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Aortic stiffness, inflammation, denutrition and type 2 diabetes in the elderly.
MedLine Citation:
PMID:  22030242     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIM: Observational studies in the elderly have shown that some of the classical cardiovascular (CV) risk factors are difficult to interpret. Thus, our study investigated whether increased aortic stiffness is associated with higher mortality risk in both the diabetic and non-diabetic elderly before and after adjusting for geriatric confounders such as inflammation (sedimentation rate, C-reactive protein, orosomucoid levels, leukocyte count) and denutrition parameters (body weight, body mass index [BMI], plasma albumin and prealbumin). METHODS: In a cohort of 324 (84 men) hospitalized elderly subjects, including 255 non-diabetic and 69 diabetic subjects, aortic stiffness was assessed by carotid-femoral pulse wave velocity (PWV) together with CV risk factors. Subjects were studied over a 2-year mean follow-up period, thus enabling evaluation of long-term all-cause mortality. RESULTS: A total of 105 subjects died during the follow-up. Kaplan-Meier curves showed a significantly higher mortality in the diabetics (P=0.024). Multivariate Cox analyses differed for non-diabetic subjects and diabetics. In the former, the hazard ratio (HR) for an increase of 1 SD (with confidence intervals) was 1.36 (1.07-1.72) for PWV, 0.73 (0.52-1.01) for plasma albumin and 0.63 (0.45-0.89) for BMI. In diabetic patients, the HR was 1.60 (1.02-2.50) for leukocyte count, 1.75 (1.03-2.96) for orosomucoid levels and 0.32 (0.15-0.68) for BMI. CONCLUSION: In this very elderly population, although marginally significant on crude analysis, PWV, but not systolic or pulse pressure, was a powerful determinant of total mortality after taking into account the important role of type 2 diabetes. In diabetics, inflammation and denutrition predominated over mechanical factors.
Authors:
J Blacher; A D Protogerou; O Henry; S Czernichow; P Iaria; Y Zhang; D Agnoletti; M E Safar
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-24
Journal Detail:
Title:  Diabetes & metabolism     Volume:  -     ISSN:  1878-1780     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607599     Medline TA:  Diabetes Metab     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Affiliation:
HTA unit, Diagnosis and Therapeutic Center, Paris Descartes University, Paris 5, Hôtel-Dieu, AP-HP, place du Parvis-Notre-Dame, 75004 Paris, France.
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