The Confucius Hometown Aging Project: a community-based study of ageing and health in a rural area

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• 作者：Dr Chengxuan Qiu ; PhD^a ; ^b ; ^{chengxuan.qiu@ki.se" class="auth_mail" title="E-mail the corresponding author} ; Prof Zhongrui Yan ; MD^c ; Chuanzhu Cai ; MD^d ; Hui Jiang ; MD^d ; Binglun Sun ; MD^d ; Prof Aiqin Song ; MSb^b ; Yajun Liang ; PhD^a ; ^b
• 刊名：The Lancet
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：386
• 期：supp_S1
• 页码：S57
• 全文大小：54 K

文摘

Vascular risk factors (eg, smoking, hypertension, and diabetes) are associated with cognitive and physical dysfunction in old age. We hypothesised that atherosclerotic process plays a central part in linking vascular risk factors and disorders to cognitive and physical impairment in ageing. We sought to test this hypothesis in Chinese elderly people (aged 60 years or older) living in a rural community.

Methods

The Confucius Hometown Aging Project (CHAP) is a longitudinal study of vascular risk factors, ageing, and health in people aged 60 years or older who live in a community near Qufu (hometown of Confucius), Shandong, China. The study was done by local hospital staff consisting of clinicians and nurses. In 2010–11, 1539 people were examined following a questionnaire developed from the WHO STEPwise approach to surveillance and Study on Global Ageing and Adult Health. We assessed epidemiological data (eg, lifestyle and health history), markers of atherosclerosis (eg, ankle-brachial index, carotid plaques, carotid intima-media thickness, cerebral blood flow, retinal microvascular signs, and blood lipids), cognitive function (Mini-Mental State Examination), functional disability (Katz Index of Activities of Daily Living and Instrumental Activities of Daily Living), and depressive symptoms (15-item Geriatric Depression Scale). The CHAP cohort was re-examined in 2014–15. The CHAP protocols were approved by the ethics committee at Jining No. 1 People's Hospital of Jining Medical University, Shandong, China. Written informed consent was obtained from participants or informants of people with cognitive impairment.

Findings

In the cross-sectional phase of CHAP, major vascular risk factors were highly prevalent (prevalence 26·6% for diabetes, 42·4% for high total cholesterol, and 76·0% for hypertension) and poorly controlled (control rate 11·3% for hypertension, 13·7% for diabetes, and 31·7% for high total cholesterol) in Chinese elderly people in rural areas. Metabolic syndrome was associated with markers of clinical and subclinical systematic atherosclerosis (eg, multiadjusted odds ratio [OR] of carotid artery plaque was about 1·4 [p=0·023]). Vascular risk factors, especially when occurring concurrently, were associated with cognitive impairment (multiadjusted OR of cognitive impairment related to diabetes was 1·5 [95% CI 1·1–2·1; p=0·024]), functional disability (multiadjusted ORs were 3·5 [1·2–9·8; p=0·020] and 5·4 [1·9–15·8; p=0·002] for two and three or more of these concurrent vascular risk factors, respectively; p for linear trend=0·002), and depressive symptoms (multiadjusted OR of high depressive symptoms related to dyslipidemia was 1·5 [1·2–2·0; p=0·002]). The associations were partly explained by markers of atherosclerosis.

Interpretation

Vascular risk factors contribute to cognitive and functional impairment, and depressive symptoms in old age partly through atherosclerotic mechanisms. Preventive and therapeutic interventions targeting major vascular risk factors might reduce the burden of systemic atherosclerosis, thus providing the potential to achieve the goal of living a long and healthy life.

Funding

The CHAP was supported in part by grants from the Department of Science and Technology (2008GG30002058), the Department of Health (2009-067), the Natural Science Foundation (ZR2010HL031) in Shandong, China, and the Young Scholar Grant for Strategic Research in Epidemiology at Karolinska Institutet, Stockholm, Sweden.