X

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Online Resource
    Online Resource
    Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease
    Massachusetts Medical Society ; 2021
    In:  New England Journal of Medicine Vol. 384, No. 21 ( 2021-05-27), p. 1981-1990
    Details
    In: New England Journal of Medicine, Massachusetts Medical Society, Vol. 384, No. 21 ( 2021-05-27), p. 1981-1990
    Type of Medium: Online Resource
    ISSN: 0028-4793 , 1533-4406
    URL: Article
    DOI: 10.1056/NEJMoa2102137
    RVK:
    XA 10000
    Language: English
    Publisher: Massachusetts Medical Society
    Publication Date: 2021
    detail.hit.zdb_id: 1468837-2
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 2
    Online Resource
    Online Resource
    Abstract P013: Prevalence and Outcomes of Anemia in Patients Hospitalized with Acute Decompensated Heart Failure: The ARIC Study Community Surveillance
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Circulation Vol. 127, No. suppl_12 ( 2013-03-26)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 127, No. suppl_12 ( 2013-03-26)
    Abstract: Background: Anemia has been associated with increased mortality in heart failure patients. The prevalence and outcomes of anemia in patients hospitalized with acute decompensated heart failure (ADHF) in population-based settings are unknown. Methods: Hospitalizations related to heart failure among black and white residents 55 years and older were sampled by stratified design from 4 US communities (total population age 55+ =177,000), January 1, 2005 -December 31,2008 in the Atherosclerosis Risk in Communities (ARIC) Study. Events were validated by physician review of medical records, and linked to mortality files. Those classified as definite or probable ADHF were included in the analysis; chronic, stable heart failure and hospitalizations not for heart failure were excluded. ADHF was further classified as heart failure with preserved (≥50%) or reduced ( 〈 50%) ejection fraction. Laboratory values were abstracted from the hospital record. Anemia was defined by WHO guidelines ( 〈 12 g/dL for women; 〈 13 g/dL for men), using the lowest hemoglobin. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-Epi formula using serum creatinine. Length of stay and mortality outcomes were analyzed by linear and logistic regression, respectively. All analyses were weighted to account for the sampling design and adjusted for race, age, sex, eGFR and smoking. Results: Over four years, 13,554 (weighted) hospitalized events for definite or probable ADHF occurred, based on 2,804 sampled events. Comorbidities of ADHF included: hypertension (84%), coronary heart disease (55%), chronic bronchitis or COPD (34%), diabetes (48%), and chronic kidney disease (eGFR 〈 60 mL/min/1.73m 2 ) (73%). Prevalence of anemia was 77% (95%CI: 75-79%) overall and did not differ by race (p=0.6), gender (p=0.1) or by subtype of heart failure based on preserved or reduced ejection fraction (p=0.09). Anemia was more common in patients over age 75 (80%; 95%CI: 78-83%) than patients aged 55-74 (73%; 95% CI: 70-76%); p 〈 .0001. Anemia was associated with an increased length of stay by 3.6 (95%CI: 3.0-4.3) days, and with 1-year mortality (OR=1.3, 95%CI: 1.0-1.8). In a subset of ADHF hospitalizations (N=7,989; 59%) with two hemoglobin values, anemia prevalence was 84% (95%CI:82-86%) by the lowest hemoglobin, improving to 72% (95%CI: 70-75%) by the last documented hemoglobin. Anemia resolved over the course of the hospitalization for 15% of patients; more commonly for women than men (18% vs. 11%; p=.002). Conclusion: Among patients hospitalized for ADHF in these 4 US areas, anemia was common, particularly for those over age 75, and was associated with a longer length of hospital stay and higher 1-year mortality.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.127.suppl_12.AP013
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1466401-X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 3
    Online Resource
    Online Resource
    Abstract 14192: Effect of Aspirin Dosing in Patients Treated With P2Y12 Inhibitors for Secondary Prevention of Cardiovascular Events
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Background: The ADAPTABLE was a pragmatic randomized controlled trial that found no difference between high dose vs low dose aspirin for secondary prevention of ischemic or bleeding events. Whether concomitant P2Y12 inhibitor therapy modifies the effect of aspirin dose on clinical events remains unclear. Methods: Participants in ADAPTABLE were stratified according to baseline use of clopidogrel or prasugrel (P2Y12 group). Ticagrelor was not permitted due to a black box warning with high dose aspirin. The primary effectiveness endpoint was a composite of myocardial infarction, stroke, or death and the primary safety endpoint was hospitalization for major bleeding. We used multivariable Cox regression to compare the relative effectiveness and safety of aspirin dose within P2Y12 and non-P2Y12 groups. Results: Of the 13,815 (91.6%) participants with available data, 3,051 (22.1%) were on a P2Y12 inhibitor at baseline (clopidogrel: 93.4%; prasugrel: 6.6%). P2Y12 inhibitor use was associated with higher risk of the primary effectiveness endpoint (10.86% vs. 6.31%; adjusted HR 1.44 95% CI 1.22-1.62) but was not associated with bleeding (0.53% vs. 0.95%; adjusted HR:1.42; 95% CI 0.91, 2.22). We found no interaction in the relative effectiveness and safety of high vs. low dose aspirin by P2Y12 inhibitor use (Table, P interaction 0.09 and 0.73 for primary effectiveness and safety endpoint, respectively). Aspirin dose switching and discontinuation occurred in 28.6% of patients. Although this was more common in high dose vs. low dose aspirin, the above rates did not differ between the P2Y12 and non-P2Y12 groups. Conclusion: In this pre-specified subgroup analysis of a large, pragmatic trial, we found that the relative effectiveness and safety of high dose vs. low dose aspirin was not modified by baseline use of P2Y12 inhibitors. Decisions regarding aspirin dosing should be individualized based on clinical factors and patient preference, regardless of P2Y12 inhibitor use.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.14192
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 4
    Online Resource
    Online Resource
    Abstract P237: Measuring Cognition in the Atherosclerosis Risk in Communities (ARIC) Study Cohort: An approach to Account for Informative Attrition
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 131, No. suppl_1 ( 2015-03-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 131, No. suppl_1 ( 2015-03-10)
    Abstract: Introduction: Understanding the role of risk factors associated with accelerated cognitive decline has important public health relevance for the aging US population. To test hypotheses that mid-life cardiovascular (CV) risk factors increase risk of dementia in old age, the Atherosclerosis Risk in Communities (ARIC) cohort was evaluated for dementia in 2011-2013. Anticipating challenges of complete dementia ascertainment in an elderly population, supplementary data sources were collected to aid analysis accounting for potentially informative attrition. Methods: ARIC enrolled 15,792 participants 45-64 years old at baseline (1987-1989) from four US communities and collected baseline CV exposure data. A complete neurocognitive battery including informant interview was completed 2011-2013, yielding an algorithmic diagnosis of dementia, mild cognitive impairment (MCI) or normal cognition. Cognitively impaired and a random sample of cognitively normal were selected for further clinical evaluation. Syndromic diagnoses (dementia/MCI/normal) and etiologic diagnoses were made by a panel of experts using standardized criteria. Standardized protocols, timely reports of reviewer reliability, ongoing training of reviewers and a web-based data management system were developed to ensure reliability, consistency and efficiency of data collection and review. Living participants not attending the visit were asked to complete the Telephone Interview for Cognitive Status (TICS). Based on dementia discharge codes and death codes identified during cohort surveillance, interviewer impression of hearing loss or cognitive impairment or need for a proxy during semi-annual calls, or random sampling, participants refusing the TICS are eligible for proxy dementia interview. Medicare claims are being examined to identify missed dementia discharge codes. Results: Of 11,017 participants alive as of 2011, 6495 (59%) completed the neurocognitive battery; 2937 of these (45%) were selected for, and completed, additional clinical assessments and classification by committee (algorithmic or reviewer diagnosis: dementia 5%, MCI 21%). Of the 4522 participants who did not undergo the neurocognitive battery, 1463 (32%) completed the TICS (dementia 7%), while 1627 of the remaining participants were eligible for proxy calls (903 completed to date, dementia 58%). Conclusions: Participants who were not examined were more likely to be cognitively impaired, highlighting the importance of collecting supplementary data to support analyses of midlife CV risk factors accounting for informative attrition. Collection of exam data in an elderly cohort is difficult and requires a multi-pronged approach, especially for an outcome highly correlated with attrition. The strategy described here could be applied in other settings.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.131.suppl_1.p237
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1466401-X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 5
    Online Resource
    Online Resource
    Abstract P094: Accuracy of Self-reported Heart Failure Following a Hospitalized Heart Failure Event: The Atherosclerosis Risk in Communities (ARIC) Study
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation Vol. 133, No. suppl_1 ( 2016-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. suppl_1 ( 2016-03)
    Abstract: Background: Self-reports of heart failure (HF) are relied upon to quantify the burden of HF in the community. While self-report of HF is often considered subject to recall bias, accuracy of self-reported HF following a HF hospitalization has not been estimated. Methods: Hospital admission of ARIC cohort members is monitored on an ongoing basis. Starting in 2005, hospital records with HF were abstracted and events validated with a standardized protocol based on review of history and physical examination, echocardiography, nuclear imaging, chest X-ray, catheterization reports, cardiac markers, and discharge summary. HF was classified as acute decompensated HF (ADHF) or chronic stable HF (CSHF). Also starting in 2005, ARIC participants were asked annually to report whether a physician had told them they have HF or a weak heart. Those self-reporting HF were asked to authorize release of medical information and their providers of medical care were sent a survey to confirm their patient’s HF status, HF characteristics, and treatment status. After excluding participants with a HF hospitalization prior to 2005 (defined by an ICD-9 discharge code of 428 in any position), self-reported HF following an incident HF hospitalization was quantified as the proportion of hospitalized participants who self-reported HF (sensitivity) and the proportion of non-hospitalized participants who did not self-report HF (specificity). The proportion of self-reported HF confirmed by physicians was calculated among those with a returned survey. Results: Of the 10,509 ARIC participants alive from 2005-2013, 512 were hospitalized with ADHF and 154 were hospitalized with CSHF prior to self-reporting their HF status and 328 self-reported having HF. Comparing self-reported to hospitalized HF, sensitivity was poor (0.28) and specificity excellent (0.99), although some participants who self-reported HF but were not hospitalized may have been diagnosed in the outpatient setting. A physician survey was available for 92 participants who self-reported HF. In 64 (70%; 95% confidence interval (CI): 61, 80) instances, self-reported HF was confirmed by their physician. Of the latter, 23 (36%; 95% CI: 24, 48) were reported as diastolic dysfunction while 19 (30%; 95% CI: 18, 41) and 8 (13%; 95% CI: 4, 21) were characterized as systolic dysfunction or mixed, respectively. HF type was not specified by the physician in 14 cases. Seventy-eight percent (95% CI: 68, 89) of patients with confirmed HF, the physician also reported HF treatment. Conclusion: Self-report of HF was highly specific and quite insensitive calling into question the validity of self-reports of HF. Our results underscore the need for methods more effective than self-report to identify persons with clinically manifest HF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.133.suppl_1.p094
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1466401-X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 6
    Online Resource
    Online Resource
    Abstract P268: Survival Advantage of Participating in Cohort Studies Varies Over Time
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation Vol. 133, No. suppl_1 ( 2016-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. suppl_1 ( 2016-03)
    Abstract: Background: Volunteers in cohort studies are reported to have lower mortality (survival advantage) over non-participants. However, it is unclear if the early survival advantage in study participants compared to non-participants remains over time. Hypothesis: Cohort participation will be associated with survival advantage that diminishes over time. Methods: We had mortality follow-up among people who were covered by the Washington County private census (90,286, about 92% of all 94,881 Washington County residents). This census data was used to compare volunteers in 3 cohort studies (ARIC, CLUE1 & 2) to non-participants at baseline and with respect to subsequent mortality adjust for demographics. Individual death data between 1975 and 2015 was obtained from Maryland Vital Statistics and National Death Index and analyzed using Kaplan-Meier graph. Cox regression models were used to estimate the hazard ratios for mortality comparing participants to non-participants in 5-year time periods since enrollment in each cohort. Results: The Washington County Private Census included 2,933 participants and 18,196 non-participants in ARIC study (recruited 1986-1989; born 1922-1943); 19,912 participants and 52,973 non-participants in CLUE1 (recruited 1974, born in 1877-1963); and 14,408 participants and 44,356 non-participants in CLUE2 (recruited 1989; born in 1893-1961). Participants in each study were more likely to be female, older, married, more educated and never smokers relative to non-participants. Cohort participation was associated with lower mortality as compared to non-participation during the first five years in all studies; this survival advantage diminished over time and after very long follow-up ( 〉 20 years) participants actually had higher mortality than non-participants (Figure). Conclusion: In conclusion, the survival advantage associated with cohort participation was strongest in the first 5 years after study enrollment and diminished overtime and even reversed with very long follow-up.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.133.suppl_1.p268
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1466401-X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 7
    Online Resource
    Online Resource
    External Control Arms in Idiopathic Pulmonary Fibrosis Using Clinical Trial and Real-World Data Sources
    American Thoracic Society ; 2023
    In:  American Journal of Respiratory and Critical Care Medicine Vol. 208, No. 5 ( 2023-09-01), p. 579-588
    Details
    In: American Journal of Respiratory and Critical Care Medicine, American Thoracic Society, Vol. 208, No. 5 ( 2023-09-01), p. 579-588
    Type of Medium: Online Resource
    ISSN: 1073-449X , 1535-4970
    URL: Article
    DOI: 10.1164/rccm.202210-1947OC
    RVK:
    XA 21200
    Language: English
    Publisher: American Thoracic Society
    Publication Date: 2023
    detail.hit.zdb_id: 1468352-0
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 8
    Online Resource
    Online Resource
    Abstract P008: Repeatability of Ectopic Beats From 48-hour Ambulatory Electrocardiography: The Atherosclerosis Risk in Communities (ARIC) Study
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation Vol. 133, No. suppl_1 ( 2016-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. suppl_1 ( 2016-03)
    Abstract: Background: Ectopic beats, defined by premature atrial contractions (PACs) and premature ventricular contractions (PVCs), are one of the most common findings on the electrocardiogram (ECG). Excess ectopic beats on ambulatory ECG monitoring are associated with atrial fibrillation (AF), stroke and death in symptomatic patients and in population-based studies. However, the repeatability of ECG-enumerated ectopic beats has not been sufficiently examined in a general population. Objectives: Characterize the repeatability of PACs and PVCs in a community-based population of older adults. Methods: Ambulatory, 48-hour ECG was measured in a subsample of the Atherosclerosis Risk in Communities Study (ARIC; 2011-2013) at two locales. Participants were randomly invited to participate in the repeatability study (n=92). Following an identical, standardized protocol, the participants wore a Holter monitor for two, 48-hour periods separated by a mean of 38 days (range: 11, 130 days) and completed a symptom questionnaire during each period. Each visit included new electrodes and Holter placement. All participants wore monitors for 48 hours and had recordings with 〈 1% noise. Participants with AF (n=4) or paced rhythm (n=2) were excluded (total n=86; mean age 74.6 years; 56 females, 55 black). Visit-specific quartiles and 80th percentile cut-points for the total counts of PACs and PVCs over the 48 hour monitoring period were used. Between-visit agreement was quantified using the weighted kappa for quartiles and kappa for 80th percentile cut-points. Results: About 17% of the participants reported symptoms of dizziness, palpitations, or chest pain while wearing the monitor. During the 48-hour recordings, all participants had ≥1 PAC count and 2 participants had a 0 PVC count. The overall median (interquartile range (IQR)) was 266 counts (IQR: 80, 1,692.5) for PACs and 223 counts (IQR: 17.5, 1,085.5) for PVCs. The median between-visit difference (visit 2 - visit 1) was -12.5 counts for PACs (IQR: -154, 65) and 0 counts for PVCs (IQR: -78, 320). The between-visit, weighted kappa for count quartiles was 0.70 (95% confidence interval (CI): 0.61, 0.80) for PACs and 0.68 (95% CI: 0.58, 0.78) for PVCs. The kappa for counts 〉 80th percentile was 0.56 (95% CI: 0.34, 0.78) for PACs and 0.71 (95% CI: 0.52, 0.90) for PVCs. Conclusion: Between-visit agreement is high to moderate for 48-hour, Holter-based PACs and PVCs quantiles, according to common interpretations for kappa coefficients. When paired with pending examination of how agreement varies over shorter duration recordings within the 48-hour monitoring period, the present results can facilitate epidemiologic and clinical applications in which knowledge of measurement error, variability and misclassification are needed to inform risk assessment.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.133.suppl_1.p008
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1466401-X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 9
    Online Resource
    Online Resource
    Abstract MP03: Epidemiology of Hospitalized Heart Failure Patients with Preserved Ejection Fraction: The ARIC Heart Failure Surveillance Project
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Circulation Vol. 127, No. suppl_12 ( 2013-03-26)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 127, No. suppl_12 ( 2013-03-26)
    Abstract: Background Despite the high burden of heart failure with preserved ejection fraction (HFpEF), information about its epidemiology is limited. We describe the population distribution of HFpEF according to criteria commonly used to ascertain heart failure (HF) and compare the characteristics and outcomes of patients with HFpEF to those with HF with reduced ejection fraction (HFrEF). Methods From the Atherosclerosis Risk in Communities (ARIC) HF surveillance of 21 hospitals in four US communities during 2005-2008, potential HF events were sampled based on ICD discharge codes from patients ages 55 years and older, . Trained study personnel abstracted charts (unweighted n =4784), and the presence of HF was determined both by computerized classification and by a panel of standardized physicians. Left ventricular ejection fraction (EF) was missing in 19%; HFpEF was defined as HF with EF ≥ 50%. All statistical analyses incorporated sampling weights. A multivariable logistic model of the probability of HFpEF was developed using variables associated with HFpEF in univariate analyses (p 〈 0.2). Results The proportion of the hospitalized HF patients with HFpEF varied only slightly according to HF classification schema: NHANES (49%), Modified Boston (48%), Framingham (47%), ‘2008 Consensus criteria’ (44%), and ARIC review panel (43%). The following characteristics were independently associated with HFpEF (Odds Ratio and 95% Confidence Interval): female (2.28; 1.87, 2.82), history of sleep apnea (1.90; 1.30, 2.77), systolic blood pressure (1.08; 1.05, 1.12) per 10 mm of Hg increase), atrial fibrillation (1.29 (1.03, 1.61), heart rate (0.91; 0.87, 0.95 per 10 beats per minute increase), paroxysmal nocturnal dyspnea (0.70; 0.54, 0.92), and study community. Length of hospital stay was comparable for HFpEF and HFrEF patients (median = 5 days, p for geometric mean = 0.76). Absolute mortality at one-year was 4.4% lower among HFpEF compared to HFrEF (12.3% vs. 16.7%, p 〈 0.05) with age, gender, and race adjusted case fatality OR= 0.75 (95% CI 0.56, 0.99). Conclusions The proportion of patients with HFpEF among HF patients hospitalized in 2005-2008 varied from 43 to 49% according to the main published HF classification schema. HFpEF patients had a similar length of hospital stay but lower one-year case fatality than those with HFrEF. These results support increasing efforts to better characterize HFpEF and its course to reduce the total burden of HF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.127.suppl_12.AMP03
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1466401-X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 10
    Online Resource
    Online Resource
    Abstract 47: Subclinical Atherosclerosis and 20-Year Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 131, No. suppl_1 ( 2015-03-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 131, No. suppl_1 ( 2015-03-10)
    Abstract: Introduction: Cardiovascular risk factors are reportedly predictive of cognitive decline and dementia but the association between the extent and severity of subclinical atherosclerosis with cognitive decline remains understudied. Hypothesis: The systemic burden of atherosclerosis measured non-invasively is associated with the rate of decline in domain-specific (memory, executive function and language) and global cognition from mid-life to late life. Methods: Members of the ARIC cohort (N=12313; 58% women, 24% African American (AA), 76% white) aged 46-70 years at their 1990-1992 examination were followed through 2011-2013. Participants with prevalent stroke, myocardial infarction or coronary heart disease were excluded. Atherosclerosis at baseline (n=5217) was assessed by carotid artery b-mode ultrasound (presence and number of plaques, bilaterally) and by ankle-brachial index 〈 0.9 measured with an oscillometric device. Tests of memory (Delayed Word Recall Test), executive function (Digit Symbol Substitution Test), and language (Word Fluency Test) were administered in 1990-92, 1996-98 and 2011-13. Test-specific z scores were calculated at each exam based on the means and standard deviations at baseline. A global cognition z score was estimated by averaging the 3 test-specific z scores and standardizing to baseline. Race-stratified linear random effects regression was used to estimate the association between subclinical atherosclerosis and 20-year declines in domain-specific cognition and global cognition. We adjusted for age, sex and level of education. Inverse probability weighting (IPW) was used to limit bias due to attrition. Results: In AA, the presence of carotid plaque and/or ABI 〈 0.90 (n=490) was associated with a lower memory z score (Beta=-0.10, 95% confidence interval, CI: -0.18, -0.02), a lower language z score (Beta=-0.07, 95% CI: -0.14,-0.002) and a lower global cognition z score at baseline (Beta=-0.09, 95% CI: -0.16, -0.02), but not with rates of change in any cognitive score. Among whites at baseline, individuals with subclinical atherosclerosis (n=4099) exhibited lower executive function (Beta=-0.05, 95% CI: -0.08, -0.02) and global cognition (Beta=-0.04, 95% CI: -0.07, -0.01). White participants with subclinical atherosclerosis had a greater 20-year rate of decline in global cognition (Beta=-0.06, 95% CI: -0.10, -0.00) compared to those without subclinical atherosclerosis. Conclusions: Baseline memory, language, and global cognition in AA and executive function and global cognition in whites were lower among those with non-invasively ascertained atherosclerosis compared to those without, independent of covariates in the model. Among whites, subclinical clinical measures of atherosclerosis in mid-life may be indicative of modest, but measurable declines in cognition after additional adjustment for potential bias due to attrition.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.131.suppl_1.47
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1466401-X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
Nothing or not found what you are looking for? Please check your search query or use the Interlibrary Loan Search.
Close ⊗
This website uses cookies and the analysis tool Matomo. Further information can be found on the KOBV privacy pages