Ceramides and Phosphatidylcholines Associate with Cardiovascular Diseases in the Elderly.

BACKGROUND: The ceramide- and phospholipid-based cardiovascular risk score (CERT2) has been found to predict the risk for cardiovascular disease (CVD) events, especially cardiovascular mortality. In the present study, our aim was to estimate the predictive ability of CERT2 for mortality of CVD, coronary artery disease (CAD), and stroke in the elderly and to compare these results with those of conventional lipids. METHODS: We conducted a prospective study with an 18-year follow-up period that included a total of 1260 participants ages ≥64 years. Ceramides and phosphatidylcholines were analyzed using a LC-MS. Total cholesterol and triglycerides were performed by enzymatic methods and HDL cholesterol was determined by a direct enzymatic method. Concentrations of LDL-cholesterol were calculated according to the Friedewald formula. RESULTS: A higher score of CERT2 was significantly associated with higher CVD, CAD, and stroke mortality during the 18-year follow-up both in unadjusted and adjusted Cox regression models. The unadjusted hazard ratios (HRs) of CERT2 (95% CI) per SD for CVD, CAD, and stroke were 1.72 (1.52-1.96), 1.76 (1.52-2.04), and 1.63 (1.27-2.10), respectively, and the corresponding adjusted HRs (95% CI) per SD for CERT2 were 1.48 (1.29-1.69), 1.50 (1.28-1.75), and 1.41 (1.09-1.83). For conventional lipids, HRs per SD were lower than for CERT2. CONCLUSIONS: The risk score CERT2 associated strongly with CVD, CAD, and stroke mortality in the elderly, while the association between these events and conventional lipids was weak.

Associations of thyroid-stimulating hormone and free thyroxine concentrations with health and life satisfaction in elderly adults.

OBJECTIVE: To analyze associations between thyroid-stimulating hormone (TSH) and free thyroxine (FT4 concentrations and life satisfaction, symptoms, self-rated health, and common neuropsychiatric diseases (depression or dementia) in a community-dwelling elderly population to provide evidence whether to decrease the upper reference limit for TSH or the optimal TSH target in levothyroxine treatment in older adults. METHODS: In this cross-sectional study, we determined TSH and FT4 concentrations in a thyroid disease-free population of 502 men (median age, 71 years) and 584 women (median age, 73 years) and in a patient group of 49 women (median age, 75 years) with primary hypothyroidism who were stable users of thyroxine treatment. Life satisfaction, self-rated health, depression, and dementia were assessed with specific questions and with tools such as the Self-report Depression Scale and the Mini-Mental State Examination. Independent variables were dichotomized, and associations of these variables with TSH and FT4 levels were assessed in the thyroid disease-free population. Levels of TSH and FT4 in thyroid disease-free women and in women treated with thyroxine were also compared. RESULTS: After age adjustment, there were no associations between TSH levels and self-rated health, life satisfaction, or most symptoms in the thyroid disease-free population. No associations were found between diagnosed depression or Mini-Mental State Examination results and levels of TSH and FT4. Dementia was associated with higher FT4 concentration in men. Although women treated with thyroxine had TSH levels that were higher than thyroid disease-free women, there were no statistically significant differences in independent variables between these 2 groups. CONCLUSION: Our results do not support the need to decrease the upper reference limit for TSH or to lower the optimal TSH target in levothyroxine treatment in older adults, as recommended in recent guidelines.

Associations of sex hormone concentrations with health and life satisfaction in elderly men.

OBJECTIVE: To analyze associations between sex hormone concentrations and self-rated health and life satisfaction, neuropsychiatric symptoms, or diagnosed depression or dementia in elderly men. METHODS: The study subjects were men from the community-based Lieto Study (N = 517). Subjects were excluded from the study if they were taking exogenous sex hormones or medication for prostate cancer or for benign prostatic hyperplasia or if data for calculating body mass index (BMI) were missing. Thus, 466 men (64 to 97 years old; mean age, 72 years; mean BMI, 26.9 kg/m(2)) remained for further analysis. RESULTS: After adjustment for age, higher levels of testosterone and free testosterone were associated with better self-rated health. After adjustment for age and BMI, no statistically significant associations were found between sex hormone levels and self-rated health or life satisfaction or most neuropsychiatric symptoms in elderly men. Diagnosed depression was associated with a lower serum testosterone concentration. Higher levels of luteinizing hormone and follicle-stimulating hormone were associated with diagnosed dementia. CONCLUSION: In this population-based study with high attendance rate, low serum testosterone concentration was associated with diagnosed depression. Subclinical hypogonadism may be associated with diagnosed dementia. Single questions on neuropsychiatric symptoms commonly associated with androgen deficiency seemed to have weak or no correlation with testosterone or free testosterone levels among this group of elderly men.

Actual practice vs guidelines in laboratory monitoring of older patients with primary hypothyroidism in primary care.

BACKGROUND AND AIMS: Clinical guidelines are produced in order to achieve an acceptable standard of care, especially for patients with common diseases in primary care. The treatment of primary hypothyroidism serves as an example of the content of clinical guidelines and actual practice. The aim of this study was to compare the follow-up of primary hypothyroidism by thyroid function tests, serum TSH and serum-free T4, in older patients managed in primary care, with recommendations in treatment guidelines and textbooks. METHODS: Participation rate 82% (n=1260), mean age 74 years, (range 64-100 yrs). Patients with primary hypothyroidism were identified by means of cross-sectional survey (Lieto Study 1998-1999) and 4-year retrospective collection of laboratory database medical records (1994-1998), performed in autumn 2003. RESULTS: In most stable (=treated for more than 14 months) thyroxine users, both serum TSH (mean 1.4 measurements/year) and serum-free T4 (mean 0.8 measurements/year) values were measured over the 4-year period of thyroxine treatment. 66.4% of serum TSH and 85.3% of serum-free T4 values were within normal range. 41.7% of serum-free T4 determinations had been performed without indication (=with TSH in normal range). CONCLUSIONS: Compared with the recommended testing frequency given in various guidelines, a considerable number of extra measurements, especially serum-free T4, were performed. However, some key issues in the recommendations were difficult to interpret, and the age or other main characteristics of the patient were not taken into consideration adequately.

Sedative drug use in the home-dwelling elderly.

BACKGROUND: The elderly use more sedatives than other populations. Reports on the sedative load of drugs and their associations with health items are scarce. OBJECTIVE: To investigate the prevalence of sedatives and drugs with sedative properties and the associations between those drugs and demographic or health items in the home-dwelling elderly in a cross-sectional community survey. METHODS: Information was obtained from 1197 persons (43% men) aged >or=64 years in the Finnish municipality of Lieto in 1998-1999. The brand names of the prescription drugs taken by each interviewee during one week prior to the interview were recorded. The classification created in a previous study, where the drugs used in Finland were divided into 4 groups by their sedative properties, was utilized to determine associations with health items. RESULTS: A total of 88% (n = 1056) of the participants used some drug. Forty percent (n = 422 persons) of the drug users took sedatives or drugs with sedative properties. The oldest individuals (>or=80 y), women, those with low education, smokers, those with poor self-perceived health, people with dementia and mobility problems, and especially those with depression had an independent association with the simultaneous use of many (>or=2) sedatives or drugs with sedative properties. CONCLUSIONS: In a population of home-dwelling elderly patients, abundant sedative drug use was common and especially associated with high age, female gender, poor basic education, poor health habits (eg, smoking), depression, dementia, or impaired mobility. Users also had poor self-perceived health. The need to further develop the classification will be a major challenge, and the classification needs to be updated every year. More studies are needed in this field.

Undiagnosed diseases in patients with dementia--a potential target group for intervention.

OBJECTIVE: To study undiagnosed diseases in older people with and without dementia. DESIGN: Cross-sectional population-based study in Lieto, southwestern Finland. PARTICIPANTS: All the inhabitants aged 64 and more in Lieto. Participation rate was 82% (n = 1,260). MEASUREMENTS: Dementia and its subtypes were diagnosed according to prevailing criteria. Medical conditions were assessed in clinical examinations and from medical records. RESULTS: 112 patients with dementia were found; 66% of them had at least 1 undiagnosed disease compared to 48% of the non-demented group (p = 0.041). The demented subjects had more undiagnosed hypercholesterolaemia (p = 0.039) and undiagnosed hypothyroidism (p = 0.032) than the controls. CONCLUSION: Undiagnosing is more common among patients with dementia. Screening strategies should be developed further to find these patients.