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Zhou Z, Tonkin AM, Curtis AJ, Murray A, Zhu C, Reid CM, Williamson JD, Ryan J, McNeil JJ, Beilin LJ, Ernst ME, Stocks N, Lacaze P, Shah RC, Woods RL, Wolfe R, Gall S, Zoungas S, Orchard SG, Nelson MR. Low-Density-Lipoprotein Cholesterol and Mortality Outcomes Among Healthy Older Adults: A Post Hoc Analysis of ASPREE Trial. J Gerontol A Biol Sci Med Sci 2024; 79:glad268. [PMID: 38038339 PMCID: PMC10960624 DOI: 10.1093/gerona/glad268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The prognostic implication of cholesterol levels in older adults remains uncertain. This study aimed to examine the relationship between low-density-lipoprotein cholesterol (LDL-c) and mortality outcomes in older individuals. METHODS This post hoc analysis examined the associations of LDL-c levels with mortality risks from all-cause, cardiovascular disease (CVD), cancer, and combined non-CVD/noncancer conditions in a cohort of individuals aged ≥65 years from the ASPirin in Reducing Events in the Elderly trial (NCT01038583). At baseline, participants had no diagnosed dementia, physical disability, or CVD, and were not taking lipid-lowering agents. Outcome analyses were performed using multivariable Cox models. RESULTS We analyzed 12 334 participants (mean age: 75.2 years). Over a median 7-year follow-up, 1 250 died. Restricted cubic splines found a U-shaped relation for LDL-c and all-cause mortality, cancer mortality, and noncancer/non-CVE mortality (nadir: 3.3-3.4 mmol/L); the risk of CVD mortality was similar at LDL-c below 3.3 mmol/L and increased above 3.3 mmol/L. Similar trends were observed in analyses modeling LDL-c by quartiles. When modeling LDL-c as a continuous variable, the risk of all-cause mortality, cancer mortality, and noncancer/non-CVD mortality was decreased by 9%, 16%, and 18%, respectively, per 1-mmol/L higher LDL-c, and the risk of CVD mortality was increased by 19% per 1-mmol/L higher LDL-c. Reduced all-cause and non-CVD/noncancer mortality risks were only significant in males but not females (pinteraction < .05). CONCLUSIONS There were U-shaped relationships between LDL-c and all-cause mortality, cancer mortality, and noncancer/non-CVD mortality in healthy older adults. Higher LDL-c levels were associated with an increased risk of CVD mortality. Future studies are warranted to confirm our results.
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Affiliation(s)
- Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea J Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, Minnesota, USA
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jeff D Williamson
- Sticht Center on Aging and Alzheimer’s Prevention, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Nigel Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Fravel MA, Ernst ME, Woods RL, Beilin L, Zhou Z, Orchard SG, Chowdhury E, Reid CM, Ekram ARMS, Espinoza SE, Nelson MR, Stocks N, Polkinghorne KR, Wolfe R, Ryan J. Long-term blood pressure variability and frailty risk in older adults. J Hypertens 2024; 42:244-251. [PMID: 38009310 PMCID: PMC10842997 DOI: 10.1097/hjh.0000000000003599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
INTRODUCTION In healthy older adults, the relationship between long-term, visit-to-visit variability in blood pressure (BP) and frailty is uncertain. METHODS Secondary analysis of blood pressure variability (BPV) and incident frailty in >13 000 participants ≥65-70 years enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) trial and its observational follow-up (ASPREE-XT). Participants were without dementia, physical disability, or cardiovascular disease at baseline. BPV was estimated using standard deviation of mean BP from three annual visits (baseline through the second annual follow-up). Frailty was defined using Fried phenotype and a frailty deficit accumulation index (FDAI). Participants with frailty during the BPV estimation period were excluded from the main analysis. Adjusted Cox proportional hazards regression evaluated the association between BPV and incident frailty, and linear mixed models for change in frailty scores, through a maximum of 9 years of follow-up. RESULTS Participants in the highest systolic BPV tertile were at higher risk of frailty compared to those in the lowest (referent) tertile of systolic BPV [Fried hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.04-1.31; FDAI HR 1.18, 95% CI 1.07-1.30]. Findings were consistent when adjusted for multiple covariates and when stratified by antihypertensive use. Linear mixed models showed that higher systolic BPV was associated with increasing frailty score over time. Diastolic BPV was not consistently associated. CONCLUSIONS High systolic BPV, independent of mean BP, is associated with increased risk of frailty in healthy older adults. Variability of BP across visits, even in healthy older adults, can convey important risk information beyond mean BP. TRIAL REGISTRATION ClinicalTrials.gov NCT01038583 and ISRCTN83772183.
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Affiliation(s)
- Michelle A. Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy. The University of Iowa, Iowa City, IA, USA
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy. The University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine. The University of Iowa, Iowa City, IA, USA
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University; Melbourne, VIC, Australia
| | - Lawrence Beilin
- Medical School Royal Perth Hospital, University of Western Australia; Perth, WA, Australia
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University; Melbourne, VIC, Australia
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University; Melbourne, VIC, Australia
| | - Enayet Chowdhury
- School of Public Health and Preventive Medicine, Monash University; Melbourne, VIC, Australia
- School of Population Health, Curtin University; Perth, WA, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University; Melbourne, VIC, Australia
- School of Population Health, Curtin University; Perth, WA, Australia
| | - ARM Saifuddin Ekram
- School of Public Health and Preventive Medicine, Monash University; Melbourne, VIC, Australia
| | - Sara E. Espinoza
- Division of Geriatrics, Gerontology & Palliative Medicine, and Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio; and, Geriatric Research Education & Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Mark R. Nelson
- School of Public Health and Preventive Medicine, Monash University; Melbourne, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania. Hobart, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Kevan R. Polkinghorne
- School of Public Health and Preventive Medicine, Monash University; Melbourne, VIC, Australia
- Department of Nephrology, Monash Medical Centre, Monash Health; and, Department of Medicine, Monash University; Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University; Melbourne, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University; Melbourne, VIC, Australia
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Zoungas S, Zhou Z, Owen AJ, Curtis AJ, Espinoza SE, Ernst ME, Woods RL, Orchard SG, McNeil JJ, Murray AM, Nelson MR, Reid CM, Ryan J, Wolfe R. Daily low-dose aspirin and incident type 2 diabetes in community-dwelling healthy older adults: a post-hoc analysis of efficacy and safety in the ASPREE randomised placebo-controlled trial. Lancet Diabetes Endocrinol 2024; 12:98-106. [PMID: 38142708 DOI: 10.1016/s2213-8587(23)00327-3] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Inflammation has been implicated in the pathogenesis of diabetes. This study investigated the randomised treatment effect of low-dose aspirin on incident type 2 diabetes and fasting plasma glucose (FPG) concentrations among older adults. METHODS ASPREE was a double-blind, placebo-controlled trial of daily oral low-dose aspirin. The study population included community-dwelling individuals aged 70 years or older (≥65 years for US minority ethnic groups) in the USA and Australia who were free of cardiovascular disease, independence-limiting physical disability, or dementia. For the post-hoc analysis, we excluded participants with diabetes at baseline or with incomplete or missing incident diabetes data during follow-up. Participants were randomly assigned 1:1 to oral 100 mg daily enteric-coated aspirin or placebo. Incident diabetes was defined as self-reported diabetes, commencement of glucose-lowering medication, or a FPG concentration of 7·0 mmol/L or more assessed at annual follow-up visits among participants with no diabetes at baseline. We used Cox proportional hazards models and mixed-model repeated measures to assess the effect of aspirin on incident diabetes and FPG concentrations in the intention-to-treat population. We assessed major bleeding in participants who had taken at least one dose of study medication. FINDINGS Between March 10, 2010, and Dec 24, 2014, a total of 16 209 participants were included (8086 [49·9%] randomly assigned to aspirin and 8123 [50·1%] randomly assigned to placebo). During a median follow-up of 4·7 years (IQR 3·6-5·7), 995 (in 6·1% individuals) incident cases of type 2 diabetes were recorded (459 in the aspirin group and 536 in the placebo group). Compared with placebo, the aspirin group had a 15% reduction in risk of incident diabetes (hazard ratio 0·85 [95% CI 0·75 to 0·97]; p=0·013) and a slower rate of increase in FPG concentration at year 5 (between-group difference estimate -0·048 mmol/L [95% CI -0·079 to -0·018]; p=0·0017). Major bleeding (major gastrointestinal bleeding, intracranial bleeding, and clinically significant bleeding at other sites) occurred in 510 (3·2%) of 16 104 participants (300 [3·7%] in the aspirin group and 210 [2·6%] in the placebo group). Compared with placebo, the aspirin group had a 44% increase in risk of major bleeding (hazard ratio 1·44 [95% CI 1·21 to 1·72]; p<0·0001). INTERPRETATION Aspirin treatment reduced the incidence of type 2 diabetes and slowed the increase in FPG concentration but increased major bleeding among community-dwelling older adults. Given the increasing prevalence of type 2 diabetes among older adults, the potential for anti-inflammatory agents such as aspirin to prevent type 2 diabetes or improve glucose levels warrants further study with a comprehensive assessment of all potential safety events of interest. FUNDING US National Institute on Aging, US National Cancer Institute, National Health and Medical Research Council of Australia, Monash University, and the Victorian Cancer Agency.
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Affiliation(s)
- Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrea J Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sara E Espinoza
- Sam and Ann Barshop Institute, UT Health San Antonio, San Antonio, TX, USA; Geriatrics Research, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne M Murray
- Department of Medicine, Geriatrics Division, Hennepin HealthCare and Berman Centre for Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Hussain SM, Robb C, Tonkin AM, Lacaze P, Chong TTJ, Beilin LJ, Yu C, Watts GF, Ryan J, Ernst ME, Zhou Z, Neumann JT, McNeil JJ. Association of plasma high-density lipoprotein cholesterol level with risk of incident dementia: a cohort study of healthy older adults. Lancet Reg Health West Pac 2024; 43:100963. [PMID: 38456089 PMCID: PMC10920036 DOI: 10.1016/j.lanwpc.2023.100963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 03/09/2024]
Abstract
Background Recent studies have reported associations between high plasma high-density lipoprotein cholesterol (HDL-C) levels and risk of all-cause mortality, age-related macular degeneration, sepsis and fractures, but associations with dementia risk remain unclear. To determine whether high plasma HDL-C levels are associated with increased incident dementia risk in initially-healthy older people. Methods We conducted a post-hoc analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial; a double-blind, randomized, placebo-controlled trial of daily low-dose aspirin in healthy older people. ASPREE recruited 16,703 participants aged ≥70 years (from Australia) and 2411 participants aged ≥65 years (from the US) between 2010 and 2014. Participants had no diagnosed cardiovascular disease, dementia, physical disability, or life-threatening illness at enrolment and were cognitively healthy (3MS score ≥78). All-cause dementia was a primary trial endpoint, and determined by DSM-IV criteria. Cox regression was used to examine hazard ratios between HDL-C categories <40 mg/dL, 40-60 mg/dL (reference category), 60-80 mg/dL, and >80 mg/dL and dementia. Restricted cubic spline curves were used to determine nonlinear associations. Data analysis was performed from October 2022 to January 2023. Findings Of the 18,668 participants, 850 (4.6%) cases of incident dementia were recorded over 6.3 (SD 1.8) years. Participants with high HDL-C (>80 mg/dL) had a 27% higher risk of dementia (HR 1.27, 95% CI 1.03, 1.58). Age stratified analyses demonstrated that the risk of incident dementia was higher in participants ≥75 years compared to participants <75 years (HR 1.42, 95% CI 1.10, 1.83 vs HR 1.02, 95% CI 0.68, 1.51). Associations remained significant after adjusting for covariates including age, sex, country of enrolment, daily exercise, education, alcohol consumption, weight change over time, non-HDL-C, HDL-C-PRS, and APOE genotype. Interpretation In a population of initially-healthy older adults aged ≥75 years, high HDL-C levels were associated with increased risk of all-cause dementia. Funding National Institutes of Health, USA; National Health and Medical Research Council Australia; Monash University (Melbourne, VIC, Australia); and the Victorian Cancer Agency (Australia).
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria, 3010, Australia
| | - Catherine Robb
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Trevor T.-J. Chong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, 3800, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, 3181, Australia
- Department of Clinical Neurosciences, St Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | | | - Chenglong Yu
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Gerald F. Watts
- School of Medicine, University of Western Australia, Perth, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Johannes T. Neumann
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
- Department of Cardiology, University Heart & Vascular Center Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
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Zhou Z, Orchard SG, Nelson MR, Fravel MA, Ernst ME. Angiotensin Receptor Blockers and Cognition: a Scoping Review. Curr Hypertens Rep 2024; 26:1-19. [PMID: 37733162 PMCID: PMC10796582 DOI: 10.1007/s11906-023-01266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the association between angiotensin II receptor blocker (ARB) use and cognitive outcomes. RECENT FINDINGS ARBs have previously shown greater neuroprotection compared to other anti-hypertensive classes. The benefits are primarily attributed to the ARB's effect on modulating the renin-angiotensin system via inhibiting the Ang II/AT1R pathway and activating the Ang II/AT2R, Ang IV/AT4R, and Ang-(1-7)/MasR pathways. These interactions are associated with pleiotropic neurocognitive benefits, including reduced β-amyloid accumulation and abnormal hyperphosphorylation of tau, ameliorated brain hypo-fusion, reduced neuroinflammation and synaptic dysfunction, better neurotoxin clearing, and blood-brain barrier function restoration. While ACEis also inhibit AT1R, they simultaneously lower Ang II and block the Ang II/AT2R and Ang IV/AT4R pathways that counterbalance the potential benefits. ARBs may be considered an adjunctive approach for neuroprotection. This preliminary evidence, coupled with their underlying mechanistic pathways, emphasizes the need for future long-term randomized trials to yield more definitive results.
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Affiliation(s)
- Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Michelle A Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA.
- Department of Family Medicine, Carver College of Medicine, 01291-A PFP, The University of Iowa, 200 Hawkins Dr, Iowa, IA, 52242, USA.
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6
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Zhou Z, Ryan J, Tonkin AM, Zoungas S, Lacaze P, Wolfe R, Orchard SG, Murray AM, McNeil JJ, Yu C, Watts GF, Hussain SM, Beilin LJ, Ernst ME, Stocks N, Woods RL, Zhu C, Reid CM, Shah RC, Chong TTJ, Sood A, Sheets KM, Nelson MR. Association Between Triglycerides and Risk of Dementia in Community-Dwelling Older Adults: A Prospective Cohort Study. Neurology 2023; 101:e2288-e2299. [PMID: 37879942 PMCID: PMC10727221 DOI: 10.1212/wnl.0000000000207923] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/22/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It has been suggested that higher triglyceride levels were associated with a lower risk of Alzheimer disease. This study aimed to examine the association of triglycerides with dementia and cognition change in community-dwelling older adults. METHODS This prospective longitudinal study used data from the Aspirin in Reducing Events in the Elderly (ASPREE) randomized trial of adults aged 65 years or older without dementia or previous cardiovascular events at enrollment. The main outcome was incident dementia. Other outcomes included changes in composite cognition and domain-specific cognition (global cognition, memory, language and executive function, and psychomotor speed). The association between baseline triglycerides and dementia risk was estimated using Cox proportional hazard models adjusting for relevant risk factors. Linear mixed models were used to investigate cognitive change. The analysis was repeated in a subcohort of participants with available APOE-ε4 genetic data with additional adjustment for APOE-ε4 carrier status and an external cohort (UK Biobank) with similar selection criteria applied. RESULTS This study included 18,294 ASPREE participants and 68,200 UK Biobank participants (mean age: 75.1 and 66.9 years; female: 56.3% and 52.7%; median [interquartile range] triglyceride: 106 [80-142] mg/dL and 139 [101-193] mg/dL), with dementia recorded in 823 and 2,778 individuals over a median follow-up of 6.4 and 12.5 years, respectively. Higher triglyceride levels were associated with lower dementia risk in the entire ASPREE cohort (hazard ratio [HR] with doubling of triglyceride: 0.82, 95% CI 0.72-0.94). Findings were similar in the subcohort of participants with APOE-ε4 genetic data (n = 13,976) and in the UK Biobank cohort (HR was 0.82 and 0.83, respectively, all p ≤ 0.01). Higher triglycerides were also associated with slower decline in composite cognition and memory over time (p ≤ 0.05). DISCUSSION Older adults with higher triglyceride levels within the normal to high-normal range had a lower dementia risk and slower cognitive decline over time compared with individuals with lower triglyceride levels. Higher triglyceride levels may be reflective of better overall health and/or lifestyle behaviors that would protect against dementia development. Future studies are warranted to investigate whether specific components within the total circulating pool of plasma triglycerides may promote better cognitive function, with the hope of informing the development of new preventive strategies.
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Affiliation(s)
- Zhen Zhou
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia.
| | - Joanne Ryan
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Andrew M Tonkin
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Sophia Zoungas
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Paul Lacaze
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Rory Wolfe
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Suzanne G Orchard
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Anne M Murray
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - John J McNeil
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Chenglong Yu
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Gerald F Watts
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Sultana Monira Hussain
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Lawrence J Beilin
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Michael E Ernst
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Nigel Stocks
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Robyn L Woods
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Chao Zhu
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Raj C Shah
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Trevor T-J Chong
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Ajay Sood
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Kerry M Sheets
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Mark R Nelson
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
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Smith CL, Kasza J, Woods RL, Lockery JE, Kirpach B, Reid CM, Storey E, Nelson MR, Shah RC, Orchard SG, Ernst ME, Tonkin AM, Murray AM, McNeil JJ, Wolfe R. Compliance-Adjusted Estimates of Aspirin Effects Among Older Persons in the ASPREE Randomized Trial. Am J Epidemiol 2023; 192:2063-2074. [PMID: 37552955 PMCID: PMC10988226 DOI: 10.1093/aje/kwad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/09/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
The Aspirin in Reducing Events in the Elderly (ASPREE) Trial recruited 19,114 participants across Australia and the United States during 2010-2014. Participants were randomized to receive either 100 mg of aspirin daily or matching placebo, with disability-free survival as the primary outcome. During a median 4.7 years of follow-up, 37% of participants in the aspirin group permanently ceased taking their study medication and 10% commenced open-label aspirin use. In the placebo group, 35% and 11% ceased using study medication and commenced open-label aspirin use, respectively. In order to estimate compliance-adjusted effects of aspirin, we applied rank-preserving structural failure time models. The results for disability-free survival and most secondary endpoints were similar in intention-to-treat and compliance-adjusted analyses. For major hemorrhage, cancer mortality, and all-cause mortality, compliance-adjusted effects of aspirin indicated greater risks than were seen in intention-to-treat analyses. These findings were robust in a range of sensitivity analyses. In accordance with the original trial analyses, compliance-adjusted results showed an absence of benefit with aspirin for primary prevention in older people, along with an elevated risk of clinically significant bleeding.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - R Wolfe
- Correspondence to Dr. Rory Wolfe, School of Public Health and Preventive Medicine, 553 St. Kilda Road, Monash University, Melbourne, VIC 3004, Australia (e-mail: )
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8
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Zhou Z, Ryan J, Nelson MR, Woods RL, Orchard SG, Zhu C, Gilmartin-Thomas JFM, Fravel MA, Owen AJ, Murray AM, Espinoza SE, Ernst ME. The association of allopurinol with persistent physical disability and frailty in a large community based older cohort. J Am Geriatr Soc 2023; 71:2798-2809. [PMID: 37158186 PMCID: PMC10524392 DOI: 10.1111/jgs.18395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/12/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The protective effects of allopurinol on physical function in older adults are not well understood, despite its potential to improve functional gains and reduce sarcopenia. This study aims to determine the association between allopurinol, persistent physical disability, and frailty in older gout patients. METHODS This analysis used data from a randomized trial in an older cohort, ASPirin in Reducing Events in the Elderly (ASPREE). ASPREE recruited 19,114 participants aged ≥65 years without prior cardiovascular events, dementia, or independence-limiting physical disability at trial enrolment. This analysis examined the association of baseline and time-varying allopurinol use with persistent physical disability and new-onset frailty in participants with gout at baseline (self-report or use of any anti-gout medications). Frailty was measured using the Fried frailty phenotype (score ≥3/5) and a deficit accumulation frailty index (FI) (score >0.21/1.0). Multivariable Cox proportional-hazards models were used for main analyses. RESULTS This analysis included 1155 gout participants, with 630 taking allopurinol at baseline and 525 not. During a median follow-up of 5.7 years, 113 new allopurinol users were identified. Compared with nonusers, baseline allopurinol use was associated with a significant risk reduction of persistent physical disability (Adjusted HR 0.46, 95% CI 0.23-0.92, p = 0.03). The strength of the association was modestly attenuated in the time-varying analysis (Adjusted HR 0.56, 0.29-1.08, p = 0.08). No significant associations with frailty measures were observed for either baseline allopurinol use (Fried frailty: Adjusted HR 0.83, 0.62-1.12; FI: Adjusted HR 0.96, 0.74-1.24) or time-varying allopurinol use (Fried frailty: Adjusted HR 0.92, 0.69-1.24; FI: Adjusted HR 1.02, 0.78-1.33). CONCLUSIONS Allopurinol use in older adults with gout is associated with a reduced risk of persistent physical disability but not associated with risk of frailty.
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Affiliation(s)
- Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Julia F-M Gilmartin-Thomas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Institute for Health & Sport, Victoria University, VIC, Australia
- Australian Institute for Musculoskeletal Science, VIC, Australia
| | - Michelle A. Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA
| | - Alice J. Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne M. Murray
- Berman Center for Outcomes & Clinical Research, Hennepin HealthCare Research Institute, and Department of Medicine, Geriatrics Division, Hennepin Healthcare, Minneapolis, MN, USA
| | - Sara E. Espinoza
- University of Texas Health Science Center and Geriatric Research, Education & Clinical Center, San Antonio and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IA, USA
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Ryan J, Ernst ME. The quid pro quo of blood pressure control and dementia. Lancet Healthy Longev 2023; 4:e444-e445. [PMID: 37573866 DOI: 10.1016/s2666-7568(23)00159-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA; Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
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Mehta RS, Kochar B, Zhou Z, Broder JC, Chung P, Yang K, Lockery J, Fravel M, Ryan J, Mahady S, Orchard SG, McNeil JJ, Murray A, Woods RL, Ernst ME, Chan AT. Association of Proton Pump Inhibitor Use With Incident Dementia and Cognitive Decline in Older Adults: A Prospective Cohort Study. Gastroenterology 2023; 165:564-572.e1. [PMID: 37315867 PMCID: PMC10527011 DOI: 10.1053/j.gastro.2023.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND & AIMS Prior studies have suggested that proton pump inhibitor (PPI) use is associated with increased risk of dementia; however, these have been limited by incomplete assessment of medication use and failure to account for confounders. Furthermore, prior studies have relied on claims-based diagnoses for dementia, which can lead to misclassification. We investigated the associations of PPI and histamine-2 receptor antagonist (H2RA) use with dementia and cognitive decline. METHODS We conducted a post hoc analysis of ASPirin in Reducing Events in the Elderly (ASPREE), a randomized trial of aspirin in the United States and Australia, including 18,934 community-based adults ≥65 years of all races/ethnicities. Baseline and recent PPI and H2RA use were determined according to review of medications during annual in-person study visits. Incident dementia was defined according to Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, criteria. Secondary endpoints include cognitive impairment, no dementia (CIND) and changes in cognition. Associations of medication use with dementia and CIND outcomes were examined using Cox proportional hazards models. Changes in cognitive test scores were examined using linear mixed-effects models. RESULTS Baseline PPI use vs nonuse was not associated with incident dementia (multivariable hazard ratio, 0.88; 95% confidence interval, 0.72-1.08), CIND (multivariable hazard ratio, 1.00; 95% confidence interval, 0.92-1.09), or with changes in overall cognitive test scores over time (multivariable B, -0.002; standard error, 0.01; P = .85). Similarly, no associations were observed between H2RA use and all cognitive endpoints. CONCLUSIONS In adults ≥65 years of age, PPI and H2RA use were not associated with incident dementia, CIND, or decline in cognition over time. These data provide reassurance about the safety of long-term use of PPIs among older adults.
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Affiliation(s)
- Raaj S Mehta
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bharati Kochar
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jonathan C Broder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paget Chung
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Keming Yang
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jessica Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Suzanne Mahady
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anne Murray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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11
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Lockery JE, Collyer TA, Woods RL, Orchard SG, Murray A, Nelson MR, Stocks NP, Wolfe R, Moran C, Ernst ME. Potentially inappropriate medication use is associated with increased risk of incident disability in healthy older adults. J Am Geriatr Soc 2023; 71:2495-2505. [PMID: 37039393 PMCID: PMC10524300 DOI: 10.1111/jgs.18353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/12/2023] [Accepted: 03/05/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications (PIMs). However, most PIMs research has focused on older people in aged or inpatient care, creating an evidence gap for community-dwelling older adults. To address this gap, we investigated the impact of PIMs use in the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial cohort. METHODS Analysis included 19,114 community-dwelling ASPREE participants aged 70+ years (65+ if US minorities) without major cardiovascular disease, cognitive impairment, or significant physical disability. PIMs were defined according to a modified 2019 AGS Beers Criteria. Cox proportional-hazards regression models were used to estimate the association between baseline PIMs exposure and disability-free survival, death, incident dementia, disability, and hospitalization, with adjustment for sex, age, country, years of education, frailty, average gait speed, and comorbidities. RESULTS At baseline, 7396 (39% of the total) participants were prescribed at least one PIM. Compared with those unexposed, participants on a PIM at baseline were at an increased risk of persistent physical disability (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.21, 1.80) and hospitalization (adjusted HR 1.26, 95% CI 1.20, 1.32), but had similar rates of disability-free survival (adjusted HR 1.02; 95% CI 0.93, 1.13) and death (adjusted HR 0.92, 95% CI 0.81, 1.05). These effects did not vary by polypharmacy status in interaction analyses. PIMs exposure was associated with higher risk of disability followed by hospitalization (adjusted HR 1.92, 95% CI 1.25, 2.96) as well as vice versa (adjusted HR 1.54, 95% CI 1.15, 2.05). PPIs, anti-psychotics and benzodiazepines, were associated with increased risk of disability. CONCLUSIONS PIMs exposure is associated with subsequent increased risk of both incident disability and hospitalization. Increased risk of disability prior to hospitalization suggests that PIMs use may start the disability cascade in healthy older adults. Our findings emphasize the importance of caution when prescribing PIMs to older adults in otherwise good health.
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Affiliation(s)
- Jessica E Lockery
- Cancer, Ageing and Vaccines Research Group, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
| | - Taya A Collyer
- Peninsula Clinical School, Monash University, Melbourne, VIC, Australia
| | - Robyn L Woods
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
| | - Suzanne G Orchard
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
| | - Anne Murray
- Hennepin Healthcare Research Institute, Hennepin Healthcare, Minnesota, U.S
- Division of Geriatrics, Department of Medicine, University of Minnesota, Minnesota, U.S
| | - Mark R Nelson
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Nigel P Stocks
- Discipline of General Practice, University of Adelaide, South Australia, Australia
| | - Rory Wolfe
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
| | - Chris Moran
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, U.S
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12
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Fravel MA, Ernst ME, Gilmartin-Thomas J, Woods RL, Orchard SG, Owen AJ. Dietary supplement and complementary and alternative medicine use among older adults in Australia and the United States. J Am Geriatr Soc 2023; 71:2219-2228. [PMID: 36852896 PMCID: PMC10460828 DOI: 10.1111/jgs.18305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Dietary supplement and complementary and alternative medication (CAM) use can contribute to drug interactions, polypharmacy, nonadherence with prescription medications, and healthcare expenses, whereas evidence supporting benefits of using these products is sparse. There is a lack of current published literature describing the patterns or predictors of their use in community-dwelling older adults. MATERIALS AND METHODS We performed a cross-sectional analysis of community-dwelling adults from Australia and the US, aged 70 years and older (65 years for US minorities), enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) study. At study enrollment, eligible participants were required to be without concurrent 5-year life-limiting illness and free of documented evidence of cardiovascular disease, dementia, or significant physical disability. During the final study visit, a questionnaire was administered to collect information about supplement/CAM use. Data from 15,729 participants who completed this questionnaire between January 2017 and January 2018 were analyzed. Descriptive statistics were used to report the prevalence and types of products used. Factors associated with use were determined using multivariate regression. RESULTS Mean age of respondents was 79.6 years; 56.4% were female, 88.8% were from Australia, 56.5% reported 12 years of education or less, and 98.7% were living at home. Two-thirds (66.2%) of participants reported use of one or more supplement/CAM in the previous month. Products most commonly used included vitamin D (33.8% of participants), fish oil (22.7%), calcium (20.6%), glucosamine (14.8%), and multivitamin (12.9%). Female sex, US residency, higher education, polypharmacy (prescription medications), and frailty (in women) were significantly associated with higher use of supplements/CAMs. CONCLUSIONS Dietary supplement and CAM use is common among community-dwelling older adults in the United States and Australia. Given the high prevalence of use, collaboration between healthcare providers and older adult patients is important to insure safe and optimal use of these products.
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Affiliation(s)
- Michelle A. Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Julia Gilmartin-Thomas
- College of Health and Biomedicine & Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Robyn L. Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G. Orchard
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice J. Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ernst ME, Broder JC, Wolfe R, Woods RL, Nelson MR, Ryan J, Shah RC, Orchard SG, Chan AT, Espinoza SE, Wilson M, Kirpach B, Reid CM, McNeil JJ, Williamson JD, Murray AM. Health Characteristics and Aspirin Use in Participants at the Baseline of the ASPirin in Reducing Events in the Elderly - eXTension (ASPREE-XT) Observational Study. Contemp Clin Trials 2023; 130:107231. [PMID: 37196887 PMCID: PMC10330669 DOI: 10.1016/j.cct.2023.107231] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Aspirin as a primary preventative in healthy older adults did not prolong disability-free survival in the ASPREE randomized trial. Observational studies following randomized trials allow assessment of benefits and harms which may not appear during the trial. We describe health characteristics, physical function, and aspirin use in the ASPREE-eXTension (ASPREE-XT) observational study cohort. METHODS Descriptive statistics compared health characteristics of those consented to ASPREE-XT at their first post-trial baseline (XT01) to corresponding ASPREE baseline values, and to those not consented. Likelihood of an indication for aspirin was assessed in participants reporting aspirin use at XT01. RESULTS 16,317 (93%) of the remaining and eligible 17,546 ASPREE participants were consented into ASPREE-XT; 14,894 completed XT01. Mean participant age had increased from 74.9 to 80.6 years. Overall health and physical function declined from the original ASPREE baseline; more participants were living alone, there was higher prevalence of chronic kidney disease, diabetes, and frailty, grip strength was lower and gait speed slower. Those not consented into ASPREE-XT were slightly older, and had lower cognitive scores and higher prevalence of age-related conditions than those who continued. 1015/11,717 (8.7%) participants without an apparent indication for aspirin reported using aspirin at XT01. CONCLUSIONS The ASPREE-XT cohort was slightly less healthy at the XT01 visit than at ASPREE trial initiation, and rates of aspirin use without indication were similar to ASPREE baseline. Participants will be followed long-term to investigate aspirin's potential legacy towards dementia and cancer prevention and explore determinants of healthy aging.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, United States of America; Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States of America.
| | - Jonathan C Broder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Raj C Shah
- Department of Family and Preventive Medicine and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States of America
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Sara E Espinoza
- Division of Geriatrics, Gerontology & Palliative Medicine, and Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America; Geriatric Research Education & Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, United States of America
| | - Michelle Wilson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Brenda Kirpach
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Population Health, Curtin University; Perth, WA, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jeff D Williamson
- Sticht Centre on Health Aging and Alzheimer's Prevention, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America; Division of Geriatrics, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States of America
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Gutteridge DS, Segal A, McNeil JJ, Beilin L, Brodtmann A, Chowdhury EK, Egan GF, Ernst ME, Hussain SM, Reid CM, Robb CE, Ryan J, Woods RL, Keage HA, Jamadar S. The relationship between long-term blood pressure variability and cortical thickness in older adults. Neurobiol Aging 2023; 129:157-167. [PMID: 37331246 DOI: 10.1016/j.neurobiolaging.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023]
Abstract
High blood pressure variability (BPV) is a risk factor for cognitive decline and dementia, but its association with cortical thickness is not well understood. Here we use a topographical approach, to assess links between long-term BPV and cortical thickness in 478 (54% men at baseline) community dwelling older adults (70-88 years) from the ASPirin in Reducing Events in the Elderly NEURO sub-study. BPV was measured as average real variability, based on annual visits across three years. Higher diastolic BPV was significantly associated with reduced cortical thickness in multiple areas, including temporal (banks of the superior temporal sulcus), parietal (supramarginal gyrus, post-central gyrus), and posterior frontal areas (pre-central gyrus, caudal middle frontal gyrus), while controlling for mean BP. Higher diastolic BPV was associated with faster progression of cortical thinning across the three years. Diastolic BPV is an important predictor of cortical thickness, and trajectory of cortical thickness, independent of mean blood pressure. This finding suggests an important biological link in the relationship between BPV and cognitive decline in older age.
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Affiliation(s)
- D S Gutteridge
- Cognitive Ageing and Impairment Neuroscience Laboratory (CAIN), University of South Australia, Adelaide, South Australia, Australia.
| | - A Segal
- Turner Institute for Brain & Mental Health, Monash University, Melbourne, Victoria, Australia
| | - J J McNeil
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - L Beilin
- School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - A Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - E K Chowdhury
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - G F Egan
- Turner Institute for Brain & Mental Health, Monash University, Melbourne, Victoria, Australia; Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - M E Ernst
- Department of Family Medicine, Carver College of Medicine. The University of Iowa, Iowa City, IA, USA; Department of Pharmacy Practice and Science, College of Pharmacy, Carver College of Medicine. The University of Iowa, Iowa City, IA, USA
| | - S M Hussain
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia; Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - C M Reid
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia; School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - C E Robb
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Ryan
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - R L Woods
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - H A Keage
- Cognitive Ageing and Impairment Neuroscience Laboratory (CAIN), University of South Australia, Adelaide, South Australia, Australia
| | - S Jamadar
- Turner Institute for Brain & Mental Health, Monash University, Melbourne, Victoria, Australia; Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
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15
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Pham T, McNeil JJ, Barker AL, Orchard SG, Newman AB, Robb C, Ernst ME, Espinoza S, Woods RL, Nelson MR, Beilin L, Hussain SM. Longitudinal association between handgrip strength, gait speed and risk of serious falls in a community-dwelling older population. PLoS One 2023; 18:e0285530. [PMID: 37155689 PMCID: PMC10166501 DOI: 10.1371/journal.pone.0285530] [Citation(s) in RCA: 1] [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] [Received: 01/05/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE Both grip strength and gait speed can be used as markers of muscle function, however, no previous study has examined them in the same population with respect to risk of falls. METHODS In this prospective cohort study, utilising data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial and ASPREE-Fracture substudy, we analysed the association of grip strength and gait speed and serious falls in healthy older adults. Grip strength was measured using a handheld dynamometer and gait speed from 3-metre timed walks. Serious falls were confined to those involving hospital presentation. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for associations with falls. RESULTS Over an average of 4.0±1.3 years, amongst 16,445 participants, 1,533 had at least one serious fall. After adjustment for age, sex, physical activity, body mass index, Short Form 12 (state of health), chronic kidney disease, polypharmacy and aspirin, each standard deviation (SD) lower grip strength was associated with 27% (HR 1.27, 95% CI 1.17-1.38) higher risk of falls. The results remained the same for males and females. There was a dose-response relationship in the association between grip strength and falls risk. The higher risk of falls was observed in males in all body mass index (BMI) categories, but only in obese females. The association between gait speed and falls risk was weaker than the association between grip strength and falls risk. CONCLUSIONS All males and only obese females with low grip strength appear to be at the greatest risk of serious falls. These findings may assist in early identification of falls.
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Affiliation(s)
- Thao Pham
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anna L. Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne B. Newman
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Catherine Robb
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, United States of America
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Sara Espinoza
- Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas, United States of America
- Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas, United States of America
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Lawrence Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Fravel MA, Ernst ME. Chlorthalidone vs. Hydrochlorothiazide for Hypertension-Cardiovascular Events. N Engl J Med 2023; 388:1342. [PMID: 37018505 DOI: 10.1056/nejmc2301922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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17
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Hussain SM, Newman AB, Beilin LJ, Tonkin AM, Woods RL, Neumann JT, Nelson M, Carr PR, Reid CM, Owen A, Ball J, Cicuttini FM, Tran C, Wang Y, Ernst ME, McNeil JJ. Associations of Change in Body Size With All-Cause and Cause-Specific Mortality Among Healthy Older Adults. JAMA Netw Open 2023; 6:e237482. [PMID: 37036703 PMCID: PMC10087052 DOI: 10.1001/jamanetworkopen.2023.7482] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Received: 12/09/2022] [Accepted: 02/25/2023] [Indexed: 04/11/2023] Open
Abstract
Importance The association between weight change and subsequent cause-specific mortality among older adults is not well described. The significance of changes in waist circumference (WC) has also not been compared with weight change for this purpose. Objective To examine the associations of changes in body weight and WC with all-cause and cause-specific mortality. Design, Setting, and Participants This cohort study is a post hoc analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial, which recruited participants between March 1, 2010, and December 31, 2014. The study included community-based older adults (16 703 Australian participants aged ≥70 years and 2411 US participants aged ≥65 years) without evident cardiovascular disease (CVD), dementia, physical disability, or life-limiting chronic illness. Data analysis was performed from April to September 2022. Exposures Body weight and WC were measured at baseline and at annual visit 2. Analysis models were adjusted for baseline body mass index because height and weight were measured at baseline, allowing for calculation of body mass index and other variables. Both body weight and WC changes were categorized as change within 5% (stable), decrease by 5% to 10%, decrease by more than 10%, increase by 5% to 10%, and increase by more than 10%. Main Outcomes and Measures All-cause, cancer-specific, CVD-specific, and noncancer non-CVD-specific mortality. Mortality events were adjudicated by an expert review panel. Cox proportional hazards regression and competing risk analyses were used to calculate hazard ratios (HRs) and 95% CIs. Results Among 16 523 participants (mean [SD] age, 75.0 [4.3] years; 9193 women [55.6%]), 1256 deaths were observed over a mean (SD) of 4.4 (1.7) years. Compared with men with stable weight, those with a 5% to 10% weight loss had a 33% higher (HR, 1.33; 95% CI, 1.07-1.66) risk of all-cause mortality, and those with more than a 10% decrease in body weight had a 289% higher (HR, 3.89; 95% CI, 2.93-5.18) risk. Compared with women with stable weight, those with a 5% to 10% weight loss had a 26% higher (HR, 1.26; 95% CI, 1.00-1.60) risk of all-cause mortality, and those with more than a 10% decrease in body weight had a 114% higher (HR, 2.14; 95% CI, 1.58-2.91) risk. Weight loss was associated with a higher cancer-specific mortality (>10% decrease among men: HR, 3.49; 95% CI, 2.26-5.40; 5%-10% decrease among women: HR, 1.44; 95% CI, 1.46-2.04; >10% decrease among women: HR, 2.78; 95% CI, 1.82-4.26), CVD-specific mortality (>10% decrease among men: HR, 3.14; 95% CI, 1.63-6.04; >10% decrease among women: HR, 1.92; 95% CI, 1.05-3.51), and noncancer non-CVD-specific mortality (>10% decrease among men: HR, 4.98; 95% CI, 3.14-7.91). A decrease in WC was also associated with mortality. Conclusions and Relevance This cohort study of healthy older adults suggests that weight loss was associated with an increase in all-cause and cause-specific mortality, including an increased risk of cancer, CVD, and other life-limiting conditions. Physicians should be aware of the significance of weight loss, especially among older men.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anne B. Newman
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lawrence J. Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Johannes T. Neumann
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Mark Nelson
- Discipline of General Practice, University of Tasmania, Hobart, Australia
| | - Prudence R. Carr
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia M. Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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18
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Ekram AS, Tonkin AM, Ryan J, Beilin L, Ernst ME, Espinoza SE, McNeil JJ, Nelson MR, Reid CM, Newman AB, Woods RL. The association between frailty and incident cardiovascular disease events in community-dwelling healthy older adults. Am Heart J Plus 2023; 28:100289. [PMID: 37168270 PMCID: PMC10168683 DOI: 10.1016/j.ahjo.2023.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 05/13/2023]
Abstract
Study objective This study examined the association between frailty and incident cardiovascular disease (CVD) events, major adverse cardiovascular events (MACE), and CVD-related mortality. Design Longitudinal cohort study. Setting The ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial in Australia and the United States. Participants 19,114 community-dwelling older adults (median age 74.0 years; 56.4 % females). Interventions Pre-frailty and frailty were assessed using a modified Fried phenotype and a deficit accumulation Frailty Index (FI) at baseline. Main outcome measures CVD was defined as a composite of CVD death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for heart failure; MACE included all except heart failure. Cox proportional hazards regression was used to analyze the association between frailty and CVD outcomes over a median follow-up of 4.7 years. Results Baseline pre-frail and frail groups had a higher risk of incident CVD events (Hazard Ratio (HR): 1.31; 95 % Confidence Interval (CI): 1.14-1.50 for pre-frail and HR: 1.63; 95 % CI: 1.15-2.32 for frail) and MACE (pre-frail HR: 1.26; 95 % CI: 1.08-1.47 and frail HR: 1.51; 95 % CI: 1.00-2.29) than non-frail participants according to Fried phenotype after adjusting for traditional CVD risk factors. Effect sizes were similar or larger when frailty was assessed with FI; similar results for men and women. Conclusion Frailty increases the likelihood of developing CVD, including MACE, in community-dwelling older men and women without prior CVD events. Screening for frailty using Fried or FI method could help identify community-dwelling older adults without prior CVD events who are more likely to develop CVD, including MACE, and may facilitate targeted preventive measures to reduce their risk.
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Affiliation(s)
- A.R.M. Saifuddin Ekram
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia
| | - Lawrence Beilin
- The Medical School Royal Perth Hospital Unit, University of Western Australia (M570), 35 Stirling Highway, Perth, WA 6009, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Sara E. Espinoza
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7001, Australia
| | - Christopher M. Reid
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Anne B. Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, St Kilda, Victoria 3004, Australia
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19
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Zhou Z, Curtis AJ, Owen A, Wolfe R, Murray AM, Tonkin AM, Ernst ME, Orchard SG, Zhu C, Carr PR, Reid CM, Espinoza SE, Shah RC, Woods RL, Ryan J, McNeil JJ, Nelson MR, Zoungas S. Prediabetes, diabetes and loss of disability-free survival in a community-based older cohort: a post-hoc analysis of the ASPirin in Reducing Events in the Elderly trial. Age Ageing 2023; 52:7136745. [PMID: 37097768 PMCID: PMC10128162 DOI: 10.1093/ageing/afad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/13/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Evidence for the prognostic implications of hyperglycaemia in older adults is inconsistent. OBJECTIVE To evaluate disability-free survival (DFS) in older individuals by glycaemic status. METHODS This analysis used data from a randomised trial recruiting 19,114 community-based participants aged ≥70 years, who had no prior cardiovascular events, dementia and physical disability. Participants with sufficient information to ascertain their baseline diabetes status were categorised as having normoglycaemia (fasting plasma glucose [FPG] < 5.6 mmol/l, 64%), prediabetes (FPG 5.6 to <7.0 mmol/l, 26%) and diabetes (self-report or FPG ≥ 7.0 mmol/l or use of glucose-lowering agents, 11%). The primary outcome was loss of disability-free survival (DFS), a composite of all-cause mortality, persistent physical disability or dementia. Other outcomes included the three individual components of the DFS loss, as well as cognitive impairment-no dementia (CIND), major adverse cardiovascular events (MACE) and any cardiovascular event. Cox models were used for outcome analyses, with covariate adjustment using inverse-probability weighting. RESULTS We included 18,816 participants (median follow-up: 6.9 years). Compared to normoglycaemia, participants with diabetes had greater risks of DFS loss (weighted HR: 1.39, 95% CI 1.21-1.60), all-cause mortality (1.45, 1.23-1.72), persistent physical disability (1.73, 1.35-2.22), CIND (1.22, 1.08-1.38), MACE (1.30, 1.04-1.63) and cardiovascular events (1.25, 1.02-1.54) but not dementia (1.13, 0.87-1.47). The prediabetes group did not have an excess risk for DFS loss (1.02, 0.93-1.12) or other outcomes. CONCLUSIONS Among older people, diabetes was associated with reduced DFS, and higher risk of CIND and cardiovascular outcomes, whereas prediabetes was not. The impact of preventing or treating diabetes in this age group deserves closer attention.
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Affiliation(s)
- Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrea J Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne M Murray
- Division of Geriatrics, Department of Medicine Hennepin HealthCare, Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IA, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Sara E Espinoza
- Sam and Ann Barshop Institute, UT Health San Antonio, San Antonio, TX, USA
- Geriatrics Research, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Raj C Shah
- Department of Family and Preventive Medicine, The Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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20
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Zhou Z, Zhang W, Burgner D, Tonkin A, Zhu C, Sun C, Magnussen CG, Ernst ME, Breslin M, Nicholls SJ, Nelson MR. The association between PCSK9 inhibitor use and sepsis - A systematic review and meta-analysis of 20 double-blind, randomized, placebo-controlled trials. Am J Med 2023; 136:558-567.e20. [PMID: 36921646 DOI: 10.1016/j.amjmed.2023.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023]
Abstract
AIMS To determine the impact of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor use on incident sepsis and other severe infections. METHODS We searched PubMed, EMBASE, CENTRAL and ClinicalTrial.gov up to September 14, 2021 for double-blind, placebo-controlled randomized trials of alirocumab, evolocumab, or inclisiran with >100 participants in each arm and report of serious adverse events related to infection. Data were synthesized with the fixed-effect Mantel-Haenszel model to generate risk ratios (RRs) with 95% confidence intervals (CIs) of each outcome for PCSK9 inhibitor versus placebo. Main outcome was sepsis. Other outcomes were total severe infections, severe bacterial and viral infections, and severe organ system-specific infections including respiratory tract, gastrointestinal, and genitourinary tract infections. RESULTS Twenty studies of 64,984 participants were included (alirocumab: n=7; evolocumab: n=9; inclisiran: n=4). Sepsis was reported in 292 (0.51%) participants from 11 trials (PCSK9 inhibitor 0.47%; placebo 0.56%). PCSK9 inhibitor use was not associated with risk of sepsis compared with placebo (Summary RR: 0.85, 95%CI: 0.67-1.07, P=.16); nor was it associated with any severe infection (0.96, 95% CI 0.89-1.03), severe bacterial (0.96, 95%CI 0.81-1.14) and viral infections (1.03, 95%CI 0.78-1.37); nor with any severe organ system-specific infection (all P values >0.05). The between-study heterogeneity in all analyses was small. CONCLUSION There was neither a beneficial nor a harmful association between PCSK9 inhibitors and risk of sepsis or severe infections. These findings provide reassurance regarding the safety of PCSK9 inhibitors in patients who are concerned about potential drug side effects related to infections.
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Affiliation(s)
- Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Wei Zhang
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - David Burgner
- Department of Paediatrics, Melbourne University, Parkville, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago 60657, Illinois, USA
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, U.S
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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21
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Carr PR, Webb KL, Neumann JT, Thao LTP, Beilin LJ, Ernst ME, Fitzgibbon B, Gasevic D, Nelson MR, Newman AB, Orchard SG, Owen A, Reid CM, Stocks NP, Tonkin AM, Woods RL, McNeil JJ. Associations of body size with all-cause and cause-specific mortality in healthy older adults. Sci Rep 2023; 13:3799. [PMID: 36882434 PMCID: PMC9992380 DOI: 10.1038/s41598-023-29586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/07/2023] [Indexed: 03/09/2023] Open
Abstract
In the general population, body mass index (BMI) and waist circumference are recognized risk factors for several chronic diseases and all-cause mortality. However, whether these associations are the same for older adults is less clear. The association of baseline BMI and waist circumference with all-cause and cause-specific mortality was investigated in 18,209 Australian and US participants (mean age: 75.1 ± 4.5 years) from the ASPirin in Reducing Events in the Elderly (ASPREE) study, followed up for a median of 6.9 years (IQR: 5.7, 8.0). There were substantially different relationships observed in men and women. In men, the lowest risk of all-cause and cardiovascular mortality was observed with a BMI in the range 25.0-29.9 kg/m2 [HR25-29.9 vs 21-24.9 kg/m2: 0.85; 95% CI, 0.73-1.00] while the highest risk was in those who were underweight [HRBMI <21 kg/m2 vs BMI 21-24.9 kg/m2: 1.82; 95% CI 1.30-2.55], leading to a clear U-shaped relationship. In women, all-cause mortality was highest in those with the lowest BMI leading to a J-shaped relationship (HRBMI <21 kg/m2 vs BMI 21-24.9 kg/m2: 1.64; 95% CI 1.26-2.14). Waist circumference showed a weaker relationship with all-cause mortality in both men and women. There was little evidence of a relationship between either index of body size and subsequent cancer mortality in men or women, while non-cardiovascular non-cancer mortality was higher in underweight participants. For older men, being overweight was found to be associated with a lower risk of all-cause mortality, while among both men and women, a BMI in the underweight category was associated with a higher risk. Waist circumference alone had little association with all-cause or cause-specific mortality risk.Trial registration ASPREE https://ClinicalTrials.gov number NCT01038583.
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Affiliation(s)
- Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Katherine L Webb
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Department of Cardiology, University Heart & Vascular Centre, Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Le T P Thao
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Bernadette Fitzgibbon
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Anne B Newman
- Centre for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Nigel P Stocks
- Discipline of General Practice, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Ernst ME, Kirpach B, Neaton JD. In Memoriam: Richard H. Grimm, Jr, MD, MPH, PhD (August 22, 1946-September 8, 2022). Hypertension 2023; 80:500-502. [PMID: 36791220 DOI: 10.1161/hypertensionaha.122.20795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Michael E Ernst
- Department of Family Medicine, Carver College of Medicine and Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA (M.E.)
| | - Brenda Kirpach
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN (B.K.)
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN (J.N.)
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23
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Orchard SG, Lockery JE, Broder JC, Ernst ME, Espinoza S, Gibbs P, Wolfe R, Polekhina G, Zoungas S, Loomans-Kropp HA, Woods RL. Association of metformin, aspirin, and cancer incidence with mortality risk in adults with diabetes. JNCI Cancer Spectr 2023; 7:pkad017. [PMID: 36857596 PMCID: PMC10042437 DOI: 10.1093/jncics/pkad017] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Metformin and aspirin are commonly co-prescribed to people with diabetes. Metformin may prevent cancer, but in older people (over 70 years), aspirin has been found to increase cancer mortality. This study examined whether metformin reduces cancer mortality and incidence in older people with diabetes; it used randomization to 100 mg aspirin or placebo in the ASPirin in Reducing Events in the Elderly (ASPREE) trial to quantify aspirin's impact on metformin users. METHODS Analysis included community-dwelling ASPREE participants (aged ≥70 years, or ≥65 years for members of US minority populations) with diabetes. Diabetes was defined as a fasting blood glucose level greater than 125 mg/dL, self-report of diabetes, or antidiabetic medication use. Cox proportional hazards regression models were used to analyze the association of metformin and a metformin-aspirin interaction with cancer incidence and mortality, with adjustment for confounders. RESULTS Of 2045 participants with diabetes at enrollment, 965 were concurrently using metformin. Metformin was associated with a reduced cancer incidence risk (adjusted hazard ratio [HR] = 0.68, 95% confidence interval [CI] = 0.51 to 0.90), but no conclusive benefit for cancer mortality (adjusted HR = 0.72, 95% CI = 0.43 to 1.19). Metformin users randomized to aspirin had greater risk of cancer mortality compared with placebo (HR = 2.53, 95% CI = 1.18 to 5.43), but no effect was seen for cancer incidence (HR = 1.11, 95% CI = 0.75 to 1.64). The possible effect modification of aspirin on cancer mortality, however, was not statistically significant (interaction P = .11). CONCLUSIONS In community-dwelling older adults with diabetes, metformin use was associated with reduced cancer incidence. Increased cancer mortality risk in metformin users randomized to aspirin warrants further investigation. ASPREE TRIAL REGISTRATION ClinicalTrials.gov ID NCT01038583.
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Affiliation(s)
- Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne,VIC, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne,VIC, Australia
- Translational Immunology and Nanotechnology Research Theme, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Department of Internal Medicine, Division of Cancer Prevention and Control, Ohio State University, Columbus, OH, USA
| | - Jonathan C Broder
- School of Public Health and Preventive Medicine, Monash University, Melbourne,VIC, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Sara Espinoza
- Division of Geriatrics, Gerontology and Palliative Medicine, Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, and Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Peter Gibbs
- The Walter & Eliza Hall Institute of Medical Research, Royal Parade, Parkville, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne,VIC, Australia
| | - Galina Polekhina
- School of Public Health and Preventive Medicine, Monash University, Melbourne,VIC, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne,VIC, Australia
| | - Holli A Loomans-Kropp
- Department of Internal Medicine, Division of Cancer Prevention and Control, Ohio State University, Columbus, OH, USA
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne,VIC, Australia
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Ekram ARMS, Ryan J, Espinoza SE, Newman AB, Murray AM, Orchard SG, Fitzgerald SM, McNeil JJ, Ernst ME, Woods RL. The Association between Frailty and Dementia-Free and Physical Disability-Free Survival in Community-Dwelling Older Adults. Gerontology 2023; 69:549-560. [PMID: 36617406 PMCID: PMC10238577 DOI: 10.1159/000528984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/22/2022] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Frailty is a common geriatric syndrome that adversely impacts health outcomes. This study examined correlates of physical frailty in healthy community-dwelling older adults and studied the effect of frailty on disability-free survival (DFS), defined as survival free of independence-limiting physical disability or dementia. METHODS This is a post hoc analysis of 19,114 community-dwelling older adults (median age: 74.0 years, interquartile range or IQR: 6.1 years) from Australia and the USA enrolled in the "ASPirin in Reducing Events in the Elderly (ASPREE)" clinical trial. Frailty was assessed using a modified Fried phenotype and a deficit accumulation frailty index (FI) utilizing a ratio score derived from 66 items. Multinomial logistic regression was used to examine the correlates of frailty and Cox regression to analyze the association between frailty and DFS (and its components). RESULTS At study enrollment, 39.0% were prefrail, and 2.2% of participants were frail, according to Fried phenotype. Older age, higher waist circumference, lower education, ethnoracial origin, current smoking, depression, and polypharmacy were associated with prefrailty and frailty according to Fried phenotype and FI. Fried phenotype defined prefrailty and frailty predicted reduced DFS (prefrail: HR: 1.67; 95% CI: 1.50-1.86 and frail: HR: 2.80; 95% CI: 2.27-3.46), affecting each component of DFS including dementia, physical disability, and mortality. Effect sizes were larger, according to FI. CONCLUSION Our study showed that prefrailty is common in community-dwelling older adults initially free of cardiovascular disease, dementia, or independence-limiting physical disability. Prefrailty and frailty significantly reduced disability-free survival. Addressing modifiable correlates, like depression and polypharmacy, might reduce the adverse impact of frailty on dementia-free and physical disability-free survival.
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Affiliation(s)
- A R M Saifuddin Ekram
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Sara E Espinoza
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
| | - Anne M Murray
- Hennepin County Medical Center, Berman Center for Outcomes and Clinical Research, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Sharyn M Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
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Saifuddin Ekram ARM, Espinoza SE, Ernst ME, Ryan J, Beilin L, Stocks NP, Ward SA, McNeil JJ, Shah RC, Woods RL. The Association between Metabolic Syndrome, Frailty and Disability-Free Survival in Healthy Community-dwelling Older Adults. J Nutr Health Aging 2023; 27:1-9. [PMID: 36651481 PMCID: PMC10061371 DOI: 10.1007/s12603-022-1860-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the association between metabolic syndrome (MetS) and frailty, and determine whether co-existent MetS and frailty affect disability-free survival (DFS), assessed through a composite of death, dementia or physical disability. DESIGN Longitudinal study. SETTING AND PARTICIPANTS Community-dwelling older adults from Australia and the United States (n=18,264) from "ASPirin in Reducing Events in the Elderly" (ASPREE) study. MEASUREMENTS MetS was defined according to American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (2018). A modified Fried phenotype and a deficit accumulation Frailty Index (FI) were used to assess frailty. Association between MetS and frailty was examined using multinomial logistic regression. Cox regression was used to analyze the association between MetS, frailty and DFS over a median follow-up of 4.7 years. RESULTS Among 18,264 participants, 49.9% met the criteria for MetS at baseline. Participants with Mets were more likely to be pre-frail [Relative Risk Ratio (RRR): 1.22; 95%Confidence Interval (CI): 1.14, 1.30)] or frail (RRR: 1.66; 95%CI: 1.32, 2.08) than those without MetS. MetS alone did not shorten DFS while pre-frailty or frailty alone did [Hazard Ratio (HR): 1.68; 95%CI: 1.45, 1.94; HR: 2.65; 95%CI:1.92, 3.66, respectively]. Co-existent MetS with pre-frailty/frailty did not change the risk of shortened DFS. CONCLUSIONS MetS was associated with pre-frailty or frailty in community-dwelling older individuals. Pre-frailty or frailty increased the risk of reduced DFS but presence of MetS did not change this risk. Assessment of frailty may be more important than MetS in predicting survival free of dementia or physical disability.
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Affiliation(s)
- A R M Saifuddin Ekram
- Dr. A R M Saifuddin Ekram, Senior Clinical Research Consultant (ASPREE), SPHPM, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia. Mobile phone: +61449031659, E-mail:
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Walker RG, Wolfe R, Bongetti E, Polkinghorne KR, Woods RL, Ryan J, Espinoza S, Murray A, Ernst ME, Mcneil JJ. The association of frailty with chronic kidney disease in older adults using the ASPirin in reducing events in the elderly cohort. Nephrology (Carlton) 2023; 28:72-77. [PMID: 36250987 PMCID: PMC9772046 DOI: 10.1111/nep.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/06/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022]
Abstract
Frailty and chronic kidney disease (CKD) both increase with age and are prevalent in older adults. However, studies in older adults examining the relationship between frailty and milder impairments of kidney function are relatively sparse. We examined the cross-sectional association of baseline estimated glomerular filtration rate (eGFR), albuminuria and CKD ([eGFR <60 ml/min/1.73 m2 ] and/or albuminuria [>3.0 mg/mmol]) with prefrailty and frailty in the ASPirin in Reducing Events in the Elderly (ASPREE) trial cohort of healthy older participants. Univariate logistic regression models measured the unadjusted odds ratios (OR) and 95% confidence intervals (CI) for prevalent combined prefrailty and frailty (respectively defined as presence of 1-2 or 3+ of 5 modified fried criteria) for the association between CKD, eGFR, albuminuria and other potential risk factors. Multivariable models calculated OR for prefrailty-frailty adjusted for potential confounders and either CKD, (i) eGFR and albuminuria measured as either continuous variables; (ii) or categorical variables; (iii). Of 17 759 eligible participants, 6934 were classified as prefrail, 389 were frail. CKD, eGFR and albuminuria were all associated with combined prefrailty-frailty on univariate analysis. In the multivariable modelling, neither CKD (reduced eGFR and/or albuminuria), nor eGFR (either continuous or categorical variables) were associated with prefrailty-frailty. However, albuminuria, either as a continuous variable (OR [95% CI] 1.07 [1.04-1.10]; p < .001), or categorical variable (OR 1.21 [1.08-1.36]; p = .001) was consistently associated with prefrailty-frailty. The complex relationship between albuminuria (which may be a biomarker for vascular inflammation), ageing, progressive CKD and frailty requires further investigation.
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Affiliation(s)
- Rowan G Walker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Nephrology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elisa Bongetti
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Kevan R Polkinghorne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sara Espinoza
- Department of Medicine Division of Geriatrics, Gerontology & Palliative Medicine, UT Health, San Antonio, Texas, USA
| | - Anne Murray
- Department of Medicine and Division of Geriatrics, The Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - John J Mcneil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Fravel MA, Ernst ME, Webb KL, Wetmore JB, Wolfe R, Woods RL, Reid CM, Chowdhury E, Murray AM, Polkinghorne KR. GFR Variability, Survival, and Cardiovascular Events in Older Adults. Kidney Med 2022; 5:100583. [PMID: 36794000 PMCID: PMC9922964 DOI: 10.1016/j.xkme.2022.100583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale & Objective Variability in estimated glomerular filtration rate (eGFR) over time is often observed, but it is unknown whether this variation is clinically important. We investigated the association between eGFR variability and survival free of dementia or persistent physical disability (disability-free survival) and cardiovascular disease (CVD) events (myocardial infarction, stroke, hospitalization for heart failure, or CVD death). Study Design Post hoc analysis. Setting & Participants 12,549 participants of the ASPirin in Reducing Events in the Elderly trial. Participants were without documented dementia, major physical disability, previous CVD, and major life-limiting illness at enrollment. Predictors eGFR variability. Outcomes Disability-free survival and CVD events. Analytical Approach eGFR variability was estimated using the standard deviation of eGFR measurements obtained from participants' baseline, first, and second annual visits. Associations between tertiles of eGFR variability with disability-free survival and CVD events occurring after the eGFR variability estimation period were examined. Results During median follow-up of 2.7 years after the second annual visit, 838 participants died, developed dementia, or acquired a persistent physical disability; 379 had a CVD event. The highest tertile of eGFR variability had an increased risk of death/dementia/disability (HR, 1.35; 95% CI, 1.14-1.59) and CVD events (HR, 1.37; 95% CI, 1.06-1.77) compared with the lowest tertile after covariate adjustment. These associations were present in patients with and without chronic kidney disease at baseline. Limitations Limited representation of diverse demographics. Conclusions In older, generally healthy adults, higher variability in eGFR over time predicts increased risk of future death/dementia/disability and CVD events.
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Affiliation(s)
- Michelle A. Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA
- Address for Correspondence: Michelle A. Fravel, PharmD, Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, 180 S. Grand Ave, Iowa City, IA 52242.
| | - Michael E. Ernst
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA
| | - Katherine L. Webb
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - James B. Wetmore
- Department of Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota
- Hennepin Healthcare Research Institute, Minneapolis, MN
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Enayet Chowdhury
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Hennepin-Health Research Institute and Division of Geriatrics, Department of Medicine, Hennepin Healthcare, Minneapolis, MN
| | - Kevan R. Polkinghorne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, Monash University; Melbourne, Victoria, Australia
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Polkinghorne KR, Wetmore JB, Thao LTP, Wolfe R, Woods RL, Ernst ME, Nelson MR, Reid CM, Shah RC, McNeil JJ, Murray AM. Effect of Aspirin on CKD Progression in Older Adults: Secondary Analysis From the ASPREE Randomized Clinical Trial. Am J Kidney Dis 2022; 80:810-813. [PMID: 35430328 PMCID: PMC9562592 DOI: 10.1053/j.ajkd.2022.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Kevan R Polkinghorne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia; Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.
| | - James B Wetmore
- Division of Nephrology, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Le Thi Phuong Thao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, and Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Department of Medicine, Division of Geriatrics, Hennepin Healthcare, Minneapolis, Minnesota; Hennepin Healthcare Research Institute, Minneapolis, Minnesota
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Espinoza SE, Woods RL, Ekram ARMS, Ernst ME, Polekhina G, Wolfe R, Shah RC, Ward SA, Storey E, Nelson MR, Reid CM, Lockery JE, Orchard SG, Trevaks R, Fitzgerald SM, Stocks NP, Chan A, McNeil JJ, Murray AM, Newman AB, Ryan J. The Effect of Low-Dose Aspirin on Frailty Phenotype and Frailty Index in Community-Dwelling Older Adults in the ASPirin in Reducing Events in the Elderly Study. J Gerontol A Biol Sci Med Sci 2022; 77:2007-2014. [PMID: 34758073 PMCID: PMC9536436 DOI: 10.1093/gerona/glab340] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Frailty is associated with chronic inflammation, which may be modified by aspirin. The purpose of this study was to determine whether low-dose aspirin reduces incident frailty in healthy older adult participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial. METHODS In the United States and Australia, 19 114 community-dwelling individuals aged ≥70 and older (U.S. minorities ≥65 years) and free of overt cardiovascular disease, persistent physical disability, and dementia were enrolled in ASPREE, a double-blind, placebo-controlled trial of 100-mg daily aspirin versus placebo. Frailty, a prespecified study end point, was defined according to a modified Fried frailty definition (Fried frailty) and the frailty index based on the deficit accumulation model (frailty index). Competing risk Cox proportional hazard models were used to compare time to incident frailty by aspirin versus placebo. Sensitivity analysis was conducted to include frailty data with and without imputation of missing data. RESULTS Over a median 4.7 years, 2 252 participants developed incident Fried frailty, and 4 451 had incident frailty according to the frailty index. Compared with placebo, aspirin treatment did not alter the risk of incident frailty (Fried frailty hazard ratio [HR]: 1.04, 95% confidence interval [CI] 0.96-1.13; frailty index HR: 1.03, 95% CI 0.97-1.09). The proportion of individuals classified as frail, and the trajectory in continuous frailty scores over time, were not different between the aspirin and placebo treatment groups. The results were consistent across a series of subgroups. CONCLUSIONS Low-dose aspirin use in healthy older adults when initiated in older ages does not reduce risk of incident frailty or the trajectory of frailty.
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Affiliation(s)
- Sara E Espinoza
- Division of Geriatrics, Gerontology and Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas, USA.,Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A R M Saifuddin Ekram
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA.,Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Galina Polekhina
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elsdon Storey
- Van Cleef/Roet Centre for Nervous Diseases, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ruth Trevaks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sharyn M Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nigel P Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Andy Chan
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Clinical Outcomes and Research, Hennepin Health Research Institute and Division of Geriatrics, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota, USA
| | - Anne B Newman
- Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joanne Ryan
- Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
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Hussain SM, Ernst ME, Barker AL, Margolis KL, Reid CM, Neumann JT, Tonkin AM, Phuong TLT, Beilin LJ, Pham T, Chowdhury EK, Cicuttini FM, Gilmartin-Thomas JFM, Carr PR, McNeil JJ. Variation in Mean Arterial Pressure Increases Falls Risk in Elderly Physically Frail and Prefrail Individuals Treated With Antihypertensive Medication. Hypertension 2022; 79:2051-2061. [PMID: 35722878 PMCID: PMC9378722 DOI: 10.1161/hypertensionaha.122.19356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Impaired cerebral blood flow has been associated with an increased risk of falls. Mean arterial pressure (MAP) and variability in MAP have been reported to affect cerebral blood flow but their relationships to the risk of falls have not previously been reported. METHODS Utilising data from the Aspirin in Reducing Events in the Elderly trial participants, we estimated MAP and variability in MAP, defined as within-individual SD of MAP from baseline and first 2 annual visits. The relationship with MAP was studied in 16 703 participants amongst whom 1539 falls were recorded over 7.3 years. Variability in MAP was studied in 14 818 of these participants who experienced 974 falls over 4.1 years. Falls were confined to those involving hospital presentation. Cox regression was used to calculate hazard ratio and 95% CI for associations with falls. RESULTS Long-term variability in MAP was not associated with falls except amongst frail or prefrail participants using antihypertensive medications. Within this group each 5 mm Hg increase in long-term variability in MAP increased the risk of falls by 16% (hazard ratio, 1.16 [95% CI, 1.02-1.33]). Amongst the antihypertensive drugs studied, beta-blocker monotherapy (hazard ratio, 1.93 [95% CI, 1.17-3.18]) was associated with an increased risk of falls compared with calcium channel blockers. CONCLUSIONS Higher levels of long-term variability in MAP increase the risk of serious falls in older frail and prefrail individuals taking antihypertensive medications. The observation that the relationship was limited to frail and prefrail individuals might explain some of the variability of previous studies linking blood pressure indices and falls.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria 3010 Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine. The University of Iowa, Iowa City, Iowa. USA
| | - Anna L Barker
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | | | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- Department of Cardiology, University Heart & Vascular Center Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Thao Le Thi Phuong
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Lawrence J Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Thao Pham
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Enayet K Chowdhury
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Julia FM Gilmartin-Thomas
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- College of Health and Biomedicine, and Institute for Health & Sport, Victoria University, Victoria, Australia
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
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Liew SM, Chowdhury EK, Ernst ME, Gilmartin‐Thomas J, Reid CM, Tonkin A, Neumann J, McNeil JJ, Kaye DM. Prescribed opioid use is associated with adverse cardiovascular outcomes in community-dwelling older persons. ESC Heart Fail 2022; 9:3973-3984. [PMID: 35985663 PMCID: PMC9773735 DOI: 10.1002/ehf2.14101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/13/2022] [Accepted: 07/19/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Prescribed opioids are commonly used in the older community-dwelling population for the treatment of chronic pain. Although the harmful effects of opioid abuse and overdose are well understood, little is known about the long-term cardiovascular (CV) effects of prescribed opioids. The aim of this study was to investigate the CV effects associated with prescribed opioid use. METHODS AND RESULTS A post hoc analysis of participants in the Aspirin in Reducing Events in the Elderly (ASPREE) trial was conducted. Participants in the ASPREE trial included community-dwelling older adults without a prior history of CV disease (CVD). Prescribed opioid use was defined as opioid use at baseline and/or at the first annual visit (AV1). Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals (95% CI) for associations between opioid use and CVD events following AV1. Of the 17 701 participants included (mean age 75.2 years, 58.2% female), 813 took opioids either at baseline or at AV1. Over a median follow-up period of 3.58 years (IQR 2.50-4.62), CVD events, most notably heart failure hospitalization, occurred in 7% (n = 57) amongst opioid users and 4% (n = 680) amongst non-opioid users. After adjustment for multiple covariates, opiate use was associated with a 1.67-fold (CI 1.26-2.23, P < 0.001) increase in the hazard ratio for CVD events. CONCLUSIONS These findings identify opioid use as a non-traditional risk factor for CVD events in community-dwelling older adults.
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Affiliation(s)
- Stephanie M. Liew
- Cardiology DepartmentAlfred HospitalMelbourneVICAustralia,Department of CardiologyUniversity Hospital GeelongGeelongVICAustralia
| | - Enayet K. Chowdhury
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of MedicineThe University of IowaIowa CityIAUSA
| | - Julia Gilmartin‐Thomas
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Christopher M. Reid
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVICAustralia,School of Population HealthCurtin UniversityPerthWAAustralia
| | - Andrew Tonkin
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVICAustralia,Department of CardiologyAustin HealthMelbourneVICAustralia
| | - Johannes Neumann
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVICAustralia,Department of CardiologyUniversity Medical Centre HamburgHamburgGermany
| | - John J. McNeil
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - David M. Kaye
- Cardiology DepartmentAlfred HospitalMelbourneVICAustralia,Department of CardiologyUniversity Medical Centre HamburgHamburgGermany,Baker Heart and Diabetes InstituteMelbourneAustralia
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Ekram ARMS, Woods RL, Ryan J, Espinoza SE, Gilmartin-Thomas JF, Shah RC, Mehta R, Kochar B, Lowthian JA, Lockery J, Orchard S, Nelson M, Fravel MA, Liew D, Ernst ME. The association between polypharmacy, frailty and disability-free survival in community-dwelling healthy older individuals. Arch Gerontol Geriatr 2022; 101:104694. [PMID: 35349875 PMCID: PMC9437977 DOI: 10.1016/j.archger.2022.104694] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Polypharmacy and frailty are two common geriatric conditions. In community-dwelling healthy older adults, we examined whether polypharmacy is associated with frailty and affects disability-free survival (DFS), assessed as a composite of death, dementia, or persistent physical disability. METHODS We included 19,114 participants (median age 74.0 years, IQR: 6.1 years) from ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial. Frailty was assessed by a modified Fried phenotype and a deficit accumulation Frailty Index (FI). Polypharmacy was defined as concomitant use of five or more prescription medications. Multinomial logistic regression was used to examine the cross-sectional association between polypharmacy and frailty at base line, and Cox regression to determine the effect of polypharmacy and frailty on DFS over five years. RESULTS Individuals with polypharmacy (vs. <5 medications) were 55% more likely to be pre-frail (Relative Risk Ratio or RRR: 1.55; 95%Confidence Interval or CI:1.44, 1.68) and three times more likely to be frail (RRR: 3.34; 95%CI:2.64, 4.22) according to Fried phenotype. Frailty alone was associated with double risk of the composite outcome (Hazard ratio or HR: 2.16; 95%CI: 1.56, 2.99), but frail individuals using polypharmacy had a four-fold risk (HR: 4.24; 95%CI: 3.28, 5.47). Effect sizes were larger when frailty was assessed using the FI. CONCLUSION Polypharmacy was significantly associated with pre-frailty and frailty at baseline. Polypharmacy-exposed frailty increased the risk of reducing disability-free survival among older adults. Addressing polypharmacy in older people could ameliorate the impact of frailty on individuals' functional status, cognition and survival.
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Ernst ME, Fravel MA. Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide. Am J Hypertens 2022; 35:573-586. [PMID: 35404993 DOI: 10.1093/ajh/hpac048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/27/2023] Open
Abstract
The term thiazide is universally understood to refer to diuretics that exert their principal action in the distal tubule. The thiazide class is heterogenous and can be further subdivided into compounds containing the benzothiadiazine ring structure-the thiazide-type (e.g., hydrochlorothiazide)-and those lacking the benzothiadiazine ring-the thiazide-like (e.g., chlorthalidone and indapamide) drugs. Thiazide-like agents are longer acting and constitute the diuretics used in most of the cardiovascular outcome trials that established benefits of treatment with diuretics, but pragmatic aspects, such as lack of availability in convenient formulations, limit their use. Regardless of class heterogeneity, thiazides have retained importance in the management of hypertension for over 60 years. They are reliably effective as monotherapy in a majority of hypertensive patients, and augment the efficacy of other classes of antihypertensives when used in combination. Importantly, a thiazide-based treatment regimen lowers cardiovascular events, and their sturdy effect reinforces their place among the recommended first-line agents to treat hypertension in major domestic and international hypertension guidelines. There are few head-to-head comparisons within the class, but potential differences have been explored indirectly as well as in non-blood pressure mechanisms and potential pleiotropic properties. Until proven otherwise, the importance of these differences remains speculative, and clinicians should assume that cardiovascular events will be lowered similarly across agents when equivalent blood pressure reduction occurs. Thiazides remain underutilized, with only about one-third of hypertensive patients receiving them. For many patients, however, a thiazide is an indispensable component of their regimen to achieve adequate blood pressure control.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA.,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Michelle A Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
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Zhou Z, Nelson M, Ernst ME, Reid C, McNeil J, Tonkin A. Does Aspirin Prevent Incident Heart Failure in Healthy Older Adults? Examining the Evidence From the ASPREE Trial. Circ Heart Fail 2022; 15:e009511. [PMID: 35727884 PMCID: PMC9228581 DOI: 10.1161/circheartfailure.122.009511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IA, USA
| | - Christopher Reid
- School of Public Health, Curtin University, Perth, WA, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Nelson MR, Polekhina G, Woods RL, Reid CM, Tonkin AM, Wolfe R, Murray AM, Kirpach B, Ernst ME, Lockery JE, Shah RC, Stocks N, Orchard SG, Zhou Z. Safety of Ceasing Aspirin Used Without a Clinical Indication After Age 70 Years: A Subgroup Analysis of the ASPREE Randomized Trial. Ann Intern Med 2022; 175:761-764. [PMID: 35286146 PMCID: PMC9434500 DOI: 10.7326/m21-3823] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Galina Polekhina
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, and School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes & Clinical Research, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, and Division of Geriatrics, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota
| | - Brenda Kirpach
- Berman Center for Outcomes & Clinical Research, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, and Translational Immunology and Nanotechnology Research Program, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Nigel Stocks
- Discipline of General Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Ernst ME, Fravel MA, Webb KL, Wetmore JB, Wolfe R, Chowdhury E, Reid CM, Woods RL, Beilin L, Margolis KL, Murray AM, Polkinghorne KR. Long-Term Blood Pressure Variability and Kidney Function in Participants of the ASPREE Trial. Am J Hypertens 2022; 35:173-181. [PMID: 34519331 PMCID: PMC8807162 DOI: 10.1093/ajh/hpab143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Whether long-term blood pressure variability (BPV) predicts kidney function decline in generally healthy older adults is unknown. We investigated this association in ASPirin in Reducing Events in the Elderly (ASPREE) trial participants. METHODS Between 2010 and 2014, Australian and US individuals aged ≥70 years (≥65 if US minority) were recruited and followed with annual study visits for a median of 4.7 years. Time-to-event analyses and linear mixed effects models were used to examine associations between incident chronic kidney disease (CKD), and trajectories of estimated glomerular filtration rate (eGFR) and log albumin-creatinine ratio (log ACR) with systolic BPV as a continuous measure, and, by tertile of SD of systolic blood pressure (BP). BPV was estimated using systolic BP measures from baseline through the second annual visit, and kidney outcomes were assessed following this period. RESULTS Incident CKD occurred in 1,829 of 6,759 participants (27.2%), and more commonly in BPV tertiles 2 (27.4%) and 3 (28.3%) than tertile 1 (25.5%); however, the risk was not significantly increased after covariate adjustment (tertile 3 hazard ratio = 1.02; 95% confidence interval: 0.91-1.14). Analysis of eGFR (n = 16,193) and log ACR trajectories (n = 15,213) showed individuals in the highest BPV tertile having the lowest eGFR and highest log ACR, cross-sectionally. However, the trajectories of eGFR and log ACR did not differ across BPV tertiles. CONCLUSIONS CKD and markers of reduced kidney function occur more commonly in individuals with higher BPV; however, BPV does not influence trajectory of decline in kidney function over time in older adults who are in generally good health. CLINICAL TRIALS REGISTRATION Trial Number NCT01038583 and ISRCTN83772183.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Michelle A Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
| | - Katherine L Webb
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - James B Wetmore
- Division of Nephrology, Department of Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota, USA
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Enayet Chowdhury
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lawrence Beilin
- Medical School Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
| | | | - Anne M Murray
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Kevan R Polkinghorne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Neumann JT, Thao LTP, Callander E, Carr PR, Qaderi V, Nelson MR, Reid CM, Woods RL, Orchard SG, Wolfe R, Polekhina G, Williamson JD, Trauer JM, Newman AB, Murray AM, Ernst ME, Tonkin AM, McNeil JJ. A multistate model of health transitions in older people: a secondary analysis of ASPREE clinical trial data. The Lancet Healthy Longevity 2022; 3:e89-e97. [PMID: 35224525 PMCID: PMC8880962 DOI: 10.1016/s2666-7568(21)00308-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Ekram ARMS, Woods RL, Britt C, Espinoza S, Ernst ME, Ryan J. Erratum: The Association Between Frailty and All-Cause Mortality in Community-Dwelling Older Individuals: An Umbrella Review. J Frailty Aging 2022; 11:247. [PMID: 35441207 PMCID: PMC10433462 DOI: 10.14283/jfa.2021.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
The original version of this article unfortunately contained a mistake. Appendix II was published twice in the supporting information. The original publication has been updated. Appendix I and Appendix II are now both available in the online publication.
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Affiliation(s)
- A R M S Ekram
- ARM Saifuddin Ekram, School of Public Health and Preventive Medicine, Monash University, Alfred Campus, Melbourne, Victoria-3004, Australia; E-mail:
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Broder JC, Ryan J, Shah RC, Lockery JE, Orchard SG, Gilmartin-Thomas JFM, Fravel MA, Owen AJ, Woods RL, Wolfe R, Storey E, Murray AM, Ernst ME. Anticholinergic medication burden and cognitive function in participants of the ASPREE study. Pharmacotherapy 2021; 42:134-144. [PMID: 34866212 DOI: 10.1002/phar.2652] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVE What is the association between anticholinergic burden and specific domains of cognitive function in older adults who are initially without major cognitive impairment? DESIGN Post-hoc analysis of longitudinal observational data from the ASPirin in Reducing Events in the Elderly (ASPREE) study. PATIENTS 19,114 participants from Australia and the United States aged 70 years and older (65 years and older for US minorities) were recruited and followed for a median of 4.7 years. At enrollment, participants were free of known cardiovascular disease, major physical disability, or dementia. MEASUREMENTS Cognitive assessments administered at baseline and biennially at follow-up visits included the Modified Mini-Mental State examination (3MS), Hopkins Verbal Learning Test-Revised (HVLT-R) delayed recall, Controlled Oral Word Association Test (COWAT), and Symbol Digit Modalities Test (SDMT). Anticholinergic burden was calculated at baseline using the Anticholinergic Cognitive Burden (ACB) scale and grouped as scores of 0 (no burden), 1-2 (low to moderate), or 3+ (high). MAIN RESULTS Linear mixed effects models were used to assess the relationship between ACB score and cognition over time. After adjusting for sex, age, education, minority status, smoking status, hypertension, diabetes, depression, chronic kidney disease, country, and frailty, participants with a high ACB score had worse performance over time for 3MS (Adjusted [Adj] B=-0.092, P=0.034), HVLT-R delayed recall (Adj B=-0.104, P<0.001), COWAT (Adj B=-0.151, P<0.001), and SDMT (Adj B=-0.129, P=0.026), than participants with an ACB score of 0. A low to moderate ACB score was also associated with worse performance over time for HVLT-R delayed recall (Adj B=-0.037, P=0.007) and COWAT (Adj B=-0.065, P=0.003), compared to those with no ACB. CONCLUSIONS Anticholinergic burden predicts worse cognitive function over time in initially dementia-free older adults, particularly for executive function (COWAT) and episodic memory (HVLT-R).
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Affiliation(s)
- Jonathan C Broder
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University, Chicago, Illinois, USA
| | - Jessica E Lockery
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Translational Immunology and Nanotechnology Research Program, RMIT University, Bundoora, Victoria, Australia
| | - Suzanne G Orchard
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Julia F-M Gilmartin-Thomas
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- College of Health and Biomedicine & Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science, St Albans, Victoria, Australia
| | - Michelle A Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
| | - Alice J Owen
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elsdon Storey
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Health Research Institute, Minneapolis, Minnesota, USA
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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Woods RL, Espinoza S, Thao LTP, Ernst ME, Ryan J, Wolfe R, Shah RC, Ward SA, Storey E, Nelson MR, Reid CM, Lockery JE, Orchard SG, Trevaks RE, Fitzgerald SM, Stocks NP, Williamson JD, McNeil JJ, Murray AM, Newman AB. Effect of Aspirin on Activities of Daily Living Disability in Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:2007-2014. [PMID: 33367621 DOI: 10.1093/gerona/glaa316] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cerebrovascular events, dementia, and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin's effects on incident and persistent ADL disability within a primary prevention aspirin trial in community-dwelling older adults. METHODS The ASPREE (ASPirin in Reducing Events in the Elderly) trial of daily 100 mg aspirin versus placebo recruited 19 114 healthy adults aged 70+ years (65+ years if U.S. minority) in Australia and the United States. Six basic ADLs were assessed every 6 months. Incident ADL disability was defined as inability or severe difficulty with ≥1 ADL; persistence was confirmed if the same ADL disability remained after 6 months. Proportional hazards modeling compared time to incident or persistent ADL disability for aspirin versus placebo; death without prior disability was a competing risk. RESULTS Over a median of 4.7 years, incident ADL disability was similar in those receiving aspirin (776/9525) and placebo (787/9589) with walking, bathing, dressing, and transferring the most commonly reported. Only 24% of incident ADL disability progressed to persistent. Persistent ADL disability was lower in the aspirin group (4.3 vs 5.3 events/1000 py; hazard ratio [HR] = 0.81, 95% confidence interval [CI]: 0.66-1.00), with bathing and dressing the most common ADL disabilities in both groups. Following persistent ADL disability, there were more deaths in the aspirin group (24 vs 12). DISCUSSION Low-dose aspirin in initially healthy older people did not reduce the risk of incident ADL disability, although there was evidence of reduced persistent ADL disability.
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Affiliation(s)
- Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sara Espinoza
- Division of Geriatrics, Gerontology and Palliative Medicine, Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, USA.,Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, USA
| | - Le T P Thao
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, USA
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Healthy Brain Ageing, The University of New South Wales, Sydney, Australia
| | - Elsdon Storey
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Jessica E Lockery
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ruth E Trevaks
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sharyn M Fitzgerald
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nigel P Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Jeff D Williamson
- Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Clinical Outcomes and Research, Minneapolis Medical Research Foundation, Hennepin Healthcare Research Institute, Minneapolis, USA.,Division of Geriatrics, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, USA
| | - Anne B Newman
- Center for Aging and Population Health, University of Pittsburgh, Pennsylvania, USA
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Zhou Z, Ryan J, Ernst ME, Murray A, Nelson MR. Reply: Statin Therapy on Cognitive Decline and Incident Dementia. J Am Coll Cardiol 2021; 78:e103. [PMID: 34593132 PMCID: PMC10012831 DOI: 10.1016/j.jacc.2021.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
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Yan MK, Wolfe R, Orchard SG, Ernst ME, Mar VJ. Effect of methotrexate on melanoma risk in older adults: Secondary analysis of a randomised controlled trial. Australas J Dermatol 2021; 63:114-115. [PMID: 34581443 DOI: 10.1111/ajd.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/07/2021] [Accepted: 09/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mabel K Yan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Melanoma Service, Alfred Health, Melbourne, Victoria,, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA,, USA
| | - Victoria J Mar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Melanoma Service, Alfred Health, Melbourne, Victoria,, Australia
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Ekram ARMS, Woods RL, Britt C, Espinoza S, Ernst ME, Ryan J. The Association between Frailty and All-Cause Mortality in Community-Dwelling Older Individuals: An Umbrella Review. J Frailty Aging 2021; 10:320-326. [PMID: 34549245 PMCID: PMC10376924 DOI: 10.14283/jfa.2021.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Frailty is associated with multiple adverse health outcomes, including mortality. Several methods have been used to characterize frailty, each based on different frailty scales. These include scales based on phenotype, multidomain, and deficit accumulations. Several systematic reviews have examined the association between frailty and mortality; however, it is unclear whether these different frailty scales similarly predict mortality. This umbrella review aims to examine the association between frailty assessed by different frailty scales and all-cause mortality among community-dwelling older adults. A protocol was registered at PROSPERO, and it was conducted following the PRISMA statement. MEDLINE, Embase, PubMed, Cochrane Database of Systematic Reviews, Joanna Briggs Institute (JBI) EBP database, and Web of Science database was searched. Methodological quality was assessed using the JBI critical appraisal checklist and online AMSTAR-2 critical appraisal checklist. For eligible studies, essential information was extracted and synthesized qualitatively. Five systematic reviews were included, with a total of 434,115 participants. Three systematic reviews focused on single frailty scales; one evaluated Fried's physical frailty phenotype and its modifications; another focused on the deficit accumulation frailty index. The third evaluated the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale. The two other systematic reviews determined the association between frailty and mortality using different frailty scales. All of the systematic reviews found that frailty was significantly associated with all-cause mortality. This umbrella review demonstrates that frailty is a significant predictor of all-cause mortality, irrespective of the specific frailty scale.
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Affiliation(s)
- A R M S Ekram
- ARM Saifuddin Ekram, School of Public Health and Preventive Medicine, Monash University, Alfred Campus, Melbourne, Victoria-3004, Australia; E-mail:
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Ryan J, Espinoza S, Ernst ME, Ekram ARMS, Wolfe R, Murray AM, Shah RC, Orchard SG, Fitzgerald S, Beilin LJ, Ward SA, Williamson JD, Newman AB, McNeil JJ, Woods RL. Validation of a Deficit-Accumulation Frailty Index in the ASPirin in Reducing Events in the Elderly Study and Its Predictive Capacity for Disability-Free Survival. J Gerontol A Biol Sci Med Sci 2021; 77:19-26. [PMID: 34338761 PMCID: PMC8751791 DOI: 10.1093/gerona/glab225] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Frailty is a state of heightened vulnerability and susceptibility to physiologic stressors that increases with age. It has shown increasing utility in predicting a range of adverse health outcomes. Here, we characterize a 67-item deficit-accumulation frailty index (FI) in 19 110 community-dwelling individuals in the ASPirin in Reducing Events in the Elderly clinical trial. Participants aged 65-98 years were recruited from the United States and Australia and were without diagnosed dementia and cardiovascular disease, and major physical disability. The median FI score was .10 (interquartile range: .07-.14) at baseline, and the prevalence of frailty (FI > .21) increased from 8.1% to 17.4% after 6 years. FI was positively associated with age, and women had significantly higher scores than men at all ages. The FI was negatively correlated with gait speed (r = -.31) and grip strength (r = -.46), and strongly associated with a modified Fried's frailty phenotype (p < .0001, for all comparisons). Frailty was associated with the primary composite outcome capturing independent life lived free of major disability and dementia, and increased the rate of persistent physical disability (hazard ratio: 21.3, 95% confidence interval: 15.6-28.9). It added significantly to the predictive capacity of these outcomes above age, sex, and ethnicity alone. The FI is thus a useful biomarker of aging even among relatively healthy older individuals and provides important information about an individual's vulnerability to and risk of disease.
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Affiliation(s)
- Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,Address correspondence to: Joanne Ryan, PhD, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, 3004 Victoria, Australia. E-mail:
| | - Sara Espinoza
- Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, Texas, USA,Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, USA,Department of Family Medicine, Carver College of Medicine, University of Iowa, USA
| | - A R M Saifuddin Ekram
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Clinical Outcomes and Research, Hennepin Health Research Institute and Division of Geriatrics, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, USA
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sharyn Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeff D Williamson
- Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anne B Newman
- Center for Aging and Population Health, University of Pittsburgh, Pennsylvania, USA
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ernst ME, Ryan J, Chowdhury EK, Margolis KL, Beilin LJ, Reid CM, Nelson MR, Woods RL, Shah RC, Orchard SG, Wolfe R, Storey E, Tonkin AM, Brodtmann A, McNeil JJ, Murray AM. Long-Term Blood Pressure Variability and Risk of Cognitive Decline and Dementia Among Older Adults. J Am Heart Assoc 2021; 10:e019613. [PMID: 34176293 PMCID: PMC8403315 DOI: 10.1161/jaha.120.019613] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Blood pressure variability (BPV) in midlife increases risk of late‐life dementia, but the impact of BPV on the cognition of adults who have already reached older ages free of major cognitive deficits is unknown. We examined the risk of incident dementia and cognitive decline associated with long‐term, visit‐to‐visit BPV in a post hoc analysis of the ASPREE (Aspirin in Reducing Events in the Elderly) trial. Methods and Results ASPREE participants (N=19 114) were free of dementia and significant cognitive impairment at enrollment. Measurement of BP and administration of a standardized cognitive battery evaluating global cognition, delayed episodic memory, verbal fluency, and processing speed and attention occurred at baseline and follow‐up visits. Time‐to‐event analysis using Cox proportional hazards regression models were used to calculate hazard ratios (HR) and corresponding 95% CI for incident dementia and cognitive decline, according to tertile of SD of systolic BPV. Individuals in the highest BPV tertile compared with the lowest had an increased risk of incident dementia and cognitive decline, independent of average BP and use of antihypertensive drugs. There was evidence that sex modified the association with incident dementia (interaction P=0.02), with increased risk in men (HR, 1.68; 95% CI, 1.19–2.39) but not women (HR, 1.01; 95% CI, 0.72–1.42). For cognitive decline, similar increased risks were observed for men and women (interaction P=0.15; men: HR, 1.36; 95% CI, 1.16–1.59; women: HR, 1.14; 95% CI, 0.98–1.32). Conclusions High BPV in older adults without major cognitive impairment, particularly men, is associated with increased risks of dementia and cognitive decline. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583; isrctn.com. Identifier: ISRCTN83772183.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science College of Pharmacy The University of Iowa Iowa City IA.,Department of Family Medicine Carver College of Medicine The University of Iowa Iowa City IA
| | - Joanne Ryan
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Enayet K Chowdhury
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia.,School of Public Health Curtin University Perth Western Australia Australia
| | | | - Lawrence J Beilin
- Medical School Royal Perth HospitalUniversity of Western Australia Perth Western Australia Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia.,School of Public Health Curtin University Perth Western Australia Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Raj C Shah
- Department of Family Medicine Rush University Medical Center Chicago IL.,Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health Melbourne Victoria Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research Hennepin-Health Research InstituteHennepin Healthcare Minneapolis MN.,Division of Geriatrics Department of Medicine Hennepin Healthcare Minneapolis MN
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Lockery JE, Broder JC, Ryan J, Stewart AC, Woods RL, Chong TTJ, Cloud GC, Murray A, Rigby JD, Shah R, Storey E, Ward SA, Wolfe R, Reid CM, Collyer TA, Ernst ME. A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults. J Gen Intern Med 2021; 36:1629-1637. [PMID: 33754317 PMCID: PMC8175463 DOI: 10.1007/s11606-020-06550-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Anticholinergic medications may increase risk of dementia and stroke, but prospective studies in healthy older people are lacking. OBJECTIVE Compare risk of incident dementia and stroke by anticholinergic burden among initially healthy older people. DESIGN Prospective cohort study. SETTING Primary care (Australia and USA). PARTICIPANTS 19,114 community-dwelling participants recruited for the ASPREE trial, aged 70+ years (65+ if US minorities) without major cardiovascular disease, dementia diagnosis, or Modified Mini-Mental State Examination score below 78/100. MEASUREMENTS Baseline anticholinergic exposure was calculated using the Anticholinergic Cognitive Burden (ACB) score. Dementia was adjudicated using Diagnostic and Statistical Manual of Mental Disorders volume IV criteria, and stroke using the World Health Organization definition. RESULTS At baseline, 15,000 participants (79%) had an ACB score of zero, 2930 (15%) a score of 1-2, and 1184 (6%) a score of ≥ 3 (indicating higher burden). After a median follow-up of 4.7 years and adjusting for baseline covariates, a baseline ACB score of ≥ 3 was associated with increased risk of ischemic stroke (adjusted HR 1.58, 95% CI 1.06, 2.35), or dementia (adjusted HR 1.36, 95% CI 1.01, 1.82), especially of mixed etiology (adjusted HR 1.53, 95% CI 1.06, 2.21). Results were similar for those exposed to moderate/highly anticholinergic medications. LIMITATIONS Residual confounding and reverse causality are possible. Assessment of dose or duration was not possible. CONCLUSIONS High anticholinergic burden in initially healthy older people was associated with increased risk of incident dementia and ischemic stroke. A vascular effect may underlie this association. These findings highlight the importance of minimizing anticholinergic exposure in healthy older people.
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Affiliation(s)
- Jessica E Lockery
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia.
| | - Jonathan C Broder
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Joanne Ryan
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Ashley C Stewart
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Robyn L Woods
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Trevor T-J Chong
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Geoffrey C Cloud
- Department of Clinical Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Anne Murray
- Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA
- Division of Geriatrics, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jason D Rigby
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Raj Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Elsdon Storey
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Stephanie A Ward
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
| | - Rory Wolfe
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Taya A Collyer
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
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Zhou Z, Ryan J, Ernst ME, Zoungas S, Tonkin AM, Woods RL, McNeil JJ, Reid CM, Curtis AJ, Wolfe R, Wrigglesworth J, Shah RC, Storey E, Murray A, Orchard SG, Nelson MR. Effect of Statin Therapy on Cognitive Decline and Incident Dementia in Older Adults. J Am Coll Cardiol 2021; 77:3145-3156. [PMID: 34167639 DOI: 10.1016/j.jacc.2021.04.075] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The neurocognitive effect of statins in older adults remain uncertain. OBJECTIVES The aim of this study was to investigate the associations of statin use with cognitive decline and incident dementia among older adults. METHODS This analysis included 18,846 participants ≥65 years of age in a randomized trial of aspirin, who had no prior cardiovascular events, major physical disability, or dementia initially and were followed for 4.7 years. Outcome measures included incident dementia and its subclassifications (probable Alzheimer's disease, mixed presentations); mild cognitive impairment (MCI) and its subclassifications (MCI consistent with Alzheimer's disease, other MCI); and changes in domain-specific cognition, including global cognition, memory, language and executive function, psychomotor speed, and the composite of these domains. Associations of baseline statin use versus nonuse with dementia and MCI outcomes were examined using Cox proportional hazards models and with cognitive change using linear mixed-effects models, adjusting for potential confounders. The impact of statin lipophilicity on these associations was further examined, and effect modifiers were identified. RESULTS Statin use versus nonuse was not associated with dementia, MCI, or their subclassifications or with changes in cognitive function scores over time (p > 0.05 for all). No differences were found in any outcomes between hydrophilic and lipophilic statin users. Baseline neurocognitive ability was an effect modifier for the associations of statins with dementia (p for interaction < 0.001) and memory change (p for interaction = 0.02). CONCLUSIONS In adults ≥65 years of age, statin therapy was not associated with incident dementia, MCI, or declines in individual cognition domains. These findings await confirmation from ongoing randomized trials.
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Affiliation(s)
- Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Andrea J Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jo Wrigglesworth
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anne Murray
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA; Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, Minnesota, USA; University of Minnesota, Minneapolis, Minnesota, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Gilmartin-Thomas JFM, Forbes A, Liew D, McNeil JJ, Cicuttini FM, Owen AJ, Ernst ME, Nelson MR, Lockery J, Ward SA, Busija L. Evaluation of the Pain Impact Index for Community-Dwelling Older Adults Through the Application of Rasch Modelling. Pain Pract 2021; 21:501-512. [PMID: 33295122 PMCID: PMC8187294 DOI: 10.1111/papr.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate the Pain Impact Index, a simple, brief, easy-to-use, and novel tool to assess the impact of chronic pain in community-dwelling older adults. METHODS A Rasch modelling analysis was undertaken in Stata using a partial credit model suited to the Likert-type items that comprised the Index. The Index was evaluated for ordering of category thresholds, unidimensionality, overall fit to the Rasch model, measurement bias (Differential Item Functioning, DIF), targeting, and construct validity. RESULTS The four-item Pain Impact Index was self-completed by 6454 community-dwelling Australians who were aged at least 70 years and experienced pain on most days. Two items showed evidence of threshold disordering, and this was resolved by collapsing response categories (from 5 to 3) for all items. The rescored Index conformed to the unidimensionality assumption and had satisfactory fit with the Rasch model (analyses conducted on a reduced sample size to mitigate the potential for overpowering: n = 377, P > 0.0125, power > 77%). When considering uniform DIF, the most frequent sources of measurement bias were age, knee pain, and upper back pain. When considering nonuniform DIF, the most frequent source of measurement bias was knee pain. The Index had good ability to differentiate between respondents with different levels of pain impact and had highest measurement precision for respondents located around the average level of pain impact in the study sample. Both convergent and discriminant validity of the Index were supported. CONCLUSION The Pain Impact Index showed evidence of unidimensionality, was able to successfully differentiate between levels of pain impact, and had good evidence of construct validity.
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Affiliation(s)
- Julia F-M Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alice J Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, U.S.A
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, U.S.A
| | - Mark R Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jessica Lockery
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ljoudmila Busija
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Mahady SE, Margolis KL, Chan A, Polekhina G, Woods RL, Wolfe R, Nelson MR, Lockery JE, Wood EM, Reid C, Ernst ME, Murray A, Thao LTP, McNeil JJ. Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial. Gut 2021; 70:717-724. [PMID: 32747412 PMCID: PMC7957959 DOI: 10.1136/gutjnl-2020-321585] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is a lack of robust data on significant gastrointestinal bleeding in older people using aspirin. We calculated the incidence, risk factors and absolute risk using data from a large randomised, controlled trial. DESIGN Data were extracted from an aspirin versus placebo primary prevention trial conducted throughout 2010-2017 ('ASPirin in Reducing Events in the Elderly (ASPREE)', n=19 114) in community-dwelling persons aged ≥70 years. Clinical characteristics were collected at baseline and annually. The endpoint was major GI bleeding that resulted in transfusion, hospitalisation, surgery or death, adjudicated independently by two physicians blinded to trial arm. RESULTS Over a median follow-up of 4.7 years (88 389 person years), there were 137 upper GI bleeds (89 in aspirin arm and 48 in placebo arm, HR 1.87, 95% CI 1.32 to 2.66, p<0.01) and 127 lower GI bleeds (73 in aspirin and 54 in placebo arm, HR 1.36, 95% CI 0.96 to 1.94, p=0.08) reflecting a 60% increase in bleeding overall. There were two fatal bleeds in the placebo arm. Multivariable analyses indicated age, smoking, hypertension, chronic kidney disease and obesity increased bleeding risk. The absolute 5-year risk of bleeding was 0.25% (95% CI 0.16% to 0.37%) for a 70 year old not on aspirin and up to 5.03% (2.56% to 8.73%) for an 80 year old taking aspirin with additional risk factors. CONCLUSION Aspirin increases overall GI bleeding risk by 60%; however, the 5-year absolute risk of serious bleeding is modest in younger, well individuals. These data may assist patients and their clinicians to make informed decisions about prophylactic use of aspirin. TRIAL REGISTRATION NUMBER ASPREE. NCT01038583.
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Affiliation(s)
- Suzanne E Mahady
- School of Public Health & Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia .,Gastroenterology, Melbourne Health, Parkville, Victoria, Australia
| | | | - Andrew Chan
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Galina Polekhina
- School of Public Health & Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health & Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health & Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jessica E Lockery
- School of Public Health & Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Erica M Wood
- School of Public Health & Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Christopher Reid
- School of Public Health & Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
| | - Anne Murray
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA,Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - LTP Thao
- School of Public Health & Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health & Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
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50
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Mehta RS, Kochar BD, Kennelty K, Ernst ME, Chan AT. Emerging approaches to polypharmacy among older adults. Nat Aging 2021; 1:347-356. [PMID: 37117591 DOI: 10.1038/s43587-021-00045-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/10/2021] [Indexed: 12/22/2022]
Abstract
Polypharmacy is a major health issue for older adults. Entangled with several geriatric syndromes, including frailty, falls and cognitive decline, research focused on polypharmacy has been challenged by heterogeneity in its definition, confounding by comorbidities and limited prospective data. In this Review, we discuss varying definitions for polypharmacy and highlight the need for a uniform definition for future studies. We critically appraise strategies for reducing medication prescriptions and implementing deprescribing as a mechanism to reduce the potential harmful effects of polypharmacy. As we look to the future, we assess the role of novel analytics and high-throughput technology, including multiomics profiling, to advance research in polypharmacy and the development of new strategies for risk stratification in the age of precision medicine.
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Affiliation(s)
- Raaj S Mehta
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bharati D Kochar
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Korey Kennelty
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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