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Background Evidence is needed regarding the air pollutant components and their sources responsible for associations between particle mass concentrations and human cardiovascular outcomes. We previously found associations between circulating biomarkers of inflammation and mass concentrations of quasi-ultrafine particles ≤ 0.25 μm in aerodynamic diameter (PM0.25) in a panel cohort study of 60 elderly subjects with coronary artery disease living in the Los Angeles Basin. Objectives We reassessed biomarker associations with PM0.25 using new particle composition data. Methods Weekly biomarkers of inflammation were plasma interleukin-6 (IL-6) and soluble tumor necrosis factor-α receptor II (sTNF-RII) (n = 578). Exposures included indoor and outdoor community organic PM0.25 constituents [polycyclic aromatic hydrocarbons (PAHs), hopanes, n-alkanes, organic acids, water-soluble organic carbon, and transition metals]. We analyzed the relation between biomarkers and exposures with mixed-effects models adjusted for potential confounders. Results Indoor and outdoor PAHs (low-, medium-, and high-molecular-weight PAHs), followed by hopanes (vehicle emissions tracer), were positively associated with biomarkers, but other organic components and transition metals were not. sTNF-RII increased by 135 pg/mL [95% confidence interval (CI), 45–225 pg/mL], and IL-6 increased by 0.27 pg/mL (95% CI, 0.10–0.44 pg/mL) per interquartile range increase of 0.56 ng/m3 outdoor total PAHs. Two-pollutant models of PM0.25 with PAHs showed that nominal associations of IL-6 and sTNF-RII with PM0.25 mass were completely confounded by PAHs. Vehicular emission sources estimated from chemical mass balance models were strongly correlated with PAHs (R = 0.71). Conclusions Traffic emission sources of organic chemicals represented by PAHs are associated with increased systemic inflammation and explain associations with quasi-ultrafine particle mass.

Background and Aim Depression is emerging as an independent risk factor for CV events, though mechanisms underlying this association are unknown. We investigated the relation between depression and LV hypertrophy (LVH) and LV structure in a group of elderly subjects. Methods and Results Three hundred seventy patients (mean age 79 ± 6 years) were enrolled. CV risk factors were assessed. Depression was defined as a score ≥6 on the 15-item Geriatric Depression Scale. On the basis of the presence of LVH and of LV relative wall thickness (RWT) 4 echocardiographic patterns of LV adaptation were defined: concentric LVH (LVH with increased RWT); eccentric LVH (LVH with normal RWT); concentric LV remodeling (no LVH with increased RWT); normal LV (no LVH with normal RWT). Prevalence of hypertension was approximately 86% and 24.7% had diabetes (n.s. depressed vs not depressed subjects). BP was comparable in these two groups (134.7 ± 1.4 vs 135.3 ± 1.8 mmHg, 77.1 ± 0.8 vs 76.3 ± 1.0 mmHg for SBP and DBP respectively). Depressed subjects (n = 165) showed a significantly higher occurrence of concentric LVH than not depressed, after adjustment for age, sex, and hypertension. Depression was associated with a 2.1 fold higher risk of showing a LV concentric, either remodeling or LVH, pattern after adjustment for age, sex, and traditional CV risk factors. Conclusions Depression is accompanied by a higher occurrence of concentric LVH in elderly subjects, independently of BP levels.

Background and Objective Exposure to ambient particles has been shown to be responsible for cardiovascular effects, especially in elderly with cardiovascular disease. The study assessed the association between deceleration capacity (DC) as well as heart rate variability (HRV) and ambient particulate matter (PM) in patients with coronary artery disease (CAD). Methods A prospective study with up to 12 repeated measurements was conducted in Erfurt, Germany, between October 2000 and April 2001 in 56 patients with physician-diagnosed ischemic heart disease, stable angina pectoris or prior myocardial infarction at an age of at least 50 years. Twenty-minute ECG recordings were obtained every two weeks and 24-hour ECG recordings every four weeks. Exposure to PM (size range from 10 nm to 2.5 μm), and elemental (EC) and organic (OC) carbon was measured. Additive mixed models were used to analyze the association between PM and ECG recordings. Results The short-term recordings showed decrements in the high-frequency component of HRV as well as in RMSSD (root-mean-square of successive differences of NN intervals) in association with increments in EC and OC 0-23 hours prior to the recordings. The long-term recordings revealed decreased RMSSD and pNN50 (% of adjacent NN intervals that differed more than 50 ms) in association with EC and OC 24-47 hours prior to the recordings. In addition, highly significant effects were found for DC which decreased in association with PM2.5, EC and OC concurrent with the ECG recordings as well as with a lag of up to 47 hours. Conclusions The analysis showed significant effects of ambient particulate air pollution on DC and HRV parameters reflecting parasympathetic modulation of the heart in patients with CAD. An air pollution-related decrease in parasympathetic tone as well as impaired heart rate deceleration capacity may contribute to an increased risk for cardiac morbidity and sudden cardiac death in vulnerable populations.

We evaluated pressor responses to the hyperventilation test in elderly normotensive (n=43, mean age 82 ± 5 years) and elderly hypertensive subjects (n=45 with essential hypertension, mean age 82 ± 2 years, and n=49 with secondary hypertension, mean age 82 ± 3 years). Hyperventilation did not change blood pressure (BP) in normotensive and secondary hypertensive subjects, whereas it decreased BP in essential hypertensives. Hierarchical cluster analysis based on BP responses to hyperventilation disclosed three groups of subjects in each population: group 1 exhibited a reduction in BP (essential hypertensives: 76%), group 2 no change (normotensives: 70%, secondary hypertensives: 76%), and group 3 an increase (normotensives: 19%, essential hypertensives: 13%, secondary hypertensives: 14%). Ambulatory BP monitoring found significant differences in pressor daytime profiles of hypertensive patients according to pressor responses to hyperventilation showing wide fluctuations in group 1 and 3 patients. Interestingly, the peak ambulatory SBP values correlated to the pre-hyperventilation SBP values in group 1, and to the hyperventilation peak SBP values in group 3. In conclusion: 1) Aging decreases reactivity to respiratory alkalosis in elderly normotensives; 2) hyperventilation induces significant pressor changes frequently in essential hypertension, but rarely in secondary hypertension; 3) the significant pressor responses to hyperventilation reflect the daytime pressor profiles predicting the highest daily fluctuations of BP values.

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OBJECTIVE - Chromium treatment has been reported to improve glycemic control in patients with type 2 diabetes. However, concern exists about the possible toxic effects of chromium picolinate. The aim of this study was to determine the effect of chromium treatment in the form of chromium yeast on glycemic control in a Western population of patients with type 2 diabetes who were being treated with oral hypoglycemic agents. RESEARCH DESIGN AND METHODS - In this 6-month, double-blind study, patients with moderate glycemic control, being treated with oral hypoglycemic agents, were randomly assigned to receive either a placebo or treatment with 400 mu g of chromium daily in the form of chromium yeast. The primary efficacy parameter was a change in A1C. Secondary end points were changes in lipid profile, BMI, blood pressure, body fat, and insulin resistance. RESULTS - No differences were found for the change in A1C between the intervention and placebo groups, nor were any differences found between the groups for the secondary end points. CONCLUSIONS - There is no evidence that chromium in the form of chromium yeast is effective in improving glycemic control in Western patients with type 2 diabetes who are taking oral hypoglycemic agents.

Differences between elderly subjects ( n = 52 , 60–85 years) and young subjects ( n = 55 , 18–35) in their food liking and their olfactory capability were investigated. Two food systems were used: custard desserts and tomato drinks. Flavor enhancement/enrichment, textural change, and/or irritant addition were incorporated as compensatory strategies into these foods. The addition of low concentrations of both cherry flavor and cream flavor to the custard desserts influenced their pleasantness for the majority of the elderly. The addition of cream topping increased the pleasantness of the custard desserts for both the elderly and the young. The elderly equally liked the tomato drinks with no or with low irritant addition, whereas the young generally disliked an irritant addition. However, the food liking of the elderly was not generally increased by these different compensatory strategies. Instead, subgroups were observed for each compensatory strategy, in which applied compensatory strategies led to an increase in product pleasantness. Age-associated losses in olfactory capabilities did not sufficiently explain differences in food liking, as only elderly with similar olfactory capabilities to the young demonstrated a liking of enhanced flavor. The present study does not support the assumption that age-associated impairment in olfactory capability will inevitably lead to changes in food liking.

Differences between elderly subjects (n = 46, 61¿86 years) and young subjects (n = 36, 18¿25 years) in food perception and food liking were investigated. Intensity and liking ratings were assessed for custard dessert, in which flavor enrichment, textural change, and irritant addition were incorporated as strategies to compensate for sensory losses with increasing age. The sensory acuity (taste, olfaction, irritation, chewing efficiency) of both young and elderly subjects was measured with the help of different sensitivity tests. The elderly perceived the custards differently from the young, mainly as less intense in flavor (cherry/vanilla) and less intense in creaminess/swallowing effort. Several of the observed interaction effects were different for the elderly and the young. The majority of these differences manifested as lower intensity slopes for the elderly. Losses in sensitivity to taste and to olfactory and trigeminal stimuli as well as a reduced chewing efficiency were observed on average for the elderly compared with the young. Furthermore, subgroups of the elderly were observed in which the compensatory strategies flavor enrichment, textural change, and irritant addition led to an increase in food liking. However, these subgroups did not differ in their sensory acuity. The present study does not support the assumption that age-associated changes in food perception¿caused by losses in sensory acuity¿inevitably reduce the food liking of the elderly.

The concept of reserve in neuroscience maintains that there are aspects of brain structure and function that can buffer the effects of neuropathology such that the greater the reserve, the more severe the pathology must be to cause functional impairment. This article provides a concise overview of structural and functional approaches to reserve and shows how reserve may be conceived as the sum of its lifetime input. In this context, reserve therefore provides an empirical yet general model of cognitive aging and development.

Serum antibodies specific for the capsular polysaccharides of Streptococcus pneumoniae provide protection against invasive pneumococcal infection. In Brazil, this vaccine has been used for people over 65 years with clinical risk to develop pneumococcal infection since 1999. We evaluated the immune response of 102 elderly subjects (75.5% females and 24.5% males) with a mean age of 71 years, and 19 young healthy adults (63.2% females and 36.8% males) with a mean age of 27 years. The elderly study group consisted of outpatients who received follow-up care in the Geriatric Department of General Hospital, Faculty of Medicine, University of Sao Paulo. None had acute illness at the time of vaccination. Both groups were immunized with one intra-deltoid injection with 0.5 ml of a 23-valent pneumococcal polysaccharide vaccine. The total IgG specific antibody concentrations to capsular polysaccharides 1, 3, 5, 6B, 8, and 14 were determined against pre- and 1-month post-vaccination sera. All samples were analyzed according to the second-generation pneumococcal polysaccharide ELISA protocol. We observed that the pneumococcal polysaccharide vaccine evoked consistent antibody increase for serotypes 1, 5, 6B, 8, and 14 (geometric mean concentration increase of 2.46 in the elderly and 2.84 in the young adults). Otherwise, we observed no increase in antibody concentration for serotype 3 in both groups.

Although patients with type 2 diabetes mellitus and cardiovascular disease share common risk factors, the link between these diseases remains largely unexplained. In this case-control study, the earlier use of cardiovascular drugs (before the diagnosis of diabetes) was investigated among cases with type 2 diabetes mellitus and controls without diabetes. Using the PHARMO database, we identified 4,864 patients who were prescribed oral hypoglycaemic agent (OHA) therapy between 1985-1998 in the Netherlands. For each case, two controls matched on age, sex and pharmacy were randomly selected. Controls had not received insulins or OHA therapy. There were 2,656 (55.0%) cases compared with 2,727 (28.1%) controls who used cardiovascular drugs at the start of OHA therapy. Cases had a 3.5-fold increased risk of cardiovascular drug use (OR95% CI = 3.5 [3.2-3.8]) compared to controls. Differences in cardiovascular drug use were noted as early as 7 years before the start of OHA therapy, distinguishing cases from controls. Our finding that patients with type 2 diabetes mellitus were more likely to receive treatment for cardiovascular disease several years before they start diabetes therapy supports the hypothesis of a common underlying mechanism of these two disorders and stresses the importance of the pre-diabetic state. (C) 2002 Elsevier Science Inc. All rights reserved.

The purpose of this study was to establish incidence of symptoms and tissue-specific changes of tempromandibular joint function in elderly subjects. The study comprised 218 subjects aged 67.2 on average. Manual functional analysis was used for diagnosing tissue-specific changes of temporomandibular joint function. The history established that 30 (13.8%) subjects had subjective symptoms of temporomandibular joint disorders, and tissue-specific internal tempromandibular joint disorders were diagnosed in 90 (41.3%) subjects. The most usual tissue-specific changes were osteoarthrosis (13.8%) and total anterior disk displacement with reposition (10.1%). A statistically significant difference was found between sexes in incidence of symptoms and tissue-specific diagnoses (p

We compared, in a prospective double-blind randomized study, the effect of the angiotensin-converting enzyme inhibitor quinapril (QUI) with that of triamterene/hydrochlorothiazide (THCT) treatment on cardiovascular end-organ damage in subjects with untreated isolated systolic hypertension (ISH). End-organ damage measurements, performed initially and after 6 and 26 weeks of treatment, included echocardiographic determination of left ventricular mass index (LVMI) and of diastolic function and measurement of aortic distensibility and peripheral vascular resistance. Blood pressure was significantly reduced in the 44 subjects (21 QUI, 23 THCT) completing the study. Both LVMI and aortic distensibility had changed at 6 weeks, with comparable improvements in both groups. LV diastolic function showed overall no significant changes, although patterns of early filling did differ between the two drug groups. Peripheral vascular resistance appeared to increase between 6 and 26 weeks in THCT subjects only, along with a decreased aortic distensibility. Blood pressure and LV mass were rapidly and markedly reduced in both treatment groups of ISH subjects, paralleled by an improvement of aortic distensibility. In interpreting these results, the pathophysiologic alterations in ISH need to be taken into account, because these differ strongly from those in diastolic hypertension. Results of LV diastolic function and peripheral vascular resistance were less clear bur appear to show less favorable changes in the THCT subjects treatment group.

To investigate the relationship between age and energy expenditure, resting metabolic rate (RMR) and diet-induced thermogenesis (DII; for 180 mm after a 1.3-MJ meal) were measured by indirect calorimetry in 56 young and 103 elderly subjects. In addition, the influence of body corn- position, body-fat distribution, and physical activity level on this relationship was studied. RMR was significantly lower in elderly (3.98 ± 0.46 and 3.33 ± 0.39 kJ/min for men and women, respectively) than in young (5.29 ± 0.53 and 4.08 ± 0.33 kJ/min for men and women, respectively) subjects, which persisted after adjustment for body composition. DII was significantly lower in older than in younger men (126 ± 27 vs 154 ± 34 kJ/180 mm) but not in women (111 ± 26 vs 115 ± 25 kJ/180 mm). The difference in men disappeared after ad- justment for body composition. No clear relation between physical activity level and RMR or DII was observed. These results demonstrate a relationship of age per se with RMR but not with DII. Am J Clin Nutr 1995;61:772-8.

Body composition was assessed by means of densitometry, anthropometry and bioelectrical impedance in 28 healthy, elderly females, aged 67-78 years. Underwater weighing was used as the reference method. Mean body mass index (BMI) was 26.3 +/- 3.4 kg/m2. Body fat percentage from body density was 39.6 +/- 5.6%. The fat-free mass (FFM) from body density was 41.0 +/- 5.4 kg. Mean predicted FFM using different prediction formulas from the literature ranged from 38.8 +/- 4.2 to 46.3 +/- 5.3 kg. The differences between FFM from densitometry and FFM using either prediction equation were highly correlated, thus part of the difference is probably due to an error in the reference method. The different prediction equations revealed rather good relative validity, compared to the densitometric method, with the exception of equations based on skinfold measurements developed in younger reference populations. Age-specific prediction equations based on BMI and bioelectrical impedance measurement may be used to assess body composition in the elderly. Prediction equations using skinfold thickness measurements are less appropriate for this purpose.

Background Chronic obstructive pulmonary disease (COPD) is a very common lung disease most often related to history of smoking. It becomes more prevalent with increasing age but remains under-diagnosed and under-treated in the elderly population. Under diagnosis of COPD is universal in elderly patients because of multiple pathology, difficulty with measurement of lung function, under-reporting of symptoms and reduced perception of dyspnoea. However the screening of the elderly (age >60 years) is not performed routinely even when they are symptomatic. Objective The study was undertaken to screen elderly subjects with dyspnoea and/or reduced exercise tolerance for COPD. Study design A cross sectional hospital based study. Methods A total of 1000 elderly subjects were screened for COPD using standard spirometry as per GOLD guidelines. Diagnostic evaluation and classification of patients as “no COPD”, “new COPD” and “known COPD” were done by panel of experts which included a Pulmonologist, Cardiologist, General Physician and Physiotherapist. Subjects were categorized as mild, moderate, severe and very severe COPD based on FEV 1 (forced expiratory volume in 1st sec) values. Results Of the total 1000 elderly participants screened, 596 (59.6%) were classified as having no COPD, 228 (22.8%) with new COPD and 176 (17.6%) with known COPD. Among the total 228 of new COPD patients 27 (11.8%), 176 (77.4%), 5 (2.1%) and 20 (8.7%) were having mild, moderate, severe and very severe COPD respectively as per GOLD guidelines. Similarly of the total 176 subjects with known COPD, 9 (5.1%), 136 (77.3%), 0 (0%) and 31 (17.6%) were having mild, moderate, severe and very severe COPD respectively. Conclusion An active screening for COPD in elderly subjects with dyspnoea or reduced exercise tolerance leads to diagnoses of substantially more new patients with COPD.

The interhemispheric relationship during sleep in elderly subjects was studied throughout the night by a minute-by-minute computation of two linear correlation coefficients between right and left EEG activities. One of these coefficients (X delta) related to the 1-4-Hz band activity, and the other (X sigma) to the 12.5-14.5-Hz band activity. For five of the six subjects examined, it was found that the rapid-eye-movement (REM) mean values of both coefficients were significantly different from the nonrapid-eye-movement (NREM) values. A comparison between this elderly group and a control group of young subjects, examined previously, did not reveal any significant shift, either for the REM or for the NREM mean values of the coefficients.

OBJECTIVE: To examine whether supplementation with multivitamins and multiminerals influences self reported days of infection, use of health services, and quality of life in people aged 65 or over. DESIGN: Randomised, placebo controlled trial, with blinding of participants, outcome assessors, and investigators. SETTING: Communities associated with six general practices in Grampian, Scotland. PARTICIPANTS: 910 men and women aged 65 or over who did not take vitamins or minerals. INTERVENTIONS: Daily multivitamin and multimineral supplementation or placebo for one year. MAIN OUTCOME MEASURES: Primary outcomes were contacts with primary care for infections, self reported days of infection, and quality of life. Secondary outcomes included antibiotic prescriptions, hospital admissions, adverse events, and compliance. RESULTS: Supplementation did not significantly affect contacts with primary care and days of infection per person (incidence rate ratio 0.96, 95% confidence interval 0.78 to 1.19 and 1.07, 0.90 to 1.27). Quality of life was not affected by supplementation. No statistically significant findings were found for secondary outcomes or subgroups. CONCLUSION: Routine multivitamin and multimineral supplementation of older people living at home does not affect self reported infection related morbidity. TRIAL REGISTRATION: ISRCTN: 66376460.