Background-The relationship between impaired brachial flow-mediated dilation (FMD) and subsequent clinical cardiovascular events is not well established, especially in older adults whose FMD is often diminished. We assessed the hypothesis that FMD predicts incident cardiovascular events in a population-based cohort of older adults. Methods and Results-FMD was measured at the 1997 to 1998 Cardiovascular Health Study clinic visit in 2792 adults aged 72 to 98 years (82.7% white, 58.6% women) recruited at 4 clinic sites in the United States. Log-rank test and Cox proportional hazard models were used to examine the association between FMD and adjudicated cardiovascular events. A total of 674 subjects (24.1%) had an adjudicated event over the 5-year follow-up period. Event-free survival rates for cardiovascular events were significantly higher in subjects with FMD greater than the sex-specific medians than in subjects with FMD less than or equal to the sex-specific medians (78.3% versus 73.6%, log-rank Pϭ0.006

Regular PA may reduce frailty, especially in individuals at higher risk of disability. Future studies should be aimed at testing the possible benefits produced by multidomain interventions on frailty.

Objectives-The purpose of this study was to determine the effects of a long-term exercise intervention on two prominent biomarkers of inflammation (C-reactive protein and interleukin-6) in elderly men and women.Design-Single-blind, randomized, controlled trial: The Lifestyle Interventions and Independence for Elders trial (LIFE). Setting-TheCooper Institute, Dallas, Texas; Stanford University, Stanford, California; University of Pittsburgh, Pittsburgh, Pennsylvania; and Wake Forest University, Winston-Salem, North Carolina Participants-Elderly (70-89 yrs), non-disabled, community-dwelling men and women at risk for physical disability (n=424).Intervention-A 12-month moderate-intensity physical activity (PA) intervention compared to a successful aging (SA) health education intervention. Measurements-CRP and IL-6Corresponding author: Barbara J. Nicklas, Ph.D., J. Paul Sticht Center on Aging, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, 336-713-8569 (phone) 336-713-8588 (fax), bnicklas@wfubmc.edu. Author Contributions: BN: Acquisition of data, study concept and design, analysis and interpretation of data, preparation of manuscript FCH: study concept and design, analysis and interpretation of data, preparation of manuscript TB: Acquisition of data, analysis and interpretation of data, preparation of manuscript TC: Acquisition of data, study concept and design, analysis and interpretation of data, preparation of manuscript BG: Acquisition of data, study concept and design, preparation of manuscript SK: Acquisition of data, study concept and design, preparation of manuscript MP: Acquisition of data, study concept and design, preparation of manuscript NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptResults-After adjustment for baseline IL-6, gender, clinic site, diabetes, treatment group, visit, and group by visit interaction, the PA intervention resulted in a lower (P=0.02) IL-6 concentration compared to the SA intervention. The adjusted mean IL-6 at month 12 was 8.5% (0.21 pg/ml) higher in the SA compared to the PA group. There were no significant differences in CRP between the groups at 12 months (P=0.09). Marginally significant interaction effects of the PA intervention by baseline functional status (P=0.051) and IL-6 (above versus below the median; P=0.06) were observed. There was a greater effect of the PA intervention in participants with a lower functional status and those with a higher baseline IL-6.Conclusion-Increased physical activity results in reduced systemic concentrations of IL-6 in elderly individuals and this benefit is most pronounced in those individuals at the greatest risk for disability and subsequent loss of independence.

OBJECTIVES To explore mechanisms whereby hepatic steatosis may be associated with cardiovascular risk, we investigated cross-sectional relationships between hepatic steatosis, regional fat accumulation, inflammatory biomarkers, and subclinical measures of atherosclerosis in the Diabetes Heart Study. METHODS The Diabetes Heart Study is a family study of sibling pairs concordant for type 2 diabetes. A subset of 623 randomly selected participants was evaluated for hepatic steatosis, defined as a liver:spleen attenuation ratio of <1.0 by computed tomography. We quantified visceral fat, subcutaneous fat, coronary, aortic, and carotid artery calcium by computed tomography; and carotid atherosclerosis by ultrasound. Associations between the liver:spleen attenuation ratio and these factors were expressed as Spearman correlations. RESULTS After adjustment for age, race, gender, body mass index, and diabetes status, the liver:spleen attenuation ratio correlated with visceral fat (r = −0.22, P < 0.0001) and subcutaneous fat (r = −0.13, P = 0.031). Hepatic steatosis was associated with lower high-density lipoprotein (r = 0.21, P < 0.0001), higher triglycerides (r = −0.25, P < 0.0001), higher C-reactive protein (r = −0.095, P = 0.004), and lower serum adiponectin (r = 0.34, P < 0.0001). There were no significant associations between the liver:spleen attenuation ratio and coronary, aortic, or carotid calcium, or carotid intimal thickness. CONCLUSIONS This suggests that hepatic steatosis is less likely a direct mediator of cardiovascular disease and may best be described as an epiphenomenon. The strong correlations between pro-atherogenic biomarkers, visceral fat, and elements of the metabolic syndrome suggest that hepatic steatosis reflects more than general adiposity, but represents a systemic, inflammatory, pro-atherogenic adipose state.

Excellent interobserver reliability exists regardless of expertise level for quantitative analysis of muscle parameters on sonography in the critically ill population. On the basis of these findings, it is recommended that echogenicity analysis be performed using the square technique for the quadriceps and the trace technique for the diaphragm.