title: Prognostic implications of microvascular and macrovascular abnormalities in older adults: cardiovascular health study.
abstract: BACKGROUND
  Microvascular and macrovascular abnormalities are frequently found on noninvasive tests performed in older adults. Their prognostic implications on disability and life expectancy have not been collectively assessed.
  
  
  METHODS
  This prospective study included 2,452 adults (mean age: 79.5 years) with available measures of microvascular (brain, retina, kidney) and macrovascular abnormalities (brain, carotid, coronary, peripheral artery) in the Cardiovascular Health Study. The burden of microvascular and macrovascular abnormalities was examined in relation to total, activity-of-daily-living disability-free, and severe disability-free life expectancies in the next 10 years (1999-2009).
  
  
  RESULTS
  At 75 years, individuals with low burden of both abnormalities lived, on average, 8.71 years (95% confidence interval: 8.29, 9.12) of which 7.67 years (7.16, 8.17) were without disability. In comparison, individuals with high burden of both abnormalities had shortest total life expectancy (6.95 years [6.52, 7.37]; p < .001) and disability-free life expectancy (5.60 years [5.10, 6.11]; p < .001). Although total life expectancy was similarly reduced for those with high burden of either type of abnormalities (microvascular: 7.96 years [7.50, 8.42] vs macrovascular: 8.25 years [7.80, 8.70]; p = .10), microvascular abnormalities seemed to have larger impact than macrovascular abnormalities on disability-free life expectancy (6.45 years [5.90, 6.99] vs 6.96 years [6.43, 7.48]; p = .016). These results were consistent for severe disability-free life expectancy and in individuals without clinical cardiovascular disease.
  
  
  CONCLUSIONS
  Considering both microvascular and macrovascular abnormalities from multiple noninvasive tests may provide additional prognostic information on how older adults spend their remaining life. Optimal clinical use of this information remains to be determined.
authors.affiliation: Division of Gerontology, Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, and dkim2@bidmc.harvard.edu.
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Francine
authors.initials: F
authors.lastname: Grodstein
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pennsylvania.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.affiliation: Benjamin Leon Center for Geriatric Research and Education, Herbert Wertheim College of Medicine, Florida International University, Miami.
authors.forename: Paulo H M
authors.initials: PH
authors.lastname: Chaves
authors.affiliation: School of Biological and Population Health Sciences, Oregon State University, Corvallis.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Odden
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison.
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle.
authors.forename: Kushang V
authors.initials: KV
authors.lastname: Patel
authors.affiliation: Division of Gerontology, Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, and.
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D055109:Ankle Brachial Index; D004185:Disability Evaluation; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D054079:Vascular Malformations / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*
keywords: Cardiovascular; Disablement process.; Epidemiology; Longevity