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Objectives To study the association between total and differential white blood cell ( WBC) count and incident stroke in an older Asian population. Design Prospective population-based study with 8 years of follow-up. Setting The Honolulu Heart Program, Oahu, Hawaii. Participants Japanese-American men aged 71 to 93 who were free of stroke and had baseline WBC counts measured in 1991-93 (N = 3,342). Measurements Participants were divided into quartiles of total and differential WBC count for analysis and were followed for incident stroke (thromboembolic and hemorrhagic (hemorrhagic)) for 8 years using data from a comprehensive hospital surveillance system. Results Age-adjusted incident stroke rates increased significantly with increasing WBC quartile (Q1, 7.68; Q2, 9.04; Q3, 9.26; Q4, 14.10 per 1,000 person-years of follow-up, P = .001). Hazard ratios ( HRs) for stroke for each quartile of total and differential WBC count were obtained using Cox regression analysis, with the lowest quartile as the reference group. After full adjustment, including age; cardiovascular risk factors; fibrinogen; prevalent coronary heart disease, cancer, or chronic obstructive pulmonary disease, and nonsteroidal anti-inflammatory drug use, HRs were 1.62 (95% confidence interval ( CI) = 1.04-2.52, P = .03) in the highest quartile of total WBC and 2.19 (95% CI = 1.41-3.39, P < .001) in the highest quartile of neutrophil counts. Significant associations were also seen for thromboembolic but not for hemorrhagic strokes. No significant associations were found between lymphocyte or monocyte counts and incident stroke or subtypes. Conclusion In elderly Japanese-American men, higher total WBC and neutrophil counts were independent predictors of overall stroke, as well as thromboembolic stroke. [ABSTRACT FROM AUTHOR]

Objectives To provide the first report on prevalence of vitamin D deficiency in newly admitted nursing home ( NH) residents and associations with functional disabilities and chronic diseases. Design Retrospective chart review. Setting Nursing home ( NH). Participants Male veterans newly admitted to a NH for rehabilitation, skilled-nursing care, intermediate care, or respite care between January 2011 and June 2012. Measurements Total serum 25-hydroxyvitamin D (25(OH)D) levels were measured on admission. Vitamin D supplement users and those without 25(OH)D measurement within 7 days of admission were excluded, leaving an analytical sample of 104 residents. Vitamin D deficiency was defined as 25(OH)D less than 20 ng/ mL. Data were collected on age, ethnicity, season, body mass index (BMI), functional disability in activities of daily living (ADLs) (mobility, bathing, dressing, toileting, continence, and feeding), and prevalent chronic diseases. Results Prevalence of vitamin D deficiency was 49.0%. In multivariate logistic regression models adjusted for age, ethnicity, and BMI, vitamin D deficiency was significantly associated with number of ADL disabilities (odds ratio ( OR) = 1.4 for each 1-point increase in ADL disability score, P = .03) and prevalent diabetes mellitus ( OR = 3.0, P = .03). In regression models using each ADL disability as a separate variable, only disability in feeding ( OR = 4.7, P = .05) and diabetes mellitus ( OR = 2.9, P = .04) remained significant. Conclusion Almost half the individuals entering the NH and not taking vitamin D supplements had vitamin D deficiency. Greater number of ADL disabilities, disability in feeding, and prevalent diabetes mellitus were independently associated with vitamin D deficiency. [ABSTRACT FROM AUTHOR]

Objectives To determine whether adhering to a healthy lifestyle in midlife may reduce the risk of dementia. Design Case-control study nested in a prospective cohort. Setting The Honolulu-Asia Aging Study, Oahu, Hawaii. Participants Three thousand four hundred sixty-eight Japanese- American men (mean age 52 in 1965-1968) examined for dementia 25 years later. Measurements Men at low risk were defined as those with the following midlife characteristics: nonsmoking, body mass index (BMI) less than 25.0 kg/m2, physically active, and having a healthy diet (based on alcohol, dairy, meat, fish, fruits, vegetables, cereals, and ratio of monounsaturated to saturated fat). Logistic regression was used to calculate odds ratios ( ORs) and 95% confidence intervals ( CIs) for developing overall dementia, Alzheimer's disease ( AD), and vascular dementia ( VaD), adjusting for potential confounders. Results Dementia was diagnosed in 6.4% of men (52.5% with AD, 35.0% with VaD). Examining the risk factors individually, BMI was most strongly associated with greater risk of overall dementia ( OR = 1.87, 95% CI = 1.26-2.77; BMI > 25.0 vs <22.6 kg/m2). All of the individual risk factors except diet score were significantly associated with VaD, whereas none were significantly associated with AD alone. Men with all four low-risk characteristics (7.2% of the cohort) had the lowest OR for overall dementia ( OR = 0.36, 95% CI = 0.15-0.84). There were no significant associations between the combined low-risk characteristics and the risk of AD alone. Conclusion Among Japanese-American men, having a healthy lifestyle in midlife is associated with a lower risk of dementia in late life. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To study white matter lesions (WMLs) and 5-year cognitive decline in elderly Japanese-American men. DESIGN: Longitudinal cohort study. SETTING: Population-based study in Honolulu, Hawaii. PARTICIPANTS: Japanese-American men aged 74 to 95 from the Honolulu-Asia Aging Study (HAAS) who were free of prevalent dementia, underwent a protocol brain MRI scan at the fifth HAAS examination (1994-1996), and returned for cognitive testing 5 years later (N=267). MEASUREMENTS: WMLs were dichotomized as present (grade 3-9, 38.2%) or absent (grade 1-2, 61.8%). Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI), and 5-year cognitive decline was defined as a drop in CASI score of 12 points or more (1 standard deviation). RESULTS: Men with WMLs on MRI at baseline were significantly more likely to experience cognitive decline at 5 years than those without (22.4% vs 34.4%, P=.03). Using multiple logistic regression, adjusting for age, education, apolipoprotein (Apo)E4 allele, large or small infarcts on MRI, baseline CASI score, and hypertension, those with WMLs were significantly more likely to develop 5-year cognitive decline (odds ratio=2.00, 95% confidence interval=1.10-3.65, P=.02). This association was stronger in men who were cognitively intact and free of the ApoE4 genotype and clinical stroke at baseline. CONCLUSION: Presence of WMLs on MRI was significantly associated with higher odds of 5-year cognitive decline in older Japanese-American men. Presence of WMLs may help identify people at risk for developing dementia, who may benefit from early intervention. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of occupational exposure to pesticides, metals, and solvents on mortality. Participants: Middle-aged Japanese-American men (n= 7,540) who had participated in the Honolulu Heart Program during 1965-1968. Methods: Industrial hygienists assessed participants' potential for exposure based on their primary job. Cumulative exposure scores were categorized as none, low, medium, and high. The underlying cause of death was ascertained by a physician panel. All associations were assessed using Cox proportional hazards models. Results: A total of 4, 485 deaths occurred. Compared to no exposure, pesticide exposure was significantly associated with mortality from all causes, circulatory diseases, stroke, and all cancers. Results for all-cause mortality at the 0-yr lag after risk-factor adjustment were: Low, hazard ratio (HR) = 0.85, 95% confidence interval (CI)=0.68-1.08; medium, HR = 1.18, 95% CI = 1.01-1.37; and high, HR=1.29, 95% CI=1.06-1.57; trend, p=0.002. Exposure to metals and solvents was significantly associated with mortality from all causes, cancer, and respiratory disease, and exposure to solvents was additionally associated with mortality from circulatory disease. Associations were strongest at the 15-yr lag. Conclusions: Results show that occupational exposures to pesticides, metals, and solvents during mid-life are independently associated with increased mortality, and indicate potential importance of exposures that occurred approximately 15 years prior to death. [ABSTRACT FROM AUTHOR]

The objective of this study is to investigate the relationship between low levels of human serum albumin (HSA) and the incidence of coronary heart disease (CHD) in a cohort of elderly Japanese-American men. Using data from the Honolulu Heart Program's fourth examination (1991-1993), HSA levels of 998 Japanese American men aged 71-93 years was compared with plasma levels of fibrinogen, total cholesterol HDL cholesterol, LDL cholesterol triglycerides, diastolic BP, BMI, and fasting blood glucose. HSA was significantly negatively associated with age and fibrinogen, and significantly positively associated with total cholesterol, HDL cholesterol LDL cholesterol triglycerides, diastolic BP, BMI and fasting blood glucose. After adjusting for age, tertiles of HSA were significantly positively associated with total cholesterol, HDL cholesterol and triglycerides, and significantly negatively associated with fibrinogen. Using multivariate stepwise regression, significant correlations were seen between HSA and fibrinogen, cholesterol age, HDL cholesterol and triglycerides, and a borderline correlation was seen with systolic blood pressure. However, the model R-square for all variables was only 0.10. In conclusion, HSA levels are significantly associated with several traditional cardiovascular risk factors, particularly serum lipid levels. [ABSTRACT FROM AUTHOR]

We report a cardiovascular risk factor survey of "native" Hawaiians 20-59 years old (70 percent, or 257), living on the island of Milokai, Hawaii. More than 60 percent of both sexes were overweight. Among males, 42 percent were smokers. The percent of the population with systolic blood pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg or taking hypertensive medications was 14 percent of those ages 20-39 and 36 percent of those ages 40-59. The percent with serum cholesterol ≥ 6.2 mmol/L ranged from 8 percent of those 20-29 years old to 46 percent in those 50-59 years old. Two percent of those ages 20-29 had a history of diabetes, or 2+ or greater glycosuria by dipsitick, as did 23 percent of those ages 50-59. The majority of the known diabetics exhibited glycosuria and elevated glycohemoglobin levels, indicating poor control. Hypertension, although usually known to the participant, was frequently uncontrolled. From these data, it appears that among this group of Hawaiians major risk factors for cardiovascular disease were frequent, while at the same time the levels of awareness and/or control for most of these factors were low. [ABSTRACT FROM AUTHOR]

Background Associations of higher levels of physical activity with fewer depressive symptoms have been reported from both cross-sectional and longitudinal studies. However, there are few data in elderly populations. We studied the association between physical activity and 8-year incident depressive symptoms in a cohort of elderly Japanese-American men. Methods The Honolulu-Asia Aging Study is a continuation of the Honolulu Heart Program, a longitudinal population-based study of Japanese- American men on Oahu, Hawai'i. At the fourth exam in 1991-93, 3734 survivors aged 71-93 years were examined. Physical activity was assessed by self-reported distance walked per day. Depressive symptoms were measured with an 11-question version of the Centers for Epidemiologic Studies Depression Scale (CES-D) at the 4th exam (n = 3196) and again at the 7th exam 8 years later (1999-2000, n = 1417). Presence of depressive symptoms was defined as CESD- 11 score ≥ 9 or taking anti-depressants. Subjects with prevalent depressive symptoms at exam 4 were excluded from the incidence analysis. Chi square, t-tests and multiple logistic regression models were used for analyses. This study was approved by the IRB of Kuakini Medical Center. Results Incident depressive symptoms were present in 9.8% of men. Age adjusted 8-year incident depressive symptoms were 13.6%, 7.6% and 8.5% for low (< 1/4 miles/day), intermediate (1/4 to 1.5 miles/ d) and high (>1.5 miles/day) walking groups at baseline, p=0.008. Multiple logistic regression analyses were adjusted for age, education, marital status, BMI, hypertension, diabetes, alcohol, smoking status, prevalent coronary heart disease, stroke, cancer, Parkinson's disease, dementia or cognitive impairment and difficulty walking. Compared to the lowest walking group (reference), those in the intermediate and highest walking groups had significantly lower odds for developing 8-year incident depressive symptoms (OR = 0.52; 95% CI = 0.32-0.83, p = 0.006; and OR = 0.61; 95% CI = 0.39-0.97, p = 0.04 respectively). Conclusion Daily physical activity, even low level activity such as walking, is strongly associated with a lower risk for development of depressive symptoms over eight years in elderly Japanese-American men. [ABSTRACT FROM AUTHOR]

Background The timed 10-foot walk is used clinically to diagnose and monitor functional impairment. Case-control studies have shown slower walking speeds in patients with prevalent Parkinson's disease (PD). We examined whether walking time predicts 10-year incident PD in elderly Japanese-American men. Methods The Honolulu-Asia Aging Study began with the fourth Honolulu Heart Program examination in 1991-93, when 3606 Japanese- American men ages 71-93 years performed the timed 10-foot walk. Walking time (seconds) was used both as a continuous variable and divided into three groups (fast, intermediate, slow). Subgroup analysis excluded those with prevalent stroke or dementia at baseline. Both prevalent (n = 66) and incident (n = 45) PD were studied as outcomes. Final diagnosis of PD was based on consensus from 2 neurologists using standardized criteria. Chi-square tests, T-tests, multiple logistic regression and Cox regression were used for analyses. This study was approved by the IRB of Kuakini Medical Center. Results The prevalence of PD was highest in those with slowest walking times (3.1%, 1.2%, 0.4% respectively, p <0.0001). Using multiple logistic regression analyses adjusting for age, triceps skinfold thickness, midlife smoking and midlife caffeine, those with the slowest (OR = 7.39, 95% CI = 2.92-18.73, p <0.0001) and intermediate (OR = 2.88, 95% CI = 1.10-7.57, p = 0.03) walking times were significantly more likely to have prevalent PD compared to those with the fastest walk times (reference). Cox proportional hazards models demonstrated a significant increase in risk of 10-year incident PD in those with slow walk times compared to fast (RR = 2.26, 95% CI = 1.08-4.73, p = 0.03). This relationship was slightly stronger when subjects with prevalent stroke or dementia at baseline were excluded (RR = 2.49, CI = 1.19-5.21, p = 0.02). Conclusion Slower walk time was significantly independently associated with prevalent PD, and with 10-year incident PD. It is likely that slow walking time is a marker of pre-clinical PD, in addition to being a manifestation of clinically recognized PD. Early screening for PD will be helpful when treatments become available that delay or arrest progression of disease. [ABSTRACT FROM AUTHOR]

Background There are many variations of the Circle of Willis (COW). The purpose of this study was to compare the prevalence at autopsy of hypoplasticity of the posterior communicating artery (PCoA) in Japanese American men to results from studies involving other ethnic groups. Methods 703 men of the Honolulu Asia-Aging Study (HAAS) were autopsied and the COW was dissected and examined. Hypoplasticity of the PCoA was recorded and compared with previous studies. Results The prevalence of hypoplastic PCoA was found to be greater in HAAS men than in other published reports. Previous studies reported hypoplasia of the PCoA ranging from 16.7% - 81% of cases. In this series, some degree of PCoA hypoplasia was observed in 85% of decedents, including 60.2% with bilateral hypoplasia. The age at death was unassociated with the severity, side, uni-laterality or bilaterality of the hypoplasia. Conclusion A high prevalence of hypoplastic PCoA was observed in this cohort. The lack of any apparent relationship with age at death suggests that brain perfusion sufficient to sustain life was not embarassed by the hypoplasia. Additional analyses will be needed to address the likely origins of the hypoplasia, and to discern any impact on parenchymal brain structure, or relationship with infarcts, hemorrhages, or atrophy. [ABSTRACT FROM AUTHOR]