Role of modifiable risk factors in life expectancy in the elderly.

OBJECTIVE: The aim of the present study was to evaluate the role of 'modifiable' risk factors, assessed between the ages of 60 and 70 years, in late survival. DESIGN: The study population included subjects aged 60-70 years, who had a standard health examination at the IPC Center, and who could potentially reach the age of 80 years for men and 85 years for women at the end of the follow-up period. METHODS: The role of 'modifiable' risk factors was assessed by comparing subjects who died before the age of 80 years for men (n=1333) and before 85 years for women (n=543) to subjects who survived beyond these ages (3681 men, 1910 women). Multivariate analyses were conducted to determine which parameters were independently associated with survival to an advanced age. RESULTS: The multivariate analysis showed a decreased probability of late survival with higher pulse pressure (P<0.0001), higher heart rate (P<0.002), higher glycemia (P<0.0034), and an increased probability with regular physical activity (P<0.0001). A significant interaction between heart rate and gender (P<0.01) was observed, indicating that heart rate was a predictor of late survival in men but not in women. Body mass index, cholesterol and triglyceride levels, and diastolic blood pressure and tobacco smoking were not associated with late survival in this population. CONCLUSIONS: A systematic search for certain risk factors in an elderly patient can have a significant impact on late survival and can lead to the establishment of priority goals, such as increasing physical activity and reducing blood pressure, heart rate and glycemia.

Short telomeres are associated with increased carotid atherosclerosis in hypertensive subjects.

Recent studies have shown that individuals with shorter telomeres present a higher prevalence of arterial lesions and higher risk of cardiovascular disease mortality. As a group, patients with high blood pressure are at an increased risk for cardiovascular diseases. However, some hypertensive patients are more prone than others to atherosclerotic lesions. The main objective of this study was to examine the relationship between telomere length, as expressed in white blood cells, and carotid artery atherosclerotic plaques in hypertensive males. Data from 163 treated hypertensive men who were volunteers for a free medical examination were analyzed. Extracranial carotid plaques were assessed with B-mode ultrasound. Telomere length was measured from DNA samples extracted from white blood cells. The results of this study show that telomere length was shorter in hypertensive men with carotid artery plaques versus hypertensive men without plaques (8.17+/-0.07 kb versus 8.46+/-0.07 kb; P<0.01). Multivariate analysis showed that in addition to age, telomere length was a significant predictor of the presence of carotid artery plaques. The findings from this study suggest that in the presence of chronic hypertension, which is a major risk factor for atherosclerotic lesions, shorter telomere length in white blood cells is associated with an increased predilection to carotid artery atherosclerosis.

Why cardiovascular mortality is higher in treated hypertensives versus subjects of the same age, in the general population.

OBJECTIVE: The aim of the present study was to assess whether increased cardiovascular mortality in treated hypertensives could be explained by high blood pressure levels, or by the presence of associated risk factors and/or associated diseases. DESIGN: The study sample consisted of 8893 treated hypertensive men and women from the Investigations Préventives et Cliniques cohort, and 25880 gender-matched and age-matched untreated subjects from the same cohort. Vital status was obtained for an 8-12 year period. RESULTS: Treated hypertensive subjects had higher systolic blood pressure (SBP) (+ 15 mmHg) and higher diastolic blood pressure (+ 9 mmHg), and a higher prevalence of associated risk factors and diseases. Treated hypertensives compared with untreated subjects presented a two-fold increase in the risk ratio (RR) for cardiovascular mortality [RR, 1.96; 95% confidence interval (CI), 1.74-2.22] and coronary mortality (RR, 1.99; 95% CI, 1.63-2.44). Adjustment for unmodifiable risk factors decreased the excess cardiovascular risk observed in treated subjects only slightly: RR, 1.77; 95% CI, 1.56-2.00 for cardiovascular mortality; and RR, 1.76; 95% CI, 1.44-2.16 for coronary mortality. After additional adjustment for modifiable associated risk factors, the increased mortality in treated subjects persisted: RR, 1.52; 95% CI, 1.33-1.74 for cardiovascular mortality; and RR, 1.49; 95% CI, 1.19-1.86 for coronary mortality. Only after additional adjustment for SBP were cardiovascular mortality and coronary mortality similar in the two groups of subjects: RR, 1.06; 95% CI, 0.92-1.23; and RR, 1.06; 95% CI, 0.85-1.35, respectively. CONCLUSIONS: The increased cardiovascular mortality in treated hypertensive subjects as compared with untreated subjects is mainly due to high SBP levels under treatment. This result suggests that the excess risk found in treated hypertensives may be drastically reduced if SBP were brought under control.