Is The Association Between Cognitive Decline And Mortality Modified By High Blood Pressure Among The Oldest Old?

Few studies have systematically explored the association between cognitive decline and mortality among the aged (above 80 years old) and also have limited evidence of the potential effect modifiers between them. Therefore, this study included 14,891 aged (mean age: 90.3±7.5 years) and 10,904 aged deaths with 34,486 person-years were observed. Cognitive decline was continuous and stratified into ten categories. Potential effect modifiers were identified as age, sex, blood pressure (BP) and high BP related diseases, including hypertension and cardiovascular disease (CVD) mortality. Cox proportional hazards model was used to evaluate the relationship between them after adjusting for demographic characteristics, socioeconomic status, lifestyle factors, leisure activities and health conditions. Compared to those with maintained high normal cognitive function, participants who have declined to severe cognitive impairment from a high normal cognitive function, low normal cognitive function and mild cognitive impairment have 55%, 56% and 63% mortality risks respectively. The multivariable-adjusted model indicated that the aged with decreasing one more point in MMSE score per year, had around 4% higher risk of mortality. There was a significant association of interaction of cognitive decline-mortality and sex (P=0.013) as well as hypertension (P=0.004) but with no significant association among age (P=0.277), high BP (P=0.082), and CVD mortality (P=0.058). Our findings suggest that periodic screen cognitive decline and strengthen BP control may be necessary for public health.

Regulation of Mitochondrial Dynamics by Aerobic Exercise in Cardiovascular Diseases

Mitochondrial dynamics, including continuous biogenesis, fusion, fission, and autophagy, are crucial to maintain mitochondrial integrity, distribution, size, and function, and play an important role in cardiovascular homeostasis. Cardiovascular health improves with aerobic exercise, a well-recognized non-pharmaceutical intervention for both healthy and ill individuals that reduces overall cardiovascular disease (CVD) mortality. Increasing evidence shows that aerobic exercise can effectively regulate the coordinated circulation of mitochondrial dynamics, thus inhibiting CVD development. This review aims to illustrate the benefits of aerobic exercise in prevention and treatment of cardiovascular disease by modulating mitochondrial function.

Impact of Behavioral Risk Factors on Mortality Risk in Older Korean Women

Background: To investigate the impact of lifestyle risk factors on all-cause and cardiovascular disease (CVD) mortality in Korean women aged 60 yr and older. Methods: Data (n = 3,034) obtained from the Korean longitudinal study of aging were analyzed. Exposures included lifestyle risk factors, such as smoking, alcohol abuse, underweight/obesity, physical inactivity, and unintentional weight loss. Primary outcomes were premature deaths from specific and all-causes. Results: During 9.6±2.0 yr of follow-up, there were 628 cases (20.7%) of death from all causes, of which 137 cases (4.5%) were from CVD. Compared to zero risk factor (hazard ratio, HR=1), crude HR of all-cause mortality was 2.277 (95% confidence interval, CI, 1.712 ~ 3.030, P < 0.001) for one risk factor, 2.977 (95% CI, 2.124 ~ 4.003, P < 0.001) for two risk factors, and 5.154 (95% CI, 3.515 ~ 7.557, P < 0.001) for three or more risk factors. Compared to zero risk factor (HR=1), crude HR of CVD mortality was 2.035 (95% CI, 1.422 ~ 2.913, P < 0.001) for one risk factor, 2.468 (95% CI, 1.708 ~ 3.567, P < 0.001) for two risk factor, and 4.484 (95% CI, 2.830 ~ 7.102, P < 0.001) for three or more risk factors. Adjusted HRs of all-cause (P = 0.016) and CVD (P = 0.050) for three or more risk factors only remained significant for three or more risk factors. Conclusion: The current findings showed that individual and combined lifestyle risk factors were significantly associated with increased risks of all-cause and CVD mortality in older Korean women.

The Isocaloric Substitution of Plant-Based and Animal-Based Protein in Relation to Aging-Related Health Outcomes: A Systematic Review

Plant-based and animal-based protein intake have differential effects on various aging-related health outcomes, but less is known about the health effect of isocaloric substitution of plant-based and animal-based protein. This systematic review summarized current evidence of the isocaloric substitutional effect of plant-based and animal-based protein on aging-related health outcomes. PubMed and Embase databases were searched for epidemiologic observational studies published in English up to 15 March 2021. Studies that included adults ≥18 years old; use of a nutritional substitution model to define isocaloric substitution of plant protein and animal protein; health outcomes covering mortality, aging-related diseases or indices; and reported association estimates with corresponding 95% confidence intervals were included. Nine cohort studies and 3 cross-sectional studies were identified, with a total of 1,450,178 subjects included in this review. Consistent and significant inverse association of substituting plant protein for various animal proteins on all-cause mortality was observed among 4 out of 5 studies with relative risks (RRs) from 0.54 to 0.95 and on cardiovascular disease (CVD) mortality among all 4 studies with RRs from 0.58 to 0.91. Among specific animal proteins, the strongest inverse association on all-cause and CVD mortality was identified when substituting plant protein for red and/or processed meat protein, with the effect mainly limited to bread, cereal, and pasta protein when replacing red meat protein. Isocaloric substitution of plant-based protein for animal-based protein might prevent all-cause and CVD-specific mortality. More studies are needed on this topic, particularly for cancer incidence and other specific aging-related diseases.

Sexual Effect of Platelet-to-Lymphocyte Ratio in Predicting Cardiovascular Mortality of Peritoneal Dialysis Patients

Background. The study is aimed at exploring the relationship of platelet-to-lymphocyte (PLR), all-cause, and cardiovascular disease (CVD) mortality in peritoneal dialysis (PD) patients based on gender. Methods. A total of 1438 PD patients from January 1,2007 to December 31, 2014 in PD center at The First Affiliated Hospital, Sun Yat-sen University, were included. Patients were followed up until December 31, 2019. The endpoint was all-cause mortality and CVD mortality. Cox proportional hazards regression models were used to evaluate the association of PLR with all-cause and CVD mortality to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results. After a median of 48.9 (interquartile range [IQR]: 23.4-79.3) months of follow-up, 406 (28.2%) patients died based on all-cause death, among which 200 (49.3%) patients died from CVD. In the multivariate Cox regression model, we found that PLR was independently related to an increased risk of CVD mortality only in female PD patients, with HR of 1.003 (95% CI: 1.001-1.006). Interaction test showed that the correlation between PLR level for all-cause and CVD mortality varied with gender ( p = 0.042 and p = 0.012 , respectively). Conclusion. Higher PLR was associated with a higher risk of CVD mortality in female PD patients.

The Combined Effects of Animal Products Intake and Physical Activity With Cause-specific and All-cause Mortality Among Patients With Type 2 Diabetes Mellitus in China: A Prospective Cohort Study

BackgroundTo determine the associations of animal products intake and physical activity and their combined effects with cause-specific and all-cause mortality among type 2 diabetes mellitus (T2DM) patients in China.MethodsBaseline data of 7311 type 2 diabetes mellitus (T2DM) patients recruited with a stratified random cluster sampling method were collected from December 2013 to January 2014. Participants were followed up until the date of their death or December 2019 for survivors, whichever came first. Nonlinear trends of cause-specific and all-cause mortality were assessed using restricted cubic splines with three knots placed at centiles 10, 50, and 90 of diet intake. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the combined relationship of physical activity and animal products with cause-specific and all-cause mortality.ResultsDuring a median follow-up of 6.1 years, 692 (9.5%) T2DM patients died. The main cause of death was cardiovascular disease (CVD) (35.8%), followed by cancer (20.6%). After multivariable adjustment, a higher level of physical activity was nonlinearly associated with lower all-cause and CVD mortality in a J-shaped pattern, with the protective effect observed >8 MET-h/d. Higher consumption of red meat, poultry, and aquatic products was associated with a lower risk of all-cause mortality (HR = 0.75, 0.64, 0.75, respectively, all P<0.05). In the highest tertiles of physical activity, a higher intake of red meat, poultry, and aquatic products was associated with a lower risk for all-cause mortality than in the lowest tertiles (red meat, HR = 0.80, 0.62, 0.51, and 0.48; poultry, HR = 0.85, 0.51, 0.48, and 0.45; aquatic products, HR = 0.80, 0.57, 0.55, and 0.40, respectively). Similarly, the protective effect of moderate to high intake of poultry, aquatic products, and eggs on CVD mortality in high physical activity was found. ConclusionsOur study highlights that in T2DM patients, better adherence to moderate to high consumption of animal products, including red meat, poultry, and aquatic products, together with engaging in moderate to high levels of physical activity exerts a beneficial effect in lowering cause-specific and all-cause mortality in China.

Changes in the Frequency of Moderate-to-Vigorous Physical Activity and Subsequent Risk of All-Cause and Cardiovascular Disease Mortality

We investigated the association of changes in the frequency of moderate-to-vigorous physical activity (MVPA) and the risks of all-cause and cardiovascular disease (CVD) mortality. This study used the nationally representative National Health Insurance Service-National Sample Cohort database. We included 286,402 individuals aged ≥20 years and estimated changes in the frequency of MVPA over a two-year period. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard regression models. The HRs (95% CIs) for the risk of all-cause and CVD mortality for an increased frequency of MVPA from physical inactivity compared with continual physical inactivity were 0.82 and 0.68 (0.73–0.92 and 0.51–0.91) for 1–2, 0.72 and 0.48 (0.62–0.84 and 0.31–0.74) for 3–4, and 0.73 and 0.70 (0.63–0.85 and 0.50–0.98) for ≥5 sessions of MVPA/week. The HRs (95% CIs) for the risk of all-cause and CVD mortality were 1.28 and 1.58 (1.07–1.53 and 1.01–2.46), 1.25 and 2.17 (1.01–1.57 and 1.14–4.12), and 1.43 and 1.44 (1.15–1.77 and 0.84–2.47) for changes from 1–2, 3–4, and ≥5 sessions of MVPA/week to physical inactivity, respectively. This study showed the beneficial effect of increasing physical activity, particularly for those who were physically inactive at baseline, as well as the increased risk of all-cause and CVD mortality after adapting a physically inactive lifestyle regardless of their baseline physical activity status.

Adding Estimated Cardiorespiratory Fitness to the Framingham Risk Score and Mortality Risk in a Korean Population-Based Cohort Study

Background: The added value of non-exercise-based estimation of cardiorespiratory fitness (eCRF) to cardiovascular disease (CVD) risk factors for mortality risk has not been examined in Korean populations. Methods: This population-based prospective cohort study examined the relationship of the 10-year Framingham risk score (FRS) for CVD risk and eCRF with all-cause and CVD mortality in a representative sample of Korean adults aged 30 years and older. Data regarding a total of 38,350 participants (16,505 men/21,845 women) were obtained from the 2007–2015 Korea National Health and Nutrition Examination Survey (KNHANES). All-cause and CVD mortality were the main outcomes. The 10-year FRS point sum and eCRF level were the main exposures. Results: All-cause and CVD mortality was positively correlated with the 10-year FRS point summation and inversely correlated with eCRF level in this study population. The protective of high eCRF against all-cause and CVD mortality was more prominent in the middle and high FRS category than in the low FRS category. Notably, the FRS plus eCRF model has better predictor power for estimating mortality risk compared to the FRS only model. Conclusions: The current findings indicate that eCRF can be used as an alternative to objectively measured CRF for mortality risk prediction.

Current Causes of Death in Familial Hypercholesterolemia

Background: Familial hypercholesterolemia (FH) is a codominant autosomal disease characterized by high low-density lipoprotein cholesterol (LDLc) and high risk of premature cardiovascular disease (CVD). The molecular bases have been well defined and effective lipid-lowering is possible. This analysis aimed to study the current major causes of death of genetically defined heFH. Methods: Case-control study designed to analyze life-long mortality in a group of heFH and control families. Data of first-degree family members of cases and controls (non-consanguineous cohabitants), including deceased relatives, were collected from a questionnaire and review of medical records. Mortality was compared among heFH, non-heFH, and non-consanguineous family members.Results: We analyzed 813 family members, 26.4% of them, deceased. Among deceased, mean age of death was 69.3 years in heFH, 73.5 years in non-heFH, and 73.2 years in non-consanguineous, differences that were not statistically significant. Among them, CVD cause of death was 59.7% in heFH, 37.7.% in non-heFH, and 37.4% in non-consanguineous (P=0.012). These differences were greater restricting the analyses to parents’ mortality. The hazard ratio of dying from CVD was 3.02 times higher (95% CI, 1.90-4.79) in heFH members in comparison with the other two groups (non-FH and non-consanguineous), who did not differ in their risk.Conclusions: Current CVD mortality in heFH is lower and occurs later than that described in the last century but still higher than in non-FH. This better prognosis in CVD risk is not associated with changes in non-CVD mortality.

The Relationship Between Racial Prejudice and Cardiovascular Disease Mortality Risk at the State and County Level

Background Robust evidence shows that perceived discrimination among stigmatized groups is associated with negative health outcomes. However, little work has examined whether holding prejudiced attitudes toward others is associated with health risks for prejudiced individuals. Purpose The study is a test of the hypothesis that holding prejudicial attitudes has negative health implications for both the holders and targets of prejudicial attitudes. Methods The project connected data (2003–2015) at the state and county levels on average explicit and implicit prejudice held by White, Black, and Native American respondents from Project Implicit with data on cardiovascular disease (CVD) mortality for White, Black, and Native American individuals from the CDC Wonder database. Separate analyses regressed implicit and explicit prejudice on CVD mortality risk for White, Black, and Native American individuals, respectively. Results At the state level, among White individuals, explicit prejudice toward Blacks (β = .431, p =.037) and implicit prejudice toward Native Americans (β = .283, p = .045) were positively associated with greater CVD mortality for Whites. At the county level, White individuals’ implicit prejudice toward Blacks (β =.081, p = .015) and Black individuals’ implicit prejudice toward Whites (β = −.066, p = .018) were associated with greater CVD mortality for Whites. Also, at the county-level, among Black individuals, higher implicit (β = −.133, p &lt; .001) and explicit (β = −.176, p &lt; .001) prejudice toward Whites predicted CVD mortality for Blacks. Moreover, explicit prejudice held by White individuals was positively associated with Blacks’ county-level CVD deaths (β = .074, p = .036). Conclusions This evidence suggests that across racial groups, holding racial prejudice is associated with CVD mortality risk for both the prejudiced and the stigmatized groups. Future research should verify the reliability of this potential public health effect with additional work explicating moderators and mediators to inform surveillance and interventions.