OBJECTIVES: To examine the association between muscle strength and total and cause‐specific mortality and the plausible contributing factors to this association, such as presence of diseases commonly ...underlying mortality, inflammation, nutritional deficiency, physical inactivity, smoking, and depression.
DESIGN: Prospective population‐based cohort study with mortality surveillance over 5 years.
SETTING: Elderly women residing in the eastern half of Baltimore, Maryland, and part of Baltimore County.
PARTICIPANTS: Nine hundred nineteen moderately to severely disabled women aged 65 to 101 who participated in handgrip strength testing at baseline as part of the Women's Health and Aging Study.
MEASUREMENTS: Cardiovascular disease (CVD), cancer, respiratory disease, other measures (not CVD, respiratory, or cancer), total mortality, handgrip strength, and interleukin‐6.
RESULTS: Over the 5‐year follow‐up, 336 deaths occurred: 149 due to CVD, 59 due to cancer, 38 due to respiratory disease, and 90 due to other diseases. The unadjusted relative risk (RR) of CVD mortality was 3.21 (95% confidence interval (CI) = 2.00–5.14) in the lowest and 1.88 (95% CI = 1.11–3.21) in the middle compared with the highest tertile of handgrip strength. The unadjusted RR of respiratory mortality was 2.38 (95% CI = 1.09–5.20) and other mortality 2.59 (95% CI = 1.59–4.20) in the lowest versus the highest grip‐strength tertile. Cancer mortality was not associated with grip strength. After adjusting for age, race, body height, and weight, the RR of CVD mortality decreased to 2.17 (95% CI = 1.26–3.73) in the lowest and 1.56 (95% CI = 0.89–2.71) in the middle, with the highest grip‐strength tertile as the reference. Further adjustments for multiple diseases, physical inactivity, smoking, interleukin‐6, C‐reactive protein, serum albumin, unintentional weight loss, and depressive symptoms did not materially change the risk estimates. Similar results were observed for all‐cause mortality.
CONCLUSION: In older disabled women, handgrip strength was a powerful predictor of cause‐specific and total mortality. Presence of chronic diseases commonly underlying death or the mechanisms behind decline in muscle strength in chronic disease, such as inflammation, poor nutritional status, disuse, and depression, all of which are independent predictors of mortality, did not explain the association. Handgrip strength, an indicator of overall muscle strength, may predict mortality through mechanisms other than those leading from disease to muscle impairment. Grip strength tests may help identify patients at increased risk of deterioration of health.
Due to the aging and increasingly complex nature of our patients, frailty has become a high-priority theme in cardiovascular medicine. Despite the recognition of frailty as a pivotal element in the ...evaluation of older adults with cardiovascular disease (CVD), there has yet to be a road map to facilitate its adoption in routine clinical practice. Thus, we sought to synthesize the existing body of evidence and offer a perspective on how to integrate frailty into clinical practice. Frailty is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Upward of 20 frailty assessment tools have been developed, with most tools revolving around the core phenotypic domains of frailty—slow walking speed, weakness, inactivity, exhaustion, and shrinking—as measured by physical performance tests and questionnaires. The prevalence of frailty ranges from 10% to 60%, depending on the CVD burden, as well as the tool and cutoff chosen to define frailty. Epidemiological studies have consistently demonstrated that frailty carries a relative risk of >2 for mortality and morbidity across a spectrum of stable CVD, acute coronary syndromes, heart failure, and surgical and transcatheter interventions. Frailty contributes valuable prognostic insights incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients. Interventions designed to improve outcomes in frail elders with CVD such as multidisciplinary cardiac rehabilitation are being actively tested. Ultimately, frailty should not be viewed as a reason to withhold care but rather as a means of delivering it in a more patient-centered fashion.
Aging is characterized by rising susceptibility to development of multiple chronic diseases and, therefore, represents the major risk factor for multimorbidity. From a gerontological perspective, the ...progressive accumulation of multiple diseases, which significantly accelerates at older ages, is a milestone for progressive loss of resilience and age-related multisystem homeostatic dysregulation. Because it is most likely that the same mechanisms that drive aging also drive multiple age-related chronic diseases, addressing those mechanisms may reduce the development of multimorbidity. According to this vision, studying multimorbidity may help to understand the biology of aging and, at the same time, understanding the underpinnings of aging may help to develop strategies to prevent or delay the burden of multimorbidity. As a consequence, we believe that it is time to build connections and dialogue between the clinical experience of general practitioners and geriatricians and the scientists who study aging, so as to stimulate innovative research projects to improve the management and the treatment of older patients with multiple morbidities.
Omalizumab is a biological drug targeting circulating IgE, approved for use in allergic asthma, chronic spontaneous urticaria, and recently for chronic rhinosinusitis with nasal polyps, with good ...efficacy in all these settings. Some concerns about omalizumab safety have been raised as its use has been recently linked to potential increased cancer risk. Nevertheless, literature evidence does not support this statement, and clinical studies and evidence from real-world registries and surveillance analysis have consistently reported drug safety.
OBJECTIVES: To describe a set of complex walking tasks (CWTs) that can be used to evaluate mobility and to characterize age‐ and sex‐specific performance on these tests.
DESIGN: A population‐based ...study of persons living in the Chianti geographic area (Tuscany, Italy).
SETTING: Community.
PARTICIPANTS: One thousand two hundred twenty‐seven persons (aged 20–95) selected from the city registries of Greve and Bagno a Ripoli (Tuscany, Italy).
MEASUREMENTS: Gait velocity (m/s) was measured during 13 walking tests (Walking InCHIANTI Toolkit (WIT)) used to examine walking ability under a range of conditions and distances. Other measures included performance on the Short Physical Performance Battery and self‐reported health and functional status, including disability in activities of daily living.
RESULTS: Age‐associated differences on the WIT were reflected in the number of older adults unable to complete CWTs and a decrease in gait velocity. For all tasks, decrements in walking speed with increasing age were significantly larger at aged 65 and older. Performance on CWTs was highly variable and could not be explained by usual gait speed measured under low‐challenge conditions alone.
CONCLUSION: CWTs may provide important insight into mobility function, particularly in persons with normal or near‐normal usual gait speed. Further research is needed to elucidate the specific physiological mechanisms that contribute to declining performance on CWT with increasing age.
OBJECTIVES: To determine whether lower ankle brachial index (ABI) levels are associated with lower calf skeletal muscle area and higher calf muscle percentage fat in persons with and without lower ...extremity peripheral arterial disease (PAD).
DESIGN: Cross‐sectional.
SETTING: Three Chicago‐area medical centers.
PARTICIPANTS: Four hundred thirty‐nine persons with PAD (ABI<0.90) and 265 without PAD (ABI 0.90–1.30).
MEASUREMENTS: Calf muscle cross‐sectional area and the percentage of fat in calf muscle were measured using computed tomography at 66.7% of the distance between the distal and proximal tibia. Physical activity was measured using an accelerometer. Functional measures included the 6‐minute walk, 4‐meter walking speed, and the Short Physical Performance Battery (SPPB).
RESULTS: Adjusting for age, sex, race, comorbidities, and other potential confounders, lower ABI values were associated with lower calf muscle area (ABI<0.50, 5,193 mm2; ABI 0.50–0.90, 5,536 mm2; ABI 0.91–1.30, 5,941 mm2; P for trend<.001). These significant associations remained after additional adjustment for physical activity. In participants with PAD, lower calf muscle area in the leg with higher ABI was associated with significantly poorer performance in usual‐ and fast‐paced 4‐meter walking speed and on the SPPB, adjusting for ABI, physical activity, percentage fat in calf muscle, muscle area in the leg with lower ABI, and other confounders (P<.05 for all comparisons).
CONCLUSION: These data support the hypothesis that lower extremity ischemia has a direct adverse effect on calf skeletal muscle area. This association may mediate previously established relationships between PAD and functional impairment.
Pulse Wave Velocity Is an Independent Predictor of the Longitudinal Increase in Systolic Blood Pressure and of Incident Hypertension in the Baltimore Longitudinal Study of Aging Samer S. Najjar, ...Angelo Scuteri, Veena Shetty, Jeanette G. Wright, Denis C. Muller, Jerome L. Fleg, Harold P. Spurgeon, Luigi Ferrucci, Edward G. Lakatta Pulse wave velocity (PWV) was assessed in 449 volunteers (age 53 ± 17 years) whose blood pressure was measured over 4.9 ± 2.5 years of follow-up. By linear mixed effects regressions, PWV was an independent determinant of the longitudinal increase in systolic blood pressure. In the subset who were normotensive at baseline and who were followed up for >4.3 years, PWV was also an independent predictor of incident hypertension (hazard ratio 1.10, p = 0.03). This suggests that PWV could help identify normotensive individuals who should be targeted for the implementation of interventions aimed at preventing or delaying the progression of subclinical arterial stiffening and the onset of hypertension.
Objectives: To determine the changes in serum erythropoietin with age in patients with and without anemia and to assess the importance of certain comorbidities on changes in erythropoietin level and ...the development of anemia.
Design: Clinical history, hematological parameters, and serum erythropoietin levels were examined at 1‐ to 2‐year intervals for 8 to 30 years.
Setting: Baltimore Longitudinal Study on Aging (BLSA), National Institute on Aging.
Participants: One hundred forty‐three BLSA participants.
Measurements: Complete blood count and serum chemistries were performed at the time of each visit, and archived serum samples were used for erythropoietin level.
Results: Although all subjects were healthy and without anemia at the time of initial evaluation, some developed chronic illness—most notably hypertension and diabetes mellitus. Erythropoietin levels rose significantly for the group as a whole, and the slope of the rise was found to be greater for those who did not have associated diabetes mellitus or hypertension. During the subsequent years, subjects who developed anemia but did not have hypertension or diabetes mellitus had the greatest slope in erythropoietin rise over time, whereas those with hypertension or diabetes mellitus and anemia had the lowest erythropoietin slope.
Conclusion: The increase in serum erythropoietin with aging may be compensation for subclinical blood loss, increased red blood cell turnover, or increased erythropoietin resistance of red cell precursors. It is suspected that, with very advanced age, or in those with compromised renal function (e.g., diabetes mellitus or hypertension), the compensatory mechanism becomes inadequate and anemia results.
OBJECTIVES: To examine the independent association between heart rate variability (HRV), a marker of cardiac autonomic function, and cognitive impairment.
DESIGN: Cross‐sectional analysis of baseline ...data from Women's Health and Aging Study I.
SETTING: Urban community in Baltimore, Maryland.
PARTICIPANTS: A subset of 311 physically disabled, community‐dwelling women aged 65 and older whose HRV data were obtained.
MEASUREMENTS: Reduced HRV was defined as the lowest quartile of each of several HRV measures exploring time and frequency domains and compared with the remaining three quartiles. Cognitive impairment was defined as a Mini‐Mental State Examination score less than 24. Multiple logistic regression was used to model the independent relationship between reduced HRV and prevalent cognitive impairment.
RESULTS: The age‐, education‐, and race‐adjusted prevalence of cognitive impairment was higher in those with reduced HRV than in those with nonreduced HRV. After adjusting for relevant demographic and clinical characteristics, participants with reduced HRV were significantly more likely than those with nonreduced HRV to have cognitive impairment; these findings were consistent across different HRV indices. In particular, reduced high‐frequency power, indicative of decreased parasympathetic activity, was associated with 6.7 times greater odds of cognitive impairment (95% confidence interval=2.27–20.0).
CONCLUSION: Cardiac autonomic dysfunction, particularly decreased parasympathetic activity, was independently associated with cognitive impairment in older disabled women in the community. This finding may improve understanding of the pathophysiological basis of cognitive impairment. The potential role of HRV as a cause or consequence of cognitive impairment needs to be elucidated in future studies.
To determine the association between glaucomatous visual field (VF) loss and the amount of physical activity and walking in normal life.
Prospective, observational study.
Glaucoma suspects without ...significant VF or visual acuity loss (controls) and glaucoma subjects with bilateral VF loss between 60 and 80 years of age.
Participants wore an accelerometer over 7 days of normal activity.
Daily minutes of moderate or vigorous physical activity (MVPA) was the primary measure. Steps per day was a secondary measure.
Fifty-eight controls and 83 glaucoma subjects provided sufficient study days for analysis. Control and glaucoma subjects were similar in age, race, gender, employment status, cognitive ability, and comorbid illness (P>0.1 for all). Better-eye VF mean deviation (MD) averaged 0.0 decibels (dB) in controls and -11.1 dB in glaucoma subjects. The median control subject engaged in 16.1 minutes of MVPA daily and walked 5891 steps/day, as compared with 12.9 minutes of MVPA daily (P = 0.25) and 5004 steps/day (P = 0.05) for the median glaucoma subject. In multivariate models, glaucoma was associated with 21% less MVPA (95% confidence interval CI, -53% to 32%; P = 0.37) and 12% fewer steps per day (95% CI, -22% to 9%; P = 0.21) than controls, although differences were not statistically significant. There was a significant dose response relating VF loss to decreased activity, with each 5 dB decrement in the better-eye VF associated with 17% less MVPA (95% CI, -30% to -2%; P = 0.03) and 10% fewer steps per day (95% CI, -16% to -5%; P = 0.001). Glaucoma subjects in the most severe tertile of VF damage (better-eye VF MD worse than -13.5 dB) engaged in 66% less MVPA than controls (95% CI, -82% to -37%; P = 0.001) and took 31% fewer steps per day (95% CI, -44% to -15%; P = 0.001). Other significant predictors of decreased physical activity included older age, comorbid illness, depressive symptoms, and higher body mass index.
Overall, no significant difference in physical activity was found between individuals with and without glaucoma, although substantial reductions in physical activity and walking were noted with greater levels of VF loss. Further study is needed to characterize better the relationship between glaucoma and physical activity.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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