OBJECTIVES: To compare the predictive value of biomarkers commonly measured in older patients with cardiovascular disease (CVD) with an indicator of cognitive function. DESIGN: Prospective cohort study. SETTING: Helsinki, Finland. PARTICIPANTS: Three hundred ninety-eight home-dwelling older persons (261 women, mean age 80) with stable CVD and without a diagnosis of clinical dementia. MEASUREMENTS: Simple laboratory and clinical measurements (including the Mini Mental State Examination (MMSE, maximum score 30 points) and New York Heart Association (NYHA) classification) were used to predict mortality. A MMSE score between 18 and 24 points was considered to indicate cognitive impairment. RESULTS: At baseline, median MMSE score was 27 (interquartile range 25-28), with 59 individuals having a score below 24 points. During a mean follow-up of 6.0 years, 129 participants died. In the fully adjusted Cox proportional hazards model, low MMSE score was the strongest predictor of mortality, with a relative hazard of 2.38 (95% confidence interval=1.52-3.74; P<.001). Of the various clinical and laboratory variables, only creatinine, C-reactive protein, and history of congestive heart failure were significant independent predictors, whereas conventional risk factors were not. CONCLUSION: Only a few clinical variables independently predicted 6-year mortality in older home-living patients with CVD. The strongest predictor was impaired cognitive function assessed using MMSE.
OBJECTIVES: To compare the predictive value of biomarkers commonly measured in older patients with cardiovascular disease (CVD) with an indicator of cognitive function. DESIGN: Prospective cohort study. SETTING: Helsinki, Finland. PARTICIPANTS: Three hundred ninety-eight home-dwelling older persons (261 women, mean age 80) with stable CVD and without a diagnosis of clinical dementia. MEASUREMENTS: Simple laboratory and clinical measurements (including the Mini Mental State Examination (MMSE, maximum score 30 points) and New York Heart Association (NYHA) classification) were used to predict mortality. A MMSE score between 18 and 24 points was considered to indicate cognitive impairment. RESULTS: At baseline, median MMSE score was 27 (interquartile range 25-28), with 59 individuals having a score below 24 points. During a mean follow-up of 6.0 years, 129 participants died. In the fully adjusted Cox proportional hazards model, low MMSE score was the strongest predictor of mortality, with a relative hazard of 2.38 (95% confidence interval=1.52-3.74; P<.001). Of the various clinical and laboratory variables, only creatinine, C-reactive protein, and history of congestive heart failure were significant independent predictors, whereas conventional risk factors were not. CONCLUSION: Only a few clinical variables independently predicted 6-year mortality in older home-living patients with CVD. The strongest predictor was impaired cognitive function assessed using MMSE.
Authors: Alexandra M Hajduk; Stephenie C Lemon; David D McManus; Darleen M Lessard; Jerry H Gurwitz; Frederick A Spencer; Robert J Goldberg; Jane S Saczynski Journal: Clin Epidemiol Date: 2013-10-24 Impact factor: 4.790