Biomedical subjects

A Hofman

Publications and source records attributed to A Hofman.

At least 163 records · Page 9Linked to original sources

PubMed1999

Homocysteine and short-term risk of myocardial infarction and stroke in the elderly: the Rotterdam Study.

BACKGROUND: Elevated homocysteine level increases vascular disease risk. Most data are based on subjects younger than 60 years; data for the elderly are more limited. We examined the relationship of homocysteine level to incident myocardial infarction and stroke among older subjects in a nested case-control study. METHODS: Subjects were participants in the Rotterdam Study, a cohort study among 7983 subjects residing in the Ommoord district of Rotterdam, the Netherlands. Baseline examinations were performed from March 1, 1990, to July 31, 1993. The analysis is restricted to myocardial infarction and stroke that occurred before December 31, 1994. One hundred four patients with a myocardial infarction and 120 with a stroke were identified with complete data. Control subjects consisted of a sample of 533 subjects drawn from the study base, free of myocardial infarction and stroke. Nonfasting total homocysteine levels were measured. RESULTS: Results were adjusted for age and sex. The risk of stroke and myocardial infarction increased directly with total homocysteine. The linear coefficient suggested a risk increase by 6% to 7% for every 1-micromol/L increase in total homocysteine. The risk by quintiles of total homocysteine level was significantly increased only in the group with levels above 18.6 micromol/L (upper quintile): odds ratios were 2.43 (95% confidence interval, 1.11-5.35) for myocardial infarction and 2.53 (95% confidence interval, 1.19-5.35) for stroke. Associations were more pronounced among those with hypertension. CONCLUSIONS: The present study, based on a relatively short follow-up period, provides evidence that among elderly subjects an elevated homocysteine level is associated with an increased risk of cardiovascular disease.

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PubMed1999

Rates and risk factors for dementia and Alzheimer's disease: results from EURODEM pooled analyses. EURODEM Incidence Research Group and Work Groups. European Studies of Dementia.

OBJECTIVE: To investigate the risk of AD associated with a family history of dementia, female gender, low levels of education, smoking, and head trauma. BACKGROUND: These putative factors have been identified in cross-sectional studies. However, those studies are prone to bias due to systematic differences between patients and control subjects regarding survival and how risk factors are recalled. METHODS: The authors performed a pooled analysis of four European population-based prospective studies of individuals 65 years and older, with 528 incident dementia patients and 28,768 person-years of follow-up. Patients were detected by screening the total cohort with brief cognitive tests, followed by a diagnostic assessment of those who failed the screening tests. Dementia was diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (revised), and AD was diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Incident rates and relative risk (95% CI) express the association of a risk factor for dementia. RESULTS: Incident rates for dementia and AD were similar across studies. The incidence of AD increased with age. At 90 years of age and older the incidence was 63.5 (95% CI, 49.7 to 81.0) per 1,000 person-years. Female gender, current smoking (more strongly in men), and low levels of education (more strongly in women) increased the risk of AD significantly. A history of head trauma with unconsciousness and family history of dementia did not increase risk significantly. CONCLUSION: Contrary to previous reports, head trauma was not a risk factor for AD, and smoking did not protect against AD. The association of family history with the risk of AD is weaker than previously estimated on the basis of cross-sectional studies. Female gender may modify the risk of AD, whether it be via biological or behavioral factors.

Age Distribution↗

PubMed1999

1H chemical shift imaging of the human brain at age 60-90 years reveals metabolic differences between women and men.

1H magnetic resonance spectroscopy was used to compare brain metabolism in 540 elderly persons, stratified by sex and age (60-90 years old). An 8 x 8 x 2 cm3 supraventricular brain volume, a transverse plane parallel to the canthomeatal line, was examined by automated 1H chemical shift imaging [point-resolved spectroscopy (PRESS), TE of 35 msec]. Regional choline (Cho), creatine (Cr), and N-acetyl aspartate (NAA) peak areas in the 518 successful examinations (96%) were studied by division through the total area of the particular metabolite in each spectral map. This procedure eliminated intersubject variance, maximized intervoxel variance (26 < or = F < or = 149, P < 0.0001) and reduced the standard deviations in the voxel metabolite signals threefold. Normalized signals in women (n = 257) and men (n = 261) differed in 9 (Cho/sigma Cho), 8 (Cr/sigma Cr), and 10 (NAA/sigma NAA) of 36 voxels examined (P < or = 0.001). In the cingulate gyrus Cho/sigma Cho, Cr/sigma Cr, and NAA/sigma NAA were reduced in men compared with women. These findings are consistent with a sex-related reduction of glucose metabolism in the same brain lobe revealed by positron emission tomography.

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PubMed1999

Heritabilities of radiologic osteoarthritis in peripheral joints and of disc degeneration of the spine.

OBJECTIVE: To estimate the genetic influence on the occurrence of radiologic osteoarthritis (ROA) in the knees, hips, and hands and disc degeneration of the spine in the general population. METHODS: A random sample of 1,583 individuals was drawn to estimate the prevalence of ROA and disc degeneration in the general population. Of 118 probands with multiple affected joint sites who were derived from this sample, we were able to recruit 257 siblings. The variance of ROA and disc degeneration within sibling pairs was compared with the variance between sibling pairs. Heritability estimates for ROA in the knees, hips, and hands and for disc degeneration of the spine were calculated. OA was defined according to radiologic criteria, using the Kellgren/Lawrence grading system. RESULTS: We observed that hand ROA and disc degeneration of the spine were statistically significantly more frequent in siblings than in the random sample, whereas the prevalence of knee and of hip ROA was similar and lower, respectively. Heritability estimates for hand ROA and disc degeneration were statistically significant, P = 0.56 (95% confidence interval [95% CI] 0.34-0.76) and P = 0.75 (95% CI 0.30-1.00), respectively. For knee and hip ROA, no evidence of a genetic effect in the general population was found. Finally, the heritability estimate for a score that summed the number of joints affected in the knees, hips, hands, and spine was 0.78 (95% CI 0.52-0.98). All heritability estimates were adjusted for age, sex, body mass index, and bone mineral density. CONCLUSION: The present study shows that in the general population, there is a strong genetic effect for hand ROA and disc degeneration of the spine. The findings on the total number of joints affected at multiple sites suggest genetic susceptibility to generalized OA.

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PubMed1999

A follow-up study of blood pressure and cerebral white matter lesions.

White matter lesions are often observed on cerebral magnetic resonance imaging scans of elderly people and may play a role in the pathogenesis of dementia. Cross-sectional studies have shown an association between elevated blood pressure and white matter lesions. We prospectively studied the relation between blood pressure and white matter lesions in 1,077 subjects aged 60 to 90 years who were randomly sampled from two prospective population-based studies. One study had blood pressure measurements 20 years before, the other 5 years before. Overall response for the magnetic resonance imaging study was 63%, and declined from 73% among 60- to 70-year-olds to 48% for 80- to 90-year-olds. Diastolic and systolic blood pressure levels assessed 20 years before were significantly associated with subcortical and periventricular white matter lesions. The association between 20-year change in diastolic blood pressure and subcortical white matter lesions was J-shaped (relative risk, 2.2; 95% confidence interval, 1.0-5.2; and relative risk, 3.2; 95% confidence interval, 1.4-7.4, for decrease or increase of more than 10 mm Hg, respectively). The association between concurrent diastolic blood pressure level and white matter lesions was linear in subjects without, and J-shaped in subjects with, a history of myocardial infarction. Our results indicate that the J-shape relationship of diastolic blood pressure is not restricted to cardiovascular disease, but is also manifest in cerebrovascular disease.

Age Factors↗

PubMed1999

Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study.

The aim of this study was to estimate the additional cost of medical care (the incremental cost) caused by incident hip and vertebral fractures, using a matched case cohort design within a longitudinal follow-up study. Incident hip fractures were recorded using the regular follow-up system of the Rotterdam Study. Incident vertebral fractures were recorded by morphometric comparison of spinal radiographs taken at intervals of 2.2 years on average. The matched control group was randomly selected from other participants of the Rotterdam Study in whom no fracture occurred during follow-up, but who were otherwise comparable at baseline. Cases were matched for age, gender, self-perceived health, ability to perform activities of daily life, living situation and general practitioner. Medical expenditure was assessed by retrieval of the general practice medical records and by recording all hospital and nursing home admissions, and all general practice and outpatient visits. Pharmaceutical consumption was recorded through the computerized records of the central pharmacy. Valid results were obtained for 44 pairs (91%) in the hip fracture and for 42 pairs (93%) in the vertebral fracture group. Cost of medical consumption in the year before the hip fracture was similar in patients and control subjects, but the incremental cost in the first year after the hip fracture was almost US$10 000. In the second year after hip fracture the incremental cost was still about $1000. Accounting for the excess mortality in hip fracture patients had little effect on cost in the first year, but cost in the second year was doubled to almost $2000. For vertebral fractures, we did not detect important acute care costs, but these fractures were associated with a yearly recurrent incremental cost of over $1000. However, almost half this difference was already present before the occurrence of the fracture, and was attributable to hospital admissions. The remainder of the incremental cost was mainly due to pharmaceutical consumption and to a lesser extent to admissions to orthopedic surgery wards. We conclude that hip fractures cause excess mortality and an important incremental cost especially during the first year, and that these could probably be avoided by prevention of hip fractures. For vertebral fractures we found no evidence of important acute care costs but we observed a yearly returning incremental cost. Part of this incremental cost, however, was pre-existing and might therefore by caused by co-morbidity.

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PubMed1999

Apolipoprotein E genotype and progression of Alzheimer's disease: the Rotterdam Study.

The APOE*4 allele of the apolipoprotein E gene increases the risk of Alzheimer's disease (AD), but whether it also affects the course of the disease is controversial. However, all studies on this issue until now have been based on patients at various stages of disease. In the present population-based study, 97 patients were included at a similar stage, i.e., before the onset of symptoms, and followed for up to 5 years. We found that the APOE*4 allele is not a strong determinant of survival in AD. As change in cognitive function and severity of dementia are similar for AD patients with and without APOE*4, our study suggests that progression of AD is not related to the APOE*4 allele.

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PubMed1999

Determinants of optic disc characteristics in a general population: The Rotterdam Study.

OBJECTIVE: To determine whether age, gender, height, and refractive error are associated with optic disc morphology in a general elderly population. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 5114 subjects 55 years of age or older participated in this study, representing 76% of a population-based sample of 6777 ophthalmologically examined white patients from a geographically well-defined suburb in Rotterdam, The Netherlands. MAIN OUTCOME MEASURES: Disc area, neural rim area, cup area, vertical and horizontal cup-to-disc ratios, and parapapillary atrophy. METHODS: Disc characteristics were measured on stereoscopic simultaneous optic disc transparencies using an image analyzer. The presence and location of parapapillary atrophy, differentiated into zones alpha and beta, were assessed from disc transparencies of both eyes in a random sample of 894 persons. Subjects with open-angle glaucoma were excluded. RESULTS: The mean disc area was 2.42 mm2 (standard deviation [SD], 0.47), mean neural rim area was 1.85 mm2 (SD, 0.39), mean cup area was 0.57 mm2 (SD, 0.34), mean vertical cup-to-disc ratio was 0.49 (SD, 0.14), and mean horizontal cup-to-disc ratio was 0.40 (SD, 0.14). Age was not a determinant of any disc characteristic. Disc and rim areas were 3.2% (P < 0.0005; 95% confidence interval [CI], 2.7%-3.7%) and 4.3% (P < 0.0005; 95% CI, 3.5%-4.6%) larger in men than in women. For each diopter increase toward myopia, the disc area increased by 0.033 mm2 (P < 0.0005; 95% CI, 0.027-0.038) and neural rim area by 0.029 mm2 (P < 0.0005; 95% CI, 0.025-0.034). The disc area increased by 0.02 mm2 (P = 0.02; 95% CI, 0.005,0.05) for each 10-cm increase in height. The prevalence of zone alpha slightly decreased by 0.4% per 10 years of age (P = 0.035; 95% CI, 0.03%-0.8%), whereas the prevalence of zone beta increased by 1.3% (P = 0.0003; 95% CI, 0.57%-1.9%) for each diopter increase toward myopia. CONCLUSIONS: In a general population, statistically normal discs may vary twofold in disc area and threefold in rim area. Age is not associated with any disc characteristic, whereas disc area and neural rim area are slightly larger in men than in women. Refractive error is weakly related to disc area and neural rim area. Height is weakly related to disc area in persons of medium height. The prevalence of zone beta is higher in myopic eyes.

Age Factors↗

PubMed1999

Cup-to-disc ratio: ophthalmoscopy versus automated measurement in a general population: The Rotterdam Study.

OBJECTIVE: To determine the correlations between ophthalmoscopic estimations and the measurements with a semiautomated image-analysis device of the vertical cup-to-disc ratio (VCDR) in the human optic disc. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: All subjects 55 years of age and older from the population-based sample of 6777 ophthalmologically examined subjects from The Rotterdam Study of whom gradable optic disc transparencies of at least 1 eye and ophthalmoscopic data of the same eye were available. MAIN OUTCOME MEASURES: Ophthalmoscopic assessment of the VCDR and semiautomated measurement of the VCDR. METHODS: Indirect and direct ophthalmoscopy were performed in mydriasis to assess the VCDR. Optic disc transparencies made with a simultaneous stereoscopic telecentric fundus camera were analyzed with a semiautomated measurement system (Topcon Imagenet). RESULTS: In 5143 subjects, the mean ophthalmoscopic VCDR was 0.30 (standard error [SE], 0.0021; range, 0.00, 1.00) compared with a semiautomatically measured VCDR of 0.49 (SE, 0.0019; range, 0.04, 0.86; difference, 0.19; P < 0.0001). The overall correlation between both methods was moderate (correlation coefficient, 0.61; SE, 0.11) and lower in small optic discs. Semiautomated optic disc measurements correctly identified 76% of the glaucoma cases (as defined using visual field data and ophthalmoscopic data about the optic disc). CONCLUSION: Semiautomated measurements of the VCDR are larger than the ophthalmoscopic VCDR estimate with a moderate correlation. The interobserver variability using Imagenet was smaller compared with the ophthalmoscopic assessments, and Imagenet was better standardized, which is important for epidemiologic surveys and follow-up studies.

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PubMed1999

Added value of bone mineral density in hip fracture risk scores.

Hip fractures constitute a major health problem. For effective prevention, high-risk groups need to be identified. The objective here was to develop hip fracture risk scores while assessing the added value of bone mineral density relative to more conventional risk indicators. We prospectively followed during 4 years a cohort of 5208 persons (2193 men) aged 55 years and over from the Rotterdam Study, a population-based cohort study conducted in the Netherlands. Risk scores for hip fracture were constructed using several conventional risk indicators requiring interview and anthropometry only, and bone mineral density. During follow-up, 50 persons (14 men) suffered hip fracture. Hip fracture risk was independently determined by age, gender, height, the use of a walking aid, cigarette smoking, and either bone mineral density or weight. We developed two risk scores, with and without bone mineral density. The observed 4-year risk ranged from 3/3389 (0.1%) to 17/169 (10.1%) for the lowest and highest category of the score including bone mineral density, respectively. For the score without bone mineral density, these risks were 8/3117 (0.3%) and 16/144 (11.1%), respectively. The area under the receiver operating characteristic curve indicating discriminatory power was 0.88 for the risk score including, and 0.83 for the score excluding, bone mineral density (p for difference = 0.04). In conclusion, risk scores with and without bone mineral density measurement can be used for hip fracture risk assessment in elderly persons. While the score with bone mineral density has a modestly better performance, the score requiring interview and anthropometry only may be especially useful in primary care settings.

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PubMed1999

Ommoord district residents: prevalence and treatment of depression.

BACKGROUND: Ommoord District residents of Rotterdam, The Netherlands, age 55 and older, completed a two-stage interview to assess the risk factors for chronic disease and disability. METHODS: In the in-home Stage I interview (N = 7,983), demographic data and medical history were collected by a trained lay interviewer. During Stage II, a physician interview and examination were conducted at the study center. Subjects (N = 7,129) were asked about their history of psychiatric disorders and 6,596 responded. RESULTS: The lifetime prevalence of self-reported psychiatric disorders was 5.44% for unipolar and bipolar depressive disorders combined, 0.27% for psychotic disorders, 0.08% for alcoholism, 0.05% for drug addiction, and 3.71% for other diagnoses. Residents reporting a psychiatric diagnosis of depression were more likely to be currently taking an antidepressant medication (p < .001) and an antipsychotic medication (p < .0001), to be in current outpatient treatment (p < .001), to have been hospitalized for psychiatric illness (p < .001), to have undergone electroconvulsive treatments (p < .001), and to report a history of having made suicide attempts (p < .001). CONCLUSION: The self-reported lifetime prevalence of affective disorders was similar to the rates found in the Stirling County Study (Canada) and the Epidemiologic Catchment Area Survey (United States). The lower prevalence rates of the other psychiatric disorders may reflect underreporting or an age cohort effect, or may be due to the nonresponse bias.

Age Distribution↗

PubMed1999

Prevalence of aortic aneurysm in men with a history of inguinal hernia repair.

BACKGROUND: Population-based screening for abdominal aortic aneurysm (AAA) is still a subject of debate. This study examined whether subjects with a history of inguinal hernia were at increased risk sufficient to justify screening. METHODS: The prevalence of AAA was documented in 156 men aged 55 years and older, discharged after inguinal hernia surgery, and compared with the prevalence in 1771 men without a history of inguinal hernia who were participating in a screening survey for AAA. The influence of age and smoking status was assessed. RESULTS: The prevalence of AAA in men with a history of inguinal hernia was 12.2 (95 per cent confidence interval (c.i.) 7.0-17.4) per cent and 3.7 (95 per cent c.i. 2.8-4.6) per cent in those without such a history; prevalence ratio 3.3 (95 per cent c.i. 2.0-5.3). In current smokers the prevalence of abdominal aneurysm was 4.2 (95 per cent c.i. 2.1-8.2) times higher in those with compared with those without a history of inguinal hernia. In non-smokers the prevalence ratio was 1.9 (95 per cent c.i. 0.5-7.0). CONCLUSION: Men with a history of inguinal hernia are at increased risk of AAA, most notably if they are cigarette smokers. Ultrasonographic screening could be considered before operation for inguinal hernia.

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PubMed1999

Serum cholesterol is a risk factor for myocardial infarction in elderly men and women: the Rotterdam Study.

OBJECTIVE: To investigate the associations of serum total and HDL cholesterol with the risk of myocardial infarction in men and women of 55 years and over. DESIGN: The Rotterdam Study is a population-based prospective cohort study. In total 2453 men and 3553 women of 55 years and older were included in this study. The mean duration of follow-up was 4 years. MAIN OUTCOME MEASURES: Relative risks were estimated with Cox's proportional-hazard analysis. Cholesterol was analysed as a continuous variable and in sex-specific quartiles. RESULTS: In subjects aged 55 years and older the relative risk of myocardial infarction was 1.9 in men (95% confidence interval 1.1-3.3) and 3.2 in women (1.5-6.4) in the highest compared to the lowest serum total cholesterol quartile (Q4 vs. Q1). In men and women of 70 years and older, total cholesterol remained an important risk factor for myocardial infarction (Q4 vs. Q1 relative risk 3.2; 1.3-7.7 and 2.9; 1.3-6.6, respectively). For HDL cholesterol, the relative risk in the highest compared to the lowest quartile (Q4 vs. Q1) was 0.5 in men (0.3-0.9) and 0.4 in women (0.2-0.9). HDL cholesterol was a weaker predictor in men after the age of 70 (Q4 vs. Q1 0.8; 0.3-2.1). In women of 70 years and older the relative risk was also not significant (Q4 vs. Q1 0.6; 0.3-1.3), although the trend over the quartiles was still significant. CONCLUSION: Serum total cholesterol remains an important risk factor for myocardial infarction in men and women aged 70 years and older, whilst HDL cholesterol at older age remains important in women only.

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PubMed1999

Menopausal status and risk factors for cardiovascular disease.

OBJECTIVES: Changes in cardiovascular risk factors with menopausal status are difficult to study, owing to the high correlation of menopausal status with age. Therefore we examined cardiovascular risk factors in a meticulously selected population in which the contrast in oestrogen status between pre- and postmenopausal women of the same age was maximized. DESIGN: Risk factors were compared in 93 premenopausal and 93 postmenopausal women who were matched on age (range 43-55 years). SETTING: The women were selected from respondents to a mailed questionnaire about the menopause, which was sent to all women aged 40-60 years in the Dutch town of Zoetermeer (n = 12 675; response 54%). SUBJECTS: Postmenopausal women who were at least 3 years after menopause or whose menses had stopped naturally before age 48 were age-matched with premenopausal women with regular menses and without menopausal complaints. RESULTS: Compared to premenopausal women, postmenopausal women had significantly increased levels of total cholesterol (10.0%, 95% confidence interval 5.1-14.0), low density lipoprotein (LDL) cholesterol (14.0%, 6.9-19.9), and apolipoprotein B (8.2%, 0.6-15.5). The difference was present within 3 years after onset of menopause and did not show a trend towards an increase with the number of postmenopausal years. No differences were found in high density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein A1, blood glucose, insulin, body mass index, waist-to-hip ratio, and systolic and diastolic blood pressure. CONCLUSIONS: The results of this study add to the evidence that total cholesterol, LDL cholesterol and apolipoprotein B are the primary cardiovascular risk factors affected by menopause.

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PubMed1999

Cross-sectionally assessed carotid intima-media thickness relates to long-term risk of stroke, coronary heart disease and death as estimated by available risk functions.

OBJECTIVE: To relate cross-sectionally assessed indicators of carotid atherosclerosis measured in participants of the Rotterdam Study to absolute 10-12 year risks of stroke, coronary heart disease and death estimated by risk functions available from other studies. SETTING: General population living in the suburb of Ommoord in Rotterdam, The Netherlands. SUBJECTS: A sample of men and women (n = 1683), aged 55 years or over, drawn from participants from the Rotterdam Study (n = 7983). MAIN OUTCOMES MEASURES: Three risk scores were used to estimate for each individual the absolute risk of stroke, coronary heart disease and death within 10-12 years as a function of their cardiovascular risk factor profile. Cross-sectionally measured indicators of carotid atherosclerosis (presence of atherosclerotic lesions and common carotid intima-media thickness) were subsequently related to these risk scores. RESULTS: The 10-year absolute risk of stroke increased linearly from 4.8% (95% CI = 3.8, 5.8) for subjects in the lowest quintile to 16.1% (12.3, 21.9) for subjects in the highest quintile of common carotid intima-media thickness distribution. Similarly, the 10-year absolute risk for coronary heart disease rose from 13.1% (95% CI = 12.0, 14.2) to 23.4% (95% CI = 21.4, 25.4), whereas the risk of death within 11.5 years rose from 15.0% (95% CI = 12.8, 17.4) in the lowest quintile to 46.0% (42.8, 49.3) in the upper quintile. The absolute risks of stroke, coronary heart disease or death rose from 8.8, 15.8 and 26.9% to 14.3, 19.8 and 40.9%, respectively, when plaques in the common carotid artery were present. Similar findings were observed for plaques in the carotid bifurcation. CONCLUSION: Common carotid intima-media thickness and carotid plaques are markers for increased risk of stroke, coronary heart disease and death within 10-12 years.

Carotid Arteries↗

PubMed1999

Haplotype analysis of three polymorphisms of the COL2A1 gene and associations with generalised radiological osteoarthritis.

It was investigated whether radiographic osteoarthritis (ROA) is associated with specific haplotypes of the COL2A1 gene. Radiographs of knees, hips, hands, and spine were scored for the presence of ROA in subjects of 55-70 years from a population-based cohort study, the Rotterdam study. Cases had ROA in 3 or more joint groups; controls, from the same population, had ROA in less than 3 joint groups. Allele frequencies of 3 dimorphisms (HaeIII, HindIII, MaeII) and a VNTR polymorphism of the COL2A1 gene were determined. The VNTR allele 14R2 and the HindIII polymorphism showed a significant association. Haplotype analysis of the HaeIII, HindIII and VNTR polymorphisms showed that a specific haplotype (1-2-14R2) is strongly associated with ROA in 3 or more joint groups (OR = 5.3, 95% CI 2.3-12.7). Our results suggest that a specific haplotype of the COL2A1 locus may predispose to generalised ROA.

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PubMed1999

Prolonged QT interval predicts cardiac and all-cause mortality in the elderly. The Rotterdam Study.

AIMS: To examine the association between heart-rate corrected QT prolongation and cardiac and all-cause mortality in the population-based Rotterdam Study among men and women aged 55 years or older and to compare the prognostic value of the QT interval, using different formulas to correct for heart rate. METHODS AND RESULTS: After exclusion of participants with arrhythmias or bundle branch block on the ECG, the study population consisted of 2083 men and 3158 women. The QT interval was computed by the Modular ECG Analysis System (MEANS). Data were analysed using Cox' proportional hazards model. Participants in the highest quartile of the heart-rate corrected QT interval had about a 70% age- and sex-adjusted increased risk for both all-cause mortality (hazard ratio (HR) 1.8; 95% CI:1.3-2.4) and cardiac mortality (HR 1.7; 95% CI:1.0-2.7) compared to those in the lowest quartile. In women, the increased risk associated with prolonged QT for cardiac death was more pronounced than in men. These risk estimates did not change after adjustment for potential confounders, including history of myocardial infarction, hypertension and diabetes mellitus. CONCLUSION: A prolonged heart-rate corrected QT interval is an independent predictor for cardiac and all-cause mortality in older men and women. The risk associated with prolonged QT is hardly affected by the heart-rate correction formula used.

Age Distribution↗

PubMed1999

Study on COgnition and Prognosis in the Elderly (SCOPE).

The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multicentre, prospective, randomized, double-blind, parallel-group study designed to compare the effects of candesartan cilexetil and placebo in elderly patients with mild hypertension. The primary objective of the study is to assess the effect of candesartan cilexetil on major cardiovascular events. The secondary objectives of the study are to assess the effect of candesartan cilexetil on cognitive function and on total mortality, cardiovascular mortality, myocardial infarction, stroke, renal function, hospitalization, quality of life and health economics. Male and female patients aged between 70 and 89 years, with a sitting systolic blood pressure (SBP) of 160-179 mmHg and/or diastolic blood pressure (DBP) of 90-99 mmHg, and a Mini-Mental State Examination (MMSE) score of 24 or above, are eligible for the study. The overall target study population is 4000 patients, at least 1000 of whom are also to be assessed for quality of life and health economics data. After an open run-in period lasting 1-3 months, during which patients are assessed for eligibility and those who are already on antihypertensive therapy at enrolment are switched to hydrochlorothiazide 12.5 mg o.d., patients are randomized to receive either candesartan cilexetil 8 mg once daily (o.d.) or matching placebo o.d. At subsequent study visits, if SBP remains >160 mmHg, or has decreased by <10 mmHg since the randomization visit, or DBP is >85 mmHg, study treatment is doubled to candesartan cilexetil 16 mg o.d. or two placebo tablets o.d. Recruitment was completed in January 1999. At that time 4964 patients had been randomized. All randomized patients will be followed for an additional 2 years. If the event rate is lower than anticipated, the follow-up will be prolonged.

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