80岁及以上患者的亚临床心血管疾病与死亡、痴呆和冠心病
Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years.
作者信息
Kuller Lewis H, Lopez Oscar L, Mackey Rachel H, Rosano Caterina, Edmundowicz Daniel, Becker James T, Newman Anne B
机构信息
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
出版信息
J Am Coll Cardiol. 2016 Mar 8;67(9):1013-1022. doi: 10.1016/j.jacc.2015.12.034.
BACKGROUND
The successful prevention and treatment of coronary heart disease (CHD) and stroke has resulted in a substantial increase in longevity, with subsequent growth in the population of older people at risk for dementia.
OBJECTIVES
The authors evaluated the relationship of coronary and other peripheral atherosclerosis to risk of death, dementia, and CHD in the very elderly. Because the extent of vascular disease differs substantially between men and women, sex- and race-specific analyses were included, with a specific focus on women with low coronary artery calcium (CAC) Agatston scores.
METHODS
We evaluated the relationship between measures of subclinical cardiovascular disease (CAC, carotid intimal medial thickness, stenosis, and ankle brachial index) and risk of dementia, CHD, and total mortality in 532 participants of the Cardiovascular Health Study-Cognition Study from 1998/1999 (mean age, 80 years) to 2012/2013 (mean age, 93 years).
RESULTS
Thirty-six percent of participants had CAC scores >400. Women and African-Americans had lower CAC scores. Few men had low CAC scores. CAC score and number of coronary calcifications were directly related to age-adjusted total mortality and CHD. The age-specific incidence of dementia was higher than for CHD. Only about 25% of deaths were caused by CHD and 16% by dementia. Approximately 64% of those who died had a prior diagnosis of dementia. White women with low CAC scores had a significantly decreased incidence of dementia.
CONCLUSIONS
In subjects 80+ years of age, there is a greater incidence of dementia than of CHD. CAC, as a marker of atherosclerosis, is a determinant of mortality, and risk of CHD and myocardial infarction. White women with low CAC scores had a significantly decreased risk of dementia. A very important unanswered question, especially in the very elderly, is whether prevention of atherosclerosis and its complications is associated with less Alzheimer disease pathology and dementia. (Cardiovascular Health Study [CHS]; NCT00005133).
背景
冠心病（CHD）和中风的成功防治使寿命大幅延长，随之而来的是患痴呆症风险的老年人口增加。
目的
作者评估了冠状动脉及其他外周动脉粥样硬化与高龄人群死亡、痴呆和冠心病风险之间的关系。由于男性和女性的血管疾病程度存在显著差异，因此纳入了性别和种族特异性分析，特别关注冠状动脉钙化（CAC）阿加斯顿评分较低的女性。
方法
我们评估了1998/1999年至2012/2013年心血管健康研究认知研究的532名参与者（平均年龄80岁）中亚临床心血管疾病指标（CAC、颈动脉内膜中层厚度、狭窄和踝臂指数）与痴呆、冠心病和全因死亡率风险之间的关系（平均年龄93岁）。
结果
36%的参与者CAC评分>400。女性和非裔美国人的CAC评分较低。很少有男性的CAC评分较低。CAC评分和冠状动脉钙化数量与年龄调整后的全因死亡率和冠心病直接相关。痴呆的年龄特异性发病率高于冠心病。只有约25%的死亡由冠心病引起，16%由痴呆引起。约64%的死者此前被诊断患有痴呆症。CAC评分较低的白人女性患痴呆症的发病率显著降低。
结论
在80岁及以上的人群中，痴呆症的发病率高于冠心病。CAC作为动脉粥样硬化的标志物，是死亡率、冠心病和心肌梗死风险的决定因素。CAC评分较低的白人女性患痴呆症的风险显著降低。一个非常重要的未解决问题，尤其是在高龄人群中，是预防动脉粥样硬化及其并发症是否与较少的阿尔茨海默病病理和痴呆症相关。（心血管健康研究[CHS]；NCT00005133）
Zotero 插件