and hip circumference. The significances of female NC with 24 hr CCR and uric acid were improved after adjusted age and serum creatinine. Conclusions. NC is associated with indicators of CKD for high cardiometabolic risk patients and can be routinely measured as easy as WC in the future.

Self- Perception of Body Weight Status in Older Dutch Adults

INTRODUCTION

OBJECTIVES

The prevalence of obesity is highest in older persons and a correct self-perception of body weight status is necessary for optimal weight control. The aim of this study was to determine self-perception of, and satisfaction with, body weight status, and to compare current versus ideal body image in a large, nationally representative sample of older people. Furthermore, determinants of misperception were explored.

DESIGN

A cross-sectional study.

SETTING

The Longitudinal Aging Study Amsterdam (LASA), conducted in a population-based sample in the Netherlands.

PARTICIPANTS

1295 men and women aged 60-96 years.

MEASUREMENTS

Body weight status was assessed using measured weight and height. Self-perceived body weight status, satisfaction with body weight and current and ideal body image were also assessed. Multiple logistic regression analysis was used to investigate the association of age, educational level and objectively measured BMI with underestimation of body weight status.

RESULTS

The prevalence of obesity was 19.9% in men and 29.3% in women. The agreement between objective and self-perceived body weight status was low (Kappa < 0.2). Among overweight and obese persons, 42.1% of men and 44.1% of women were (very) dissatisfied with their body weight status and >99% of obese participants desired to be thinner (ideal body image < current image). Only 4.4% of obese men and 12.3% of obese women perceived their body weight status correctly. Higher age (women), lower educational level (men) and higher BMI (all) were associated with greater underestimation of body weight status.

CONCLUSION

Many older persons misperceive their body weight status. Future actions to improve body weight perception in older persons are necessary to increase the impact of public health campaigns focussing on a healthy body weight in old age.

Safety and efficacy of colesevelam HCl in the treatment of elderly patients

BACKGROUND AND OBJECTIVES

Colesevelam significantly lowers cholesterol in patients with hypercholesterolemia, and both cholesterol and hemoglobin A1C (A1C) in patients with type 2 diabetes mellitus (T2DM). The purpose of this post hoc analysis was to evaluate the efficacy and safety/tolerability of colesevelam in older (≥65 years) and younger (<65 years) adults.

METHODS

We conducted post hoc analyses of pooled clinical trial data from seven phase II and III randomized, double-blind, placebo-controlled, primary hyperlipidemia and T2DM clinical trials. The hyperlipidemia safety/tolerability analysis included seven studies (≥65 years, n = 154; <65 years, n = 381); the efficacy analysis utilized one study with sufficient patients in both age groups for meaningful comparison. The T2DM analyses included four studies (safety/tolerability: ≥65 years, n = 249; <65 years, n = 880) or three studies (efficacy). In the hyperlipidemia studies, patients received colesevelam 1.5-4.5 g/day or placebo, alone or with a statin, for 4 weeks to 6 months. In the T2DM studies, colesevelam 3.75 g/day or placebo was added to existing antidiabetes therapies for 16 or 26 weeks. Low-density lipoprotein cholesterol (LDL-C), A1C, and adverse events were assessed.

RESULTS

In the hyperlipidemia analysis, colesevelam versus placebo produced similar mean reductions from baseline in LDL-C in older (-16.6 vs. +0.5 %) and younger (-13.7 vs. +0.4 %) patients. In the T2DM analysis, older and younger patients had similar reductions from baseline in A1C (treatment difference -0.59 and -0.54 %, respectively; both p < 0.001) and LDL-C (-14.7 and -15.5 %, respectively; both p < 0.001) with colesevelam. In both analyses, adverse event incidence was generally similar between subgroups. In the T2DM analysis, hypoglycemia was slightly more frequent with colesevelam versus placebo in older patients (5.8 vs. 2.3 %); no reports of hypoglycemia were considered serious adverse events.

CONCLUSIONS

In primary hyperlipidemia and in T2DM, colesevelam appeared to be generally as safe, well tolerated, and efficacious in patients aged ≥65 years as in those aged <65 years.

Effects of routine rehabilitation training on glucose tolerance among nondiabetic stroke patients: a pilot study

OBJECTIVE

Impaired glucose tolerance (IGT) and diabetic glucose tolerance (DGT) are closely associated with vascular disease mortality and morbidity. This study was designed to determine whether routine stroke rehabilitation training can be used to improve the glucose status and whether IGT and DGT persist among nondiabetic stroke patients at discharge after such training.

METHODS

Eighty eligible subjects were evaluated using Oral Glucose Tolerance Tests (OGTTs) at entry and discharge at the rehabilitation medical departments of two large hospitals in China. Routine rehabilitation training was provided during hospitalization. The secondary outcome measurements were BMI, Fugl-Meyer motor score, Barthel index, HbA1c, triglycerides, HDL cholesterol and LDL cholesterol. Non-acute and nondiabetic stroke patients treated at the rehabilitation department.

RESULTS

Fifty-four patients had IGT or DGT at entry, while 61 patients exhibited abnormal glucose tolerance at discharge, accounting for 67.7% and 76.25% of all subjects respectively. The mean 2-hour plasma glucose level was 8.98 mmol/L at entry and 9.11 mmol/L at discharge. No changes were noted in the OGTT results or secondary outcomes after training (p>0.05), with the exceptions of significant improvements in the Fugl-Meyer motor score and Barthel index (p<0.05).

CONCLUSION

These preliminary results suggest that IGT and DGT are present at a high frequency among nondiabetic stroke patients both before and after routine rehabilitation training. Routine stroke rehabilitation training, which greatly improves functional outcomes, may have no effect on the incidence of abnormal glucose tolerance.

Effect of low-intensity ergometer aerobic training on glucose tolerance in severely impaired nondiabetic stroke patients

OBJECTIVE

To investigate whether low-intensity ergometer aerobic training has beneficial effect on glucose tolerance in nondiabetic patients with severely impaired stroke.

METHODS

Fifty-four severely impaired stroke survivors were recruited and randomly assigned to the experimental group and control group. They have no diabetes history with fasting plasma glucose less than 7 mmol/L. Both groups participated in a 6-week rehabilitation training program with low-intensity ergometer aerobic training added only in the experimental group 3 times per week. Primary outcome variables were fasting glucose, fasting insulin, 2-hour glucose, and homeostasis model assessment-insulin resistance (HOMA-IR) in oral glucose tolerance test before and after intervention.

RESULTS

Before intervention, 36 of 54 (66.7%) were diagnosed with impaired glucose status or diabetic glucose tolerance totally. The average 2-hour plasma glucose level was 9.14 ± 1.39 mmol/L. After intervention, aerobic training significantly improved fasting insulin (from 8.51 ± 2.01 μU/mL to 7.11 ± 2.02 μU/mL), 2-hour glucose level (from 9.13 ± 1.14 mmol/L to 7.22 ± 1.23 mmol/L), and HOMA-IR (from 1.62 ± 1.01 to 1.29 ± .79) in the intervention group compared with the control group (P < .05). Aerobic training also significantly improved their glucose tolerance state (P < .05).

CONCLUSIONS

Preliminary findings suggest that abnormal glucose tolerance may be highly present among severely impaired nondiabetic stroke patients and low-intensity ergometer aerobic training may have beneficial role in improving glucose tolerance.

Decreased functional capacity and muscle strength in elderly women with metabolic syndrome

Purpose

To compare the metabolic parameters, flexibility, muscle strength, functional capacity, and lower limb muscle power of elderly women with and without the metabolic syndrome (MetS).

Methods

This cross-sectional study included 28 older women divided into two groups: with the MetS (n = 14; 67.3 ± 5.5 years; 67.5 ± 16.7 kg; 1.45 ± 0.35 m; 28.0 ± 7.6 kg/m²), and without the MetS (n = 14; 68.7 ± 5.3 years; 58.2 ± 9.9 kg; 1.55 ± 0.10 m; 24.3 ± 3.8 kg/m²). Body composition was evaluated by dual-energy X-ray absorptiometry and dynamic muscle strength was assessed by one-maximum repetition (1RM) tests in leg press, bench press and biceps curl exercises. Six-minute walk test, Timed Up and Go (TUG); 30-second sitting-rising; arm curl using a 2-kg dumbbell, sit-and-reach (flexibility), and vertical jump tests were performed.

Results

There was no difference between groups regarding age (P = 0.49), height (P = 0.46), body fat (%) (P = 0.19), systolic (P = 0.64), diastolic (P = 0.41) and mean blood pressure (P = 0.86), 30-second sitting-rising (P = 0.57), 30-s arm curl (P = 0.73), leg press 1RM (P = 0.51), bench press 1RM (P = 0.77), and biceps curl 1RM (P = 0.85). However, women without the MetS presented lower body mass (P = 0.001), body mass index (BMI) (P = 0.0001), waist circumference (P = 0.02), waist-to-height ratio (P = 0.02), fat body mass (kg) (P = 0.05), lean body mass (kg) (P = 0.02), blood glucose (P = 0.05), triglycerides (P = 0.03), Z-score for the MetS (P = 0.05), higher high-density lipoprotein-cholesterol (HDL-C) (P = 0.002), better performance on TUG (P = 0.01), flexibility (P = 0.03), six-minute walk test (P = 0.04), vertical jump (P = 0.05) and relative muscle strength for leg press (P = 0.03), bench press (P = 0.04) and biceps curl (P = 0.002) exercises as compared to women with the MetS.

Conclusion

Elderly women with the MetS have higher metabolic risk profile and lower functional capacity, muscle strength, lower limb power and flexibility as compared to women without the MetS. The evaluation of functional capacity may help to determine the degree of physical decline in older persons with the MetS, while exercise interventions should be encouraged.

Carbonyl stress in aging process: role of vitamins and phytochemicals as redox regulators

There is a growing scientific agreement that the cellular redox regulators such as antioxidants, particularly the natural polyphenolic forms, may help lower the incidence of some pathologies, including metabolic diseases like diabetes and diabesity, cardiovascular and neurodegenerative abnormalities, and certain cancers or even have anti-aging properties. The recent researches indicate that the degree of metabolic modulation and adaptation response of cells to reductants as well as oxidants establish their survival and homeostasis, which is linked with very critical balance in imbalances in cellular redox capacity and signaling, and that might be an answer the questions why some antioxidants or phytochemicals potentially could do more harm than good, or why some proteins lose their function by increase interactions with glyco- and lipo-oxidation mediates in the cells (carbonyl stress). Nonetheless, pursue of healthy aging has led the use of antioxidants as a means to disrupt age-associated physiological dysfunctions, dysregulated metabolic processes or prevention of many age-related diseases. Although it is still early to define their exact clinical benefits for treating age-related disease, a diet rich in polyphenolic or other forms of antioxidants does seem to offer hope in delaying the onset of age-related disorders. It is now clear that any deficiency in antioxidant vitamins, inadequate enzymatic antioxidant defenses can distinctive for many age-related disease, and protein carbonylation can used as an indicator of oxidative stress associated diseases and aging status. This review examines antioxidant compounds and plant polyphenols as redox regulators in health, disease and aging processes with hope that a better understanding of the many mechanisms involved with these distinct compounds, which may lead to better health and novel treatment approaches for age-related diseases.

Linking the EASY-care standard to the international classification of functioning, disability and health

PURPOSE

This study aimed to document the content of the EASY-Care Standard questionnaire to the International Classification of Functioning, Disability and Health (ICF) and present its ICF Core Set.

METHOD

The EASY-Care was linked to the ICF by two trained health professionals according to the established linking rules. The agreement between the health professionals was determined using the Cohen's kappa.

RESULTS

The agreement between the two health professionals was almost perfect for each level of the ICF (Cohen's kappas between 0.91 and 0.97). The 65 items of the EASY-Care were linked to 61 different ICF categories, 16 (26%) from the Body functions component, 3 from the Body structures (5%), 30 from the Activities and participation (49%) and 12 from the Environmental factors (20%). Twelve concepts could not be linked to the ICF at all: 6 were classified as Personal factors, 1 as not defined-general health and 5 were not classified.

CONCLUSIONS

The integration of the universal language of the ICF in the EASY-Care illustrates the potential of use this instrument in primary care settings at community level.

IMPLICATIONS FOR REHABILITATION

The integration of the universal language of the ICF in the EASY-Care potentiates the use of this comprehensive instrument in assessing older people needs at primary care settings. The information obtained with the EASY-Care Standard can be worldwide understood and can be used to plan rehabilitation interventions at community settings for older adults.

Inflammatory status in older women with and without metabolic syndrome: is there a correlation with risk factors?

Purpose

To compare the inflammatory status in older women with and without metabolic syndrome (MetS) and to correlate inflammatory parameters, anthropometric measures, metabolic profile, and blood pressure with MetS Z-score.

Methods

This cohort transversal study included 129 older women assigned into two groups: with MetS (n = 48; 66.4 ± 4.4 years; 68.1 ± 8.3 kg; 1.51 ± 0.06 m; 29.8 ± 3.9 kg/m²) and without MetS (n = 81; 68.0 ± 5.8 years; 61.0 ± 9.4 kg; 1.53 ± 0.06 m; 26.0 ± 3.9 kg/m²). Body composition was evaluated by dual-energy X-ray absorptiometry (General Electric-GE model 8548 BX1L, year 2005, Lunar DPX type, software Encore 2005; Rommelsdorf, Germany) and cytokines by enzyme-linked immunosorbent assay.

Results

There was no difference between the groups regarding age, height, fat mass, glycosylated hemoglobin, total cholesterol, and low-density lipoprotein cholesterol. However, older women with MetS presented higher body mass, body mass index, waist and hip circumference, waist-hip and waist-height ratio, systolic, diastolic, and mean blood pressure, glucose, insulin, homeostasis model assessment of insulin resistance, MetS Z-score, tumor necrosis factor-α, interferon-γ, and lower lean body mass values compared to women without MetS. Moreover, there were correlations between MetS Z-score and body mass (r = 0.20), waist circumference (r = 0.26), waist-hip (r = 0.32) and waist-height ratio (r = 0.24), blood glucose (r = 0.24), insulin (r = 0.24), homeostasis model assessment of insulin resistance (r = 0.32), triglycerides (r = 0.39), tumor necrosis factor-α (r = 0.28), interferon-γ (r = 0.22), and inverse correlation with high-density lipoprotein cholesterol (r = −0.32). MetS Z-score was positively associated with systolic (r = 0.92), diastolic (r = 0.94), and mean blood pressure (r = 0.98).

Conclusion

Older women with MetS have higher cytokine levels, anthropometric measures, metabolic profile, and blood pressure. Inflammatory cytokines may help to improve the understanding of the progression status of MetS in older persons.