Objective To facilitate clinical use of central PP, we sought to determine a value that might predict adverse outcome and thereby provide a target for assessment of intervention strategies. Background We previously documented that central pulse pressure (PP) more strongly relates to carotid hypertrophy and extent of atherosclerosis and, more importantly, better predicts incident cardiovascular disease (CVD) than brachial PP. Methods Radial applanation tonometry was performed in the 3rd Strong Heart Study exam to determine central blood pressure. Cox regression analyses were performed using pre-specified covariates and quartiles of central and brachial PP. Results Among 2,405 participants without prevalent CVD, 344 suffered CVD events during 5.6±1.7 years. Quartiles of central PP (p<0.001) predicted outcome more strongly than quartiles of brachial PP (p=0.052). With adjustment for covariates, only the event rate in the 4th quartile of central PP (≥50 mmHg) was significantly higher than that in the first quartile (HR 1.69, 95% CI: 1.20–2.39, p=0.003). Central PP ≥50 mmHg was related to outcome in both men (HR 2.06, 95% CI: 1.39–3.04, p<0.001) and women (HR 2.03, 95% CI: 1.55–2.65, p<0.001); in participants with (HR 1.84, 95% CI: 1.41–2.39, p<0.001) and without diabetes (HR 1.91, 95% CI: 1.29–2.83, p=0.001); and in individuals below (HR 2.51, 95% CI: 1.59–3.95, p<0.001) and above (HR 1.53, 95% CI: 1.19–1.97, p=0.001) the age of 60. Conclusions Central PP ≥50 mmHg predicts adverse CVD outcome and may serve as a target in intervention strategies, if confirmed in other populations and in prospective studies.

Adult height has directionally opposing relationships with risk of death from several different major causes of chronic diseases.

Objectives To examine the associations of depressive symptoms, antidepressant use, and duration of use with incident frailty three years later in nonfrail women ≥ age 65. Design Secondary analysis of the Women’s Health Initiative Observational Study (WHI-OS), a prospective cohort study. Setting WHI-OS was conducted in 40 U.S. clinical centers. Participants Women aged 65-79, not frail at baseline. Measurements Antidepressant use was assessed through medication container inspection at baseline. We created four groups according to baseline use and Burnam depression screen (range 0-1, 0.06 cut-off): antidepressant non-users without depressive symptoms (referent group), antidepressant non-users with depressive symptoms, antidepressant users without depressive symptoms, and antidepressant users with depressive symptoms. Frailty components included slowness/weakness, exhaustion, low physical activity, and unintended weight loss, ascertained through self-report and physical measurements at baseline and year 3. Results Among 27652 women at baseline, 4.9% (n=1350) were antidepressant users and 6.5% (n=1794) were categorized depressed. At year 3, 14.9% (n=4125) were frail. All groups had an increased risk for incident frailty compared to the referent group. Odds ratios ranged from 1.73 (95% Confidence Interval (CI) =1.41-2.12) among non-depressed antidepressant users to 3.63 among depressed antidepressant users (95% CI = 2.37-5.55). All durations of use were associated with incident frailty (<1 year OR = 1.95, 95% CI = 1.41-2.68; 1 to 3 years OR = 1.99, 95% CI = 1.45-2.74; > 3 years OR = 1.60, 95% CI = 1.20-2.14). Conclusion In older adult women, depressive symptoms and antidepressant use were associated with frailty after 3 years follow-up.

The association of low birth weight and chronic kidney disease was examined in a screened volunteer population by the National Kidney Foundation's Kidney Early Evaluation Program. This is a free, community-based health program enrolling individuals aged 18 years or older with diabetes, hypertension, or a family history of kidney disease, diabetes, or hypertension. Self-reported birth weight was categorized and chronic kidney disease defined as an estimated glomerular filtration rate less than 60 ml per min per 1.73 m(2) or a urine albumin/creatinine ratio >or=30 mg/g. Among 12 364 participants, 15% reported a birth weight less than 2500 g. In men, significant corresponding odds ratios were found after adjustment for demographic characteristics and health conditions to this low birth weight and chronic kidney disease, but there was no association among women. There was no significant interaction between birth weight and race for either gender. Efforts to clinically understand the etiology of this association and potential means of prevention are essential to improving public health.

OBJECTIVEThe purposes of this study were to investigate whether reduced lung function is associated with metabolic syndrome (MS) and diabetes (DM) in American Indians (AIs) and to determine whether lower pulmonary function presents before the development of DM or MS.RESEARCH DESIGN AND METHODSThe Strong Heart Study (SHS) is a multicenter, prospective study of cardiovascular disease (CVD) and its risk factors among AI adults. The present analysis used lung function assessment by standard spirometry at the SHS second examination (1993–1995) in 2,396 adults free of overt lung disease or CVD, with or without DM or MS. Among MS-free/DM-free participants, the development of MS/DM at the SHS third examination (1996–1999) was investigated.RESULTSSignificantly lower pulmonary function was observed for AIs with MS or DM. Impaired pulmonary function was associated with MS and DM after adjustment for age, sex, abdominal obesity, current smoking status, physical activity index, hypertension, and SHS field center. Both forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were negatively associated with insulin resistance or DM severity and with serum markers of inflammation (P < 0.05). FVC and FEV1-to-FVC ratio both predicted DM in unadjusted analyses but not when adjusted for covariates, including waist circumference. In the adjusted model, abdominal obesity predicted both MS and DM.CONCLUSIONSReduced lung function is independently associated with MS and with DM, and impaired lung function presents before the development of MS or DM; these associations may result from the effects of obesity and inflammation.