Andreea M Rawlings1, Stephen P Juraschek2, Gerardo Heiss2, Timothy Hughes2, Michelle L Meyer2, Elizabeth Selvin2, A Richey Sharrett2, B Gwen Windham2, Rebecca F Gottesman2. 1. From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson. arawlin2@jhu.edu. 2. From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson.
Abstract
OBJECTIVE: To examine associations of orthostatic hypotension (OH) with dementia and long-term cognitive decline and to update previously published results in the same cohort for stroke with an additional 16 years of follow-up. METHODS: We analyzed data from 11,709 participants without a history of coronary heart disease or stroke who attended the baseline examination (1987-1989) of the prospective Atherosclerosis Risk in Communities (ARIC) study. OH was defined as a drop in systolic blood pressure (BP) of at least 20 mm Hg or a drop in diastolic BP of at least 10 mm Hg on standing. Dementia was ascertained via examination, contact with participants or their proxy, or medical record surveillance. Ischemic stroke was ascertained via cohort surveillance of hospitalizations, cohort follow-up, and linkage with registries. Both outcomes were adjudicated. Cognitive function was ascertained via 3 neuropsychological tests administered in 1990 to 1992 and 1996 to 1998 and a full battery of tests in 2011 to 2013. Scores were summarized and reported as SDs. We used adjusted Cox regression and linear mixed models. RESULTS: Over ≈25 years, 1,068 participants developed dementia and 842 had an ischemic stroke. Compared to persons without OH at baseline, those with OH had a higher risk of dementia (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.20-1.97) and ischemic stroke (HR 2.08, 95% CI 1.65-2.62). Persons with OH had greater, although nonsignificant, cognitive decline over 20 years (SD 0.09, 95% CI -0.02 to 0.21). CONCLUSIONS: OH assessed in midlife was independently associated with incident dementia and ischemic stroke. Additional studies are needed to elucidate potential mechanisms for these associations and possible applications for prevention.
OBJECTIVE: To examine associations of orthostatic hypotension (OH) with dementia and long-term cognitive decline and to update previously published results in the same cohort for stroke with an additional 16 years of follow-up. METHODS: We analyzed data from 11,709 participants without a history of coronary heart disease or stroke who attended the baseline examination (1987-1989) of the prospective Atherosclerosis Risk in Communities (ARIC) study. OH was defined as a drop in systolic blood pressure (BP) of at least 20 mm Hg or a drop in diastolic BP of at least 10 mm Hg on standing. Dementia was ascertained via examination, contact with participants or their proxy, or medical record surveillance. Ischemic stroke was ascertained via cohort surveillance of hospitalizations, cohort follow-up, and linkage with registries. Both outcomes were adjudicated. Cognitive function was ascertained via 3 neuropsychological tests administered in 1990 to 1992 and 1996 to 1998 and a full battery of tests in 2011 to 2013. Scores were summarized and reported as SDs. We used adjusted Cox regression and linear mixed models. RESULTS: Over ≈25 years, 1,068 participants developed dementia and 842 had an ischemic stroke. Compared to persons without OH at baseline, those with OH had a higher risk of dementia (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.20-1.97) and ischemic stroke (HR 2.08, 95% CI 1.65-2.62). Persons with OH had greater, although nonsignificant, cognitive decline over 20 years (SD 0.09, 95% CI -0.02 to 0.21). CONCLUSIONS: OH assessed in midlife was independently associated with incident dementia and ischemic stroke. Additional studies are needed to elucidate potential mechanisms for these associations and possible applications for prevention.
Authors: W D Rosamond; A R Folsom; L E Chambless; C H Wang; P G McGovern; G Howard; L S Copper; E Shahar Journal: Stroke Date: 1999-04 Impact factor: 7.914
Authors: Frank J Wolters; Hazel I Zonneveld; Albert Hofman; Aad van der Lugt; Peter J Koudstaal; Meike W Vernooij; M Arfan Ikram Journal: Circulation Date: 2017-06-06 Impact factor: 29.690
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Mark P M Harms; Ciáran Finucane; Laura Pérez-Denia; Stephen P Juraschek; Veera K van Wijnen; Lewis A Lipsitz; Johannes J van Lieshout; Wouter Wieling Journal: Auton Neurosci Date: 2020-12-10 Impact factor: 3.145
Authors: Michelle C Johansen; Thomas H Mosley; David S Knopman; Dean F Wong; Lynne E Wagenknecht; Amil M Shah; Scott D Solomon; Rebecca F Gottesman Journal: Stroke Date: 2019-10-10 Impact factor: 7.914
Authors: Matthieu Gautier; Lois Mahe; Jan Elaine Soriano; Andreas Rowald; Jordan W Squair; Arnaud Bichat; Newton Cho; Mark A Anderson; Nicholas D James; Jerome Gandar; Anthony V Incognito; Giuseppe Schiavone; Zoe K Sarafis; Achilleas Laskaratos; Kay Bartholdi; Robin Demesmaeker; Salif Komi; Charlotte Moerman; Bita Vaseghi; Berkeley Scott; Ryan Rosentreter; Claudia Kathe; Jimmy Ravier; Laura McCracken; Xiaoyang Kang; Nicolas Vachicouras; Florian Fallegger; Ileana Jelescu; YunLong Cheng; Qin Li; Rik Buschman; Nicolas Buse; Tim Denison; Sean Dukelow; Rebecca Charbonneau; Ian Rigby; Steven K Boyd; Philip J Millar; Eduardo Martin Moraud; Marco Capogrosso; Fabien B Wagner; Quentin Barraud; Erwan Bezard; Stéphanie P Lacour; Jocelyne Bloch; Grégoire Courtine; Aaron A Phillips Journal: Nature Date: 2021-01-27 Impact factor: 49.962
Authors: Stephen P Juraschek; W T Longstreth; Oscar L Lopez; John S Gottdiener; Lewis A Lipsitz; Lewis H Kuller; Kenneth J Mukamal Journal: Neurology Date: 2020-07-30 Impact factor: 11.800