Advertisement

Measures of carotid atherosclerosis and fall-related hospitalization risk: The Perth Longitudinal Study of Ageing Women

  • Abadi K. Gebre
    Affiliations
    Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray
    Search for articles by this author
  • Marc Sim
    Correspondence
    Corresponding author. Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia.
    Affiliations
    Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    Medical School, The University Western Australia, Perth, WA, Australia
    Search for articles by this author
  • Jack Dalla Via
    Affiliations
    Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
    Search for articles by this author
  • Alexander J. Rodríguez
    Affiliations
    Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
    Search for articles by this author
  • Jonathan M. Hodgson
    Affiliations
    Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    Medical School, The University Western Australia, Perth, WA, Australia
    Search for articles by this author
  • Catherine P. Bondonno
    Affiliations
    Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    Medical School, The University Western Australia, Perth, WA, Australia
    Search for articles by this author
  • Peter L. Thompson
    Affiliations
    Medical School, The University Western Australia, Perth, WA, Australia

    Department of Cardiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
    Search for articles by this author
  • Richard L. Prince
    Affiliations
    Medical School, The University Western Australia, Perth, WA, Australia
    Search for articles by this author
  • Joshua R. Lewis
    Affiliations
    Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    Medical School, The University Western Australia, Perth, WA, Australia

    Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
    Search for articles by this author
Published:October 10, 2022DOI:https://doi.org/10.1016/j.numecd.2022.10.003

      Highlights

      • The presence of carotid plaque was associated with a higher risk of injurious falls.
      • Each standard deviation increase in CCA-IMT was associated with injurious falls.
      • Including measure of muscle and physical function did not attenuate the associations.
      • Carotid atherosclerosis may be used for falls risk stratification in older women.

      Abstract

      Background and aims

      We and others have identified links between cardiovascular conditions and poor musculoskeletal health. However, the relationship between measures of carotid atherosclerosis such as focal carotid plaque and common carotid intima media thickness (CCA-IMT) and falls remains understudied. This study examined the association between measures of carotid atherosclerosis and fall-related hospitalization over 11.5 years in community dwelling older women.

      Methods and results

      1116 older women recruited in 1998 to a five-year randomized controlled trial to examine the effect of calcium supplementation in preventing fracture and who had undertaken B-mode ultrasound in 2001 (three years after the baseline clinical visit) were included in this study. The participants were followed for over 11.5 years as Perth Longitudinal Study of Ageing Women (PLSAW). Over the follow up period, 428 (38.4%) women experienced a fall-related hospitalization. Older women with carotid plaque had 44% a higher relative hazard for fall-related hospitalization (HR 1.44; 95%CI, 1.18 to 1.76) compared to those without carotid plaque. The association persisted after adjustment for established falls risk factors such as measures of muscle strength and physical function.Each SD increase in the mean and maximum CCA-IMT was also associated with a higher risk of fall-related hospitalizations (HR 1.10; 95%CI, 1.00 to 1.21 and HR 1.11; 95%CI, 1.01 to 1.22, respectively).

      Conclusions

      Measures of carotid atherosclerosis are associated with a higher risk of fall-related hospitalization independent of established falls risk factors. These findings suggest the importance of vascular health when considering falls risk.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Nutrition, Metabolism and Cardiovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • WHO
        Falls: key acts.
        2021
        • WHO
        Ageing WHO, Unit LC. WHO global report on falls prevention in older age.
        World Health Organization, 2008
        • Scuccato R.
        [Falls in the elderly.].
        Recenti Prog Med. 2018; 109: 401-404
        • Berry S.D.
        • Miller R.R.
        Falls: epidemiology, pathophysiology, and relationship to fracture.
        Curr Osteoporos Rep. 2008; 6: 149-154
        • Immonen M.
        • Haapea M.
        • Similä H.
        • Enwald H.
        • Keränen N.
        • Kangas M.
        • et al.
        Association between chronic diseases and falls among a sample of older people in Finland.
        BMC Geriatr. 2020; 20: 225
        • Paliwal Y.
        • Slattum P.W.
        • Ratliff S.M.
        Chronic health conditions as a risk factor for falls among the community-dwelling US older adults: a zero-inflated regression modeling approach.
        BioMed Res Int. 2017; 20175146378
        • Weerdesteyn V.
        • de Niet M.
        • van Duijnhoven H.J.
        • Geurts A.C.
        Falls in individuals with stroke.
        J Rehabil Res Dev. 2008; 45: 1195-1213
        • Lee K.
        • Davis M.A.
        • Marcotte J.E.
        • Pressler S.J.
        • Liang J.
        • Gallagher N.A.
        • et al.
        Falls in community-dwelling older adults with heart failure: a retrospective cohort study.
        Heart Lung. 2020; 49: 238-250
        • Fahs C.A.
        • Heffernan K.S.
        • Ranadive S.
        • Jae S.Y.
        • Fernhall B.
        Muscular strength is inversely associated with aortic stiffness in young men.
        Med Sci Sports Exerc. 2010; 42: 1619-1624
        • Ramírez-Vélez R.
        • García-Hermoso A.
        • Correa-Rodríguez M.
        • Lobelo F.
        • González-Ruiz K.
        • Izquierdo M.
        Abdominal aortic calcification is associated with decline in handgrip strength in the U.S. adult population ≥40 years of age.
        Nutr Metabol Cardiovasc Dis. 2021; 31: 1035-1043
        • Rodríguez A.J.
        • Lewis J.R.
        • Scott D.S.
        • Kiel D.P.
        • Schousboe J.T.
        • Ebeling P.R.
        • et al.
        Aortic calcification is associated with five-year decline in handgrip strength in older women.
        Calcif Tissue Int. 2018; 103: 589-598
        • Gebre A.K.
        • Sim M.
        • Rodríguez A.J.
        • Hodgson J.M.
        • Blekkenhorst L.C.
        • Szulc P.
        • et al.
        Abdominal aortic calcification is associated with a higher risk of injurious fall-related hospitalizations in older Australian women.
        Atherosclerosis. 2021; 328: 153-159
        • Wong A.K.
        • Lord S.R.
        • Trollor J.N.
        • Sturnieks D.L.
        • Delbaere K.
        • Menant J.
        • et al.
        High arterial pulse wave velocity is a risk factor for falls in community-dwelling older people.
        J Am Geriatr Soc. 2014; 62: 1534-1539
        • Moreland J.D.
        • Richardson J.A.
        • Goldsmith C.H.
        • Clase C.M.
        Muscle weakness and falls in older adults: a systematic review and meta-analysis.
        J Am Geriatr Soc. 2004; 52: 1121-1539
        • Bots M.L.
        • Hoes A.W.
        • Koudstaal P.J.
        • Hofman A.
        • Grobbee D.E.
        Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study.
        Circulation. 1997; 96: 1432-1437
        • Sillesen H.
        • Sartori S.
        • Sandholt B.
        • Baber U.
        • Mehran R.
        • Fuster V.
        Carotid plaque thickness and carotid plaque burden predict future cardiovascular events in asymptomatic adult Americans.
        European Heart Journal - Cardiovascular Imaging. 2017; 19: 1042-1050
        • Wu Y.
        • He J.
        • Sun X.
        • Zhao Y.M.
        • Lou H.Y.
        • Ji X.L.
        • et al.
        Carotid atherosclerosis and its relationship to coronary heart disease and stroke risk in patients with type 2 diabetes mellitus.
        Medicine (Baltim). 2017; 96e8151
        • Bea A.M.
        • Civeira F.
        • Jarauta E.
        • Lamiquiz-Moneo I.
        • Pérez-Calahorra S.
        • Marco-Benedí V.
        • et al.
        Association between the presence of carotid artery plaque and cardiovascular events in patients with genetic hypercholesterolemia.
        Rev Esp Cardiol. 2017; 70: 551-558
        • Schwaiger J.P.
        • Lamina C.
        • Neyer U.
        • König P.
        • Kathrein H.
        • Sturm W.
        • et al.
        Carotid plaques and their predictive value for cardiovascular disease and all-cause mortality in hemodialysis patients considering renal transplantation: a decade follow-up.
        Am J Kidney Dis. 2006; 47: 888-897
        • Lewis J.R.
        • Schousboe J.T.
        • Lim W.H.
        • Wong G.
        • Zhu K.
        • Lim E.M.
        • et al.
        Abdominal aortic calcification identified on lateral spine images from bone densitometers are a marker of generalized atherosclerosis in elderly women.
        Arterioscler Thromb Vasc Biol. 2016; 36: 166-173
        • Yamanashi H.
        • Kulkarni B.
        • Edwards T.
        • Kinra S.
        • Koyamatsu J.
        • Nagayoshi M.
        • et al.
        Association between atherosclerosis and handgrip strength in non-hypertensive populations in India and Japan.
        Geriatr Gerontol Int. 2018; 18: 1071-1078
        • Gray V.L.
        • Goldberg A.P.
        • Rogers M.W.
        • Anthony L.
        • Terrin M.L.
        • Guralnik J.M.
        • et al.
        Asymptomatic carotid stenosis is associated with mobility and cognitive dysfunction and heightens falls in older adults.
        J Vasc Surg. 2020; 71: 1930-1937
        • Prince R.L.
        • Devine A.
        • Dhaliwal S.S.
        • Dick I.M.
        Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women.
        Arch Intern Med. 2006; 166: 869-875
        • Bruce D.G.
        • Devine A.
        • Prince R.L.
        Recreational physical activity levels in healthy older women: the importance of fear of falling.
        J Am Geriatr Soc. 2002; 50: 84-89
        • Lewis J.R.
        • Schousboe J.T.
        • Lim W.H.
        • Wong G.
        • Wilson K.E.
        • Zhu K.
        • et al.
        Long-term atherosclerotic vascular disease risk and prognosis in elderly women with abdominal aortic calcification on lateral spine images captured during bone density testing: a prospective study.
        J Bone Miner Res. 2018; 33: 1001-1089
        • Austin N.
        • Devine A.
        • Dick I.
        • Prince R.
        • Bruce D.
        Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors.
        J Am Geriatr Soc. 2007; 55: 1598-1603
        • Blekkenhorst L.C.
        • Lewis J.R.
        • Bondonno C.P.
        • Sim M.
        • Devine A.
        • Zhu K.
        • et al.
        Vegetable diversity in relation with subclinical atherosclerosis and 15-year atherosclerotic vascular disease deaths in older adult women.
        Eur J Nutr. 2020; 59: 217-230
        • Maunsell Z.
        • Wright D.J.
        • Rainbow S.J.
        Routine isotope-dilution liquid chromatography-tandem mass spectrometry assay for simultaneous measurement of the 25-hydroxy metabolites of vitamins D2 and D3.
        Clin Chem. 2005; 51: 1683-1690
        • Lewis J.R.
        • Lim W.H.
        • Zhu K.
        • Wong G.
        • Dhaliwal S.S.
        • Lim E.M.
        • et al.
        Elevated osteoprotegerin predicts declining renal function in elderly women: a 10-year prospective cohort study.
        Am J Nephrol. 2014; 39: 66-74
        • Bondonno C.P.
        • Blekkenhorst L.C.
        • Prince R.L.
        • Ivey K.L.
        • Lewis J.R.
        • Devine A.
        • et al.
        Association of vegetable nitrate intake with carotid atherosclerosis and ischemic cerebrovascular disease in older women.
        Stroke. 2017; 48: 1724-1729
        • Wilson P.W.
        • Hoeg J.M.
        • D'Agostino R.B.
        • Silbershatz H.
        • Belanger A.M.
        • Poehlmann H.
        • et al.
        Cumulative effects of high cholesterol levels, high blood pressure, and cigarette smoking on carotid stenosis.
        N Engl J Med. 1997; 337: 516-522
        • Blekkenhorst L.C.
        • Bondonno C.P.
        • Lewis J.R.
        • Woodman R.J.
        • Devine A.
        • Bondonno N.P.
        • et al.
        Cruciferous and total vegetable intakes are inversely associated with subclinical atherosclerosis in older adult women.
        J Am Heart Assoc. 2018; 7
        • Lewis J.R.
        • Zhu K.
        • Thompson P.L.
        • Prince R.L.
        The effects of 3 years of calcium supplementation on common carotid artery intimal medial thickness and carotid atherosclerosis in older women: an ancillary study of the CAIFOS randomized controlled trial.
        J Bone Miner Res. 2014; 29: 534-541
        • Sim M.
        • Prince R.L.
        • Scott D.
        • Daly R.M.
        • Duque G.
        • Inderjeeth C.A.
        • et al.
        Utility of four sarcopenia criteria for the prediction of falls-related hospitalization in older Australian women.
        Osteoporos Int. 2019; 30: 167-176
        • Sim M.
        • Zhu K.
        • Lewis J.R.
        • Hodgson J.M.
        • Prince R.L.
        Association between vitamin D status and long-term falls-related hospitalization risk in older women.
        J Am Geriatr Soc. 2021; 69: 3114-3123
        • Zhu G.
        • Hom J.
        • Li Y.
        • Jiang B.
        • Rodriguez F.
        • Fleischmann D.
        • et al.
        Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease.
        Cardiovasc Diagn Ther. 2020; 10: 1048
        • Rosfors S.
        • Hallerstam S.
        • Jensen-Urstad K.
        • Zetterling M.
        • Carlstrӧm C.
        Relationship between intima-media thickness in the common carotid artery and atherosclerosis in the carotid bifurcation.
        Stroke. 1998; 29: 1378-1382
        • Lorenz M.W.
        • Markus H.S.
        • Bots M.L.
        • Rosvall M.
        • Sitzer M.
        Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis.
        Circulation. 2007; 115: 459-467
        • Johri A.M.
        • Nambi V.
        • Naqvi T.Z.
        • Feinstein S.B.
        • Kim E.S.H.
        • Park M.M.
        • et al.
        Recommendations for the assessment of carotid arterial plaque by ultrasound for the characterization of atherosclerosis and evaluation of cardiovascular risk: from the American society of echocardiography.
        J Am Soc Echocardiogr. 2020; 33: 917-933
        • Naqvi T.Z.
        • Lee M.S.
        Carotid intima-media thickness and plaque in cardiovascular risk assessment.
        JACC Cardiovasc Imaging. 2014; 7: 1025-1038
        • Bauer M.
        • Caviezel S.
        • Teynor A.
        • Erbel R.
        • Mahabadi A.A.
        • Schmidt-Trucksäss A.
        Carotid intima-media thickness as a biomarker of subclinical atherosclerosis.
        Swiss Med Wkly. 2012; 142
        • Ganz D.A.
        • Latham N.K.
        Prevention of falls in community-dwelling older adults.
        N Engl J Med. 2020; 382: 734-743
        • Mughal M.M.
        • Khan M.K.
        • DeMarco J.K.
        • Majid A.
        • Shamoun F.
        • Abela G.S.
        Symptomatic and asymptomatic carotid artery plaque.
        Expert Rev Cardiovasc Ther. 2011; 9: 1315-1330
        • Dempsey R.J.
        • Vemuganti R.
        • Varghese T.
        • Hermann B.P.
        A review of carotid atherosclerosis and vascular cognitive decline: a new understanding of the keys to symptomology.
        Neurosurgery. 2010; 67 (discussion 93-4): 484-493
        • Juraschek S.P.
        • Daya N.
        • Appel L.J.
        • Miller 3rd, E.R.
        • Matsushita K.
        • Michos E.D.
        • et al.
        Subclinical cardiovascular disease and fall risk in older adults: results from the atherosclerosis risk in communities study.
        J Am Geriatr Soc. 2019; 67: 1795-1802
        • Mikos M.
        • Winnicki K.
        • Henry B.M.
        • Sanchis-Gomar F.
        Link between cardiovascular disease and the risk of falling: a comprehensive review of the evidence.
        Pol Arch Intern Med. 2021; 131: 369-376
        • Jansen S.
        • Bhangu J.
        • de Rooij S.
        • Daams J.
        • Kenny R.A.
        • van der Velde N.
        The association of cardiovascular disorders and falls: a systematic review.
        J Am Med Dir Assoc. 2016; 17: 193-199
        • Jhamnani S.
        • Patel D.
        • Heimlich L.
        • King F.
        • Walitt B.
        • Lindsay J.
        Meta-analysis of the effects of lifestyle modifications on coronary and carotid atherosclerotic burden.
        Am J Cardiol. 2015; 115: 268-275
        • Karlsson M.K.
        • Magnusson H.
        • von Schewelov T.
        • Rosengren B.E.
        Prevention of falls in the elderly—a review.
        Osteoporos Int. 2013; 24: 747-762
        • Näslund U.
        • Ng N.
        • Lundgren A.
        • Fhärm E.
        • Grönlund C.
        • Johansson H.
        • et al.
        Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial.
        Lancet. 2019; 393: 133-142
        • Bengtsson A.
        • Norberg M.
        • Ng N.
        • Carlberg B.
        • Grönlund C.
        • Hultdin J.
        • et al.
        The beneficial effect over 3 years by pictorial information to patients and their physician about subclinical atherosclerosis and cardiovascular risk: results from the VIPVIZA randomized clinical trial.
        Am J Prev Cardiol. 2021; 7100199
        • Villamizar-Pita P.C.
        • Angarita-Fonseca A.
        • de Souza H.C.D.
        • Martínez-Rueda R.
        • Villamizar García M.C.
        • Sánchez-Delgado J.C.
        Handgrip strength is associated with risk of falls in physically active older women.
        Health Care Women Int. 2022; : 1-14
        • Abizanda Soler P.
        • Paterna Mellinas G.
        • Martín Sebastiá E.
        • Casado Moragón L.
        • López Jiménez E.
        • Martínez Sánchez E.
        [Subclinial atherosclerosis as a predictor of functional limitation at one year in high-functioning older adults: the Albacete study].
        Rev Esp Geriatr Gerontol. 2010; 45: 125-130
        • Finn C.
        • Giambrone A.E.
        • Gialdini G.
        • Delgado D.
        • Baradaran H.
        • Kamel H.
        • et al.
        The association between carotid artery atherosclerosis and silent brain infarction: a systematic review and meta-analysis.
        J Stroke Cerebrovasc Dis. 2017; 26: 1594-1601
        • Karabinus J.A.
        • DeBlois J.P.
        • Keller A.
        • Glasgow A.C.
        • Barreira T.V.
        • Heffernan K.S.
        The inverse association of muscular strength with carotid intima-media and extra-media thickness in women.
        Int J Sports Med. 2021; 42: 419-424
        • Maloberti A.
        • Fribbi F.
        • Motto E.
        • Vallerio P.
        • Occhi L.
        • Palazzini M.
        • et al.
        Ankle-brachial index is a predictor of in-hospital functional status but not of complications in hospitalized elderly patients.
        Gerontology. 2021; 67: 674-680