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Search Results: 1 - 10 of 727974 matches for " Anton J. M. de Craen "
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NT-proBNP Best Predictor of Cardiovascular Events and Cardiovascular Mortality in Secondary Prevention in Very Old Age: The Leiden 85-Plus Study
Petra G. van Peet, Yvonne M. Drewes, Anton J. M. de Craen, Jacobijn Gussekloo, Wouter de Ruijter
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081400
Abstract: Background In the aging population cardiovascular disease (CVD) is highly prevalent. Identification of very old persons at high risk of recurrent CVD is difficult, since traditional risk markers loose predictive value with age. Methods In a population-based sample of 282 85-year old participants with established CVD from the Leiden 85-plus Study, we studied predictive values of traditional cardiovascular risk markers, a history of major CVD (myocardial infarction, stroke or arterial surgery), and new cardiovascular biomarkers (estimated glomerular filtration rate (MDRD), C-reactive protein (CRP), homocysteine and N-terminal pro B-type natriuretic peptide (NT-proBNP)) regarding 5-year risk of recurrent cardiovascular events and mortality (composite endpoint). Results During complete 5-year follow-up 157 (56%) participants died. 109 (39%) had a cardiovascular event or died from cardiovascular causes. Individually related to the composite endpoint were: a history of major CVD (HR 1.5 (95%CI 1.03-2.3)), CRP (HR 1.3 (95%CI 1.03-1.5)), homocysteine (HR 1.4 (95%CI 1.2-2.6)) and NT-proBNP (HR 1.7 (95%CI 1.4-2.1)). A prediction model including all traditional risk markers yielded a C-statistic of 0.59 (95%CI 0.52-0.66). Of all five new markers only addition of NT-proBNP improved the C-statistic (0.67 (95%CI 0.61-0.74, p=0.023)). The categoryless net reclassification improvement for NT-proBNP was 39% (p=0.001), for a history of major CVD 27.2% (p=0.03) and for homocysteine 24.7% (p=0.04). Conclusions Among very old subjects with established CVD, NT-proBNP was the strongest risk marker for cardiovascular events and cardiovascular mortality. When estimating risk in secondary prevention in very old age, use of NT-proBNP should be considered.
Randomised Controlled Trial of Unsolicited Occupational Therapy in Community-Dwelling Elderly People: The LOTIS Trial
Anton J. M de Craen, Jacobijn Gussekloo, Gerard J Blauw, Charles G Willems, Rudi G. J Westendorp
PLOS ONE , 2006, DOI: 10.1371/journal.pctr.0010002
Abstract: Objective The objective of this trial, the Leiden 85-Plus Occupational Therapy Intervention Study (LOTIS), was to assess whether unsolicited occupational therapy, as compared to no therapy, can decelerate the increase in disability in high-risk elderly people. Design This was a randomised controlled trial with 2-y follow-up. Setting The study took place in the municipality of Leiden in the Netherlands. Participants The participants were 402 community-dwelling 85-y-old people, with a Mini-Mental State Examination score of >18 points at baseline. Interventions Participants in the intervention group were visited by an occupational therapist who provided training and education about assistive devices that were already present and who gave recommendations and information about procedures, possibilities, and costs of assistive devices and community-based services. Control participants were not visited by an occupational therapist. Outcome Measures The primary outcome measure was the score achieved on the Groningen Activity Restriction Scale. Secondary outcome measures included self-evaluations of well-being and feelings of loneliness. Results The participants were evenly divided between the two groups: 202 participants were allocated to the intervention group and 200 participants to the control group. Of the 202 participants randomised to occupational therapy, 55 participants declined the proposed intervention. An occupational therapist indicated that of the remaining 147 participants, 66 (45%) needed an occupational therapy intervention. A total of 44 new assistive devices and five community-based services were implemented. During follow-up there was a progressive increase in disability in the intervention group (mean annual increase, 2.0 points; SE 0.2; p < 0.001) and control group (mean annual increase, 2.1 points; SE 0.2; p < 0.001). The increase in disability was not significantly different between study groups (0.08 points; 95% CI, ？1.1–1.2; p = 0.75). There was also no difference between study groups for any of the secondary outcome measures. Conclusion Unsolicited occupational therapy in high-risk elderly participants does not decelerate the increase in disability over time. Trial Registration ClinicalTrials.gov NCT00278096
Familial Longevity Is Marked by Better Cognitive Performance at Middle Age: The Leiden Longevity Study
Marjon Stijntjes, Anton J. M. de Craen, Diana van Heemst, Carel G. M. Meskers, Mark A. van Buchem, Rudi G. J. Westendorp, P. Eline Slagboom, Andrea B. Maier
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0057962
Abstract: Background Decline in cognitive performance is a highly prevalent health condition in elderly. We studied whether offspring of nonagenarian siblings with a familial history of longevity, perform better on cognitive tests compared to their partners as controls. This is relevant since it could provide insights into determinants underlying decline in cognitive performance. Methods Cross-sectional analysis within the longitudinal cohort of the Leiden Longevity Study consisting of middle-aged offspring of nonagenarian siblings together with their partners (n = 500, mean age (SD) 66.3 (6.1) and 65.7 (7.2) years, respectively) as controls. Memory function, attention and processing speed were tested using the 15-Picture Learning Test, Stroop test and Digit Symbol Substitution Test. Data were analyzed with regression adjusted for age, gender, years of education and additionally for diabetes mellitus, cardiovascular diseases, alcohol use, smoking, inflammatory markers and apolipoprotein E genotype. Robust standard errors were used to account for familial relationships among the offspring. Results Cognitive performance was worse at higher calendar age (p<0.001, all except Stroop test part 1). The offspring performed better compared to their partners on trial 3 (p = 0.005), the immediate (p = 0.016) and delayed (p = 0.004) recall of the 15-Picture Learning Test as well as on the interference and combined interference score of the Stroop test (p = 0.014 and p = 0.036, respectively) in the fully adjusted model. The difference between offspring and partners was estimated to be more than three years according to the observed difference in calendar age. Conclusions Offspring of nonagenarian siblings with a familial history of longevity have better cognitive performance compared to the group of their partners of comparable age. This effect is independent of age-related diseases and known possible confounders. Possible explanations might be differences in subclinical vascular pathology between both groups.
Predictive Value of a Profile of Routine Blood Measurements on Mortality in Older Persons in the General Population: The Leiden 85-Plus Study
Anne H. van Houwelingen, Wendy P.J. den Elzen, Simon P. Mooijaart, Margot Heijmans, Jeanet W. Blom, Anton J. M. de Craen, Jacobijn Gussekloo
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0058050
Abstract: Background Various questionnaires and performance tests predict mortality in older people. However, most are heterogeneous, laborious and a validated consensus index is not available yet. Since most older people are regularly monitored by laboratory tests, we compared the predictive value of a profile of seven routine laboratory measurements on mortality in older persons in the general population with other predictors of mortality; gait speed and disability in instrumental activities of daily living (IADL). Methodology/Principal Findings Within the Leiden 85-plus Study, a prospective population-based study, we followed 562 participants aged 85 years for mortality over five years. At baseline (age 85 years) high-density lipoprotein cholesterol, albumin, alanine transaminase, hemoglobin, creatinin clearance, C-reactive protein and homocysteine were measured. Participants were stratified based on their number of laboratory abnormalities (0, 1, 2–4 and 5–7). The predictive capacity was compared with gait speed (6-meter walking test) and disability in IADL (Groningen Activity Restriction Scale) by C-statistics. At baseline, 418 (74%) 85-year old participants had at least one laboratory abnormality. All cause mortality risk increased with increasing number of laboratory abnormalities to a hazard ratio of 5.64 [95% CI 3.49–9.12] for those with 5–7 laboratory abnormalities (p<0.001) compared to those without abnormalities. The c-statistic was 0.66 [95% CI 0.59–0.69], similar to that of gait speed and disability in IADL. Conclusions/Significance In the general population of oldest old, the number of abnormalities in seven routine laboratory measurements predicts five-year mortality as accurately as gait speed and IADL disability.
Blood Pressure Variability and Cardiovascular Risk in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER)
Rosalinde K. E. Poortvliet, Ian Ford, Suzanne M. Lloyd, Naveed Sattar, Simon P. Mooijaart, Anton J. M. de Craen, Rudi G. J. Westendorp, J. Wouter Jukema, Christopher J. Packard, Jacobijn Gussekloo, Wouter de Ruijter, David J. Stott
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0052438
Abstract: Variability in blood pressure predicts cardiovascular disease in young- and middle-aged subjects, but relevant data for older individuals are sparse. We analysed data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) study of 5804 participants aged 70–82 years with a history of, or risk factors for cardiovascular disease. Visit-to-visit variability in blood pressure (standard deviation) was determined using a minimum of five measurements over 1 year; an inception cohort of 4819 subjects had subsequent in-trial 3 years follow-up; longer-term follow-up (mean 7.1 years) was available for 1808 subjects. Higher systolic blood pressure variability independently predicted long-term follow-up vascular and total mortality (hazard ratio per 5 mmHg increase in standard deviation of systolic blood pressure = 1.2, 95% confidence interval 1.1–1.4; hazard ratio 1.1, 95% confidence interval 1.1–1.2, respectively). Variability in diastolic blood pressure associated with increased risk for coronary events (hazard ratio 1.5, 95% confidence interval 1.2–1.8 for each 5 mmHg increase), heart failure hospitalisation (hazard ratio 1.4, 95% confidence interval 1.1–1.8) and vascular (hazard ratio 1.4, 95% confidence interval 1.1–1.7) and total mortality (hazard ratio 1.3, 95% confidence interval 1.1–1.5), all in long-term follow-up. Pulse pressure variability was associated with increased stroke risk (hazard ratio 1.2, 95% confidence interval 1.0–1.4 for each 5 mmHg increase), vascular mortality (hazard ratio 1.2, 95% confidence interval 1.0–1.3) and total mortality (hazard ratio 1.1, 95% confidence interval 1.0–1.2), all in long-term follow-up. All associations were independent of respective mean blood pressure levels, age, gender, in-trial treatment group (pravastatin or placebo) and prior vascular disease and cardiovascular disease risk factors. Our observations suggest variability in diastolic blood pressure is more strongly associated with vascular or total mortality than is systolic pressure variability in older high-risk subjects.
No Excess Mortality in Patients Aged 50 Years and Older Who Received Treatment for Ductal Carcinoma In Situ of the Breast
Esther Bastiaannet,Willemien van de Water,Rudi G. J. Westendorp,Maryska L. G. Janssen-Heijnen,Cornelis J. H. van de Velde,Anton J. M. de Craen,Gerrit-Jan Liefers
International Journal of Surgical Oncology , 2012, DOI: 10.1155/2012/567506
Abstract: Background. The incidence of ductal carcinoma in situ (DCIS) has increased at a fast rate.The aim of this study was to assess the incidence and treatment in the Netherlands and estimate the excess mortality risk of DCIS. Methods. From the Netherlands Cancer Registry, adult female patients (diagnosed 1997–2005) with DCIS were selected. Treatment was described according to age. Relative mortality at 10 years of follow-up was calculated by dividing observed mortality over expected mortality. Expected mortality was calculated using the matched Dutch general population. Results. Overall, 8421 patients were included in this study. For patients aged 50–64, and 65–74 an increase in breast-conserving surgery was observed over time ( ). For patients over 75 years of age, 8.0% did not undergo surgery; this percentage remained stable over time ( ). Overall, treated patients aged >50 years experienced no excess mortality regardless of treatment (relative mortality 1.0). Conclusion. The present population-based study of almost 8500 patients showed no excess mortality in surgically treated women over 50 years with DCIS. 1. Introduction Carcinoma in situ of the breast is defined as abnormal proliferation of epithelial cells that do not trespass the basal membrane of the breast ductal or lobular system and consist of a heterogeneous group with different types of histology and also different prognosis [1]. The incidence of ductal carcinoma in situ (DCIS) has increased significantly in all parts of the world including the Netherlands, mainly due to the introduction of breast cancer screening. The biologic behavior of DCIS detected by mammography is unclear [2]. Few treated patients will ultimately die of breast cancer; however, despite the relatively benign nature of DCIS, patients commonly undergo mastectomy [2–4]. The risks of overdiagnosis and overtreatment have been discussed in several studies [2, 3, 5]. Nonetheless, some patients with DCIS have a less benign course than other patients, and it is still not possible to identify which DCIS lesions will progress to invasive carcinoma and in what time interval [6]. Besides, although DCIS is thought of as an early-stage cancer, lesions can be quite large [6]. Most clinical series have focused on the risk of breast cancer recurrence, rather than risk of death per se [3]. Population-based reports of actual deaths from breast cancer in women with DCIS are scarce, but show little excess mortality [7, 8]. The mass mammographic screening program in the Netherlands started in 1990/1991 for females aged 50–70 years; in 1997 the
Reduced Glomerular Filtration Rate and Its Association with Clinical Outcome in Older Patients at Risk of Vascular Events: Secondary Analysis
Ian Ford ,Vladimir Bezlyak,David J Stott,Naveed Sattar,Chris J Packard,Ivan Perry,Brendan M Buckley,J. Wouter Jukema,Anton J. M de Craen,Rudi G. J Westendorp,James Shepherd
PLOS Medicine , 2009, DOI: 10.1371/journal.pmed.1000016
Abstract: Background Reduced glomerular filtration rate (GFR) is associated with increased cardiovascular risk in young and middle aged individuals. Associations with cardiovascular disease and mortality in older people are less clearly established. We aimed to determine the predictive value of the GFR for mortality and morbidity using data from the 5,804 participants randomized in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). Methods and Findings Glomerular filtration rate was estimated (eGFR) using the Modification of Diet in Renal Disease equation and was categorized in the ranges ([20–40], [40–50], [50–60]) ≥ 60 ml/min/1.73 m2. Baseline risk factors were analysed by category of eGFR, with and without adjustment for other risk factors. The associations between baseline eGFR and morbidity and mortality outcomes, accrued after an average of 3.2 y, were investigated using Cox proportional hazard models adjusting for traditional risk factors. We tested for evidence of an interaction between the benefit of statin treatment and baseline eGFR status. Age, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, C-reactive protein (CRP), body mass index, fasting glucose, female sex, histories of hypertension and vascular disease were associated with eGFR (p = 0.001 or less) after adjustment for other risk factors. Low eGFR was independently associated with risk of all cause mortality, vascular mortality, and other noncancer mortality and with fatal and nonfatal coronary and heart failure events (hazard ratios adjusted for CRP and other risk factors (95% confidence intervals [CIs]) for eGFR < 40 ml/min/1.73m2 relative to eGFR ≥ 60 ml/min/1.73m2 respectively 2.04 (1.48–2.80), 2.37 (1.53–3.67), 3.52 (1.78–6.96), 1.64 (1.18–2.27), 3.31 (2.03–5.41). There were no nominally statistically significant interactions (p < 0.05) between randomized treatment allocation and eGFR for clinical outcomes, with the exception of the outcome of coronary heart disease death or nonfatal myocardial infarction (p = 0.021), with the interaction suggesting increased benefit of statin treatment in subjects with impaired GFRs. Conclusions We have established that, in an elderly population over the age of 70 y, impaired GFR is associated with female sex, with presence of vascular disease, and with levels of other risk factors that would be associated with increased risk of vascular disease. Further, impaired GFR is independently associated with significant levels of increased risk of all cause mortality and fatal vascular events and with composite
Associations between Total Cerebral Blood Flow and Age Related Changes of the Brain
Adriaan C. G. M. van Es,Jeroen van der Grond,V. Hester ten Dam,Anton J. M. de Craen,Gerard J. Blauw,Rudi G. J. Westendorp,Faiza Admiraal-Behloul,Mark A. van Buchem
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0009825
Abstract: Although total cerebral blood flow (tCBF) is known to be related to age, less is known regarding the associations between tCBF and the morphologic changes of the brain accompanying cerebral aging. The purpose of this study was to investigate whether total cerebral blood flow (tCBF) is related to white matter hyperintensity (WMH) volume and/or cerebral atrophy. Furthermore, we investigate whether tCBF should be expressed in mL/min, as was done in all previous MR studies, or in mL/100 mL/min, which yielded good results in precious SPECT, PET and perfusion MRI studies investigating regional cerebral blood flow.
Total Joint Replacement in the Past Does Not Relate to a Deteriorated Functional Level and Health Status in the Oldest Old
Wiebe Chr. Verra,Anton J. M. de Craen,Coen C. M. M. Jaspars,Jacobijn Gussekloo,Gerard Jan Blauw,Rudi G. J. Westendorp,Andrea B. Maier,Rob G. H. H. Nelissen
Journal of Aging Research , 2012, DOI: 10.1155/2012/968389
Abstract: Total hip or knee replacement is effective in improving joint function, quality of life, and pain reduction. The oldest old population with joint replacements (TJR) is underrepresented in current literature. We compared health-related and functional characteristics of oldest olds with and without TJR. Participants (aged 85 years) were divided into a group with and without TJR. Comorbidity, physical and joint functioning, daily living activities, quality of life, and mortality were recorded. Thirty-eight of 599 participants (6.3%) received a TJR in the past. Participants with a TJR had slightly less comorbidities, walked slower ( ？？ = 0 . 0 0 6 ), and complained more about hip-pain ( ？？ = 0 . 0 0 7 ). Mortality of those with a TJR was lower during the first 8-year followup ( ？？ = 0 . 0 4 ). All other characteristics were comparable between groups. We conclude that subjects with a TJR performed equally well, besides showing a lower gait speed and a higher frequency of hip-pain. Except for the lower gaitspeed, having a TJR is not associated with poorer health. 1. Introduction The population of oldest olds (i.e., 85 years and older) is the fastest growing segment of the elderly population in the western society [1]. The health status decreases with increasing chronological age [2]. One of the major age-related diseases is osteoarthritis (OA), which is more common in females [3–5]. In subjects between 60 and 70 years of age, prevalences of symptomatic knee OA are reported of approximately 10 percent in males and 20 percent in females [4]. Prevalence of knee OA is comparable in subjects aged 80 years and older [4, 5]. Symptomatic OA of the hip is present in approximately five percent of the 60 to 70 years old females and up to 18 percent in females of 80 years and older. In males, prevalences are slightly lower [3, 4]. Due to the demographic changes, the number of total hip replacement (THR) and total knee replacement (TKR) procedures steadily increases [6]. Increasing age is associated with a higher complication and mortality rate after total joint replacement [6]. However, the results of total joint replacement in elderly patients have been proven effective in terms of pain reduction, functional improvement, and cost-effectiveness and show similar results compared to younger patients receiving total joint replacement [7, 8]. OA of the hip or the knee impairs physical activity [4]. Restriction of physical activity is associated with numerous detrimental effects on general health status, physical function, and quality of life [4, 9]. Maintaining physical
C-Reactive Protein and Genetic Variants and Cognitive Decline in Old Age: The PROSPER Study
Simon P. Mooijaart, Naveed Sattar, Stella Trompet, Eliana Polisecki, Anton J. M. de Craen, Ernst J. Schaefer, Sabine E. Jahn, Thomas van Himbergen, Paul Welsh, Ian Ford, David J. Stott, Rudi G. J. Westendorp, on behalf of The PROSPER Study Group
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0023890
Abstract: Background Plasma concentrations of C-reactive protein (CRP), a marker of chronic inflammation, have been associated with cognitive impairment in old age. However, it is unknown whether CRP is causally linked to cognitive decline. Methods and Findings Within the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) trial, with 5680 participants with a mean age of 75 years, we examined associations of CRP levels and its genetic determinants with cognitive performance and decline over 3.2 years mean follow-up. Higher plasma CRP concentrations were associated with poorer baseline performance on the Stroop test (P = 0.001) and Letter Digit Tests (P<0.001), but not with the immediate and delayed Picture Learning Test (PLT; both P>0.5). In the prospective analyses, higher CRP concentrations associated with increased rate of decline in the immediate PLT (P = 0.016), but not in other cognitive tests (all p>0.11). Adjustment for prevalent cardiovascular risk factors and disease did not change the baseline associations nor associations with cognitive decline during follow-up. Four haplotypes of CRP were used and, compared to the common haplotype, carrierships associated strongly with levels of CRP (all P<0.007). In comparison to strong associations of apolipoprotein E with cognitive measures, associations of CRP haplotypes with such measures were inconsistent. Conclusion Plasma CRP concentrations associate with cognitive performance in part through pathways independent of (risk factors for) cardiovascular disease. However, lifelong exposure to higher CRP levels does not associate with poorer cognitive performance in old age. The current data weaken the argument for a causal role of CRP in cognitive performance, but further study is warranted to draw definitive conclusions.
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