Cardiometabolic determinants of mortality in a geriatric population: is there a "reverse metabolic syndrome"?
U M Vischer1, M E Safar, H Safar
1Department of Rehabilitation and Geriatrics, hôpital des Trois-Chêne, 3, chemin du Pont-Bochet, 1226 Thonex, Suisse. ulrich.vischer@hcuge.ch
Insights
In elderly individuals, low body mass index (BMI) and low HDL cholesterol predict mortality, challenging traditional cardiovascular disease risk factors. Malnutrition may explain these reverse associations, warranting further research into nutritional interventions.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Metabolic Syndrome
Background:
- Traditional cardiovascular (CV) disease risk factors include diabetes, insulin resistance, overweight, hypertension, and dyslipidemia.
- The predictive value and hierarchy of these factors in elderly populations are not well-established.
Purpose of the Study:
- To investigate the impact of cardiometabolic risk factors on mortality in a cohort of high-risk elderly subjects.
- To identify key predictors of mortality in this demographic.
Main Methods:
- Prospective cohort study of 331 elderly individuals (mean age 85 years).
- Analysis of cardiometabolic risk factors and their association with 2-year total mortality.
Main Results:
- Mortality predictors included age, diabetes, low BMI, low diastolic blood pressure (DBP), low total and HDL cholesterol, and prior CV events.
- Low BMI, low HDL cholesterol, and previous myocardial infarction were the strongest predictors in multivariate analyses.
- Inverse associations suggest a
- reverse metabolic syndrome
- potentially linked to malnutrition or chronic disease.
Conclusions:
- Low BMI, low DBP, low HDL cholesterol, and high insulin sensitivity predict mortality in very old individuals.
- Conventional risk factors may have limited relevance due to malnutrition and chronic disorders.
- Previous CV events and HDL cholesterol remain significant predictors; nutritional interventions require further study.
Aims:
Diabetes or insulin resistance, overweight, arterial hypertension, and dyslipidaemia are recognized risk factors for cardiovascular (CV) disease. However, their predictive value and hierarchy in elderly subjects remain uncertain.
Methods:
We investigated the impact of cardiometabolic risk factors on mortality in a prospective cohort study of 331 elderly high-risk subjects (mean age+/-SD: 85+/-7 years).
Results:
Two-year total mortality was predicted by age, diabetes, low BMI, low diastolic blood pressure (DBP), low total and HDL cholesterol, and previous CV events. The effect of diabetes was explained by previous CV events. In non-diabetic subjects, mortality was predicted by high insulin sensitivity, determined by HOMA-IR and QUICKI indices. In multivariate analyses, the strongest mortality predictors were low BMI, low HDL cholesterol and previous myocardial infarction. Albumin, a marker of malnutrition, was associated with blood pressure, total and HDL cholesterol, and HOMA-IR. The inflammation marker CRP was associated with low total and HDL cholesterol, and high HOMA-IR.
Conclusion:
In very old patients, low BMI, low DBP, low total and HDL cholesterol, and high insulin sensitivity predict total mortality, indicating a "reverse metabolic syndrome" that is probably attributable to malnutrition and/or chronic disorders. These inverse associations limit the relevance of conventional risk factors. Previous CV events and HDL cholesterol remain strong predictors of mortality. Future studies should determine if and when the prevention and treatment of malnutrition in the elderly should be incorporated into conventional CV prevention.
More Related Videos
06:04Pulse-Wave Velocity, Flow-Mediated Dilation, and Carotid Intima-Media Thickness to Assess Cardiovascular Risk in Population with Metabolic Syndrome
Published on: September 27, 2024
12:59Improving Strength, Power, Muscle Aerobic Capacity, and Glucose Tolerance through Short-term Progressive Strength Training Among Elderly People
Published on: July 5, 2017
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
01:15Drug Dosing: Geriatric Patients
01:00Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution