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Ibrahim-Verbaas CA, Bressler J, Debette S, Schuur M, Smith AV, Bis JC, Davies G, Trompet S, Smith JA, Wolf C, Chibnik LB, Liu Y, Vitart V, Kirin M, Petrovic K, Polasek O, Zgaga L, Fawns-Ritchie C, Hoffmann P, Karjalainen J, Lahti J, Llewellyn DJ, Schmidt CO, Mather KA, Chouraki V, Sun Q, Resnick SM, Rose LM, Oldmeadow C, Stewart M, Smith BH, Gudnason V, Yang Q, Mirza SS, Jukema JW, deJager PL, Harris TB, Liewald DC, Amin N, Coker LH, Stegle O, Lopez OL, Schmidt R, Teumer A, Ford I, Karbalai N, Becker JT, Jonsdottir MK, Au R, Fehrmann RSN, Herms S, Nalls M, Zhao W, Turner ST, Yaffe K, Lohman K, van Swieten JC, Kardia SLR, Knopman DS, Meeks WM, Heiss G, Holliday EG, Schofield PW, Tanaka T, Stott DJ, Wang J, Ridker P, Gow AJ, Pattie A, Starr JM, Hocking LJ, Armstrong NJ, McLachlan S, Shulman JM, Pilling LC, Eiriksdottir G, Scott RJ, Kochan NA, Palotie A, Hsieh YC, Eriksson JG, Penman A, Gottesman RF, Oostra BA, Yu L, DeStefano AL, Beiser A, Garcia M, Rotter JI, Nöthen MM, Hofman A, Slagboom PE, Westendorp RGJ, Buckley BM, Wolf PA, Uitterlinden AG, Psaty BM, Grabe HJ, Bandinelli S, Chasman DI, Grodstein F, Räikkönen K, Lambert JC, Porteous DJ, Price JF, Sachdev PS, Ferrucci L, Attia JR, Rudan I, Hayward C, Wright AF, Wilson JF, Cichon S, Franke L, Schmidt H, Ding J, de Craen AJM, Fornage M, Bennett DA, Deary IJ, Ikram MA, Launer LJ, Fitzpatrick AL, Seshadri S, van Duijn CM, Mosley TH. GWAS for executive function and processing speed suggests involvement of the CADM2 gene. Mol Psychiatry 2016; 21:189-197. [PMID: 25869804 PMCID: PMC4722802 DOI: 10.1038/mp.2015.37] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/21/2015] [Accepted: 02/11/2015] [Indexed: 01/20/2023]
Abstract
To identify common variants contributing to normal variation in two specific domains of cognitive functioning, we conducted a genome-wide association study (GWAS) of executive functioning and information processing speed in non-demented older adults from the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) consortium. Neuropsychological testing was available for 5429-32,070 subjects of European ancestry aged 45 years or older, free of dementia and clinical stroke at the time of cognitive testing from 20 cohorts in the discovery phase. We analyzed performance on the Trail Making Test parts A and B, the Letter Digit Substitution Test (LDST), the Digit Symbol Substitution Task (DSST), semantic and phonemic fluency tests, and the Stroop Color and Word Test. Replication was sought in 1311-21860 subjects from 20 independent cohorts. A significant association was observed in the discovery cohorts for the single-nucleotide polymorphism (SNP) rs17518584 (discovery P-value=3.12 × 10(-8)) and in the joint discovery and replication meta-analysis (P-value=3.28 × 10(-9) after adjustment for age, gender and education) in an intron of the gene cell adhesion molecule 2 (CADM2) for performance on the LDST/DSST. Rs17518584 is located about 170 kb upstream of the transcription start site of the major transcript for the CADM2 gene, but is within an intron of a variant transcript that includes an alternative first exon. The variant is associated with expression of CADM2 in the cingulate cortex (P-value=4 × 10(-4)). The protein encoded by CADM2 is involved in glutamate signaling (P-value=7.22 × 10(-15)), gamma-aminobutyric acid (GABA) transport (P-value=1.36 × 10(-11)) and neuron cell-cell adhesion (P-value=1.48 × 10(-13)). Our findings suggest that genetic variation in the CADM2 gene is associated with individual differences in information processing speed.
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Affiliation(s)
- CA Ibrahim-Verbaas
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus
University Medical Center, Rotterdam, The Netherlands,Department of Neurology, Erasmus University Medical Center,
Rotterdam, The Netherlands,Geriatric Unit, Azienda Sanitaria Firenze (ASF), Florence,
Italy
| | - J Bressler
- Human Genetics Center, School of Public Health, University of
Texas Health Science Center at Houston, Houston, TX, USA,Geriatric Unit, Azienda Sanitaria Firenze (ASF), Florence,
Italy
| | - S Debette
- Department of Neurology, Boston University School of Medicine,
Boston, MA, USA,Institut National de la Santé et de la Recherche
Médicale (INSERM), U897, Epidemiology and Biostatistics, University of Bordeaux,
Bordeaux, France,Department of Neurology, Bordeaux University Hospital, Bordeaux,
France,Geriatric Unit, Azienda Sanitaria Firenze (ASF), Florence,
Italy
| | - M Schuur
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus
University Medical Center, Rotterdam, The Netherlands,Department of Neurology, Erasmus University Medical Center,
Rotterdam, The Netherlands,Geriatric Unit, Azienda Sanitaria Firenze (ASF), Florence,
Italy
| | - AV Smith
- Icelandic Heart Association, Kopavogur, Iceland,Faculty of Medicine, University of Iceland, Reykjavik,
Iceland,Geriatric Unit, Azienda Sanitaria Firenze (ASF), Florence,
Italy
| | - JC Bis
- Cardiovascular Health Research Unit, Department of Medicine,
University of Washington, Seattle, WA, USA,Geriatric Unit, Azienda Sanitaria Firenze (ASF), Florence,
Italy
| | - G Davies
- Centre for Cognitive Ageing and Cognitive Epidemiology, The
University of Edinburgh, Edinburgh, UK,Geriatric Unit, Azienda Sanitaria Firenze (ASF), Florence,
Italy
| | - S Trompet
- Department of Cardiology, Leiden University Medical Center,
Leiden, The Netherlands,Department of Gerontology and Geriatrics, Leiden University
Medical Center, Leiden, The Netherlands
| | - JA Smith
- Department of Epidemiology, University of Michigan, Ann Arbor,
MI, USA
| | - C Wolf
- RG Statistical Genetics, Max Planck Institute of Psychiatry,
Munich, Germany
| | - LB Chibnik
- Program in Translational Neuropsychiatric Genomics, Department
of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Y Liu
- Department of Epidemiology, Wake Forest School of Medicine,
Winston-Salem, NC, USA
| | - V Vitart
- MRC Human Genetics Unit, Institute of Genetics and Molecular
Medicine, University of Edinburgh, Edinburgh, UK
| | - M Kirin
- Centre for Population Health Sciences, University of Edinburgh,
Edinburgh, UK
| | - K Petrovic
- Department of Neurology, Medical University and General
Hospital of Graz, Graz, Austria
| | - O Polasek
- Department of Public Health, University of Split, Split,
Croatia
| | - L Zgaga
- Department of Public Health and Primary Care, Trinity College
Dublin, Dublin, Ireland
| | - C Fawns-Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, The
University of Edinburgh, Edinburgh, UK
| | - P Hoffmann
- Institute of Neuroscience and Medicine (INM -1), Research
Center Juelich, Juelich, Germany,Division of Medical Genetics, Department of Biomedicine,
University of Basel, Basel, Switzerland,Department of Genomics, Life and Brain Research Center,
Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - J Karjalainen
- Department of Genetics, University Medical Centre Groningen,
University of Groningen, Groningen, The Netherlands
| | - J Lahti
- Institute of Behavioural Sciences, University of Helsinki,
Helsinki, Finland,Folkhälsan Research Centre, Helsinki, Finland
| | - DJ Llewellyn
- Institute of Biomedical and Clinical Sciences, University of
Exeter Medical School, Exeter, UK
| | - CO Schmidt
- Institute for Community Medicine, University Medicine
Greifswald, Greifswald, Germany
| | - KA Mather
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW
Medicine, University of New South Wales, Sydney, Australia
| | - V Chouraki
- Inserm, U1167, Institut Pasteur de Lille, Université
Lille-Nord de France, Lille, France
| | - Q Sun
- Channing Division of Network Medicine, Department of Medicine,
Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - SM Resnick
- Laboratory of Behavioral Neuroscience, National Institute on
Aging, NIH, Baltimore, MD, USA
| | - LM Rose
- Division of Preventive Medicine, Brigham and Women's Hospital,
Boston, MA, USA
| | - C Oldmeadow
- Hunter Medical Research Institute and Faculty of Health,
University of Newcastle, Newcastle, NSW, Australia
| | - M Stewart
- Centre for Population Health Sciences, University of Edinburgh,
Edinburgh, UK
| | - BH Smith
- Medical Research Institute, University of Dundee, Dundee,
UK
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland,Faculty of Medicine, University of Iceland, Reykjavik,
Iceland
| | - Q Yang
- The National Heart Lung and Blood Institute's Framingham Heart
Study, Framingham, MA, USA,Department of Biostatistics, Boston University School of Public
Health, Boston, MA, USA
| | - SS Mirza
- Department of Epidemiology, Erasmus University Medical Center,
Rotterdam, The Netherlands,Netherlands Consortium for Healthy Ageing, Leiden, The
Netherlands
| | - JW Jukema
- Department of Cardiology, Leiden University Medical Center,
Leiden, The Netherlands
| | - PL deJager
- Program in Translational Neuropsychiatric Genomics, Department
of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - TB Harris
- Laboratory of Epidemiology and Population Sciences, National
Institute on Aging, Bethesda, MD, USA
| | - DC Liewald
- Centre for Cognitive Ageing and Cognitive Epidemiology, The
University of Edinburgh, Edinburgh, UK,Department of Psychology, University of Edinburgh, Edinburgh,
UK
| | - N Amin
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus
University Medical Center, Rotterdam, The Netherlands
| | - LH Coker
- Division of Public Health Sciences and Neurology, Wake Forest
School of Medicine, Winston-Salem, NC, USA
| | - O Stegle
- Max Planck Institute for Developmental Biology, Max Planck
Institute for Intelligent Systems, Tübingen, Germany
| | - OL Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh,
PA, USA
| | - R Schmidt
- Department of Neurology, Medical University and General
Hospital of Graz, Graz, Austria
| | - A Teumer
- Interfaculty Institute for Genetics and Functional Genomics,
University Medicine Greifswald, Greifswald, Germany
| | - I Ford
- Robertson Center for biostatistics, University of Glasgow,
Glasgow, UK
| | - N Karbalai
- RG Statistical Genetics, Max Planck Institute of Psychiatry,
Munich, Germany
| | - JT Becker
- Department of Neurology, University of Pittsburgh, Pittsburgh,
PA, USA,Department of Psychiatry, University of Pittsburgh, Pittsburgh,
PA, USA,Department of Psychology, University of Pittsburgh, Pittsburgh,
PA, USA
| | | | - R Au
- Department of Neurology, Boston University School of Medicine,
Boston, MA, USA,The National Heart Lung and Blood Institute's Framingham Heart
Study, Framingham, MA, USA
| | - RSN Fehrmann
- Department of Genetics, University Medical Centre Groningen,
University of Groningen, Groningen, The Netherlands
| | - S Herms
- Division of Medical Genetics, Department of Biomedicine,
University of Basel, Basel, Switzerland,Department of Genomics, Life and Brain Research Center,
Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - M Nalls
- Laboratory of Neurogenetics, National Institute on Aging,
Bethesda, MD, USA
| | - W Zhao
- Department of Epidemiology, University of Michigan, Ann Arbor,
MI, USA
| | - ST Turner
- Division of Nephrology and Hypertension, Department of Internal
Medicine, Mayo Clinic, Rochester, MN, USA
| | - K Yaffe
- Departments of Psychiatry, Neurology and Epidemiology,
University of California, San Francisco and San Francisco VA Medical Center, San Francisco,
CA, USA
| | - K Lohman
- Department of Epidemiology, Wake Forest School of Medicine,
Winston-Salem, NC, USA
| | - JC van Swieten
- Department of Neurology, Erasmus University Medical Center,
Rotterdam, The Netherlands
| | - SLR Kardia
- Department of Epidemiology, University of Michigan, Ann Arbor,
MI, USA
| | - DS Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - WM Meeks
- Department of Medicine, Division of Geriatrics, University of
Mississippi Medical Center, Jackson, MS, USA
| | - G Heiss
- Department of Epidemiology, Gillings School of Global Public
Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - EG Holliday
- Hunter Medical Research Institute and Faculty of Health,
University of Newcastle, Newcastle, NSW, Australia
| | - PW Schofield
- School of Medicine and Public Health, Faculty of Health,
University of Newcastle, Newcastle, SW, Australia
| | - T Tanaka
- Translational Gerontology Branch, National Institute on Aging,
Baltimore, MD, USA
| | - DJ Stott
- Department of Cardiovascular and Medical Sciences, University
of Glasgow, Glasgow, UK
| | - J Wang
- Department of Biostatistics, Boston University School of Public
Health, Boston, MA, USA
| | - P Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital,
Boston, MA, USA
| | - AJ Gow
- Centre for Cognitive Ageing and Cognitive Epidemiology, The
University of Edinburgh, Edinburgh, UK,Department of Psychology, University of Edinburgh, Edinburgh,
UK
| | - A Pattie
- Centre for Cognitive Ageing and Cognitive Epidemiology, The
University of Edinburgh, Edinburgh, UK
| | - JM Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, The
University of Edinburgh, Edinburgh, UK,Alzheimer Scotland Research Centre, Edinburgh, UK
| | - LJ Hocking
- Division of Applied Medicine, University of Aberdeen, Aberdeen,
UK
| | - NJ Armstrong
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW
Medicine, University of New South Wales, Sydney, Australia,Cancer Research Program, Garvan Institute of Medical Research,
Sydney, NSW, Australia,School of Mathematics & Statistics and Prince of Wales
Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - S McLachlan
- Centre for Population Health Sciences, University of Edinburgh,
Edinburgh, UK
| | - JM Shulman
- Department of Neurology, Baylor College of Medicine, Houston,
TX, USA,Department of Molecular and Human Genetics, The Jan and Dan
Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - LC Pilling
- Epidemiology and Public Health Group, University of Exeter
Medical School, Exeter, UK
| | | | - RJ Scott
- Hunter Medical Research Institute and Faculty of Health,
University of Newcastle, Newcastle, NSW, Australia
| | - NA Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW
Medicine, University of New South Wales, Sydney, Australia,Neuropsychiatric Institute, The Prince of Wales Hospital,
Sydney, NSW, Australia
| | - A Palotie
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus,
Cambridge, UK,Institute for Molecular Medicine Finland (FIMM), University of
Helsinki, Helsinki, Finland,Department of Medical Genetics, University of Helsinki and
University Central Hospital, Helsinki, Finland
| | - Y-C Hsieh
- School of Public Health, Taipei Medical University, Taipei,
Taiwan
| | - JG Eriksson
- Folkhälsan Research Centre, Helsinki, Finland,Department of General Practice and Primary Health Care,
University of Helsinki, Helsinki, Finland,National Institute for Health and Welfare, Helsinki,
Finland,Helsinki University Central Hospital, Unit of General Practice,
Helsinki, Finland,Vasa Central Hospital, Vasa, Finland
| | - A Penman
- Center of Biostatistics and Bioinformatics, University of
Mississippi Medical Center, Jackson, MS, USA
| | - RF Gottesman
- Department of Neurology, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - BA Oostra
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus
University Medical Center, Rotterdam, The Netherlands
| | - L Yu
- Rush Alzheimer's Disease Center, Rush University Medical
Center, Chicago, IL, USA
| | - AL DeStefano
- Department of Neurology, Boston University School of Medicine,
Boston, MA, USA,The National Heart Lung and Blood Institute's Framingham Heart
Study, Framingham, MA, USA,Department of Biostatistics, Boston University School of Public
Health, Boston, MA, USA
| | - A Beiser
- Department of Neurology, Boston University School of Medicine,
Boston, MA, USA,The National Heart Lung and Blood Institute's Framingham Heart
Study, Framingham, MA, USA,Department of Biostatistics, Boston University School of Public
Health, Boston, MA, USA
| | - M Garcia
- Laboratory of Epidemiology and Population Sciences, National
Institute on Aging, Bethesda, MD, USA
| | - JI Rotter
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los
Angeles, CA, USA,Institute for Translational Genomics and Population Sciences,
Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA,
USA,Division of Genetic Outcomes, Department of Pediatrics,
Harbor-UCLA Medical Center, Torrance, CA, USA
| | - MM Nöthen
- Department of Genomics, Life and Brain Research Center,
Institute of Human Genetics, University of Bonn, Bonn, Germany,German Center for Neurodegenerative Diseases (DZNE), Bonn,
Germany
| | - A Hofman
- Department of Epidemiology, Erasmus University Medical Center,
Rotterdam, The Netherlands,Netherlands Consortium for Healthy Ageing, Leiden, The
Netherlands
| | - PE Slagboom
- Department of Molecular Epidemiology, Leiden University Medical
Center, Leiden, The Netherlands
| | - RGJ Westendorp
- Leiden Academy of Vitality and Ageing, Leiden, The
Netherlands
| | - BM Buckley
- Department of Pharmacology and Therapeutics, University College
Cork, Cork, Ireland
| | - PA Wolf
- Department of Neurology, Boston University School of Medicine,
Boston, MA, USA,The National Heart Lung and Blood Institute's Framingham Heart
Study, Framingham, MA, USA
| | - AG Uitterlinden
- Department of Epidemiology, Erasmus University Medical Center,
Rotterdam, The Netherlands,Netherlands Consortium for Healthy Ageing, Leiden, The
Netherlands,Department of Internal Medicine, Erasmus University Medical
Center, Rotterdam, The Netherlands
| | - BM Psaty
- Cardiovascular Health Research Unit, Department of Medicine,
University of Washington, Seattle, WA, USA,Department of Epidemiology, University of Washington, Seattle,
WA, USA,Department of Health Services, University of Washington,
Seattle, WA, USA,Group Health Research Institute, Group Health, Seattle, WA,
USA
| | - HJ Grabe
- Department of Psychiatry and Psychotherapy, University Medicine
Greifswald, HELIOS-Hospital Stralsund, Stralsund, Germany
| | - S Bandinelli
- Geriatric Unit, Azienda Sanitaria Firenze (ASF), Florence,
Italy
| | - DI Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital,
Boston, MA, USA
| | - F Grodstein
- Channing Division of Network Medicine, Department of Medicine,
Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - K Räikkönen
- Institute of Behavioural Sciences, University of Helsinki,
Helsinki, Finland
| | - J-C Lambert
- Inserm, U1167, Institut Pasteur de Lille, Université
Lille-Nord de France, Lille, France
| | - DJ Porteous
- Centre for Genomic and Experimental Medicine, Institute of
Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - JF Price
- Centre for Population Health Sciences, University of Edinburgh,
Edinburgh, UK
| | - PS Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW
Medicine, University of New South Wales, Sydney, Australia,Neuropsychiatric Institute, The Prince of Wales Hospital,
Sydney, NSW, Australia
| | - L Ferrucci
- Translational Gerontology Branch, National Institute on Aging,
Baltimore, MD, USA
| | - JR Attia
- Hunter Medical Research Institute and Faculty of Health,
University of Newcastle, Newcastle, NSW, Australia
| | - I Rudan
- Centre for Population Health Sciences, University of Edinburgh,
Edinburgh, UK
| | - C Hayward
- MRC Human Genetics Unit, Institute of Genetics and Molecular
Medicine, University of Edinburgh, Edinburgh, UK
| | - AF Wright
- MRC Human Genetics Unit, Institute of Genetics and Molecular
Medicine, University of Edinburgh, Edinburgh, UK
| | - JF Wilson
- Centre for Population Health Sciences, University of Edinburgh,
Edinburgh, UK
| | - S Cichon
- Division of Medical Genetics, Department of Biomedicine,
University of Basel, Basel, Switzerland,Department of Genomics, Life and Brain Research Center,
Institute of Human Genetics, University of Bonn, Bonn, Germany,Institute of Neuroscience and Medicine (INM-1), Research Center
Juelich, Juelich, Germany
| | - L Franke
- Department of Genetics, University Medical Centre Groningen,
University of Groningen, Groningen, The Netherlands
| | - H Schmidt
- Department of Neurology, Medical University and General
Hospital of Graz, Graz, Austria
| | - J Ding
- Department of Internal Medicine, Wake Forest University School
of Medicine, Winston-Salem, NC, USA
| | - AJM de Craen
- Department of Gerontology and Geriatrics, Leiden University
Medical Center, Leiden, The Netherlands
| | - M Fornage
- Institute for Molecular Medicine and Human Genetics Center,
University of Texas Health Science Center at Houston, Houston, TX, USA
| | - DA Bennett
- Rush Alzheimer's Disease Center, Rush University Medical
Center, Chicago, IL, USA
| | - IJ Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, The
University of Edinburgh, Edinburgh, UK,Department of Psychology, University of Edinburgh, Edinburgh,
UK
| | - MA Ikram
- Department of Neurology, Erasmus University Medical Center,
Rotterdam, The Netherlands,Department of Epidemiology, Erasmus University Medical Center,
Rotterdam, The Netherlands,Netherlands Consortium for Healthy Ageing, Leiden, The
Netherlands,Department of Radiology, Erasmus University Medical Center,
Rotterdam, The Netherlands
| | - LJ Launer
- Laboratory of Epidemiology and Population Sciences, National
Institute on Aging, Bethesda, MD, USA
| | - AL Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle,
WA, USA
| | - S Seshadri
- Department of Neurology, Boston University School of Medicine,
Boston, MA, USA,The National Heart Lung and Blood Institute's Framingham Heart
Study, Framingham, MA, USA
| | - CM van Duijn
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus
University Medical Center, Rotterdam, The Netherlands,Netherlands Consortium for Healthy Ageing, Leiden, The
Netherlands
| | - TH Mosley
- Department of Medicine and Neurology, University of Mississippi
Medical Center, Jackson, MS, USA
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Agbenyikey W, Karasek R, Cifuentes M, Wolf PA, Seshadri S, Taylor JA, Beiser AS, Au R. Job strain and cognitive decline: a prospective study of the framingham offspring cohort. Int J Occup Environ Med 2015; 6:79-94. [PMID: 25890602 PMCID: PMC5282587 DOI: 10.15171/ijoem.2015.534] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/02/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Workplace stress is known to be related with many behavioral and disease outcomes. However, little is known about its prospective relationship with measures of cognitive decline. OBJECTIVE To investigate the association of job strain, psychological demands and job control on cognitive decline. METHODS Participants from Framingham Offspring cohort (n=1429), were assessed on job strain, and received neuropsychological assessment approximately 15 years and 21 years afterwards. RESULTS High job strain and low control were associated with decline in verbal learning and memory. Job strain was associated with decline in word recognition skills. Active job and passive job predicted decline in verbal learning and memory relative to low strain jobs in the younger subgroup. Active job and demands were positively associated with abstract reasoning skills. CONCLUSIONS Job strain and job control may influence decline in cognitive performance.
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Affiliation(s)
- W Agbenyikey
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA, USA.
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Tan ZS, Harris WS, Beiser AS, Au R, Himali JJ, Debette S, Pikula A, Decarli C, Wolf PA, Vasan RS, Robins SJ, Seshadri S. Red blood cell ω-3 fatty acid levels and markers of accelerated brain aging. Neurology 2012; 78:658-64. [PMID: 22371413 DOI: 10.1212/wnl.0b013e318249f6a9] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Higher dietary intake and circulating levels of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been related to a reduced risk for dementia, but the pathways underlying this association remain unclear. We examined the cross-sectional relation of red blood cell (RBC) fatty acid levels to subclinical imaging and cognitive markers of dementia risk in a middle-aged to elderly community-based cohort. METHODS We related RBC DHA and EPA levels in dementia-free Framingham Study participants (n = 1575; 854 women, age 67 ± 9 years) to performance on cognitive tests and to volumetric brain MRI, with serial adjustments for age, sex, and education (model A, primary model), additionally for APOE ε4 and plasma homocysteine (model B), and also for physical activity and body mass index (model C), or for traditional vascular risk factors (model D). RESULTS Participants with RBC DHA levels in the lowest quartile (Q1) when compared to others (Q2-4) had lower total brain and greater white matter hyperintensity volumes (for model A: β ± SE = -0.49 ± 0.19; p = 0.009, and 0.12 ± 0.06; p = 0.049, respectively) with persistence of the association with total brain volume in multivariable analyses. Participants with lower DHA and ω-3 index (RBC DHA+EPA) levels (Q1 vs. Q2-4) also had lower scores on tests of visual memory (β ± SE = -0.47 ± 0.18; p = 0.008), executive function (β ± SE = -0.07 ± 0.03; p = 0.004), and abstract thinking (β ± SE = -0.52 ± 0.18; p = 0.004) in model A, the results remaining significant in all models. CONCLUSION Lower RBC DHA levels are associated with smaller brain volumes and a "vascular" pattern of cognitive impairment even in persons free of clinical dementia.
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Affiliation(s)
- Z S Tan
- Department of Medicine, Division of Geriatric Medicine, Easton Center for Alzheimer’s Disease Research, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, USA.
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4
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Wolf PA, Dawber TR, Thomas E, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: The Framingham Study. Neurology 2011. [DOI: 10.1212/01.wnl.0000407150.80523.a4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Debette S, Seshadri S, Beiser A, Au R, Himali JJ, Palumbo C, Wolf PA, DeCarli C. Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology 2011; 77:461-8. [PMID: 21810696 DOI: 10.1212/wnl.0b013e318227b227] [Citation(s) in RCA: 557] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Our aim was to test the association of vascular risk factor exposure in midlife with progression of MRI markers of brain aging and measures of cognitive decline. METHODS A total of 1,352 participants without dementia from the prospective Framingham Offspring Cohort Study were examined. Multivariable linear and logistic regressions were implemented to study the association of midlife vascular risk factor exposure with longitudinal change in white matter hyperintensity volume (WMHV), total brain volume (TBV), temporal horn volume, logical memory delayed recall, visual reproductions delayed-recall (VR-d), and Trail-Making Test B-A (TrB-A) performance a decade later. RESULTS Hypertension in midlife was associated with accelerated WMHV progression (p < 0.001) and worsening executive function (TrB-A score; p = 0.012). Midlife diabetes and smoking were associated with a more rapid increase in temporal horn volume, a surrogate marker of accelerated hippocampal atrophy (p = 0.017 and p = 0.008, respectively). Midlife smoking also predicted a more marked decrease in total brain volume (p = 0.025) and increased risk of extensive change in WMHV (odds ratio = 1.58 [95%confidence interval 1.07-2.33], p = 0.021). Obesity in midlife was associated with an increased risk of being in the top quartile of change in executive function (1.39 [1.02-1.88], p = 0.035) and increasing waist-to-hip ratio was associated with marked decline in TBV (10.81 [1.44-81.01], p = 0.021). Longitudinal changes in brain structure were significantly correlated with decline in memory and executive function. CONCLUSIONS Midlife hypertension, diabetes, smoking, and obesity were associated with an increased rate of progression of vascular brain injury, global and hippocampal atrophy, and decline in executive function a decade later.
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Affiliation(s)
- S Debette
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
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Abstract
OBJECTIVES Depression may be associated with an increased risk for dementia, although results from population-based samples have been inconsistent. We examined the association between depressive symptoms and incident dementia over a 17-year follow-up period. METHODS In 949 Framingham original cohort participants (63.6% women, mean age = 79), depressive symptoms were assessed at baseline (1990-1994) using the 60-point Center for Epidemiologic Studies Depression Scale (CES-D). A cutpoint of > or = 16 was used to define depression, which was present in 13.2% of the sample. Cox proportional hazards models adjusting for age, sex, education, homocysteine, and APOE epsilon4 examined the association between baseline depressive symptoms and the risk of dementia and Alzheimer disease (AD). RESULTS During the 17-year follow-up period, 164 participants developed dementia; 136 of these cases were AD. A total of 21.6% of participants who were depressed at baseline developed dementia compared with 16.6% of those who were not depressed. Depressed participants (CES-D >/=16) had more than a 50% increased risk for dementia (hazard ratio [HR] 1.72, 95% confidence interval [CI] 1.04-2.84, p = 0.035) and AD (HR 1.76, 95% CI 1.03-3.01, p = 0.039). Results were similar when we included subjects taking antidepressant medications as depressed. For each 10-point increase on the CES-D, there was significant increase in the risk of dementia (HR 1.46, 95% CI 1.18-1.79, p < 0.001) and AD (HR 1.39, 95% CI 1.11-1.75, p = 0.005). Results were similar when we excluded persons with possible mild cognitive impairment. CONCLUSIONS Depression is associated with an increased risk of dementia and AD in older men and women over 17 years of follow-up.
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Affiliation(s)
- J S Saczynski
- Department of Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA.
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Abstract
Laboratory and field tests demonstrated that 2,2-dibromo-3-nitrilopropionamide was an effective slimicide for use in papermaking systems and cooling towers. It was also effective as a bactericide for soluble oil emulsions. Acute toxicity tests showed that its hydrolysis at pH 9 and 23 C yielded products that were relatively nonhazardous to fathead minnows.
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Affiliation(s)
- P A Wolf
- Designed Products Department, The Dow Chemical Company, Midland, Michigan 48640
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Debette S, Wolf PA, Beiser A, Au R, Himali JJ, Pikula A, Auerbach S, Decarli C, Seshadri S. Association of parental dementia with cognitive and brain MRI measures in middle-aged adults. Neurology 2009; 73:2071-8. [PMID: 20007524 DOI: 10.1212/wnl.0b013e3181c67833] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Studies of autosomal dominant Alzheimer disease (AD) have shown structural and cognitive changes in mutation carriers decades prior to clinical disease. Whether such changes are detectable in offspring of persons with sporadic dementia remains unknown. We related prospectively verified parental dementia to brain MRI and cognitive testing in the offspring, within a 2-generational community-based cohort. METHODS A total of 717 Framingham offspring (mean age: 59 +/- 8 years) were studied. In multivariate analyses, we compared offspring with and without verified parental dementia (and AD) for 1) performance on tests of memory, abstract reasoning, and cognitive flexibility, and 2) volumetric brain MRI measures of total cerebral brain volume (TCBV), hippocampal volume (HV), and white matter hyperintensity volume (WMHV), assessed cross-sectionally and longitudinally. RESULTS When testing the association of parental dementia and AD with baseline cognitive performance, we observed an interaction of parental dementia and AD with APOE epsilon4 status (p < 0.002). In APOE epsilon4 carriers only (n = 165), parental dementia was associated with poorer scores on tests of verbal memory (beta = -1.81 +/- 0.53, p < 0.001) and visuospatial memory (beta = -1.73 +/- 0.47, p < 0.001). These associations were stronger for parental AD (beta = -1.97 +/- 0.52, p < 0.001, beta = -1.95 +/- 0.48, p < 0.001), equivalent to 14-16 years of brain aging. Among APOE epsilon4 carriers, offspring of participants with dementia were also more likely to show an annual decline in TCBV in the top quartile (odds ratio = 4.67 [1.26-17.30], p = 0.02). Regardless of APOE epsilon4 status, participants with parental dementia were more likely to be in the highest quartile of decline in executive function test scores (odds ratio = 1.61 [1.02-2.53], p = 0.04). CONCLUSIONS Among middle-aged carriers of the APOE epsilon4 allele, parental dementia and Alzheimer disease were associated with poorer verbal and visuospatial memory and a higher rate of global brain atrophy.
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Affiliation(s)
- S Debette
- Department of Neurology, Boston University School of Medicine, B602, 72 East Concord Street, Boston, MA 02118, USA
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Dietrich M, Jacques PF, Pencina MJ, Lanier K, Keyes MJ, Kaur G, Wolf PA, D'Agostino RB, Vasan RS. Vitamin E supplement use and the incidence of cardiovascular disease and all-cause mortality in the Framingham Heart Study: Does the underlying health status play a role? Atherosclerosis 2008; 205:549-53. [PMID: 19195657 DOI: 10.1016/j.atherosclerosis.2008.12.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 11/13/2008] [Accepted: 12/10/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Observational studies generally showed beneficial associations between supplemental vitamin E intake and cardiovascular disease (CVD) risk whereas intervention trials reported adverse effects of vitamin E supplements. We hypothesize that these discordant findings result from differing underlying health status of study participants in observational and intervention studies. OBJECTIVE Determine if the relation between supplemental vitamin E intake and CVD and all-cause mortality (ACM) depends on pre-existing CVD. DESIGN Proportional hazards regression to relate supplemental vitamin E intake to the 10-year incidence of CVD and ACM in 4270 Framingham Study participants stratified by baseline CVD status. RESULTS Eleven percent of participants used vitamin E supplements at baseline. In participants with pre-existing CVD, there were 28 (44%) and 20 (32%) incident cases of CVD and ACM in the vitamin E supplement users versus 249 (47%) and 202 (38%) in the non-users, respectively (CVD HR, 0.90; 95% CL, 0.60-1.32; ACM HR, 0.74; 95% CL, 0.46-1.17). In participants without pre-existing CVD, there were 51 (13%) and 47 (12%) cases of CVD and ACM in the vitamin E supplement group versus 428 (13%) and 342 (10%) in the non-vitamin E supplement group, respectively (CVD HR, 1.00; 95% CL, 0.75-1.34; ACM HR 1.20; 95% CL, 0.89-1.64). CONCLUSION CVD status has no apparent influence on the association of supplemental vitamin E intake and risk for CVD and ACM in this large, community-based study. Further research is needed to clarify the basis for the discrepant results between intervention and observational studies of supplemental vitamin E intake.
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Affiliation(s)
- M Dietrich
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, United States.
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Szekely CA, Green RC, Breitner JCS, Østbye T, Beiser AS, Corrada MM, Dodge HH, Ganguli M, Kawas CH, Kuller LH, Psaty BM, Resnick SM, Wolf PA, Zonderman AB, Welsh-Bohmer KA, Zandi PP. No advantage of A beta 42-lowering NSAIDs for prevention of Alzheimer dementia in six pooled cohort studies. Neurology 2008; 70:2291-8. [PMID: 18509093 DOI: 10.1212/01.wnl.0000313933.17796.f6] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Observational studies show reduced incidence of Alzheimer dementia (AD) in users of nonsteroidal anti-inflammatory drugs (NSAIDs). One hypothesis holds that the subset of NSAIDs known as selective A beta(42)-lowering agents (SALAs) is responsible for this apparent reduction in AD risk. METHODS We pooled individual-level data from six prospective studies to obtain a sufficient sample to examine AD risk in users of SALA vs non-SALA NSAIDs. RESULTS Of 13,499 initially dementia-free participants (70,863 person-years), 820 developed incident AD. Users of NSAIDs (29.6%) showed reduced risk of AD (adjusted hazard ratio [aHR] 0.77, 95% CI 0.65-0.91). The point estimates were similar for SALAs (aHR 0.87, CI 0.72-1.04) and non-SALAs (aHR 0.75, CI 0.56-1.01). Because 573 NSAID users (14.5%) reported taking both a SALA and non-SALA, we examined their use alone and in combination. Resulting aHRs were 0.82 (CI 0.67-0.99) for SALA only, 0.60 (CI 0.40-0.90) for non-SALA only, and 0.87 (CI 0.57-1.33) for both NSAIDs (Wald test for differences, p = 0.32). The 40.7% of participants who used aspirin also showed reduced risk of AD, even when they used no other NSAIDs (aHR 0.78, CI 0.66-0.92). By contrast, there was no association with use of acetaminophen (aHR 0.93, CI 0.76-1.13). CONCLUSIONS In this pooled dataset, nonsteroidal anti-inflammatory drug (NSAID) use reduced the risk of Alzheimer dementia (AD). However, there was no apparent advantage in AD risk reduction for the subset of NSAIDs shown to selectively lower A beta(42), suggesting that all conventional NSAIDs including aspirin have a similar protective effect in humans.
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Affiliation(s)
- C A Szekely
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Danesh J, Erqou S, Walker M, Thompson SG, Tipping R, Ford C, Pressel S, Walldius G, Jungner I, Folsom AR, Chambless LE, Knuiman M, Whincup PH, Wannamethee SG, Morris RW, Willeit J, Kiechl S, Santer P, Mayr A, Wald N, Ebrahim S, Lawlor DA, Yarnell JWG, Gallacher J, Casiglia E, Tikhonoff V, Nietert PJ, Sutherland SE, Bachman DL, Keil JE, Cushman M, Psaty BM, Tracy RP, Tybjaerg-Hansen A, Nordestgaard BG, Frikke-Schmidt R, Giampaoli S, Palmieri L, Panico S, Vanuzzo D, Pilotto L, Simons L, McCallum J, Friedlander Y, Fowkes FGR, Lee AJ, Smith FB, Taylor J, Guralnik J, Phillips C, Wallace R, Blazer D, Khaw KT, Jansson JH, Donfrancesco C, Salomaa V, Harald K, Jousilahti P, Vartiainen E, Woodward M, D'Agostino RB, Wolf PA, Vasan RS, Pencina MJ, Bladbjerg EM, Jorgensen T, Moller L, Jespersen J, Dankner R, Chetrit A, Lubin F, Rosengren A, Wilhelmsen L, Lappas G, Eriksson H, Bjorkelund C, Cremer P, Nagel D, Tilvis R, Strandberg T, Rodriguez B, Bouter LM, Heine RJ, Dekker JM, Nijpels G, Stehouwer CDA, Rimm E, Pai J, Sato S, Iso H, Kitamura A, Noda H, Goldbourt U, Salomaa V, Salonen JT, Nyyssönen K, Tuomainen TP, Deeg D, Poppelaars JL, Meade T, Cooper J, Hedblad B, Berglund G, Engstrom G, Döring A, Koenig W, Meisinger C, Mraz W, Kuller L, Selmer R, Tverdal A, Nystad W, Gillum R, Mussolino M, Hankinson S, Manson J, De Stavola B, Knottenbelt C, Cooper JA, Bauer KA, Rosenberg RD, Sato S, Naito Y, Holme I, Nakagawa H, Miura H, Ducimetiere P, Jouven X, Crespo C, Garcia-Palmieri M, Amouyel P, Arveiler D, Evans A, Ferrieres J, Schulte H, Assmann G, Shepherd J, Packard C, Sattar N, Cantin B, Lamarche B, Després JP, Dagenais GR, Barrett-Connor E, Wingard D, Bettencourt R, Gudnason V, Aspelund T, Sigurdsson G, Thorsson B, Trevisan M, Witteman J, Kardys I, Breteler M, Hofman A, Tunstall-Pedoe H, Tavendale R, Lowe GDO, Ben-Shlomo Y, Howard BV, Zhang Y, Best L, Umans J, Onat A, Meade TW, Njolstad I, Mathiesen E, Lochen ML, Wilsgaard T, Gaziano JM, Stampfer M, Ridker P, Ulmer H, Diem G, Concin H, Rodeghiero F, Tosetto A, Brunner E, Shipley M, Buring J, Cobbe SM, Ford I, Robertson M, He Y, Ibanez AM, Feskens EJM, Kromhout D, Collins R, Di Angelantonio E, Kaptoge S, Lewington S, Orfei L, Pennells L, Perry P, Ray K, Sarwar N, Scherman M, Thompson A, Watson S, Wensley F, White IR, Wood AM. The Emerging Risk Factors Collaboration: analysis of individual data on lipid, inflammatory and other markers in over 1.1 million participants in 104 prospective studies of cardiovascular diseases. Eur J Epidemiol 2007; 22:839-69. [PMID: 17876711 DOI: 10.1007/s10654-007-9165-7] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 07/02/2007] [Indexed: 01/22/2023]
Abstract
Many long-term prospective studies have reported on associations of cardiovascular diseases with circulating lipid markers and/or inflammatory markers. Studies have not, however, generally been designed to provide reliable estimates under different circumstances and to correct for within-person variability. The Emerging Risk Factors Collaboration has established a central database on over 1.1 million participants from 104 prospective population-based studies, in which subsets have information on lipid and inflammatory markers, other characteristics, as well as major cardiovascular morbidity and cause-specific mortality. Information on repeat measurements on relevant characteristics has been collected in approximately 340,000 participants to enable estimation of and correction for within-person variability. Re-analysis of individual data will yield up to approximately 69,000 incident fatal or nonfatal first ever major cardiovascular outcomes recorded during about 11.7 million person years at risk. The primary analyses will involve age-specific regression models in people without known baseline cardiovascular disease in relation to fatal or nonfatal first ever coronary heart disease outcomes. This initiative will characterize more precisely and in greater detail than has previously been possible the shape and strength of the age- and sex-specific associations of several lipid and inflammatory markers with incident coronary heart disease outcomes (and, secondarily, with other incident cardiovascular outcomes) under a wide range of circumstances. It will, therefore, help to determine to what extent such associations are independent from possible confounding factors and to what extent such markers (separately and in combination) provide incremental predictive value.
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Tan ZS, Beiser AS, Vasan RS, Roubenoff R, Dinarello CA, Harris TB, Benjamin EJ, Au R, Kiel DP, Wolf PA, Seshadri S. Inflammatory markers and the risk of Alzheimer disease: the Framingham Study. Neurology 2007; 68:1902-8. [PMID: 17536046 DOI: 10.1212/01.wnl.0000263217.36439.da] [Citation(s) in RCA: 313] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine whether serum cytokines and spontaneous production of peripheral blood mononuclear cell (PBMC) cytokines are associated with the risk of incident Alzheimer disease (AD). METHODS We followed 691 cognitively intact community-dwelling participants (mean age 79 years, 62% women) and related PBMC cytokine production (tertiles of spontaneous production of interleukin 1 [IL-1], IL-1 receptor antagonist, and tumor necrosis factor alpha [TNF-alpha]) and serum C-reactive protein and interleukin 6 (IL-6) to the risk of incident AD. RESULTS Adjusting for clinical covariates, individuals in the top two tertiles (T2 and T3) of PBMC production of IL-1 or the top tertile (T3) of PBMC production of TNF-alpha were at increased risk of developing AD (multivariable-adjusted hazard ratio [HR] for IL-1 T2 = 2.84, 95% CI 1.09 to 7.43; p = 0.03 and T3 = 2.61, 95% CI 0.96 to 7.07; p = 0.06; for TNF-alpha, adjusted HR for T2 = 1.30, 95% CI 0.53 to 3.17; p = 0.57 and T3 = 2.59, 95% CI 1.09 to 6.12; p = 0.031]) compared with those in the lowest tertile (T1). INTERPRETATION Higher spontaneous production of interleukin 1 or tumor necrosis factor alpha by peripheral blood mononuclear cells may be a marker of future risk of Alzheimer disease (AD) in older individuals. These data strengthen the evidence for a pathophysiologic role of inflammation in the development of clinical AD.
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Affiliation(s)
- Z S Tan
- Department of Medicine, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02131, USA.
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Jefferson AL, Massaro JM, Wolf PA, Seshadri S, Au R, Vasan RS, Larson MG, Meigs JB, Keaney JF, Lipinska I, Kathiresan S, Benjamin EJ, DeCarli C. Inflammatory biomarkers are associated with total brain volume: the Framingham Heart Study. Neurology 2007; 68:1032-8. [PMID: 17389308 PMCID: PMC2758770 DOI: 10.1212/01.wnl.0000257815.20548.df] [Citation(s) in RCA: 200] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Systemic inflammation is associated with ischemia and Alzheimer disease (AD). We hypothesized that inflammatory biomarkers would be associated with neuroimaging markers of ischemia (i.e., white matter hyperintensities [WMH]) and AD (i.e., total brain volume [TCB]). METHODS MRI WMH and TCB were quantified on 1,926 Framingham Offspring participants free from clinical stroke, TIA, or dementia (mean age 60 +/- 9 years; range 35 to 85 years; 54% women) who underwent measurement of a circulating inflammatory marker panel, including CD40 ligand, C-reactive protein, interleukin-6 (IL-6), soluble intracellular adhesion molecule-1, monocyte chemoattractant protein-1, myeloperoxidase, osteoprotegerin (OPG), P-selectin, tumor necrosis factor-alpha (TNFalpha), and tumor necrosis factor receptor II. To account for head size, both TCB (TCBV) and WMH (WMH/TCV) were divided by total cranial volume. We used multivariable linear regression to relate 10 log-transformed inflammatory biomarkers to brain MRI measures. RESULTS In multivariable models, inflammatory markers as a group were associated with TCBV (p < 0.0001) but not WMH/TCV (p = 0.28). In stepwise models adjusted for clinical covariates with backwards elimination of markers, IL-6 and OPG were inversely associated with TCBV; TNFalpha was inversely related to TCBV in a subset of 1,430 participants. Findings were similar in analyses excluding individuals with prevalent cardiovascular disease. The relations between TCBV and inflammatory markers were modified by both sex and age, and generally were more pronounced in men and in older individuals. CONCLUSIONS Although our observational cross-sectional data cannot establish causality, they are consistent with the hypothesis that higher inflammatory markers are associated with greater atrophy than expected for age.
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Affiliation(s)
- A L Jefferson
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA.
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Affiliation(s)
- P A Wolf
- Biochemical Research Laboratory, The Dow Chemical Company, Midland, Michigan
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Lessov-Schlaggar CN, Reed T, Swan GE, Krasnow RE, DeCarli C, Marcus R, Holloway L, Wolf PA, Carmelli D. Association of sex steroid hormones with brain morphology and cognition in healthy elderly men. Neurology 2005; 65:1591-6. [PMID: 16301487 DOI: 10.1212/01.wnl.0000184512.08249.48] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is inconsistent evidence of the presence and direction of the relationship between sex hormone concentrations and cognitive function in older men, and there is little published literature on the relationship of sex hormone concentrations and brain volume as measured by MRI. OBJECTIVE To examine the hypothesis that midlife total serum concentrations of testosterone (T), estradiol, estrone, and sex hormone binding globulin (SHBG) predict cognitive task performance and regional brain volumes at 10- to 16-year follow-up, in a longitudinal sample of World War II veteran twin men. METHODS Treating twins as individuals, linear regression models were used, adjusting analyses for age, education, depressive symptomatology, blood pressure, alcohol consumption, years of cigarette smoking, and APOE epsilon4 allele status. RESULTS There were no significant associations between sex hormone or SHBG concentrations and performance on a series of cognitive tasks measuring global and executive function, visual and verbal learning and memory. Higher midlife T concentrations were associated with larger hemispheric, frontal, and parietal regional brain volumes and with smaller left occipital brain volume. Higher estradiol and estrone concentrations were also associated with smaller right (estradiol) and both right and left (estrone) occipital volumes, but with no other brain regions. Owing to the multiple comparisons conducted, some significant associations may have occurred by chance. CONCLUSIONS Overall, the pattern of results suggests a role for sex hormones in brain volume that predates potentially observable associations between sex hormones and cognitive task performance.
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Seshadri S, Wolf PA, Beiser A, Elias MF, Au R, Kase CS, D'Agostino RB, DeCarli C. Stroke risk profile, brain volume, and cognitive function: the Framingham Offspring Study. Neurology 2005; 63:1591-9. [PMID: 15534241 DOI: 10.1212/01.wnl.0000142968.22691.70] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mid-life stroke risk factors have been related to late-life cognitive impairment. This association may result not only from clinical strokes but also from subclinical brain injury, such as a global atrophy demonstrable on quantitative brain MRI. METHODS The authors evaluated the community-based cohort of Framingham Offspring Study participants. A total of 1,841 subjects (mean age, 62 years; 857 men, 984 women) who underwent quantitative MRI and cognitive testing between 1999 and 2001 and were free of clinical stroke and dementia constituted our study sample. The authors used age- and sex-adjusted linear regression models to relate previous (1991 to 1995) and recent (1998 to 2001) Framingham Stroke Risk Profile (FSRP) scores to the total cerebral brain volume ratio (TCBVr) on follow-up MRI, and further to relate the TCBVr with education-adjusted scores on neuropsychological tests administered at the time of imaging. RESULTS There was an inverse association between FSRP scores and TCBVr. The TCBVr also showed a significant positive association with performance on tests of attention (Trails A), executive function (Trails B), and visuospatial function (visual reproduction, Hooper visual organization), but not with performance on tests of verbal memory or naming. CONCLUSIONS The Framingham Stroke Risk Profile may identify subjects with smaller brains and poorer cognitive function among stroke- and dementia-free subjects, reinforcing the importance of managing stroke risk factors.
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Affiliation(s)
- S Seshadri
- Department of Neurology, School of Medicine, Boston University, MA 02118-2526, USA
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Abstract
BACKGROUND The antiparkinsonian drug L-dopa causes increased cellular synthesis of homocysteine and consequent hyperhomocysteinemia in rats. This effect of L-dopa on plasma homocysteine is accentuated under conditions of impaired homocysteine metabolism such as folate deficiency. OBJECTIVE To investigate the effect of L-dopa administration and B-vitamin status on plasma homocysteine concentrations in humans with PD. METHODS Plasma homocysteine, folate, vitamin B(12), and pyridoxal-5'-phosphate (PLP) concentrations were determined in 40 individuals diagnosed with idiopathic PD who were being treated as outpatients at the Boston University Medical Center Neurology Clinic. Twenty of the patients were on L-dopa therapy (treatment group) and 20 were L-dopa-naive (control group). RESULTS The mean plasma homocysteine concentration was higher in the treatment group than in the controls (p = 0.018). Plasma homocysteine was correlated with plasma folate, vitamin B(12), and PLP concentrations in the treatment group (p <or= 0.007) but not in the controls. CONCLUSION L-Dopa can cause hyperhomocysteinemia in PD patients, the extent of which is influenced by B-vitamin status. The B-vitamin requirements necessary to maintain normal plasma homocysteine concentrations are higher in L-dopa-treated patients than in those not on L-dopa therapy. B-Vitamin supplements may be warranted for PD patients on L-dopa therapy.
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Affiliation(s)
- J W Miller
- Vitamin Bioavailability Lab, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
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Abstract
OBJECTIVE To determine the independent effects of obesity and hypertension on cognitive functioning. METHODS Using a prospective design, male (n=551) and female (n=872) participants of the Framingham Heart Study were classified by presence or absence of obesity and hypertension based on data collected over an 18-y surveillance period. All subjects were free from dementia, stroke, and clinically diagnosed cardiovascular disease up to the time of cognitive testing. Statistical models were adjusted for age, education, occupation, cigarette smoking, alcohol consumption, total cholesterol, and a diagnosis of type II diabetes. Body mass index status (nonobese or obese) and blood pressure status (normotensive or hypertensive) were then related to cognitive performance (learning, memory, executive functioning, and abstract reasoning) on tests administered 4-6 y later. RESULTS Adverse effects of obesity and hypertension on cognitive performance were observed for men only. Obese and hypertensive men performed more poorly than men classified as either obese or hypertensive, and the best performance was observed in nonobese, normotensive men. CONCLUSIONS The adverse effects of obesity and hypertension in men are independent and cumulative with respect to cognitive deficit.
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Affiliation(s)
- M F Elias
- Department of Mathematics and Statistics, Statistics and Consulting Unit, Boston University, MA 02215, USA.
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Rost NS, Wolf PA, Kase CS, Kelly-Hayes M, Silbershatz H, Massaro JM, D'Agostino RB, Franzblau C, Wilson PW. Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke 2001; 32:2575-9. [PMID: 11692019 DOI: 10.1161/hs1101.098151] [Citation(s) in RCA: 474] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The role of C-reactive protein (CRP) as a novel plasma marker of atherothrombotic disease is currently under investigation. Previous studies have mostly related CRP to coronary heart disease, were often restricted to a case-control design, and failed to include pertinent risk factors to evaluate the joint and net effect of CRP on the outcome. We related plasma CRP levels to incidence of first ischemic stroke or transient ischemic attack (TIA) in the Framingham Study original cohort. METHODS There were 591 men and 871 women free of stroke/TIA during their 1980 to 1982 clinic examinations, when their mean age was 69.7 years. CRP levels were measured by using an enzyme immunoassay on previously frozen serum samples. Analyses were based on sex-specific CRP quartiles. Risk ratios (RRs) were derived, and series of trend analyses were performed. RESULTS During 12 to 14 years of follow-up, 196 ischemic strokes and TIAs occurred. Independent of age, men in the highest CRP quartile had 2 times the risk of ischemic stroke/TIA (RR=2.0, P=0.027), and women had almost 3 times the risk (RR=2.7, P=0.0003) compared with those in the lowest quartile. Assessment of the trend in risk across quartiles showed unadjusted risk increase for men (RR=1.347, P=0.0025) and women (RR=1.441, P=0.0001). After adjustment for smoking, total/HDL cholesterol, systolic blood pressure, and diabetes, the increase in risk across CRP quartiles remained statistically significant for both men (P=0.0365) and women (P=0.0084). CONCLUSIONS Independent of other cardiovascular risk factors, elevated plasma CRP levels significantly predict the risk of future ischemic stroke and TIA in the elderly.
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Affiliation(s)
- N S Rost
- National Heart, Lung, and Blood Institute's Framingham Study, Framingham, Massachusetts, USA
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Seshadri S, Wolf PA, Beiser A, Vasan RS, Wilson PW, Kase CS, Kelly-Hayes M, Kannel WB, D'Agostino RB. Elevated midlife blood pressure increases stroke risk in elderly persons: the Framingham Study. Arch Intern Med 2001; 161:2343-50. [PMID: 11606150 DOI: 10.1001/archinte.161.19.2343] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Stroke risk predictions are traditionally based on current blood pressure (BP). The potential impact of a subject's past BP experience (antecedent BP) is unknown. We assessed the incremental impact of antecedent BP on the risk of ischemic stroke. METHODS A total of 5197 stroke-free subjects (2330 men) in the community-based Framingham Study cohort were enrolled from September 29, 1948, to April 25, 1953, and followed up to December 31, 1998. We determined the 10-year risk of completed initial ischemic stroke for 60-, 70-, and 80-year-old subjects as a function of their current BP (at baseline), recent antecedent BP (average of readings at biennial examinations 1-9 years before baseline), and remote antecedent BP (average at biennial examinations 10-19 years earlier), with adjustment for smoking and diabetes mellitus. Models incorporating antecedent BP were also adjusted for baseline BP. The effect of each BP component (systolic BP, diastolic BP, and pulse pressure) was assessed separately. RESULTS Four hundred ninety-one ischemic strokes (209 in men) were observed in eligible subjects. The antecedent BP influenced the 10-year stroke risk at the age of 60 years (relative risk per SD increment of recent antecedent systolic BP: women, 1.68 [95% confidence interval, 1.25-2.25]; and men, 1.92 [95% confidence interval, 1.39-2.66]) and at the age of 70 years (relative risk per SD increment of recent antecedent systolic BP: women, 1.66 [95% confidence interval, 1.28-2.14]; and men, 1.30 [95% confidence interval, 0.97-1.75]). This effect was evident for recent and remote antecedent BP, consistent in hypertensive and nonhypertensive subjects, and demonstrable for all BP components. CONCLUSIONS Antecedent BP contributes to the future risk of ischemic stroke. Optimal prevention of late-life stroke will likely require control of midlife BP.
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Affiliation(s)
- S Seshadri
- National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA
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21
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Abstract
Stroke is a major cause of morbidity and mortality. Risk factors for stroke have been determined through prospective epidemiologic study. Control of risk factors has been demonstrated to reduce stroke incidence, either through controlled trials or inferred from observational studies. In the past few years, new approaches to the treatment of established risk factors have been discovered. These include aggressive control of hypertension in diabetes patients, prevention of type 2 diabetes through lifestyle modification, carotid endarterectomy for moderate symptomatic carotid stenosis, encouragement of a high level of physical activity, and control of abdominal obesity and elevated body mass index. In addition, new strategies for stroke prevention have been identified, including encouragement of a diet high in fruits, vegetables, whole grains, and omega-3 fatty acids, the use of vitamins B12, B6, and folic acid in hyperhomocysteinemia, and moderate alcohol consumption. Clinical trial data support the use of hydroxy-methyl-coenzyme A inhibitors in patients with coronary artery disease, and ramipril in high-risk patients with coronary artery disease and diabetes, for the primary prevention of stroke. New risk factors for stroke are being investigated, including the role of chronic inflammation and infection, and these may provide future strategies for stroke prevention.
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Affiliation(s)
- T J Jeerakathil
- Department of Neurology, Boston University School of Medicine, 715 Albany Street, B 608, Boston, MA 02118-2526, USA.
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DeCarli C, Miller BL, Swan GE, Reed T, Wolf PA, Carmelli D. Cerebrovascular and brain morphologic correlates of mild cognitive impairment in the National Heart, Lung, and Blood Institute Twin Study. Arch Neurol 2001; 58:643-7. [PMID: 11295996 DOI: 10.1001/archneur.58.4.643] [Citation(s) in RCA: 195] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the relative risk (RR) of mild cognitive impairment (MCI) associated with cerebrovascular risk factors and cerebrovascular-related brain changes. DESIGN Mild cognitive impairment was determined for the subjects of the prospective National Heart, Lung, and Blood Institute Twin Study. Quantitative measures of brain, white matter hyperintensity, cerebral infarction, apolipoprotein E genotype, and psychometric testing were obtained. RESULTS Subjects with MCI were older (73.5 +/- 3.0 vs 72.1 +/- 2.8 years), consumed less alcohol (3.7 +/- 5.8 vs 7.0 +/- 10.7 drinks per week), had greater white matter hyperintensity volumes (0.56% +/- 0.82% vs 0.25% +/- 0.34% of cranial volume), and had an increased prevalence of apolipoprotein E4 genotype (31.4% vs 19.2%) than normal subjects. White matter hyperintensity and the presence of the apolipoprotein E4 genotype were associated with a significantly increased risk for MCI. When all subjects were included in the analysis, alcohol consumption was associated with a reduced risk for MCI (RR = 0.93, P<.05). When subjects with a history of symptomatic cerebrovascular disease were excluded from the analysis, elevated midlife diastolic blood pressure was associated with an increased risk for MCI (RR = 1.70, P<.05). CONCLUSIONS Elevated midlife blood pressures, and the resulting increased white matter hyperintensities, increase the risk for MCI in a group of community-dwelling older men to at least the same degree as apolipoprotein E4 genotype. Given the common occurrence of elevations in midlife blood pressure, early and effective treatment may be warranted to prevent late-life brain abnormalities and MCI. Moreover, since many individuals with MCI progress to clinical dementia, longitudinal evaluations of this cohort will be important.
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Affiliation(s)
- C DeCarli
- Department of Neurology, University of California at Davis, 4860 Y St, Suite 3700, Sacramento, CA 95817, USA.
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Carmelli D, Swan GE, Kelly-Hayes M, Wolf PA, Reed T, Miller B. Longitudinal changes in the contribution of genetic and environmental influences to symptoms of depression in older male twins. Psychol Aging 2001. [PMID: 11014713 DOI: 10.1037//0882-7974.15.3.505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Genetically informative longitudinal data on self-reported symptoms of depression allow for an investigation of the causes of stability and change in depression symptoms throughout adult life. In this report, the authors investigated the relative contribution of genetic and environmental influences to symptoms of depression in 83 monozygotic and 84 dizygotic male twin pairs from the National Heart, Lung, and Blood Institute (NHLBI) Twin Study. Participants first completed the Center for Epidemiologic Studies-Depression (CES-D) scale in 1985-1986 and again during 1995-1997. Mean age of twins at baseline was 63 years, range 59 to 70. From cross-sectional genetic analyses we estimated the heritability of CES-D to be 25% (95% confidence interval [CI], 11%-39%) at baseline and 55% (95% CI, 40%-71%) at follow-up. Fitting longitudinal genetic models to the two-wave data, we found that stability of symptoms over the 10-year follow-up was due primarily to continuity of genetic influences.
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Affiliation(s)
- D Carmelli
- Health Science Center, SRI International, Menlo Park, California 94205, USA.
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Feng D, D'Agostino RB, Silbershatz H, Lipinska I, Massaro J, Levy D, Benjamin EJ, Wolf PA, Tofler GH. Hemostatic state and atrial fibrillation (the Framingham Offspring Study). Am J Cardiol 2001; 87:168-71. [PMID: 11152833 DOI: 10.1016/s0002-9149(00)01310-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Atrial fibrillation (AF) is strongly associated with thromboembolic complications, although the mechanism for the increased risk has not been fully explained. To determine whether AF might be associated with a hypercoagulable state, we studied hemostatic factors in subjects with or without AF in the Framingham Heart Study. In 3,577 subjects, we measured fibrinogen, von Willebrand factor antigen, tissue plasminogen activator (tPA) antigen, and plasminogen activator inhibitor-1 antigen. Forty-seven subjects had AF at the index clinic examination and 15 had AF on a prior examination, but not on the current examination. Before matching, the 47 subjects with prevalent AF had higher levels of fibrinogen, von Willebrand factor, and tPA antigen than those without AF, all p < or =0.03. Compared with 167 referent subjects matched for age, sex, and other risk factors, those with AF had higher tPA antigen levels than those without AF, 1 1.8 +/- 4.0 ng/ml versus 10.5 +/- 3.9 ng/ml (p = 0.04). However, when further stratified according to their cardiovascular disease status, the differences in hemostatic factors were no longer significant. We conclude that the prothrombotic profile associated with AF was explained by the risk factors of the subjects and the presence of cardiovascular disease. Nonetheless, the hemostatic changes may contribute toward the propensity for thromboembolic complications in AF. Further prospective studies are needed to evaluate whether measurement of these and other hemostatic factors will identify patients with AF who are at increased risk for thromboembolic complications, and who may therefore benefit from more intensive therapy.
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Affiliation(s)
- D Feng
- Institute for Prevention of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G, Hill M, Howard G, Howard VJ, Jacobs B, Levine SR, Mosca L, Sacco RL, Sherman DG, Wolf PA, del Zoppo GJ. Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Circulation 2001; 103:163-82. [PMID: 11136703 DOI: 10.1161/01.cir.103.1.163] [Citation(s) in RCA: 273] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G, Hill M, Howard G, Howard VJ, Jacobs B, Levine SR, Mosca L, Sacco RL, Sherman DG, Wolf PA, del Zoppo GJ. Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 2001; 32:280-99. [PMID: 11136952 DOI: 10.1161/01.str.32.1.280] [Citation(s) in RCA: 266] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Affiliation(s)
- P A Wolf
- Boston University School of Medicine, Boston, Massachusetts, USA
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Carmelli D, Swan GE, Kelly-Hayes M, Wolf PA, Reed T, Miller B. Longitudinal changes in the contribution of genetic and environmental influences to symptoms of depression in older male twins. Psychol Aging 2000; 15:505-10. [PMID: 11014713 DOI: 10.1037/0882-7974.15.3.505] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Genetically informative longitudinal data on self-reported symptoms of depression allow for an investigation of the causes of stability and change in depression symptoms throughout adult life. In this report, the authors investigated the relative contribution of genetic and environmental influences to symptoms of depression in 83 monozygotic and 84 dizygotic male twin pairs from the National Heart, Lung, and Blood Institute (NHLBI) Twin Study. Participants first completed the Center for Epidemiologic Studies-Depression (CES-D) scale in 1985-1986 and again during 1995-1997. Mean age of twins at baseline was 63 years, range 59 to 70. From cross-sectional genetic analyses we estimated the heritability of CES-D to be 25% (95% confidence interval [CI], 11%-39%) at baseline and 55% (95% CI, 40%-71%) at follow-up. Fitting longitudinal genetic models to the two-wave data, we found that stability of symptoms over the 10-year follow-up was due primarily to continuity of genetic influences.
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Affiliation(s)
- D Carmelli
- Health Science Center, SRI International, Menlo Park, California 94205, USA.
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29
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Reed T, Carmelli D, Swan GE, Wolf PA, Miller BL, Krasnow R, Smith WM. Ten-year follow-up for male twins divided into high- or low-risk groups for ischemic heart disease based on risk factors measured 25 years previously. Ann Epidemiol 2000; 10:278-84. [PMID: 10942875 DOI: 10.1016/s1047-2797(00)00048-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To undertake medical follow-up in white males in the National Heart, Lung, and Blood Institute (NHLBI) twin study, previously divided on the basis of cardiovascular disease risk factors. METHODS Tree structured survival analysis (TSSA) used at a mean age of 63 years to classify twins into high and low risk subgroups for ischemic heart disease (IHD) found that subjects at a mean age of 48 years were at highest risk with high systolic blood pressures and low high density lipoprotein cholesterol levels. Low risk subjects had lower blood pressures, better pulmonary function tests, and a negative family history for IHD or low post load plasma glucose levels. Medical record review was performed ten years later at the 4th Examination of the NHLBI twin cohort conducted in 1995-1997. RESULTS The percentage of men in the NHLBI twin study who died nearly tripled (from 9.3% to 25.8%) in the ten-year period between the ages of 63 and 73 years. Deaths have tended to remain higher in DZ than MZ twins (27.8% versus 23.7%). At Exam 4, the relative risk of IHD (fatal or non-fatal) was 5.24 times higher for those in the high risk group than those in the low risk class (95% confidence limit 2.72-10.07, p < 0.0001 and 5.86 for any cardiovascular disease (95% confidence limit 3.03-11.33). The proportion of deaths from IHD in subjects with a high risk profile at entry was 51.7%, and 70.0% had died from all cardiovascular related disease. CONCLUSION The present results indicate TSSA remained effective in classifying subjects into subgroups with greater risk of morbidity and mortality related to cardiovascular disease after ten additional years.
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Affiliation(s)
- T Reed
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202-5251, USA
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30
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Beiser A, D'Agostino RB, Seshadri S, Sullivan LM, Wolf PA. Computing estimates of incidence, including lifetime risk: Alzheimer's disease in the Framingham Study. The Practical Incidence Estimators (PIE) macro. Stat Med 2000; 19:1495-522. [PMID: 10844714 DOI: 10.1002/(sici)1097-0258(20000615/30)19:11/12<1495::aid-sim441>3.0.co;2-e] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The incidence of disease is estimated in medical and public health applications using various different techniques presented in the statistical and epidemiologic literature. Many of these methods have not yet made their way to popular statistical software packages and their application requires custom programming. We present a macro written in the SAS macro language that produces several estimates of disease incidence for use in the analysis of prospective cohort data. The development of the Practical Incidence Estimators (PIE) Macro was motivated by research in Alzheimer's Disease (AD) in the Framingham Study in which the development of AD has been prospectively assessed over an observation period of 24 years. The PIE Macro produces crude and age-specific incidence rates, overall and stratified by the levels of a grouping variable. In addition, it produces age-adjusted rates using direct standardization to the combined group. The user specifies the width of the age groups and the number of levels of the grouping variable. The PIE macro produces estimates of future risk for user-defined time periods and the remaining lifetime risk conditional on survival event-free to user-specified ages. This allows the user to investigate the impact of increasing age on the estimate of remaining lifetime risk of disease. In each case, the macro provides estimates based on traditional unadjusted cumulative incidence, and on cumulative incidence adjusted for the competing risk of death. These estimates and their respective standard errors, are provided in table form and in an output data set for graphing. The macro is designed for use with survival age as the time variable, and with age at entry into the study as the left-truncation variable; however, calendar time can be substituted for the survival time variable and the left-truncation variable can simply be set to zero. We illustrate the use of the PIE macro using Alzheimer's Disease incidence data collected in the Framingham Study.
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Affiliation(s)
- A Beiser
- Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA.
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31
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Swan GE, DeCarli C, Miller BL, Reed T, Wolf PA, Carmelli D. Biobehavioral characteristics of nondemented older adults with subclinical brain atrophy. Neurology 2000; 54:2108-14. [PMID: 10851372 DOI: 10.1212/wnl.54.11.2108] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the risk factors and neuropsychological performance of two subgroups of community-dwelling, white elderly men free of severe cognitive impairment (n = 383; mean age, 72.9 +/- 3.0 years) who differ on volumetric measurements of total brain parenchyma and white matter hyperintensity (WMH) volumes. METHODS Group comparisons were made of cerebrovascular disease risk factors measured at the time of imaging and at three prior examinations extending over 25 years of adult life. Measures of verbal memory and speed psychomotor processing at the time of imaging and 10 years before imaging were also available. RESULTS Compared with those in the "nonatrophy" group, individuals in the subgroup with "atrophy" (defined by low total brain volume and high WMH volume) were older, reported a higher level of depressive symptomatology, experienced a steeper decline in diastolic blood pressure (DBP) and a steeper increase in pulse pressure, were less physically active, had smoked for more years, and had a higher prevalence of several cardiovascular disease indicators, including an ankle/arm systolic blood pressure ratio less than 0.9, and hypertension. After multivariate analysis, the 25-year decline in DBP, the number of years smoked, and an ankle/arm index of less than 0.9 remained significant discriminators of the two groups. Lower levels of speeded performance at the time of imaging and a steeper 10-year decline in cognitive performance on selected tests were also observed in the atrophic group. CONCLUSION Community-dwelling older adults with volumetric brain measurements associated with accelerated aging are distinguishable on the basis of several health-related characteristics. These individuals also perform less well on certain tasks involving executive functioning.
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Affiliation(s)
- G E Swan
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
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Elias MF, Beiser A, Wolf PA, Au R, White RF, D'Agostino RB. The preclinical phase of alzheimer disease: A 22-year prospective study of the Framingham Cohort. Arch Neurol 2000; 57:808-13. [PMID: 10867777 DOI: 10.1001/archneur.57.6.808] [Citation(s) in RCA: 466] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To relate performance on tests of cognitive ability to the subsequent development of probable Alzheimer disease (pAD) and to identify the pattern of earliest changes in cognitive functioning associated with a diagnosis of pAD. DESIGN From May 1975 to November 1979, a screening neuropsychological battery was administered to Framingham Study participants. They were followed up prospectively for 22 years and examined at least every 2 years for the development of pAD. SETTING A community-based center for epidemiological research. PARTICIPANTS Subjects were 1076 participants of the Framingham Study aged 65 to 94 years who were free of dementia and stroke at baseline (initial) neuropsychological testing. MAIN OUTCOME MEASURE Presence or absence of pAD during a 22-year surveillance period was related to test performance at initial neuropsychological testing. RESULTS Lower scores for measures of new learning, recall, retention, and abstract reasoning obtained during a dementia-free period were associated with the development of pAD. Lower scores for measures of abstract reasoning and retention predicted pAD after a dementia-free period of 10 years. CONCLUSIONS The "preclinical phase" of detectable lowering of cognitive functioning precedes the appearance of pAD by many years. Measures of retention of information and abstract reasoning are among the strongest predictors of pAD when the interval between initial assessment and the development of pAD is long. Arch Neurol. 2000.
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Affiliation(s)
- M F Elias
- Department of Mathematics and Statistics, Statistical Consulting Unit, 111 Cummington St, Boston University College of Arts and Sciences, Boston, MA 02215, USA.
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Reed T, Kirkwood SC, DeCarli C, Swan GE, Miller BL, Wolf PA, Jack LM, Carmelli D. Relationship of family history scores for stroke and hypertension to quantitative measures of white-matter hyperintensities and stroke volume in elderly males. Neuroepidemiology 2000; 19:76-86. [PMID: 10686532 DOI: 10.1159/000026242] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
White-matter hyperintensities (WMHI) are frequently associated with cerebrovascular risk factors in the elderly, particularly hypertension, and have been interpreted as a subclinical form of ischemic brain damage. WMHI, clinical stroke and blood pressures show significant genetic influences. The objective of this study was to determine whether a relationship exists between family history of stroke and/or hypertension in first degree relatives and WMHI in the elderly. WMHI and stroke (CVA) volumes were quantified from brain MRI performed on 414 white, male twins born between 1917 and 1927 (average age 72.3 +/- 2.9 years). WMHI, adjusted for age and head size, was significantly correlated with the family history score (r = 0.21, p < 0.001). Dividing the family history scores into quintiles revealed significant differences in WMHI by quintile mean (p < 0.05). Subjects in the highest quintile of family history score had the highest mean WMHI. Recalculation of the family history score, by only counting relatives reported to have had a clinical stroke as a positive event, revealed a nonsignificant correlation with WMHI, but the correlation of the family history score with MRI CVA volume was significant (p < 0.05). Stepwise multivariate analysis including ApoE status, current smoking status, smoking packyear history, Doppler ankle/arm blood pressure ratios, current and long term hypertensive status and current systolic and diastolic pressures indicated that the stroke/hypertension family history score was the single best predictor (p < 0.01) of WMHI volumes. Family history was not an independent predictor of CVA volume.
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Affiliation(s)
- T Reed
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202-5251, USA.
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Carmelli D, Fabsitz RR, Swan GE, Reed T, Miller B, Wolf PA. Contribution of genetic and environmental influences to ankle-brachial blood pressure index in the NHLBI Twin Study. National Heart, Lung, and Blood Institute. Am J Epidemiol 2000; 151:452-8. [PMID: 10707913 DOI: 10.1093/oxfordjournals.aje.a010230] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The ankle-brachial index (ABI) is widely used in the clinical diagnosis of peripheral arterial disease. The contributions of genetic and environmental influences to normal and abnormal ABI values are unknown. In this study, the authors used available data on 94 monozygotic pairs and 90 dizygotic pairs of elderly, White, male twins examined in 1995-1997 to investigate the contributions of genetic and environmental influences to normative ABI values. Within-twin-pair correlations for normative ABI values were statistically significant, and the correlation in monozygotic twin pairs was significantly greater than that in dizygotic pairs. Structural equation modeling of the variance-covariance matrices of monozygotic and dizygotic twins indicated that 48% of the observed variability in ABI values could be attributed to additive genetic effects. In contrast, concordance rates for low ABI values (ABI< or =0.9) for both monozygotic and dizygotic twins were significantly greater than would be expected by chance alone, but within-pair monozygotic similarity was not significantly greater than dizygotic similarity. A matched-cotwin analysis in 21 pairs that were discordant for low ABI values found that twins with low ABI values were physically less active and more likely to be persistent smokers than their normal-control brothers. These findings reinforce the role of individual health practices (e.g., physical activity, smoking) in the manifestation of peripheral arterial disease among subjects matched for age, genetics, and early shared environment.
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Affiliation(s)
- D Carmelli
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
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35
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Carmelli D, DeCarli C, Swan GE, Kelly-Hayes M, Wolf PA, Reed T, Guralnik JM. The joint effect of apolipoprotein E epsilon4 and MRI findings on lower-extremity function and decline in cognitive function. J Gerontol A Biol Sci Med Sci 2000; 55:M103-9. [PMID: 10737693 DOI: 10.1093/gerona/55.2.m103] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cognitive decline and poor physical function are risk factors for disability in old age and may occur more often in subjects with the apolipoprotein E epsilon4 (ApoE-epsilon4) allele. The objective of this study was to investigate the joint effect of ApoE-epsilon4 and structural changes detected on MRI brain scans on cognitive decline and lower-extremity function. METHODS Brain MRI (1.5 T), neuropsychological tests, and lower-extremity physical function tests were administered to World War II male veteran twins ages 69 to 80. Quantification of MRI scans used a previously published algorithm to segment brain images into total cerebral brain (TCB), cerebrospinal fluid (CSF), and white-matter hyperintensity (WMH) volumes. A short battery of physical performance tests was used to assess lower-extremity function. Ten-year changes in performance on the Mini-Mental State Exam (MMSE), the Benton Visual Retention Test (BVRT), and the Digit Symbol Substitution (DSS) test were used to assess cognitive decline. RESULTS For the sample as a whole, the comparison of subjects by median split of total cerebral brain volume found that those with brain volumes below the median performed worse on tests of gait and balance (p < .01) and experienced greater cognitive decline on the MMSE and BVRT cognitive test batteries (both p < .01). In addition, subjects with WMH volumes above the median had poor performance on the standing balance tasks and experienced greater decline on the DSS test (p < .01). Stratified analyses revealed that the joint effect of radiological findings and the ApoE-epsilon4 allele on cognitive decline and lower-extremity function was often greater than that expected from the separate effects combined. CONCLUSIONS We conclude that radiological findings in conjunction with ApoE-epsilon4 may single out a group at higher risk for dementia. We speculate that the observed interaction effect may be due to increased susceptibility to brain injury or impaired repair mechanisms in subjects with ApoE-epsilon4.
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Affiliation(s)
- D Carmelli
- Center for Health Sciences, SRI International, Menlo Park, California 94025, USA.
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Carmelli D, Kelly-Hayes M, Wolf PA, Swan GE, Jack LM, Reed T, Guralnik JM. The contribution of genetic influences to measures of lower-extremity function in older male twins. J Gerontol A Biol Sci Med Sci 2000; 55:B49-53. [PMID: 10719763 DOI: 10.1093/gerona/55.1.b49] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tests of balance, gait, and endurance were administered to 95 monozygotic (MZ) and 92 dizygotic (DZ), white male twins aged 68 to 79 years who had been born in the United States. Within-twin-pair correlations were calculated for each individual task and for an overall summary performance score. These were subjected to structural equation modeling to determine the contributions of genetic and environmental influences to individual differences in performance scores. MZ intraclass correlations were significant and greater than DZ correlations for the 8-foot walk and the repeated chair stands task, but not for the standing balance task. The heritability of the lower-extremity summary score was 57%, of which 39% was due to additive genetic effects and 18% due to nonadditive effects. In addition, we found that genetic influences contributed primarily to twin similarity in the poorest quartile of performance, whereas shared environmental influences contributed to twin similarity in the best quartile.
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Affiliation(s)
- D Carmelli
- Center for Health Sciences, SRI International, Menlo Park, California 94025, USA.
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Sacco RL, Wolf PA, Gorelick PB. Risk factors and their management for stroke prevention: outlook for 1999 and beyond. Neurology 1999; 53:S15-24. [PMID: 10532644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Stroke is a leading cause of death and morbidity, but incidence rates vary dramatically from one population to another. The reasons for this heterogeneity are being explored in several large-scale epidemiologic studies around the world. Much of the heterogeneity in stroke can be related to the prevalence of risk factors, but some populations have a higher stroke incidence than would be predicted from risk factor levels. Hypertension, including borderline hypertension, is probably the most important stroke risk factor based on degree of risk and prevalence. However, cardiac morbidity, cigarette smoking, diabetes, physical inactivity, and high levels of alcohol consumption are also strongly related to stroke risk. High levels of blood cholesterol and homocysteine may also increase stroke risk. Mortality after stroke is highest within the first 30 days but remains elevated to a degree that depends on the presenting stroke syndrome, stroke subtype, and other co-morbidities. Lacunar strokes have the best short- and long-term prognoses. Strokes due to large-vessel atherosclerosis frequently worsen; these and cardioembolic strokes have the poorest long-term prognosis. The risk for recurrence is also highest within 30 days after a first stroke, depending on the type of infarct, history of hypertension, and blood glucose levels on admission. Predictors of late recurrence include cardiac disease, hypertension, and heavy alcohol use. Only about half of stroke survivors are independent 6 months after a stroke, and quality of life is decreased. Understanding factors that predispose to stroke and determine its outcome will help in the design of acute stroke trials and in prevention programs.
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Affiliation(s)
- R L Sacco
- Department of Neurology and Public Health (Epidemiology), the Sergievsky Center, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
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Abstract
Recent studies have indicated that moderate alcohol intake may be beneficial to cognitive functioning in women, although not necessarily in men. Data from the Framingham Heart Study, a large, prospective study of cardiovascular disease in Framingham, Massachusetts, were used to examine the relation between alcohol consumption and cognitive ability. The major research question was whether a different alcohol-cognition relation would be found for male and female drinkers. Men (n = 733) and women (n = 1,053), aged 55-88 years, were queried as to their weekly intake of alcohol, and these data were used to construct groups of abstainers, very light, light, moderate, and heavy drinkers. Data from earlier reports of alcohol consumption were also examined. Participants were administered eight tests which reflect performance in the domains of verbal memory, learning, visual organization and memory, attention, abstract reasoning, and concept formation. Multivariate linear regression analyses were used with statistical adjustment for age, education, occupation, cardiovascular disease, and associated risk factors. Women who drank moderately (2-4 drinks/day) showed superior performance in many cognitive domains relative to abstainers. For men, superior performance was found within the range of 4-8 drinks/day, although fewer significant relations were observed. These results were confirmed by prospective analyses of 24-year drinking history.
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Affiliation(s)
- P K Elias
- Department of Mathematics, Statistics and Consulting Unit, Boston University, MA 02215, USA
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Bostom AG, Rosenberg IH, Silbershatz H, Jacques PF, Selhub J, D'Agostino RB, Wilson PW, Wolf PA. Nonfasting plasma total homocysteine levels and stroke incidence in elderly persons: the Framingham Study. Ann Intern Med 1999; 131:352-5. [PMID: 10475888 DOI: 10.7326/0003-4819-131-5-199909070-00006] [Citation(s) in RCA: 296] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Total homocysteine levels are associated with arteriosclerotic outcomes. OBJECTIVE To determine whether total homocysteine levels predict incident stroke in elderly persons. DESIGN Prospective population-based cohort study with 9.9 years of follow-up. SETTING Framingham, Massachusetts. PATIENTS 1947 Framingham Study participants (1158 women and 789 men; mean age +/- SD, 70 +/- 7 years). MEASUREMENTS Baseline total homocysteine levels and 9.9-year stroke incidence. RESULTS The quartiles of nonfasting total homocysteine levels were as follows: quartile 1, 4.13 to 9.25 micromol/L; quartile 2, 9.26 to 11.43 micromol/L; quartile 3, 11.44 to 14.23 micromol/L; quartile 4, 14.24 to 219.84 micromol/L. During follow-up, 165 incident strokes occurred. In proportional hazards models adjusted for age, sex, systolic blood pressure, diabetes, smoking, and history of atrial fibrillation and coronary heart disease, relative risk (RR) estimates comparing quartile 1 with the other three quartiles were as follows: quartile 2 compared with quartile 1--RR, 1.32 (95% CI, 0.81 to 2.14); quartile 3 compared with quartile 1--RR, 1.44 (CI, 0.89 to 2.34); quartile 4 compared with quartile 1--RR, 1.82 (CI, 1.14 to 2.91). The linear trend across the quartiles was significant (P < 0.001). CONCLUSION Nonfasting total homocysteine levels are an independent risk factor for incident stroke in elderly persons.
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Affiliation(s)
- A G Bostom
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts 02111, USA
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Zusman RM, Chesebro JH, Comerota A, Hartmann JR, Massin EK, Raps E, Wolf PA. Antiplatelet therapy in the prevention of ischemic vascular events: literature review and evidence-based guidelines for drug selection. Clin Cardiol 1999; 22:559-73. [PMID: 10486695 PMCID: PMC6655822 DOI: 10.1002/clc.4960220905] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/1998] [Accepted: 12/01/1998] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND New antiplatelet drugs are being developed and many clinical trials evaluating the benefits of antiplatelet drugs for the secondary prevention of ischemic events in patients with atherosclerotic vascular disease have been performed. HYPOTHESIS An updated systematic review and evidence-based guidelines for the appropriate selection of antiplatelet drugs may be beneficial to physicians and healthcare organizations attempting to create or update current clinical practice guidelines or clinical pathways aimed at caring for these patients. METHODS (1) A systematic review of the recent literature on the relative efficacy and safety of aspirin, ticlopidine, and clopidogrel was undertaken; (2) an evidence-based, expert panel approach using a modified Delphi technique to create explicit guidelines for prescribing antiplatelet therapy was instituted; and (3) the recommendations of an expert panel were summarized. RESULTS Consensus guidelines were developed for the utilization of aspirin, ticlopidine, or clopidogrel for the prevention of ischemic events in patients with manifestations of atherosclerotic vascular disease (prior myocardial infarction, prior ischemic stroke, or established peripheral arterial disease) who are at increased risk for recurrent ischemic events. Based on efficacy and safety, clopidogrel was recommended as the drug of choice for patients with established peripheral arterial disease; aspirin or clopidogrel should be considered in patients with prior myocardial infarction (with clopidogrel favored for patients who have had a recurrent event while on aspirin or in whom aspirin is contraindicated); aspirin or clopidogrel should be considered as first-line treatment in patients with prior ischemic (nonhemorrhagic) stroke--however, clopidogrel is the favored drug in patients in whom other antiplatelet drugs are either contraindicated or who have had recurrent events while on therapy. CONCLUSIONS Myocardial infarction, ischemic stroke, and peripheral arterial disease are all clinical manifestations of the same underlying disease process (atherosclerosis), with thrombus formation on the disrupted atherosclerotic plaque (atherothrombosis) being a common precipitating factor of ischemic events in patients suffering from these disorders. An evidence-based approach was used to develop a practice guideline, based on available published evidence, for the appropriate utilization of antiplatelet agents (aspirin, ticlopidine, or clopidogrel). These guidelines may be of use to multidisciplinary teams wishing to create or update clinical guidelines or clinical pathways which address the care of patients with atherosclerotic vascular disease. New antiplatelet agents such as clopidogrel may be more effective and associated with lower risk of selected adverse effects (such as gastrointestinal distress, gastrointestinal hemorrhage, and neutropenia) than those previously used to prevent thrombus formation in the setting of atherosclerotic arterial disease. Combination antiplatelet therapy is being evaluated as an option for those patients who experience recurrent events on a single antiplatelet agent.
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Affiliation(s)
- R M Zusman
- Harvard Medical School, Massachusetts General Hospital, Division of Hypertension and Vascular Medicine, Boston, MA 02114, USA
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Wolf PA, Clagett GP, Easton JD, Goldstein LB, Gorelick PB, Kelly-Hayes M, Sacco RL, Whisnant JP. Preventing ischemic stroke in patients with prior stroke and transient ischemic attack : a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 1999; 30:1991-4. [PMID: 10471455 DOI: 10.1161/01.str.30.9.1991] [Citation(s) in RCA: 191] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Swan GE, Reed T, Jack LM, Miller BL, Markee T, Wolf PA, DeCarli C, Carmelli D. Differential genetic influence for components of memory in aging adult twins. Arch Neurol 1999; 56:1127-32. [PMID: 10488814 DOI: 10.1001/archneur.56.9.1127] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the relative proportion of genetic and environmental contributions to verbal memory in community-dwelling World War II veteran twins. DESIGN The California Verbal Learning Test (CVLT) was administered to 94 monozygotic (MZ) and 89 dizygotic (DZ) elderly male twin pair participants in the fourth examination of the National Heart, Lung, and Blood Institute Twin Study. SETTING Subjects voluntarily participated on an outpatient basis at a research or medical center facility in 1 of 4 sites in the United States. PARTICIPANTS Subjects had a mean age of 71.8 years (SD, 2.9 years), a mean educational level of 13.6 years (SD, 2.8 years), and no history of stroke and/or a Mini-Mental State Examination score of 23 or greater. MAIN OUTCOME MEASURES Twin pair similarity in performance on 4 factor analytically derived components of the CVLT measuring verbal learning and memory, response discrimination, learning strategy, and recognition memory. RESULTS The MZ intraclass correlation was significantly larger than the DZ correlation for verbal learning and memory (I<.001) but not for the other 3 components of memory. Using maximum likelihood methods, the best-fitting genetic model indicated that verbal learning and memory has a substantial genetic component (56% of total variance), whereas response discrimination has a much smaller, although still detectable, genetic component (24% of total variance). There is no evidence of genetic influence on learning strategy or recognition memory. CONCLUSION Differential contribution of genetic and environmental influences to specific components of memory suggest that, in this group of elderly male twin pairs, some components may be more amenable to intervention than others.
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Affiliation(s)
- G E Swan
- Center for Health Sciences, SRI International, Menlo Park, Calif 94024, USA.
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DeCarli C, Reed T, Miller BL, Wolf PA, Swan GE, Carmelli D. Impact of apolipoprotein E epsilon4 and vascular disease on brain morphology in men from the NHLBI twin study. Stroke 1999; 30:1548-53. [PMID: 10436099 DOI: 10.1161/01.str.30.8.1548] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Apolipoprotein E epsilon4 genotype (ApoE4) has been associated with increased risk for cardiovascular disease morbidity or mortality. This appears to be mediated by an ApoE4-related increase in cardiovascular atherosclerosis. Given the similarities between risk factors for heart disease and risk factors for stroke, a positive association between ApoE4 and stroke would be expected. Since age-related brain atrophy and the extent of white matter hyperintensities (WMH) share similar risk factors, we examined the combined effect of ApoE4 and history of vascular disease on brain volume, WMH, and MRI evidence of stroke. METHODS Subjects were the surviving members of the National Heart, Lung, and Blood Institute Twin Study. This is a longitudinal study of the effects of cardiovascular disease risk factors in community-dwelling male veterans. The fourth and final examination of this cohort included cerebral MRI and was completed in 1997. Apolipoprotein E (ApoE) genotype, quantitative measures of brain volume, WMH, and the presence of stroke on MRI were obtained from the 396 participants in the final examination. The presence or absence of a history of coronary heart disease, cerebrovascular disease, peripheral arterial disease, and ApoE genotype were determined for each subject. RESULTS Of the 396 men, 88 (22%) had at least 1 ApoE4 allele. ApoE4 was not associated with differences in age or education. While the prevalence of vascular disease was generally greater in the ApoE4 group, this was only significant for coronary heart disease (29.8% in subjects without ApoE4 versus 40.7% in subject with ApoE4; P=0.03). ApoE4 subjects had significantly smaller brain volumes (942.4+/-34.5 versus 952.2+/-40.1 cm(3); P=0. 02). MRI evidence of stroke was detected in 88 (22%) of the subjects. The distribution of ApoE genotype was marginally different between subjects with MRI-detected stroke compared with those without. Further analysis revealed that the co-occurrence of cerebrovascular disease and ApoE4 was associated with significantly greater brain atrophy and WMH than either ApoE4 or cerebrovascular disease alone. Similar relations were seen for coronary heart disease and peripheral arterial disease. CONCLUSIONS We conclude that ApoE4 enhances the extent of brain abnormalities in the presence of various vascular diseases. We speculate that this effect may be mediated by an increased susceptibility to brain injury or impaired repair mechanisms associated with ApoE4.
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Affiliation(s)
- C DeCarli
- Department of Neurology, University of Kansas, Kansas City, MO 66160, USA.
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Bostom AG, Silbershatz H, Rosenberg IH, Selhub J, D'Agostino RB, Wolf PA, Jacques PF, Wilson PW. Nonfasting plasma total homocysteine levels and all-cause and cardiovascular disease mortality in elderly Framingham men and women. Arch Intern Med 1999; 159:1077-80. [PMID: 10335684 DOI: 10.1001/archinte.159.10.1077] [Citation(s) in RCA: 224] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Elevated fasting total homocysteine (tHcy) levels were recently shown to confer an independent risk for all-cause and cardiovascular disease (CVD) mortality among selected Norwegian patients with confirmed coronary heart disease. We examined whether elevated fasting plasma tHcy levels were predictive of all-cause and CVD mortality in a large, population-based sample of elderly US women and men. METHODS Nonfasting plasma tHcy levels were determined in 1933 elderly participants (mean age, 70 +/- 7 years; 58.9% women) from the original Framingham Study cohort, examined between 1979 and 1982, with follow-up through 1992. Unadjusted and adjusted (ie, for age, sex, diabetes, smoking, systolic blood pressure, total and high-density lipoprotein cholesterol, and creatinine) relative risk estimates (with 95% confidence intervals [CIs]) for total and CVD mortality were generated by proportional hazards modeling, with tHcy levels (quartiles) as the independent variable. RESULTS There were 653 total deaths and 244 CVD deaths during a median follow-up of 10.0 years. Proportional hazards modeling revealed that tHcy levels of 14.26 micromol/L or greater (the upper quartile), vs less than 14.26 micromol/L (the lower three quartiles), were associated with relative risk estimates of 2.18 (95% CI, 1.86-2.56) and 2.17 (95% CI, 1.68-2.82) for all-cause and CVD mortality, respectively. The relative risk estimates after adjustment for age, sex, systolic blood pressure, diabetes, smoking, and total and high-density lipoprotein cholesterol levels attenuated these associations, but they remained significant: 1.54 (95% CI, 1.31-1.82) for all-cause mortality; 1.52 (95% CI, 1.16-1.98) for CVD mortality. CONCLUSION Elevated nonfasting plasma tHcy levels are independently associated with increased rates of all-cause and CVD mortality in the elderly.
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Affiliation(s)
- A G Bostom
- Tufts Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, Mass, USA.
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Carmelli D, Swan GE, Reed T, Wolf PA, Miller BL, DeCarli C. Midlife cardiovascular risk factors and brain morphology in identical older male twins. Neurology 1999; 52:1119-24. [PMID: 10214731 DOI: 10.1212/wnl.52.6.1119] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Structural changes in the human brain have been reported to a greater extent in subjects with cardiovascular risk factors. We conducted a matched co-twin analysis of elderly monozygotic twins from the National Heart, Lung, and Blood Institute Twin Study to examine the association between midlife cardiovascular risk factors and MRI-based measures of brain atrophy. METHODS Brain MRIs (1.5-T) were obtained from 74 monozygotic, white, male, World War II veteran twins born in the United States from 1917 to 1927 and age 68 to 79 at the time of the brain scan. A semiautomated algorithm was used to segment brain images into total brain, CSF, and white matter hyperintensity volumes. Cardiovascular risk factors, medical history variables, and health practices were available from data collected over 25 years of adult life. RESULTS Independent of shared genetic or familial influences, within-pair differences in midlife glucose levels, high-density lipoprotein cholesterol, and systolic blood pressure were significantly associated with differences in white matter hyperintensities. Within-pair differences in coronary heart disease history and in current consumption of alcohol and level of physical activity were significantly associated with differences in brain parenchyma. In addition, within-pair differences in white matter hyperintensity volumes were significantly associated with differences in performance on cognitive and physical function tests and self-reports of depression symptoms. CONCLUSION Independent of age effects and shared genetic or familial influences, midlife cardiovascular risk factors and lifetime health practices were predictive of structural brain changes in old age.
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Affiliation(s)
- D Carmelli
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA.
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Abstract
BACKGROUND AND PURPOSE Cross-sectional studies show that cerebrovascular risk factors are associated with increased brain atrophy, accumulation of abnormal cerebral white matter signals, and clinically silent stroke. We extend these findings by examining the relationship between midlife cerebrovascular risk factors and later-life differences in brain atrophy, amount of abnormal white matter, and stroke on MRI. METHODS Subjects were the 414 surviving members of the prospective National Heart, Lung, and Blood Institute Twin Study, who have been examined on 4 separate occasions, spanning the 25 years between 1969-1973 and 1995-1997. Quantitative measures of brain volume, volume of abnormal white matter signal (WMHI), and volume of stroke, when present, were obtained from those participating in the fourth examination. RESULTS The mean+/-SD age of the subjects was 47.2+/-3.0 years at initial examination and 72. 5+/-2.9 years at final examination. Average blood pressure (BP) levels were normal, although 32% of the subjects had received or were currently taking antihypertensive medications. As a group, 31% had symptomatic cardiovascular disease, 11% had symptomatic cerebrovascular disease, and 8% had symptomatic peripheral vascular disease. Both systolic and diastolic BP levels at initial examination were inversely related to brain volume and positively related to WMHI volume. Multiple regression analysis identified BP-related measures and vascular risk factors as significant predictors of brain and WMHI volumes. In addition, the magnitude of orthostatic BP change was significantly associated with WMHI volume. Subjects with extensive amounts of WMHI had significantly higher systolic BP at the final examination and a higher prevalence of symptomatic cardiovascular and cerebrovascular disease, without significant differences in the prevalence of hypertension treatment. CONCLUSIONS Midlife BP measures are significantly associated with later-life brain and WMHI volumes and the prevalence of symptomatic vascular disease. Since WMHI share cerebrovascular risk factors and extensive WMHI are associated with symptomatic vascular disease, extensive WMHI may be a subclinical expression of cerebrovascular disease. Careful treatment of midlife BP elevations may diminish these later-life brain changes.
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Affiliation(s)
- C DeCarli
- Department of Neurology, University of Kansas, Kansas City, USA.
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Brand FN, Kannel WB, Evans J, Larson MG, Wolf PA. Glucose intolerance, physical signs of peripheral artery disease, and risk of cardiovascular events: the Framingham Study. Am Heart J 1998; 136:919-27. [PMID: 9812089 DOI: 10.1016/s0002-8703(98)70139-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Diabetes and peripheral artery disease (PAD) are acknowledged hallmarks of development of atherosclerotic cardiovascular disease (CVD). The prognostic implications of physical indicators of PAD, compared with and in conjunction with glucose intolerance based on population based data, are not well documented. METHODS AND RESULTS The influence of carotid and femoral bruits and nonpalpable pedal pulses, with and without glucose intolerance, on development of coronary disease (CHD), congestive heart failure (CHF), and stroke (CVA) was investigated in a cohort of 1672 men and 2264 women ages 47 to 99 years participating in the Framingham Study. Cross-sectional pooling yielded 29,063 2-year person-examination units based on the sample of whom 440 men and 484 women had glucose intolerance develop. Over the 26 years of follow-up, 210 men and 199 women had 1 or more of the specified CVD events. Logistic regression analysis was used to estimate age-adjusted odds ratios comparing incidence of CVD events in subjects with glucose intolerance, signs of PAD, or both conditions with those with neither condition. Glucose intolerance was associated with a 2-fold excess occurrence of physical signs of PAD (P< .01 ). Femoral and carotid bruits were generally associated with greater increased risk of CHD, CHF, and CVA than was glucose intolerance alone. Particularly in women, the concomitant presence of bruits augmented the CVD risk of glucose intolerance. Nonpalpable pedal pulses were a stronger risk factor for CVD end points than glucose intolerance; particularly in men and in both sexes, those with both conditions were at substantially greater risk of CVD events than those with either alone. CONCLUSIONS Physical findings of PAD appear to signify a compromised arterial circulation to the heart and brain as well as the limbs in persons with glucose intolerance. Persons with the combination are candidates at high risk for CHD, CHF, and CVA.
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Affiliation(s)
- F N Brand
- Framingham Heart Study, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Mass, USA
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Abstract
Atrial fibrillation (AF) is the most common of the serious cardiac rhythm disturbances and is responsible for substantial morbidity and mortality in the general population. Its prevalence doubles with each advancing decade of age, from 0.5% at age 50-59 years to almost 9% at age 80-89 years. It is also becoming more prevalent, increasing in men aged 65-84 years from 3.2% in 1968-1970 to 9.1% in 1987-1989. This statistically significant increase in men was not explained by an increase in age, valve disease, or myocardial infarctions in the cohort. The incidence of new onset of AF also doubled with each decade of age, independent of the increasing prevalence of known predisposing conditions. Based on 38-year follow-up data from the Framingham Study, men had a 1.5-fold greater risk of developing AF than women after adjustment for age and predisposing conditions. Of the cardiovascular risk factors, only hypertension and diabetes were significant independent predictors of AF, adjusting for age and other predisposing conditions. Cigarette smoking was a significant risk factor in women adjusting only for age (OR = 1.4), but was just short of significance on adjustment for other risk factors. Neither obesity nor alcohol intake was associated with AF incidence in either sex. For men and women, respectively, diabetes conferred a 1.4- and 1.6-fold risk, and hypertension a 1.5- and 1.4-fold risk, after adjusting for other associated conditions. Because of its high prevalence in the population, hypertension was responsible for more AF in the population (14%) than any other risk factor. Intrinsic overt cardiac conditions imposed a substantially higher risk. Adjusting for other relevant conditions, heart failure was associated with a 4.5- and 5.9-fold risk, and valvular heart disease a 1.8- and 3.4-fold risk for AF in men and women, respectively. Myocardial infarction significantly increased the risk factor-adjusted likelihood of AF by 40% in men only. Echocardiographic predictors of nonrheumatic AF include left atrial enlargement (39%/ increase in risk per 5-mm increment), left ventricular fractional shortening (34% per 5% decrement), and left ventricular wall thickness (28% per 4-mm increment). These echocardiographic features offer prognostic information for AF beyond the traditional clinical risk factors. Electrocardiographic left ventricular hypertrophy increased risk of AF 3-4-fold after adjusting only for age, but this risk ratio is decreased to 1.4 after adjustment for the other associated conditions. The chief hazard of AF is stroke, the risk of which is increased 4-5-fold. Because of its high prevalence in advanced age, AF assumes great importance as a risk factor for stroke and by the ninth decade becomes a dominant factor. The attributable risk for stroke associated with AF increases steeply from 1.5% at age 50-59 years to 23.5% at age 80-89 years. AF is associated with a doubling of mortality in both sexes, which is decreased to 1.5-1.9-fold after adjusting for associated cardiovascular conditions. Decreased survival associated with AF occurs across a wide range of ages.
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Affiliation(s)
- W B Kannel
- Department of Preventive Medicine and Epidemiology, Boston University School of Medicine, Massachusetts, USA
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Swan GE, DeCarli C, Miller BL, Reed T, Wolf PA, Jack LM, Carmelli D. Association of midlife blood pressure to late-life cognitive decline and brain morphology. Neurology 1998; 51:986-93. [PMID: 9781518 DOI: 10.1212/wnl.51.4.986] [Citation(s) in RCA: 253] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the association between midlife systolic blood pressure (SBP) and late-life cognitive decline and brain morphology in a sample of community-dwelling elderly men 68 to 79 years of age. METHODS Subjects are surviving members from the prospective National Heart, Lung, and Blood Institute Twin Study (intake, 1969 to 1972) who, when examined for a fourth time in 1995 through 1997, underwent brain MRI and repeated assessment of neurobehavioral functioning. Quantification of the MR images determined cerebral volume and total volume of white matter hyperintensities (WMHIs) for 392 subjects. Midlife SBP levels measured in 1970, 1980, and 1985 were used to classify subjects into low, medium, and high midlife SBP categories. A 10-year change in performance on the Mini-Mental State Examination, Digit Symbol Substitution Test, Benton Visual Retention Test, and Verbal Fluency Test was also calculated for these subjects. For all reported analyses, patients were treated as genetically unrelated individuals. RESULTS Subjects with high midlife SBP experienced a greater decline in cognitive performance and had larger WMHI volumes at follow-up in late life than did those with low midlife SBP. Decreased brain parenchyma and increased WMHI volumes were associated with decline in neurobehavioral functioning as measured in late life independent of age, education, and baseline levels of cognition. CONCLUSIONS Midlife SBP is a significant predictor of both decline in cognitive function and MR volumetric measures of brain atrophy in late life. Because decline in neurobehavioral functioning was associated with decreased brain volume and increased WMHI volume, we conclude that the long-term impact of elevated SBP on decline in late-life neurobehavioral functioning is likely to be mediated through its chronic, negative effect on structural characteristics of the brain.
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Affiliation(s)
- G E Swan
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
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Affiliation(s)
- P A Wolf
- Department of Neurology, Boston University School of Medicine, MA 02118-2526, USA
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