Background This study aimed to describe the incidence of atrial fibrillation (AF) among older adults during 3 years of follow-up. Methods and Results In this cohort study, 5201 adults ≥65 years old were examined annually on four occasions between June 1989 and May 1993. At baseline, participants answered questionnaires and underwent a detailed examination that included carotid ultrasound, pulmonary function tests, ECG, and echocardiography. Subjects with a pacemaker or AF at baseline (n=357) were excluded. New cases of AF were identified from three sources: (1) annual self-reports, (2) annual ECGs, and (3) hospital discharge diagnoses. Cox proportional-hazards models were used to assess baseline risk factors as predictors of incident AF. Among 4844 participants, 304 developed a first episode of AF during an average follow-up of 3.28 years, for an incidence of 19.2 per 1000 person-years. The onset was strongly associated with age, male sex, and the presence of clinical cardiovascular disease. For men 65 to...

Incidence of and Risk Factors for Atrial Fibrillation in Older Adults

Background Cystatin C is a serum measure of renal function that appears to be independent of age, sex, and lean muscle mass. We compared creatinine and cystatin C levels as predictors of mortality from cardiovascular causes and from all causes in the Cardiovascular Health Study, a cohort study of elderly persons living in the community. Methods Creatinine and cystatin C were measured in serum samples collected from 4637 participants at the study visit in 1992 or 1993; follow-up continued until June 30, 2001. For each measure, the study population was divided into quintiles, with the fifth quintile subdivided into thirds (designated 5a, 5b, and 5c). Results Higher cystatin C levels were directly associated, in a dose–response manner, with a higher risk of death from all causes. As compared with the first quintile, the hazard ratios (and 95 percent confidence intervals) for death were as follows: second quintile, 1.08 (0.86 to 1.35); third quintile, 1.23 (1.00 to 1.53); fourth quintile, 1.34 (1.09 to 1.66);...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa043161

Cystatin C and the risk of death and cardiovascular events among elderly persons.

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 knownObjective—To determine the disease, functional, and personal characteristics that
jointly predict mortality in community-dwelling men and women aged 65 years
or olderDesign—Prospective population-based cohort study with 5 years of follow-up
and a validation cohort of African Americans with 425-year follow-upSetting—Four US communitiesParticipants—A total of 5201 and 685 men and women aged 65 years or older in the
original and African American cohorts, respectivelyMain Outcome Measures—Five-year mortalityResults—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<05) and independently associated
with mortality: increasing age, male sex, income less than $50000 per year,
low weight, lack of moderate or vigorous exercise, smoking for more than 50
pack-years, high brachial (>169 mm Hg) and low tibial (≤127 mm Hg) systolic
blood pressure, diuretic use by those without hypertension or congestive heart
failure, elevated fasting glucose level (>72 mmol/L [130 mg/dL]), low albumin
level (≤37 g/L), elevated creatinine level (≥106 µmol/L [12 mg/dL]),
low forced vital capacity (≤206 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 cohortsConclusions—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

https://jamanetwork.com/journals/jama/articlepdf/187277/joc7046.pdf

Risk Factors for 5-Year Mortality in Older Adults The Cardiovascular Health Study

The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study is a national, population-based, longitudinal study of 30,000 African-American and white adults aged ≧45 years. The objectiv

The reasons for geographic and racial differences in stroke study: objectives and design.

Markers of inflammation, such as C-reactive protein (CRP), are related to risk of cardiovascular disease (CVD) events in those with angina, but little is known about individuals without prevalent clinical CVD. We performed a prospective, nested case-control study in the Cardiovascular Health Study (CHS; 5201 healthy elderly men and women). Case subjects (n = 146 men and women with incident CVD events including angina, myocardial infarction, and death) and control subjects (n = 146) were matched on the basis of sex and the presence or absence of significant subclinical CVD at baseline (average follow-up, 2.4 years). In women but not men, the mean CRP level was higher for case subjects than for control subjects (P < or = .05). In general, CRP was higher in those with subclinical disease. Most of the association of CRP with female case subjects versus control subjects was in the subgroup with subclinical disease; 3.33 versus 1.90 mg/L, P < .05, adjusted for age and time of follow-up. Case-control differences were greatest when the time between baseline and the CVD event was shortest. The strongest associations were with myocardial infarction, and there was an overall odds ratio for incident myocardial infarction for men and women with subclinical disease (upper quartile versus lower three quartiles) of 2.67 (confidence interval [CI] = 1.04 to 6.81), with the relationship being stronger in women (4.50 [CI = 0.97 to 20.8]) than in men (1.75 [CI = 0.51 to 5.98]). We performed a similar study in the Rural Health Promotion Project, in which mean values of CRP were higher for female case subjects than for female control subjects, but no differences were apparent for men. Comparing the upper quintile with the lower four, the odds ratio for CVD case subjects was 2.7 (CI = 1.10 to 6.60). In conclusion, CRP was associated with incident events in the elderly, especially in those with subclinical disease at baseline.

Relationship of C-Reactive Protein to Risk of Cardiovascular Disease in the Elderly Results From the Cardiovascular Health Study and the Rural Health Promotion Project

The Cardiovascular Health Study is an observational cohort study of risk factors for cardiovascular disease in 5201 participants, ages > or = 65 years. We report the methods and quality-assurance results for blood procurement, processing, shipping, storage, and sample analysis used during the first examination period (May 1989-June 1990). The most frequent difficulty in phlebotomy and processing was the requirement of more than one venipuncture (in 2.6% of the participants). The CVs for control materials ranged from 0.93% for glucose to 10.7% for insulin; most were < 4%. In addition to standard quality-assurance methods, we applied two other methods: technical error calculation for replicates, and weighted linear regression to assess time trend in results of control materials. After outliers were excluded, technical error values ranged from 1.7 for uric acid to 18.8 for insulin. Factor VII and factor VIII had slight trends over the 12-month analysis period. Results of quality-assurance analyses used to resolve problems were successful, thereby improving the second laboratory examination.

Paula R. Howard

Papers

Laboratory methods and quality assurance in the Cardiovascular Health Study.