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Risk Factors for All-Cause and Coronary Heart Disease Mortality in the Oldest-Old The Adventist Health Study

Gary E. Fraser, MBChB, PhD; David J. Shavlik, MSPH
Arch Intern Med. 1997;157(19):2249-2258. doi:10.1001/archinte.1997.00440400099012.
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Background:  The oldest-old population (≤84 years of age) is growing rapidly and consumes a disproportionate amount of health care dollars. Risk factors for disease have not been extensively studied in this group.

Methods:  A cohort study of non-Hispanic white SeventhDay Adventists from California allowed follow-up for mortality from 1976 through 1988. Associations between traditional risk factors, consumption of selected foods, and both coronary heart disease (CHD) and all-cause mortality were evaluated in the oldest-old portion of this population, using proportional hazards regression analyses.

Results:  We observed 364 cases of CHD and 1387 total deaths during 11 828 person-years of follow-up. Men had higher risk of both all-cause mortality and mortality from CHD. The relative risks (RRs) associated with diabetes mellitus were 1.51 (95% confidence interval [CI], 1.24-1.84; P<.001) for all deaths and 1.95 (95% CI, 1.38-2.76; P<.001) for mortality from CHD. The apparent effects of hypertension were small unless subjects were currently taking antihypertensive medications. Compared with those with no regular vigorous activity, subjects who exercised at least 3 times each week had RRs of death of 0.80 (95% CI, 0.70-0.91; P<.001) and 0.74 (95% CI, 0.56-0.97; P<.05) for mortality from CHD. Subjects who consumed nuts 5 times per week had RRs of death of 0.82 (95% CI, 0.70-0.96; P<.01) and 0.61 (95% CI, 0.45-0.83; P<.001) for death from CHD compared with those consuming nuts less than weekly. In men, regular consumption of donuts appeared hazardous for both all-cause mortality (RR, 1.40; 95% CI, 1.05-1.88) and mortality from CHD (RR, 2.10; 95% CI, 1.15-3.81), and consumption of beef 4 times weekly was associated with a 2-fold RR for CHD compared with vegetarians, but there was no increase in risk for women.

Conclusions:  Even in the oldest-old, certain traditional risk factors and dietary habits are associated with mortality.Arch Intern Med. 1997;157:2249-2258


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