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The study aims to evaluate the relationship if any between subclinical hypothyroidism and the risk of coronary heart disease (CHD) and mortality. The results indicate that an association does exist between the two.

The study attempts to\ evaluate the relationship and association between adiposity and the increased risk of type 2 diabetes in adults of 65 years of age or older. The results indicate that in the case of such adults, overall and central adiposity and weight gain are associated with an increased risk of diabetes.

A study to demonstrate that the ability to walk 400 m and timed performance discriminate mortality and cardiovascular risk and risk for mobility limitation and disability in community dwelling older adults without known difficulty performing mobility-related tasks is illustrated. The findings provide validation of the importance of having the capacity to walk longer distances and show that there is a wide range of function and risk in apparently well-functioning older adults.

A study is conducted to determine whether the angiotensin-converting enzyme (ACE) genotype interacts with significant physical activity to affect the incidence of mobility limitation in well-functioning older adults. The findings indicate that older individuals who exercised with ACE are less likely to develop mobility limitation than those who did not exercise.

A study conducted to determine whether the metabolic syndrome is a risk factor for cognitive decline and if this association is modified by inflammation is presented. It is concluded that high-functioning elders with the metabolic syndrome had an increased risk of developing cognitive impairment.

Symptoms of disease appear to be more accurate predictors of death in elderly patients than the patient's medical history. This was the conclusion of the Cardiovascular Health Study, which followed 5,886 men and women 65 years and older for five years. During that time, 646 people died. Factors associated with death included male sex, poverty, increasing age, lack of exercise, smoking, elevated blood glucose levels, symptoms of cardiovascular disease, disability and difficulties with activities of daily living., Context. -- Multiple factors contribute to mortality in older adults, but the extent to which subclinical disease and other factors contribute independently to mortality risk is not known. Objective. -- To determine the disease, functional, and personal characteristics that jointly predict mortality in community-dwelling men and women aged 65 years or older. Design. -- Prospective population-based cohort study with 5 years of follow-up and a validation cohort of African Americans with 4.25-year follow-up. Setting. -- Four US communities. Participants. -- A total of 5201 and 685 men and women aged 65 years or older in the original and African American cohorts, respectively. Main Outcome Measures. -- Five-year mortality. Results. -- In the main cohort, 646 deaths (12%) occurred within 5 years. Using Cox proportional hazards models, 20 characteristics (of 78 assessed) were each significantly P [is less than].05) and independently associated with mortality: increasing age, male sex, income less than $50 000 per year, low weight, lack of moderate or vigorous exercise, smoking for more than 50 pack-years, high brachial ([is greater] 169 mm Hg) and low tibial ([is less than or equal to] 127 mm Hg) systolic blood pressure, diuretic use by those without hypertension or congestive heart failure, elevated fasting glucose level ([is greater than] 7.2 mmol/L [130 mg/dL]), low albumin level ([is less than or equal to] 37 g/L), elevated creatinine level ([is greater than or equal to] 106 [Mu]mol/L [1.2 mg/dL]), low forced vital capacity ([is less than or equal to] 2.06 mL), aortic stenosis (moderate or severe) and abnormal left ventricular ejection fraction (by echocardiography), major electrocardiographic abnormality, stenosis of internal carotid artery (by ultrasound), congestive heart failure, difficulty in any instrumental activity of daily living, and low cognitive function by Digit Symbol Substitution test score. Neither high-density lipoprotein cholesterol nor low-density lipoprotein cholesterol was associated with mortality. After adjustment for other factors, the association between age and mortality diminished, but the reduction in mortality with female sex persisted. Finally, the risk of mortality was validated in the second cohort; quintiles of risk ranged from 2% to 39% and 0% to 26% for the 2 cohorts. Conclusions. -- Objective measures of subclinical disease and disease severity were independent and joint predictors of 5-year mortality in older adults, along with male sex, relative poverty, physical activity, smoking, indicators of frailty, and disability. Except for history of congestive heart failure, objective, quantitative measures of disease were better predictors of mortality than was clinical history of disease. JAMA. 1998;279:585-592

Elderly women with a low ankle/arm blood pressure index (AAI) may have higher risk of death from cardiovascular disease. AAI is a measurement used to detect the presence of arterial disease in the lower extremities. A low AAI is a reading of less than 0.9. Among 1,492 healthy white women over 65 years old, 5.5% had a low AAI. Most women with a low AAI did not have any other symptoms such as limping or lameness. Women with a low AAI had a higher risk of dying from all causes within four years than women with a higher AAI. Individuals with a low AAI also had a higher risk of dying from cancer, heart disease and different types of cardiovascular disease., Objective. - To evaluate the relationship of the ankle/arm blood pressure index to short-term mortality in women 65 years of age or older. Design. - Prospective cohort study with average follow-up of 4.3 years. Setting. - Rural community near Pittsburgh, Pa. Participants. - A total of 1492 white women 65 year's of age or older, living in the community and ambulatory without the help of another person. Outcome Measures. - All-cause and cause-specific mortality. Results. - The ankle/arm index (the systolic pressure in the posterior tibial artery divided by that in the brachial artery) was measured in 1986 through 1988 and found to be 0.9 or less in 82 (5.5%) of the women, 67 of whom reported no symptoms of claudication. Comparing women with an index of 0.9 or less with those with an index greater than 0.9, the relative risk for all-cause mortality 4 years later (after adjustment for age, smoking, and other risk factors) was 3.1 (95% confidence interval [Cl], 1.7 to 5.5); for heart disease, 3.7 (95% Cl, 1.2 to 11.6); for cardiovascular diseases, 4.0 (95% Cl, 1.3 to 8.5); for cancer, 3.3 (95% Cl, 1.3 to 8.5); and for all other causes, 1.1 (95% Cl, 0.1 to 9.2). Similar levels of risk were found after excluding women with symptoms of claudication and/or a history of cardiovascular disease at baseline. Conclusions. - Healthy, older women with an ankle/arm index of 0.9 or less are at high risk of death and therefore may be considered for aggressive therapy to modify cardiovascular risk factors.

A low ankle/arm blood pressure index (AAI) may predict a higher risk of death or complications from coronary heart disease (CHD) or cardiovascular disease (CVD) in elderly patients with hypertension. Hypertension is chronic high arterial blood pressure. AAI is a blood pressure measurement that compares the pressures measured in the arm and the ankle. Among 1,537 patients over 60 years old with hypertension, 25.5% had a low AAI. Individuals with a low AAI were more likely to have other major risk factors for CHD or CVD than those with a higher AAI. Three and one-third percent of the patients with a low AAI died from CHD, compared with just under 1% of those with a higher AAI. Nearly five percent of the individuals with a low AAI died from CVD, compared with 1.2% of those with a higher AAI. Patients with a low AAI also experienced more episodes reflecting cardiovascular disease., Objective. - To evaluate the relationship between the ankle/arm blood pressure index (AAI, the ratio of ankle to arm systolic blood pressure, a measure of peripheral arterial disease) and short-term cardiovascular morbidity and mortality in older adults with systolic hypertension. Design. - Prospective cohort study, 1- to 2-year follow-up (mean, 16 months). Setting. - Eleven of 16 field centers from the Systolic Hypertension in the Elderly Program. Participants. - 1537 older men and women with systolic hypertension. Main Outcome Measures. - All-cause mortality, coronary heart disease (CHD) mortality, cardiovascular disease (CVD) mortality, and CHD and CVD morbidity and mortality. Results. - the AAI was measured at the 1989-1990 clinic examination and was 0.9 or less in 25.5% of 1537 participants. A low AAI was associated with most major CHD and CVD risk factors. In those with a low AAI ([is less than or equal to] 0.9) compared with those with an AAI of more than 0.9, age- and sex-adjusted relative risks for mortality end points at follow-up were as follows: total mortality, 3.8 (95% confidence interval [CI], 2.1 to 6.9); CHD mortality, 3.24 (95% CI, 1.4 to 7.5); and CVD mortality, 3.7 (95% CI, 1.8 to 7.7). For CVD morbidity and mortality, the age- and sex-adjusted relative risk was 2.5 (95% CI, 1.5 to 4.3). After adjustment for baseline CVD and other cardiovascular risk factors, the relative risk for total mortality was 4.1 (95% CI, 2.0 to 8.3) and for CVD morbidity and mortality, 2.4 (95% CI, 1.3 to 4.4). Results were similar when participants with clinical CVD at baseline were excluded. Conclusion. - A low AAI appears to be an important predictor of morbidity and mortality among older adults with systolic hypertension.

People with sleep apnea may have a higher risk of hypertension. People with sleep apnea stop breathing periodically throughout the night. Researchers gave 6,132 patients equipment to measure their breathing and blood oxygen levels at home while they slept. After adjusting for other causes of hypertension, people with the most severe sleep apnea were 37% more likely to have high blood pressure than people with mild sleep apnea. This was true in all age groups and ethnic groups and also in normal-weight and overweight people.

This Viewpoint outlines the challenges posed by the COVID-19 pandemic in conducting clinical trials and offers some solutions to those barriers. [ABSTRACT FROM AUTHOR]

Importance: In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability.Objective: To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability.Design, Setting, and Participants: The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m.Interventions: Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n = 817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises.Main Outcomes and Measures: The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m.Results: Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P = .03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P = .006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]).Conclusions and Relevance: A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults.Trial Registration: clinicaltrials.gov Identifier: NCT01072500. [ABSTRACT FROM AUTHOR]

The article details a study which examined the risks of total and coronary heart disease (CHD) mortality, CHD events, and atrial fibrillation (AF) associated with endogenous subclinical hyperthyroidism. Of the 52,674 study subjects, 4.2 percent were found to have clinical hyperthyroidism. Study authors concluded that endogenous subclinical hyperthyroidism is associated with increased risks of total and CHD mortality, and AF development.

Context: In populations of older adults, prediction of coronary heart disease (CHD) events through traditional risk factors is less accurate than in middle-aged adults. Electrocardiographic (ECG) abnormalities are common in older adults and might be of value for CHD prediction.Objective: To determine whether baseline ECG abnormalities or development of new and persistent ECG abnormalities are associated with increased CHD events.Design, Setting, and Participants: A population-based study of 2192 white and black older adults aged 70 to 79 years from the Health, Aging, and Body Composition Study (Health ABC Study) without known cardiovascular disease. Adjudicated CHD events were collected over 8 years between 1997-1998 and 2006-2007. Baseline and 4-year ECG abnormalities were classified according to the Minnesota Code as major and minor. Using Cox proportional hazards regression models, the addition of ECG abnormalities to traditional risk factors were examined to predict CHD events.Main Outcome Measure: Adjudicated CHD events (acute myocardial infarction [MI], CHD death, and hospitalization for angina or coronary revascularization).Results: At baseline, 276 participants (13%) had minor and 506 (23%) had major ECG abnormalities. During follow-up, 351 participants had CHD events (96 CHD deaths, 101 acute MIs, and 154 hospitalizations for angina or coronary revascularizations). Both baseline minor and major ECG abnormalities were associated with an increased risk of CHD after adjustment for traditional risk factors (17.2 per 1000 person-years among those with no abnormalities; 29.3 per 1000 person-years; hazard ratio [HR], 1.35; 95% CI, 1.02-1.81; for minor abnormalities; and 31.6 per 1000 person-years; HR, 1.51; 95% CI, 1.20-1.90; for major abnormalities). When ECG abnormalities were added to a model containing traditional risk factors alone, 13.6% of intermediate-risk participants with both major and minor ECG abnormalities were correctly reclassified (overall net reclassification improvement [NRI], 7.4%; 95% CI, 3.1%-19.0%; integrated discrimination improvement, 0.99%; 95% CI, 0.32%-2.15%). After 4 years, 208 participants had new and 416 had persistent abnormalities. Both new and persistent ECG abnormalities were associated with an increased risk of subsequent CHD events (HR, 2.01; 95% CI, 1.33-3.02; and HR, 1.66; 95% CI, 1.18-2.34; respectively). When added to the Framingham Risk Score, the NRI was not significant (5.7%; 95% CI, -0.4% to 11.8%).Conclusions: Major and minor ECG abnormalities among older adults were associated with an increased risk of CHD events. Depending on the model, adding ECG abnormalities was associated with improved risk prediction beyond traditional risk factors. [ABSTRACT FROM AUTHOR]

Objective: To study the associations of retinal microvascular changes, which are associated with systemic conditions and cognitive decline, with disability in performing activities of daily living (ADL). Design: Prospective cohort study of 1487 communitydwelling participants in the Cardiovascular Health Study (mean age, 78 years) who were free of ADL disability and had available data on retinal signs and carotid intimamedia thickness at the 1998-1999 visit. Main outcome measures were incident ADL disability, defined as selfreported difficulty in performing any ADL, by the presence of retinal signs and advanced carotid atherosclerosis, defined by carotid intima-media thickness in the 80th percentile or more or 25% or more stenosis, and potential mediation by cerebral microvascular disease on brain imaging or by executive dysfunction, slow gait, and depressive mood, which are symptoms of frontal subcortical dysfunction. Results: During the median follow-up of 3.1 years (maximum, 7.8 years), participants with 2 or more retinal signs had a higher rate of disability than those with fewer than 2 retinal signs (10.1% vs 7.1%; adjusted hazard ratio, 1.45; 95% confidence interval, 1.24-1.69; P>.001). There was no evidence of interaction by advanced carotid atherosclerosis (P>.10). The association seemed to be partially mediated by executive dysfunction, slow gait, and depressive symptoms but not by cerebral microvascular disease on brain imaging. Conclusions: These results provide further support for the pathophysiologic and prognostic significance of microvascular disease in age-related disability. However, it remains to be determined how to best use retinal photography in clinical risk prediction. [ABSTRACT FROM AUTHOR]

The article discusses a study which evaluated the relationship between gait speed and survival in geriatric patients, as well as determined the degree to which gait speed explains variability in survival after accounting for age and sex. The study's design, setting and participants are described. Main outcome measures include survival rates and life expectancy. The study found that survival increased across the full range of gait speeds based on the pooled analysis of individual data from 9 selected cohorts.

Background: Diabetes and the apolipoprotein E e4 allele (APOE e4) increase the risk for Alzheimer disease (AD). We hypothesize that APOE e4 may modify the risk for AD in individuals with diabetes. Objective: To examine the joint effect of type 2 diabetes and APOE e4 on the risk of AD, AD with vascular dementia (mixed AD), and vascular dementia without AD. Design: The Cardiovascular Health Study (CHS) Cognition Study (1992-2000) is a prospective study designed to identify all existing and new cases of dementia among study participants. Diagnoses were made according to international criteria for dementia and subtypes. There were 2547 dementia-free participants in the CHS Cognition Study cohort with complete information on APOE e4 and type 2 diabetes status; among these, 411 new cases of dementia developed. Risk of dementia was estimated with a Cox proportional hazard model adjusted for age and other demographic and cardiovascular risk factors. Results: Compared with those who had neither type 2 diabetes nor APOE e4, those with both factors had a significantly higher risk of AD (hazard ratio, 4.58; 95% confidence interval, 2.18-9.65) and mixed AD (hazard ratio, 3.89; 95% confidence interval, 1.46-10.40). Conclusion: These data suggest that having both diabetes and APOE e4 increases the risk of dementia, especially for AD and mixed AD. [ABSTRACT FROM AUTHOR]