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D E Grobbee

Publications and source records attributed to D E Grobbee.

At least 289 records · Page 16Linked to original sources
PubMed1997

A nested case-control study on mortality in users of ibopamine.

BACKGROUND: A recent interim analysis of the PRIME II placebo-controlled study showed a significantly higher mortality in the group treated with ibopamine than in the control group. The objective was to study mortality in patients on ibopamine, and to assess risk factors for death. METHODS: All 2147 drug-dispensing outlets (DDO) in the Netherlands were asked to provide a printout of the complete medication history of users of ibopamine. A reaction was received from 92% of the DDO. From the 14,024 identified former or current users of ibopamine, a sample of 3148 patients (22%) was enrolled in the follow-up study. All general practitioners (GP) of these patients received an enquiry pertaining to the vital status of their patient, cause of death, primary cause and NYHA classification of heart failure, echo- and electrocardiographic data, serum creatinine, admissions and the effects of ibopamine. Cases were defined as patients who died during the follow-up period which ended on the day of return of the questionnaire or the day of decease (index date). Two random controls were obtained for each case from the non-deceased patients at the index date. The design was a follow-up study with risk factor assessment in a nested case-control design. RESULTS: Questionnaires were returned regarding almost 70% of the sample. Mortality in this group was 25%. A case-control analysis was performed with the first 104 cases and 208 random controls. Patients with NYHA class IV had a 3-times increased risk of dying. In patients with a serum-creatinine level in the highest quartile the risk of dying was increased threefold. Higher doses of ibopamine seemed to have a protective effect. Significantly more cases than controls used amiodarone. Also, opioids were used more often, which may be related to their use in terminal cardiac failure. CONCLUSION: NYHA classification and serum-creatinine levels were independent risk factors for death in patients with heart failure on ibopamine. Although there were increased risk estimates for current use of ibopamine and amiodarone, these did not reach statistical significance. This may be related, however, to the fact that this analysis was restricted to the first 20% of cases.

Aged↗
PubMed1997

Left, right, near or far wall common carotid intima-media thickness measurements: associations with cardiovascular disease and lower extremity arterial atherosclerosis.

We evaluated the differences in strength of the associations of prevalent cardiovascular disease and lower extremity arterial atherosclerosis to common carotid intima-media thickness, assessed by near wall measurements only, by far wall measurements only, and by the average of near and far wall measurements. The study was based on data from 1500 participants of the Rotterdam Study, a single-center-population-based prospective follow-up study among 7983 subjects, aged 55 years or over. Comparison of the strength of the associations of near wall intima-media thickness and of combined near and far wall intima-media thickness to cardiovascular disease and lower extremity arterial atherosclerosis revealed significantly stronger associations compared to associations observed for far wall intima-media thickness, in particular for stroke and lower extremity arterial disease. We conclude that near wall common carotid intima-media thickness measurement provides at least as good an indicator of atherosclerosis elsewhere and of cardiovascular risk as the far wall intima-media thickness measurement.

Arteriosclerosis↗
PubMed1997

Efficiency optimization of the selection period in therapeutic trials.

To determine eligibility for a (randomized) clinical trial, measuring the inclusion and exclusion criteria can be extended over a period of time. During this period, known as the selection period, a patient is repeatedly examined at certain time intervals. This study describes an approach for optimizing the efficiency of the selection period. Efficiency is defined as the costs of randomizing one patient. The objective is to construct prediction models based on data obtained early in the selection period to predict subsequent exclusions. A prediction model increases the efficiency if after its application the costs per randomization are lower. The approach is illustrated using data from the selection period of the Rotterdam Cardiovascular Risk Intervention (ROCARI) trial which was composed of five consecutive patient visits. At each visit, data to determine eligibility was obtained. We found that logistic regression models based on data of the first and second visit could predict exclusions during the third visit. Application of the prediction models suggested that in this particular trial the costs per randomization would decrease by $52. As the initial costs per randomization were $1444, there would be a 3.6% (52/1444) savings in recruitment costs under the prediction models, accounting for a savings of more than $450,000. We conclude that the use of data obtained early in a selection period can predict subsequent exclusions, and therefore could increase the efficiency of such a period. The approach could be applied to data obtained in a pilot study as well as data obtained in the beginning of a prolonged intake period.

Cost Savings↗
PubMed1997

Diagnostic interpretation of electrocardiograms in population-based research: computer program research physicians, or cardiologists?

We assessed the performance of diagnostic electrocardiogram (ECG) interpretation by the computer program MEANS and by research physicians, compared to cardiologists, in a physician-based study. To establish a strategy for ECG interpretation in health surveys, we also studied the diagnostic capacity of three scenarios: use of the computer program alone (A), computer program and cardiologist (B), and computer program, research physician, and cardiologist (C). A stratified random sample of 381 ECGs was drawn from ECGs collected in the Rotterdam Study (n = 3057), which were interpreted both by a trained research physician using a form for structured clinical evaluation and by MEANS. All ECGs were interpreted independently by two cardiologists; if they disagreed (n = 175) the ECG was judged by a third cardiologist. Five ECG diagnoses were considered: anterior and inferior myocardial infarction (MI), left and right bundle branch block (LBBB and RBBB), and left ventricular hypertrophy (LVH). Overall, sensitivities and specificities of MEANS and the research physicians were high. The sensitivity of MEANS ranged from 73.8% to 92.9% and of the research physician ranged from 71.8% to 96.9%. The specificity of MEANS ranged from 97.5% to 99.8% and of the research physician from 96.3% to 99.6%. To diagnose LVH, LBBB, and RBBB, use of the computer program alone gives satisfactory results. Preferably, all positive findings of anterior and inferior MI by the program should be verified by a cardiologist. We conclude that diagnostic ECG interpretation by computer can be very helpful in population-based research, being at least as good as ECG interpretation by a trained research physician, but much more efficient and therefore less expensive.

Bundle-Branch Block↗
PubMed1997

Lipoprotein oxidation, antioxidants and cardiovascular risk: epidemiologic evidence.

This review summarizes the scientific evidence for a possible role of antioxidants in the prevention of coronary heart disease (CHD). Dietary antioxidants include vitamin E, vitamin C and beta-carotene, whereas selenium is an integral part of the antioxidant enzyme glutathione peroxidase. Experimental studies suggest that the oxidation of low-density lipoproteins (LDL) in the vessel wall plays an important role in the development of atherosclerotic lesions. The resistance of LDL to oxidation is increased by antioxidant supplementation, at least in vitro. Epidemiological studies have not demonstrated unequivocally that a high intake of antioxidants leads to a decreased risk of CHD. Studies on dietary intake and serum levels of antioxidants do point in the direction of a preventive effect of antioxidants, whereas the results of intervention studies are less conclusive. Beta-carotene supplementation is not associated with any decrease in CHD; high doses of vitamin E may be beneficial, but results from large trials are to be awaited. General preventive measures based on antioxidant supplementation are not yet justifiable.

Animals↗
PubMed1997

Classification of heart failure in population based research: an assessment of six heart failure scores.

Several scores based on symptoms and signs have been developed to assess the presence of heart failure. The goal of this study was to compare six heart failure scores in non-hospitalised subjects and to determine their usefulness in population based research. The scores were applied to 54 participants of a population based study. All underwent a complete medical examination, including chest X-ray, electrocardiography and Doppler echocardiography. Using all information available, a cardiologist, unaware of the results of the scores, clinically classified participants as having no, possible or definite heart failure. Sensitivity, specificity, predictive values and receiver operating characteristics were calculated, using the cardiologist's assessment as a gold standard. The cardiologist judged definite or possible heart failure to be present in 17 persons. All scores had a high sensitivity for the detection of definite heart failure, whereas the study of men born in 1913 and Walma's score had the highest sensitivity for the combination of possible and definite heart failure. Gheorgiade's and the Boston score had the highest positive predictive values. In conclusion, five of the six scores we studied are broadly similar in the detection of heart failure. The men born in 1913 score relies heavily on the assessment of dyspnea, resulting in a relatively large number of false positives. Although the scores are useful in detecting manifest heart failure, objective measurements of cardiac function appear necessary to reduce the false positive rate and accurately detect early stages of heart failure.

Aged↗
PubMed1997

Electrolytes are associated with blood pressure at old age: the Rotterdam Study.

We examined the association of urinary sodium and potassium excretion with blood pressure (BP) in the Rotterdam Study, a population-based study among 7983 men and women aged 55 and over. The present analysis included 1006 subjects with complete BP and urinary data who did not use antihypertensive drugs and did not report themselves to be hypertensive. Electrolyte excretions were assessed in a timed nocturnal urine sample and standardized to 24-h values. The association of electrolyte excretions with BP was studied in a multiple linear regression model with adjustment for age, sex, and body mass index. When sodium and potassium were entered simultaneously into the multivariate model, a 100 mmol increase in potassium was associated with a 9.4 decrease in systolic (P = 0.01) and a 4.9 mm Hg decrease in diastolic BP (P = 0.01). Sodium was directly related to BP, with a 2.2 mm Hg increase in systolic (P = 0.06) and a 0.8 mm Hg increase in diastolic BP (P = 0.14) per 100 mmol. Our findings suggest that an increased intake of potassium and a decrease intake of salt may lower BP at old age.

Aged↗
PubMed1997

Homocysteine, atherosclerosis and prevalent cardiovascular disease in the elderly: The Rotterdam Study.

OBJECTIVES: Elevated homocysteine increases the risk of vascular disease, in particular amongst younger subjects (< 60 years). Very few studies have been performed amongst older subjects. We evaluated the relation of plasma total homocysteine (tHcy) to atherosclerosis and symptomatic cardiovascular disease amongst older men and women. DESIGN: A cross-sectional study. SETTING: General population. SUBJECTS: A random sample of 630 men and women, participating in the Rotterdam Study, a prospective population-based cohort study amongst 7983 subjects aged 55 years and over residing in the Ommoord district of Rotterdam, the Netherlands. MAIN OUTCOME MEASURES: Carotid atherosclerosis (carotid plaques and common carotid intima-media thickness) assessed by ultrasonography; lower extremity (peripheral) artery atherosclerosis measured by the ratio of the ankle to arm systolic blood pressure; prevalent cardiovascular disease assessed as a history of myocardial infarction or stroke. RESULTS: Subjects, 55-74 years of age, with elevated tHcy levels (+/- 18.6 mumol L-1) had a thicker common carotid intima-media (difference 0.037 mm; 95% CI 0.001, 0.073), a lower ankle-arm index (-0.054; -0.104, -0.004), and an increased risk of cardiovascular disease (odds ratio 3.0; 1.5, 6.1), after adjusting for sex and age. There was no appreciable association of tHcy levels to atherosclerosis and cardiovascular disease in subjects aged 75 years and older. CONCLUSIONS: In subjects aged 55-74 years elevated tHcy is associated with an increased risk of atherosclerosis and cardiovascular disease. The lack of association in those aged > or = 75 years most probably reflect selective mortality.

Aged↗
PubMed1997

The association of dietary fat and fiber with coagulation factor VII in the elderly: the Rotterdam Study.

Considerable evidence suggests that a high concentration of coagulation factor VII is a risk factor for ischemic heart disease. Factor VII is known to be influenced by dietary fat and probably by dietary fiber in young and middle-aged people. There are no data available in elderly people and the effects of different types of fat are unclear. This study examines the relation of factor VII activity (factor VIIc) with dietary fat and fiber in The Rotterdam Study. The Rotterdam Study is a population-based study among 7983 men and women aged > or = 55 y. Factor VIIc was measured in 3007 subjects (1730 women and 1277 men aged 67.3 +/- 7.8 and 66.3 +/- 7.0 y, respectively). Measurements included cardiovascular risk factors and habitual diet was assessed by a semiquantitative food-frequency questionnaire. Associations that were significant or nearly significant differed for some nutrients between men and women. Total fat intake showed a direct association with factor VIIc only in women (beta = 0.1%/g; 95% CI: 0.01, 0.20). Saturated fat intake was associated with factor VIIc in women (beta = 0.18%/g; 95% CI: 0.001, 0.36) and in men (beta = 0.11%/g; 95% CI: -0.06, 0.27). Monounsaturated fat was positively related to factor VIIc in women (beta = 0.17%/g; 95% CI: -0.05, 0.39) and polyunsaturated fat was inversely associated with factor VIIc in men (beta = -0.15%/g; 95% CI: -0.33, 0.03). Fiber intake was inversely associated with factor VIIc in both men (beta = -0.31%/g; 95% CI: -0.57, -0.06) and women (beta = -0.36%/g; 95% CI: -0.63, -0.09). No associations were found for energy intake. In elderly persons, factor VIIc is associated with fat and fiber intake. This suggests that factor VIIc is influenced by nutritional factors, even in old age.

Aged↗
PubMed1997

Limitations of sensitivity, specificity, likelihood ratio, and bayes' theorem in assessing diagnostic probabilities: a clinical example.

We evaluated the extent to which the sensitivity, specificity, and likelihood ratio of the exercise test to diagnose coronary artery disease vary across subgroups of a certain patient population. Among 295 patients suspected of coronary artery disease, as independently determined by coronary angiography, we assessed variation in sensitivity and specificity according to patient history, physical examination, exercise test results, and disease severity in 207 patients with and 88 patients without coronary artery disease, respectively. The sensitivity varied substantially according to sex (women 30% and men 64%), systolic blood pressure at baseline (53% to 65%), expected workload (50% to 64%), systolic blood pressure at peak exercise (50% to 67%), relative workload (33% to 68%), and number of diseased vessels (39% to 77%). The specificity varied across subgroups of sex (men 89% and women 97%) and relative workload (85% to 98%). The likelihood ratio varied (3.8 to 17.0) across the same patient subgroups, as did the sensitivity. As each population tends to be heterogeneous with respect to patient characteristics, no single level of these parameters can be given that is adequate for all subgroups. Use of these parameters as a basis for calculating diagnostic probabilities in individual patients using Bayes' theorem has serious limitations.

Adult↗
PubMed1997

Prevalence, determinants, and misclassification of myocardial infarction in the elderly.

We evaluated the prevalence, determinants, and misclassification of different types of myocardial infarction in 3,272 men and women age 55 years or older. We defined self-reported myocardial infarction with electro-cardiographic evidence as "typical myocardial infarction." We defined self-reported myocardial infarction without electrocardiographic evidence, but verified with additional clinical information, as "non-Q-wave myocardial infarction." Finally, we defined myocardial infarction detected by electrocardiogram that was not self-reported as "silent myocardial infarction," after verification of absence of symptoms. Overall, the prevalence of typical myocardial infarction was 4.1% [95% confidence interval (CI) = 3.5-4.9], of non-Q-wave myocardial infarction 2.8% (95% CI = 2.2-3.4), and of silent myocardial infarction 3.9% (95% CI = 3.2-4.5). Silent myocardial infarction was more prevalent in women, hypertensives, cigarette smokers, and those with higher post-load blood glucose. Self-reported myocardial infarction without electrocardiographic characteristics could be verified as myocardial infarction by means of additional clinical information in 56% of the cases. We conclude that myocardial infarction occurs frequently in the elderly without typical symptoms or electrocardiographic changes. As all these manifestations of myocardial infarction convey an increased risk of symptomatic heart disease or death, they require further attention. Misclassification due to limited sources of information can be considerable and should be taken into account in the design and interpretation of epidemiologic studies.

Age Distribution↗
PubMed1997

Maternal use of antiepileptic drugs and the risk of major congenital malformations: a joint European prospective study of human teratogenesis associated with maternal epilepsy.

PURPOSE: To quantify the risks of intrauterine antiepileptic drug (AED) exposure in monotherapy and polytherapy. METHODS: Data from five prospective European studies totaling 1,379 children were pooled and reanalyzed. Data were available for 1,221 children exposed to AED during pregnancy and for 158 children of unexposed control pregnancies. RESULTS: Overall, when comparing a subgroup of 192 children exposed to AED with 158 children of matched nonepileptic controls, there was an increased risk of major congenital malformations (MCA) in children exposed to AED during gestation [relative risk (RR) 2.3; 95% confidence interval (CI): 1.2-4.7]. A significant increase in risk was found for children exposed to valproate (VPA) (RR 4.9; 95% CI: 1.6-15.0) or carbamazepine (CBZ) (RR 4.9; 95% CI: 1.3-18.0) in monotherapy. When comparing different AED regimens during all 1,221 pregnancies, risks of MCA were significantly increased for the combination of phenobarbital (PB) and ethosuximide (RR 9.8; 95% CI: 1.4-67.3) and the combination of phenytoin, PB, CBZ, and VPA (RR 11.0; 95% CI: 2.1-57.6). Offspring of mothers using > 1,000 mg VPA/day were at a significantly increased risk of MCA, especially neural tube defects, compared to offspring exposed < or =600 mg VPA/day (RR 6.8; 95% CI: 1.4-32.7). No difference in risk of MCA was found between the offspring exposed to 601-1,000 mg/day and < or =600 mg/day. CONCLUSIONS: This reanalysis shows that VPA is consistently associated with an increased risk of MCA in babies born to mothers with epilepsy. Significant associations were also observed with CBZ. Larger prospective population-based studies are needed to evaluate the risks of many other less frequently prescribed treatment regimens, including newly marketed AEDs.

Abnormalities, Drug-Induced↗
PubMed1997

Plasma total homocysteine, B vitamins, and risk of coronary atherosclerosis.

Epidemiological research has shown that elevated plasma total homocysteine (tHcy) is a risk factor for atherosclerotic disease. In the present case-control study, we investigated whether fasting or postmethionine-loading tHcy was a stronger predictor of risk of severe coronary atherosclerosis. Furthermore, we studied levels of B vitamins, which are involved in homocysteine metabolism. Subjects were recruited from men and women, aged 25 to 65 years, who underwent coronary angiography between June 1992 and June 1994 in a hospital in Rotterdam, The Netherlands. Cases (n=131) were defined as those with > or =90% occlusion in one and > or =40% occlusion in a second coronary artery, while control subjects (n=88) had <50% occlusion in only one coronary vessel. In addition, a population-based control group free from clinical cardiovascular disease (n=101) was studied. Coronary patients were studied at least 2.5 months after angiography or other acute illness, such as myocardial infarction. After adjusting for age and sex differences between the groups, cases had 9% (P=.01) higher geometric mean fasting and 7% (P=.04) higher geometric mean postload tHcy than the combined control groups. Despite higher levels of tHcy for cases, their geometric mean levels of red cell folate and pyridoxal 5'-phosphate were higher than for control subjects, whereas plasma vitamin B12 was only slightly lower in cases. The frequency distribution of tHcy values in cases was slightly shifted toward the right, across the entire range, compared with the distribution in the combined control group. This was somewhat more obvious for fasting than postload tHcy levels. The odds ratio (OR) for severe coronary atherosclerosis (case status) for each 1 SD increase in fasting tHcy (5 micromol/L) was 1.3 (95% confidence interval [CI], 1.0-1.6), similar to the OR for each 1 SD increase (12 micromol/L) in postmethionine-loading tHcy (1.3 [95 CI, 1.0-1.7]), after adjustment for sex, age, and other potential confounders. Furthermore, there was a significant linear trend of increasing fasting tHcy with increasing number of occluded arteries (P=.01), correcting for sex, age, and other potential confounders. Our data show a positive association between plasma tHcy and risk of severe coronary atherosclerosis, of similar strength for fasting and postload tHcy levels. The data suggest that the association exists over a wide range of tHcy levels, without a clear cutoff point below which there is no increased risk.

Adult↗
PubMed1997

Long-term effects of neonatal sodium restriction on blood pressure.

In 1980, a randomized trial was conducted among 476 Dutch newborn infants to study the effect of a low or normal sodium diet on blood pressure during the first 6 months of life. At the end of the trial, systolic blood pressure in the low sodium group (n = 231) was 2.1 mm Hg lower than in the control group (n = 245). To investigate whether contrasting levels of sodium intake in infancy are associated with blood pressure differences in adolescence, we measured blood pressure in 167 children from the original cohort (35%) after 15 years of follow-up. We assessed the differences in systolic and diastolic blood pressure levels between the diet groups using a multivariate regression model with adjustment for potential confounders. The adjusted systolic blood pressure at follow-up was 3.6 mm Hg lower (95% confidence interval, -6.6 to -0.5) and the diastolic pressure was 2.2 mm Hg lower (95% confidence interval, -4.5 to 0.2) in children who had been assigned to the low sodium group (n = 71) compared with the control group (n = 96). These findings suggest that sodium intake in infancy may be important in relation to blood pressure later in life.

Adolescent↗
PubMed1997

Birth weight, growth, and blood pressure: an annual follow-up study of children aged 5 through 21 years.

Associations between birth weight and blood pressure have been found in children and adults. In this longitudinal study, the objective was to assess the relation between birth weight and blood pressure level and the change in blood pressure from childhood and young adolescence into adulthood. A cohort of 483 children from a middle-class community in the town of Zoetermeer in the Netherlands had annual measurements of blood pressure during an average follow-up period of 14 years. For 330 of these participants, initially aged 5 through 21 years, birth weight data were collected, which were related to blood pressure level and blood pressure change. An inverse association between birth weight and systolic blood pressure was found, with adjustment for current body height and weight, sex, and use of alcohol, cigarettes, and oral contraceptives. This inverse association was found for the total follow-up in 5- to 37- year-olds (regression coefficient: -2.4 mm Hg/kg; 95% confidence interval: -3.9 to -1.0, as well as in most individual age groups: 5 through 9 years (-0.6 mm Hg/kg, -3.2 to 2.0); 10 through 14 years (-2.5 mm Hg/kg, -4.7 to -0.4); 15 through 19 years (-3.1 mm Hg/kg, -4.9 to -1.2); 20 through 24 years (-2.7 mm Hg/kg, -4.6 to -0.9); 25 through 29 years (-2.0 mm Hg/kg, -3.9 to -0.01); and 30 through 37 years (-1.9 mm Hg/kg, -4.6 to 0.7). For diastolic blood pressure, there appeared to be an inverse association with birth weight in the age group of 30 through 37 years, both unadjusted (-2.0 mm Hg/kg, -4.6 to 0.5) and adjusted for risk factors other than sex (-2.3 mm Hg/kg, -4.7 to 0.1), although these findings were of borderline statistical significance. The results were independent of gestational age and were similar in the group of subjects with low birth weight but normal gestational age (-2.7 mm Hg/kg, -4.3 to -1.0). In relation to systolic blood pressure, birth weight showed a significant interaction with body mass index (regression coefficient, 0.02; SE=0.01; P=.05). There was no relation between birth weight and change in systolic or diastolic blood pressure with age. Our longitudinal study shows that birth weight is consistently inversely associated with systolic blood pressure level from childhood to young adulthood and with diastolic blood pressure in young adulthood. Birth weight is not related to change of blood pressure with increasing age. Low birth weight in combination with high current body mass index seems to be of particular importance in the development of high blood pressure.

Adolescent↗
PubMed1997

Increased common carotid intima-media thickness. Adaptive response or a reflection of atherosclerosis? Findings from the Rotterdam Study.

BACKGROUND AND PURPOSE: Carotid intima-media thickness (IMT) measurements are used widely to study atherosclerosis. Some have suggested that an increased IMT reflects a nonatherosclerotic adaptive response to changes in shear stress and tensile stress. This stems from the hypothesis that changes in shear stress and subsequently in lumen diameter are followed by changes in IMT to keep tensile stress constant. We studied the relation of common carotid IMT to common carotid end-diastolic lumen diameter and tensile stress, as approximated by mean arterial pressure (lumen diameter/IMT)]. METHODS: A cross-sectional analysis was performed with data obtained from the first 1715 participants in the Rotterdam Study, a population-based cohort study among 7983 subjects aged 55 years and over who underwent ultrasonographic examination of the carotid arteries. End-diastolic lumen diameter and IMT of the common carotid arteries were evaluated and quantified. RESULTS: With increasing IMT, inner and outer lumen diameters increased gradually, and beyond an IMT of 1.10 mm, the inner lumen diameter decreased. Tensile stress increased with increasing lumen diameter instead of being constant. The lumen-to-IMT ratio was constant across levels of mean arterial pressure. CONCLUSIONS: Our findings are compatible with the view that at lower degrees of IMT, the thickening appears to reflect an equilibrium state in which the effects of pressure and flow on the arteries are in balance, given a characteristic relation between shear stress and local transmural pressure. Beyond a certain level, IMT more likely may represent atherosclerosis. Regardless of whether common carotid IMT reflects local atherosclerosis, it may still serve as a graded marker for cardiovascular risk.

Adaptation, Physiological↗
PubMed1997

Atrial fibrillation and dementia in a population-based study. The Rotterdam Study.

BACKGROUND AND PURPOSE: Atrial fibrillation is a frequent disorder in the elderly and a known risk factor for cerebrovascular stroke. We investigated the association of atrial fibrillation with dementia and cognitive impairment in a large cross-sectional, population-based study in the elderly. METHODS: Of the 6584 participants in the Rotterdam Study aged 55 to 106 years, detailed information on dementia status and ECG abnormalities was available. Dementia was diagnosed in three phases. First, participants were screened. Screen-positive subjects were tested further. Those with possible dementia underwent an extensive diagnostic workup. Dementia and dementia subtypes were diagnosed according to prevailing criteria. Cognitive impairment was defined as a Mini-Mental State Examination test score of < 26 points for a nondemented subject. RESULTS: Atrial fibrillation was diagnosed in 195, dementia in 276, and cognitive impairment in 635 subjects. We found significant positive associations of atrial fibrillation with both dementia and impaired cognitive function (age- and sex-adjusted odds ratios, 2.3 [95% confidence interval, 1.4 to 3.7] and 1.7 [95% confidence interval, 1.2 to 2.5]), respectively). The strongest association was found not for vascular dementia but rather for Alzheimer's disease with cerebrovascular disease. The associations were stronger in women, and the relation with dementia was more pronounced in the relatively younger elderly. A history of stroke in subjects with atrial fibrillation could not account for these associations. CONCLUSIONS: Dementia and subtypes Alzheimer's disease and vascular dementia may be related to atrial fibrillation even if no clinical stokes have occurred.

Age Factors↗