OBJECTIVES:Motoric cognitive risk syndrome (MCR) is a pre-dementia syndrome characterized by slow gait and subjective cognitive decline, increasing the risk of adverse clinical events such as dementia and falls in older adults. However, whether self-reported MCR (sMCR) predicts long-term mortality in Chinese older adults remains unknown. This study aimed to explore the role of sMCR in 8-year mortality in community-dwelling older adults. DESIGN:Longitudinal cohort study. SETTING:Data were sourced from the Beijing Longitudinal Study of Aging. PARTICIPANTS:A total of 1,683 community-dwelling individuals aged 65 years and older who were free from disability and dementia at baseline were included. MEASUREMENTS:sMCR was defined based on the presence of subjective cognitive decline and self-reported slow gait. Mortality data were tracked over the 8-year follow-up period. Cox regression models were used to analyze the association between sMCR and 8-year mortality. RESULTS:A total of 113 (6.71%) community-dwelling individuals had sMCR. sMCR was associated with female sex, older age, no spouse, living in rural areas, low education level, low monthly income, no work, no tea intake, poor sleep quality, inactivity, poor physical performance, chronic diseases, and frailty. Participants with sMCR had a higher 8-year mortality compared to those without (70.80% vs. 34.52%). Cox regression analysis showed that sMCR predicted 8-year mortality (hazard ratio [HR] = 2.859, 95% confidence interval [CI] 2.260-3.619). This association remained significant even after adjusting for sex, age, area, education level, marital status, chronic diseases, and lifestyle factors (HR = 1.540, 95% CI 1.169-2.028). CONCLUSIONS:sMCR is a predictor of 8-year mortality in Chinese community-dwelling older adults, which highlights the importance of early identification and intervention for sMCR to reduce adverse clinical outcomes in the aging population.

Objectives Functional impairment is an early stage of disability, and timely identification and intervention are critical for the health of older adults. However, little is known about the functional impairment of Chinese older adults due to the absence of specialised assessment tools. This study aimed to explore the prevalence and socio-demographic characteristics of functional impairment in Chinese community-dwelling older adults using the Function Impairment Screening Tool (FIST), which was previously developed based on the Delphi method.Design Cross-sectional study.Setting Community-based.Participants The study included 6444 community-dwelling older adults from the China Comprehensive Geriatric Assessment Study.Results The FIST identified functional impairment in 31.3% of Chinese community-dwelling older adults. The prevalence was higher among women and individuals in rural areas and increased with age. Illiteracy, no spouse, living alone, poor self-reported health, low income, limited meat intake, less exercise, chronic diseases and geriatric syndromes were associated with functional impairment. Furthermore, after adjusting for related variables, functional impairment was independently associated with disability (OR=138.5, 95% CI 70.0 to 273.9), frailty (OR=13.7, 95% CI 10.3 to 18.3), immobility (OR=6.9, 95% CI 5.4 to 8.9), fractures (OR=2.2, 95% CI 1.5 to 3.3) and falls (OR=2.6, 95% CI 1.8 to 3.7).Conclusion Approximately one-third of Chinese community-dwelling older adults experienced functional impairment, and its prevalence was associated with socio-psychological characteristics, lifestyle, chronic diseases and geriatric syndromes.

The Beijing Healthy Aging Cohort Study (BHACS) was established to supplement the limited data of a large representative cohort of older people based on the general population and was designed to evaluate the prevalence, incidence, and natural history of cognitive decline, functional disability, and conventional vascular risk factors. The aim was to determine the evolution of these conditions by estimating the rates and determinants of progression and regression to adverse outcomes, including dementia, cardiovascular events, cancer, and all-cause death. It can therefore provide evidence to help policy makers develop better policies to promote healthy aging in China. BHACS consisted of three cohorts (BLSA, CCHS-Beijing, and BECHCS) in Beijing with a total population of 11 235 (6281 in urban and 4954 in rural areas) and an age range of 55 years or older (55–101 years) with a mean age of 70.35 ± 7.71 years (70.69 ± 7.62 years in urban and 69.92 ± 7.80 years in rural areas). BHACS-BLSA conducted the baseline survey in 2009 with a multistage stratification-random clustering procedure for people aged 55 years or older; BHACS-CCHS-Beijing conducted the baseline survey in 2013–2015 with a stratified multistage cluster random sampling method for people aged 55 years or older; and BHACS-BECHCS conducted the baseline survey in 2010–2014 with two-stage cluster random sampling method for people aged 60 years or older. Data were collected through questionnaires, physical measurements, and laboratory analyses. Topics covered by BHACS include a wide range of physical and mental health indicators, lifestyles and personal, family, and socio-economic determinants of health. There are no immediate plans to make the cohort data freely available to the public, but specific proposals for further collaboration are welcome. For further information and collaboration, please contact the corresponding author Yao He (e-mail: yhe301@x263.net).

Background: Intrinsic capacity reflects an individual's functions and capacities across their lifetime. There are few studies on whether the level of intrinsic capacity can predict long-term mortality in Chinese populations. Objective: To explore the effects of intrinsic capacity on long-term outcomes in older Chinese adults. Methods: Data were obtained from the Beijing Longitudinal Study of Aging. Overall, 1699 community-dwelling adults aged >= 60 years were included and followed up for 8 years. Intrinsic capacity was determined according to the World Health Organization definition. The predictive ability for adverse outcomes was assessed using the age- and sex-adjusted Cox proportional hazards model. Results: A decline in intrinsic capacity domains was observed in 729 (42.9 %) participants. Declines in the mobility, cognition, vitality, sensory and psychology domains were observed in 21.8%, 15.1 %, 11.4%, 9.10%, and 14.2 % of the participants, respectively. Low intrinsic capacity was associated with worse physical performance, frailty, social frailty, chronic diseases, fracture, and falls. A greater decline in intrinsic capacity predicted an elevated 8-year mortality rate (decline in overall intrinsic capacity hazard ratio 2.91, 95% confidence interval 2.44-3.47, P < 0.001; decline in one domain hazard ratio 2.11, 95% confidence interval 1.71-2.61, P < 0.001; decline in two domains hazard ratio 3.54, 95 % confidence interval 2.81-4.45, P < 0.001; decline in three or more domains hazard ratio 5.30, 95 % confidence interval 4.09-6.87, P < 0.001); adjusted models did not affect prediction performance. Among the five domains of intrinsic capacity, cognition was the strongest predictor of mortality (hazard ratio 3.17, 95 % confidence interval 2.63-3.81, P < 0.001). Conclusions: Intrinsic capacity is useful in identifying older adults at higher risk of adverse outcomes, presenting significant implications for healthcare policies in China.

Purpose Function impairment is an early stage of disability in older adults and requires timely intervention. We have previously developed Function Impairment Screening Tool (FIST) based on the Delphi method, which has good reliability and validity, but the predictive effect is unknown. Therefore, we aimed to explore the role of FIST in predicting long-term mortality in community-dwelling older adults. Participants and methods Data were from the Beijing Longitudinal Study of Aging. A total of 1,833 older adults with 8 years of follow-up were included. Function impairment was assessed using FIST. Cox proportional hazards model was used to calculate the predictive effect of FIST on 8-year all-cause mortality. Results According to FIST, approximately half of the older adults had function impairment (47.6%). The prevalence of function impairment varied across populations. Logistic regression analysis showed that age, female, rural, poor health satisfaction, not drinking tea, and low Mini-Mental State Examination and intrinsic capacity score were associated with function impairment. Furthermore, function impairment was associated with poor physical function and high mortality. Cox analysis showed that FIST could predict 8-year mortality (hazard ratio [HR] = 3.26, 95% confidence interval [CI] 2.74–3.87), and this relationship persisted after adjusting for age, sex, area, marital status, live alone, educational level, smoking, drinking alcohol, and chronic diseases (HR = 1.79, 95% CI 1.45–2.17). Discussion FIST can predict 8-year mortality in community-dwelling older adults. More attention should be paid to older adults with function impairment and early intervention should be provided.

Objective: To investigate the frailty, as estimated by accumulated health deficits, in association with the symp-tomatic carotid atherosclerosis and in relation to five-year cardiovascular (CVD) outcomes. Methods: This is a five-year prospective cohort study. Secondary analysis of data from the Beijing Longitudinal Study on Aging. Community-dwelling people aged 55+ years (n = 1257) have been followed between 2009 and 2014, and having carotid ultrasonography examinations with no CVD events at baseline. Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 37 health deficits assessed at baseline. The association between the degree of frailty and carotid atherosclerosis was examined using odds ratios (OR) with multivariate logistic regression analyses. Effects of frailty on the probability of five-year cardiovascular events and mortality were evaluated using Cox proportional hazard ratios (HR). The analyses were adjusted for demographics, baseline carotid atherosclerosis status, and CVD risk factors. Results: The FI showed characteristic properties and was independently associated with the major carotid atherosclerosis symptoms, including carotid artery intima-media thickening (the most frail vs. the least frail: OR = 4.39: 1.98-7.82), carotid plaque (OR = 3.41: 1.28-6.54), and carotid plaque stability (OR = 1.19, 95 % CI: 1.01-3.59). Compared with the least frail, the most frail individuals were more likely to develop a cardiovascular event in five years, including myocardial infarction (HR = 3.38, 95 % CI = 1.84-6.19), stroke (HR = 1.26, 95 % CI = 1.00-5.87), CVD death (HR = 6.33, 95 % CI = 1.69-11.02), and all-cause death (HR = 5.95, 95 % CI = 2.74-8.95). Conclusion: Deficit accumulation was closely associated with carotid atherosclerosis risks and strongly predicted five-year CVD events. The frailty index can be used to help identify older adults at high risks of CVD for improved preventive healthcare.

INTRODUCTION AND OBJECTIVES:A new computed tomography-derived fractional flow reserve (CT-FFR) technique with a "coarse-to-fine subpixel" algorithm has been developed to generate precise lumen contours. The aim of this study was to assess the diagnostic performance of this new CT-FFR algorithm for discriminating lesion-specific ischemia using wire-based FFR ≤ 0.80 as the reference standard in patients with coronary artery disease. METHODS:This prospective, multicenter study screened 330 patients undergoing coronary CT angiography (CCTA) and invasive FFR (median interval 2 days) from 6 tertiary hospitals. CT-FFR was evaluated in a blinded fashion with a "coarse-to-fine subpixel" algorithm for lumen contour. RESULTS:Between March 2019 and May 2020, we included 316 patients with 324 vessels. There was a good correlation between CT-FFR and invasive FFR (r=0.76, P<.001). The diagnostic sensitivity, specificity, and accuracy on a per-vessel level were 95.3%, 89.8%, and 92.0% for CT-FFR, and 96.4%, 26.4%, and 53.1% for CCTA>50% stenosis, respectively. CT-FFR showed improved discrimination of ischemia compared with CCTA alone overall (AUC, 0.95 vs 0.74, P<.001) and in intermediate (AUC, 0.96 vs 0.62, P<.001) and "gray zone" lesions (AUC, 0.88 vs 0.61, P<.001). The diagnostic specificity, accuracy, and AUC for CT-FFR (71.9%, 82.8%, and 0.84) outperformed CCTA (9.4%, 48.3%, and 0.66) in patients or in vessels with severe calcification (all P<.05). CONCLUSIONS:CT-FFR with a new "coarse-to-fine subpixel" algorithm showed high performance in identifying hemodynamically significant stenosis. The diagnostic performance of CT-FFR was superior to that of CCTA in intermediate lesions, "gray zone" lesions, and severely calcified lesions. Clinical Trial Register: NCT04731285.

Se ha desarrollado una nueva técnica basada en tomografía computarizada para la evaluación de la reserva fraccional de flujo (TC-RFF) con un algoritmo de subpíxel «de grueso a fino» para generar contornos luminales precisos. El objetivo de este estudio es evaluar el rendimiento diagnóstico de este nuevo algoritmo de TC-RFF para discriminar la isquemia específica de lesión utilizando la evaluación invasiva de la RFF ≤ 0,80 como referencia en pacientes con enfermedad coronaria. Este estudio prospectivo y multicéntrico evaluó a 330 pacientes sometidos a angiografía coronaria no invasiva con TC (ACTC) y evaluación invasiva de la RFF (mediana del intervalo, 2 días) en 6 hospitales terciarios. La TC-RFF se evaluó a ciegas con un algoritmo de subpíxel «de grueso a fino» para la evaluación de la luz. Entre marzo de 2019 y mayo de 2020, se incluyó a un total de 316 pacientes con 324 vasos. Hubo una buena correlación entre la TC-RFF y la evaluación invasiva de la RFF (r = 0,76; p < 0,001). La sensibilidad, la especificidad y la exactitud diagnóstica por vaso fueron, respectivamente, del 95,3, el 89,8 y el 92,0% para la TC-RFF y del 96,4, el 26,4 y el 53,1% para la ACTC para las estenosis > 50%. La TC-RFF mostró mejor discriminación de la isquemia que la ACTC sola en general (ABC = 0,95 frente a ABC = 0,74; p < 0,001) y en lesiones intermedias (ABC = 0,96 frente a ABC = 0,62; p < 0,001) y en «zona gris» (ABC = 0,88 frente a ABC = 0,61; p < 0,001). La especificidad, la exactitud y el ABC diagnóstica de la TC-RFF (el 71,9%, el 82,8% y 0,84) superaron las de la ACTC (el 9,4%, el 48,3% y 0,66) en pacientes o vasos con calcificación grave (todos, p < 0,05). La TC-RFF con un algoritmo de subpíxel «de grueso a fino» proporcionó un alto rendimiento en la identificación de estenosis hemodinámicamente significativas. El rendimiento diagnóstico de la TC-RFF fue superior al de la ACTC en lesiones intermedias, de «zona gris» y con calcificación grave. A new computed tomography-derived fractional flow reserve (CT-FFR) technique with a “coarse-to-fine subpixel” algorithm has been developed to generate precise lumen contours. The aim of this study was to assess the diagnostic performance of this new CT-FFR algorithm for discriminating lesion-specific ischemia using wire-based FFR ≤ 0.80 as the reference standard in patients with coronary artery disease. This prospective, multicenter study screened 330 patients undergoing coronary CT angiography (CCTA) and invasive FFR (median interval 2 days) from 6 tertiary hospitals. CT-FFR was evaluated in a blinded fashion with a “coarse-to-fine subpixel” algorithm for lumen contour. Between March 2019 and May 2020, we included 316 patients with 324 vessels. There was a good correlation between CT-FFR and invasive FFR (r = 0.76, P < .001). The diagnostic sensitivity, specificity, and accuracy on a per-vessel level were 95.3%, 89.8%, and 92.0% for CT-FFR, and 96.4%, 26.4%, and 53.1% for CCTA > 50% stenosis, respectively. CT-FFR showed improved discrimination of ischemia compared with CCTA alone overall (AUC, 0.95 vs 0.74, P < .001) and in intermediate (AUC, 0.96 vs 0.62, P < .001) and “gray zone” lesions (AUC, 0.88 vs 0.61, P < .001). The diagnostic specificity, accuracy, and AUC for CT-FFR (71.9%, 82.8%, and 0.84) outperformed CCTA (9.4%, 48.3%, and 0.66) in patients or in vessels with severe calcification (all P < .05). CT-FFR with a new “coarse-to-fine subpixel” algorithm showed high performance in identifying hemodynamically significant stenosis. The diagnostic performance of CT-FFR was superior to that of CCTA in intermediate lesions, “gray zone” lesions, and severely calcified lesions. Clinical Trial Register: NCT04731285 Full English text available from:www.revespcardiol.org/en

Background Radial artery (RA) atherosclerosis in acute coronary syndrome (ACS) patients has not been systematically observed in vivo. The study aims to characterize plaque morphology and intimal hyperplasia of the RA in patients with ACS, using optical coherence tomography (OCT). Methods In this retrospective study involving 239 ACS patients underwent RA OCT without guidewire shadow, 3 groups were divided according to the following criteria: radial artery plaque (RAP) group included patients with fibrous, lipid or calcified plaque; patients without RAP were further classified into radial intimal hyperplasia (RIH) group (intima media thickness ratio [IMR] ≥ 1) or normal group (IMR < 1). The presence and characteristics of RAP and its related risk factors were identified. Results The RAP, RIH and normal groups included 76 (31.8%), 69 (28.9%) and 94 (39.3%) patients, respectively. Patients in RAP group were the oldest, compared with those in the RIH and normal groups ( p < 0.001), and more frequently had triple vessel disease ( p = 0.004). The percentage of plaque rupture (72.4% vs. 56.4%, p = 0.018) and calcification (42.1% vs. 27.6%, p = 0.026) at culprit lesion were significantly higher in patients with RAP than those without RAP. A total of 148 RAP were revealed by OCT, including fibrous (72, 48.6%), lipid (50, 33.8%) and calcified plaques (26, 17.6%). The microvessels were also frequently observed in the RAP group than that in RIH and normal groups (59.2% vs. 8.7% vs. 9.6%, p < 0.001). Multivariate logistic regression analysis showed that age, diabetes, and smoking history (all p < 0.05) were independent risk factors for RAP. Conclusions In terms of insights gained from OCT, RA atherosclerosis is not uncommon in ACS patients by OCT, sharing several morphological characters with early coronary atherosclerosis. Aging, diabetes, and smoking are risk factors for RAP.

BACKGROUND:Prediabetes (PDM) and diabetes mellitus (DM) are common among acute coronary syndrome (ACS) patients. The present study evaluated the association between diabetes status and radial artery (RA) atherosclerosis using optical coherence tomography (OCT) in ACS patients. METHODS:A total of 335 ACS patients who underwent RA OCT were categorized into the DM group, the PDM group, and the normal glucose metabolism (NGM) group. OCT characteristics and clinical variables were compared. RESULTS:RA atherosclerotic plaques were more frequent in the PDM and DM groups than in the NGM group (38.7% vs. 33.3% vs. 16.1%, p = 0.001). Lipid and calcified plaque occurrence were significantly more common in the DM group, followed by the PDM and NGM groups (19.3% vs. 14.6% vs. 6.5%, p = 0.027; 11.8% vs. 6.5% vs. 1.1%, p = 0.009). The prevalence of microvessels in the PDM group was significantly higher (42.7% vs 23.7%, p = 0.017) than in the NGM group but was comparable to the DM group. Multivariate analysis revealed that HbA1c level and age were independent predictors of RA plaque formation and eccentric intimal hyperplasia (all p<0.05). CONCLUSIONS:RA atherosclerosis characteristics differ according to diabetes status. HbA1c level could be a useful marker for RA atherosclerosis progression in ACS patients.

目的 调查1992,2000、2007和2012年北京老年人照料者的变化情况,以期为养老产业发展提供参考依据和合理化建议.方法 本研究根据中国第三-五次人口普查北京市的抽样资料为依据,采用三阶段、分层、整群抽样方法,选择西城区小红庙社区的2个居委会(城区)、大兴区魏善庄镇的9个自然村(近郊农村)以及怀柔区渤海的3个自然村(山区农村)作为调查点,分别于1992、2000、2007及2012年对调查点所有60岁以上的老年人进行调查及随访.结果 1992、2000、2007及2012年北京老年人的照料主要依靠配偶和儿女.2007-2012年北京老年人由配偶照料的比例逐渐上升,同时保姆和其他照料者的比例略有上升.1992、2000、2007及2012年北京男性老年人由配偶照料的比例均高于女性老年人,而由儿女照料的比例明显低于女性老年人,差异均有统计学意义(P＜0.05).1992、2007及2012年北京城市老年人由配偶照料的比例均高于农村老年人,差异均有统计学意义(P＜0.05).1992、2000、2007及2012年北京城市老年人由儿女照料的比例均低于农村老年人,差异均有统计学意义(P＜0.05).结论 1992、2000、2007及2012年北京老年人均以居家养老为主,儿女照料逐渐减少,配偶照料逐渐增多.因此,相关部门应积极完善长期护理保险制度,关注照料者的身心健康,为家庭照料者提供喘息服务、经济补贴和教育培训.

Objective:To explore the multimorbidity patterns in older inpatients adults, and their differences between Northern and Southern China.Methods:A total of 4 348 elderly patients aged 60 and above from the geriatrics departments of 12 grade A tertiary hospitals in 7 cities in China were investigated.Factor analysis was used to explore the comorbidity patterns and analyze the differences in comorbidity patterns between Southern and Northern China.Results:The study population consisted of 4 348 patients over the age of 60, with an average age of(74.15±8.01)years.The total sample had a Kaiser-Meyer-Olkin(KMO)sampling adequacy index of 0.657 and a cumulative variance percentage of 43.97%.Factor analysis revealed there were five major multimorbidity patterns in the patients.These were: the metabolic pattern; the liver-kidney pattern; the degenerative pattern; the neuropsychiatric pattern; dementia.Further factor analysis for the South and the North was conducted.Older inpatients in Southern regions had a KMO sampling adequacy index of 0.654 and a cumulative variance percentage of 43.50%.In Southern China, the multimorbidity patterns were similar to the overall patterns.In Northern regions, older inpatients had a KMO sampling adequacy index of 0.648 and a cumulative variance percentage of 45.16%.The liver-kidney pattern, metabolic disease pattern, lung-dementia pattern, degenerative disease pattern, and neuropsychiatric pattern were the main multimorbidity patterns in Northern China.Conclusions:Multimorbidity patterns were different between Northern and Southern China and should be differentiated in their management.In the North, older adults should pay more attention to the prevention and management of respiratory system diseases and dementia, while in the South, older adults should pay more attention to the prevention and management of degenerative disease.Early disease prevention based on multimorbidity patterns is one of the approaches to the reduction of chronic diseases in older adults.

Abstract The associations of blood pressure components with cardiovascular risks and death remain unclear, and the definition of wide pulse pressure (PP) is still controversial. Using data from 1257 participants without a history of cardiovascular disease, who were followed for 4.84 years, we performed multivariable Cox regression analyses to assess how systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP contribute to risks of cardiovascular events and all‐cause death. Among all participants, SBP and PP were significantly associated with the risks of cardiovascular events and all‐cause death (all p < .05). DBP was not significantly associated with the risk of all‐cause death; rather, it was only associated with a marginally significant 1% increased risk for cardiovascular events (p = 0.051). In participants aged < 65 years, DBP was significantly associated with a 3% increased risk for cardiovascular events (hazard ratio [HR]: 1.03, 95% confidence interval [95% CI]: 1.01–1.06). The association between PP and cardiovascular events appeared to be J‐shaped in comparison to participants with the lowest‐risk PP (50–60 mmHg), with adjusted HRs of 1.71 (95% CI: 1.03–2.85), 1.63 (95% CI: 1.00–2.68), and 2.13 (95% CI: 1.32–3.43) in the <50, 60.0–72.5, and ≥72.5 mmHg subgroups, respectively. The optimal cutoff points of a wide PP for predicting the risks of cardiovascular events and all‐cause death were 70.25 and 76.25 mmHg, respectively. SBP and PP had a greater effect on cardiovascular risk, whereas DBP independently influenced cardiovascular events in middle‐aged participants. Considerable PP alterations should be avoided in antihypertensive treatment.

Takotsubo syndrome（TTS）, also known as stress-induced cardiomyopathy, which was first described in Japanese patients in 1990by Sato, et al., [1] is a syndrome that is being increasingly recognized worldwide and usually characterized by transient left ventricular（LV） systolic dysfunction after emotional or physical stress,

Abstract Background Frailty can be operationalized based on the accumulation of deficits using a frailty index (FI) and is associated with an increased risk of adverse health outcomes. Here, we aim to compare validity of a FI from laboratory data with that of the common clinical FI for prediction of mortality in adults aged 55 + years, also examine whether combined FI could improve identification of adults aged 55 + years at increased risk of death. Methods Data for this analysis were obtained from the Beijing Longitudinal Study of Aging that involved 1,257 community-dwelling Chinese people, aged 55 + years at baseline. The main outcome measure was 5-year mortality. An FI-self-report based on 30 self-reported health-related data was constructed. An FI-lab was developed using laboratory data, in addition to pulse, systolic and diastolic blood pressure, pulse pressure, body mass index (BMI) and waist. A combined FI comprised all items from each FI. Kaplan–Meier survival curve and Cox proportional hazards models were performed to evaluate the risk of each FI on death. The area under receiver operating characteristic(ROC) curves were used to compare the discriminative performance of each FI. Results Of 1257 participants, 155 died and 156 lost at the end of the 5-year follow-up. The mean FI-self-report score was 0.11 ± 0.10, the FI-lab score was 0.33 ± 0.14 and FI-combined score was 0.19 ± 0.09. Higher frailty level defined by each FI was associated with higher risk of death. After adjustment for age and sex, Cox proportional hazards models showed that the higher scores of frailty were associated with a higher risk of mortality for each FI, the hazard ratios for the FI-self-report and FI-lab and FI-combined were 1.04 (1.03 to 1.05) and 1.02 (1.01 to 1.03) and 1.05 (1.04 to 1.07), respectively. The areas under the ROC curve were 0.79 (0.77–0.82) for the FI-self-report, 0.77(0.75–0.80) for the FI-lab and 0.81(0.78–0.82) for FI-combined. Conclusions A FI from laboratory data can stratify older adults at increased risk of death alone and in combination with FI based on self-report data. Assessment in clinical settings of creating an FI using routine collected laboratory data needs to be further developed.

Background ApoE gene polymorphism and serum total homocysteine (tHcy) has been reportedly associated with cognition. In this study, we assessed the association of combined ApoE gene polymorphism and tHcy with cognition in Chinese elder adults. Methods A cross- sectional study was carried out by recruiting 1458 community-dwelling people aged 55+ and above in Beijing in 2009. All participants were interviewed using a standard questionnaire and underwent a physical examination. The mini-mental scale examination (MMSE) score was used in assessing cognitive function. Fasting venous blood samples were taken for ApoE rs429358, rs7412 genotyping, tHcy and other serum lipid measurements. Results Participants with high serum tHcy level showed a relatively lower orientation, attention abilities as well as the total MMSE score than the group with normal tHcy after adjusting confounding factors. ApoE rs429358 and rs7412 variants were observed to have the highest serum TC and TG level in the subjects with high serum tHcy level ( p < 0.05). Cognition of the subjects was found to be significantly associated with high serum tHcy level and ApoE genetic polymorphism ( p < 0.05). Independent of age, BMI, education levels, smoking and alcohol drinking, the worst cognitive ability were detected in the high serum tHcy level subjects with ApoE rs429358C/T and rs7412 C/T as compare with other groups, especially orientation function, memory and delayed recall ability and attention ability. Conclusion High serum tHcy level in combination with ApoE rs429358 and rs7412 variants might be linked with serum lipid levels and cognition, particularly for orientation function and memory and delayed recall ability in old Chinese adults.

Objective: Hypertension and frailty are associated and often coexist in older adults. We have previously showed that frailty is associated with poorer physical function and higher mortality in community-dwelling hypertensive older adults in Beijing Longitudinal Study of Aging. However, little is known about the effect of frailty on hypertension prevalence, treatment, and control in Chinese older adults. We aimed to explore the epidemiological characteristics and related factors of frailty in Chinese older adults with hypertension in a nationwide survey. Design and method: Data were from China Comprehensive Geriatric Assessment Study (CCGAS, 2011–2012) using stratified, multiple-stage, random, and cluster sampling methods. A total of 6867 community-dwelling older adults were included. Comprehensive Geriatric Assessment frailty index (CGA-FI) was measured on the basis of six variables: demographic characteristics, physical health, physical function, living behavior and social function, mental health, and cognitive function. Frailty was defined as a score lower than 0.25. Results: The FI was positively correlated with age in both Non-HT group (male: r = 0.375, p < 0.001, female: r = 0.340, p < 0.001) and HT group (male: r = 0.273, p < 0.001, female: r = 0.340, p < 0.001). The prevalence of hypertension in older adults with frailty was higher than those without frailty (78.3% vs 64.1%, p < 0.001). However, the awareness and treatment rates of hypertension were higher in participants with frailty than those without frailty (awareness rate: 82.9% vs 67.9%, p < 0.001; treatment rate: 68.4% vs 57.8%, p < 0.001). There was no significant difference in control rate of hypertension between HT group and Non-HT group (73.9% vs 74.2%, p = 0.872). The prevalence of frailty was significantly higher in HT than in Non-HT (13.8% vs 7.4%, p < 0.001). Logistic analysis shows that age, marriage, coronary heart disease, chronic obstructive pulmonary disease, diabetic mellitus, osteoporosis, hearing loss, exercise, depression, cognitive impairment and white blood cells were independently related factors with frailty in older participants with hypertension. Conclusions: The prevalence, awareness and treatment rates of hypertension were higher in older adults with frailty than those without frailty in China.

*These authors contributed equally to this work Objective: The comprehensive geriatric assessment (CGA) is an integral tool used to identify vulnerable older adults in need of individualized plans to delay the course of diseases and monitor treatment outcomes. We previously developed and validated a 68item frailty index (FI) based on the CGA in a large, older, Chinese population. However, substantial time is needed to evaluate the 68 items. Therefore, we aimed to develop and validate a simplified FI for use in Chinese older population. Design: Longitudinal study. Setting and Participants: Data were drawn from the Beijing Longitudinal Study of Aging. The study was conducted in 2004 with 1808 participants evaluated using the CGA and was followed-up for 13 years. Mortality was recorded at 3, 5, 8, 10, and 13 years intervals. Measures: 27-Item, 50-item, and 68-item frailty indices were investigated. A Cox proportional hazards model and area under the curve of the receiver operating characteristic (AUCROC) were calculated to compare mortality predictions. Results: The FI was positively correlated with age in males (r = 0.174, P <0.001) and females (r = 0.270, P <0.001). The mean baseline FI was 0.225 ± 0.085 (range: 0.04–0.56) as evaluated by the 27-item FI, 0.181 ± 0.117 (range: 0.02–0.62) by the 50-item FI, and 0.167 ± 0.101 (range: 0.02–0.59) by the 68-item FI. Cox regression models showed that mortality was significantly higher in frail people than in non-frail people for all 3 indices (p<0.001). The AUCs of the 68-item FI, 50-item FI, and 27-item FI for predicting mortality were 0.720, 0.717, and 0.677, respectively (p<0.001). Conclusion: The 27-item FI is reasonable to expect that the AUC of the indices with the higher items number is inferior to the performance of the indices with higher number of items (FI50 and FI68). But 27-item maybe used as a tool to identify frail older adults and predict mortality in clinical and primary care practices in China.

BACKGROUNDIncreased homocysteine levels are associated with the risk of cardiovascular disease (CVD) and death. However, their prevention has not been effective in decreasing CVD risk. This study investigated the individual and combined associations of hyperhomocysteinemia and hypertension with incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.METHODSThis prospective study was conducted among 1,257 elderly participants (mean age: 69 years). A questionnaire survey, physical examinations, and laboratory tests were conducted to collect baseline data. Hyperhomocysteinemia was defined as homocysteine level ≥ 15 µmol/L. H-type hypertension was defined as concomitant hypertension and hyperhomocysteinemia. Multivariate Cox regression analysis was used to evaluate individual and combined associations of hyperhomocysteinemia and hypertension with the risks of incident CVD events and all-cause death.RESULTSOver a median of 4.84-year follow-up, hyperhomocysteinemia was independently associated with incident CVD events and all-cause death. The hazard ratios (HRs) were 1.45 (95% CI: 1.01−2.08) for incident CVD events and 1.55 (95% CI: 1.04−2.30) for all-cause death. After adjustment for confounding factors, H-type hypertension had the highest HRs for incident CVD events and all-cause death. The fully adjusted HRs were 2.44 for incident CVD events (95% CI: 1.28−4.65), 2.07 for stroke events (95% CI: 1.01−4.29), 8.33 for coronary events (95% CI: 1.10−63.11), and 2.31 for all-cause death (95% CI: 1.15−4.62).CONCLUSIONSHyperhomocysteinemia was an independent risk factor, and when accompanied by hypertension, it contributed to incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.