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Papers by Barbara Naydeck

Arteriosclerosis, Thrombosis, and Vascular Biology, Mar 1, 2002

Reports on race-related differences in coronary artery calcium (CAC) are just beginning to emerge... more Reports on race-related differences in coronary artery calcium (CAC) are just beginning to emerge and have not been well studied in the elderly. This study was undertaken to assess whether such differences exist and the relationship between CAC and cardiovascular risk factors in a cohort of elderly community-dwelling adults. CAC was measured by using electron-beam tomography in 614 adults (aged 67 to 99 years), of whom 59% were women and 23% were black. The median CAC score was lower in blacks than in whites for men (159 versus 787, respectively; PϽ0.001) and for women (134 versus 233, respectively; Pϭ0.02) after adjustment for age, cardiovascular disease, and risk factors for cardiovascular disease, although this difference was stronger and remained significant among men only. Lower CAC scores were also observed in the subgroup of blacks with a history of myocardial infarction. The lower CAC scores in blacks compared with whites observed in this study is consistent with either a lower prevalence of coronary artery disease or a lower extent of calcification of coronary artery disease.

Arteriosclerosis, Thrombosis, and Vascular Biology, Oct 1, 2002

Background-In the Cardiovascular Health Study, subclinical cardiovascular disease (CVD) predicted... more Background-In the Cardiovascular Health Study, subclinical cardiovascular disease (CVD) predicted CVD events in older adults. The extent to which this measure or its components reflect calcified coronary disease is unknown. Methods and Results-Coronary artery calcium (CAC) was assessed with electron beam tomography in 414 participants without clinical CVD and examined using cut points (CACՆ400 and CACՆ800) and the log(CAC); 274 had subclinical CVD by ankle-arm index, ECG, or carotid ultrasound. Cut points for subclinical disease as previously defined in the Cardiovascular Health Study were examined as well as continuous measures to produce receiver operating characteristic curve curves. A low ankle-arm index was highly specific for a high CAC score. The internal carotid artery intima-media thickness was most strongly correlated with CAC (rϭ0.30) and was significantly related to both CAC cut points and to the log(CAC) score independently of all other measures. Conclusions-In these community-dwelling older adults without clinical CVD, internal carotid artery intima-media thickness was most closely related to CAC. However, 17.5% of those with a CACՆ400 would be missed in the ascertainment of subclinical atherosclerosis using the previously published composite of subclinical atherosclerosis. Prospective follow-up will determine whether the CAC score improves prediction of CVD events over other noninvasive measures.

Circulation, Nov 27, 2001

Background-Coronary artery calcification has been proposed as a noninvasive method to assess card... more Background-Coronary artery calcification has been proposed as a noninvasive method to assess cardiovascular disease (CVD) risk. However, the prevalence and risk factors for coronary artery calcification in populations Ͼ65 years have not been well studied. Methods and Results-Electron beam tomography was performed to assess coronary artery calcium (CAC) in 614 older adults aged, on average, 80 years (range, 67 to 99 years); 367 (60%) were women, and 143 (23%) were black. Calcium scores ranged from 0 to 5459. Median scores were 622 for men and 205 for women. Scores increased by age and were lower in blacks than in whites. Nine percent of subjects (nϭ57) had no CAC, and 31% (nϭ190) had a score lower than 100. A history of CVD was associated with calcium score. Age, male sex, white race, CVD, triglyceride level, pack-years of smoking, and asthma, emphysema, or bronchitis (chronic obstructive pulmonary disease) were independently associated with CAC score in the fourth quartile. Conclusions-A wide range of CAC scores was observed, suggesting adaptation with aging. CAC may have potential to predict CVD in older adults, but this remains to be determined. (Circulation. 2001;104:2679-2684.) Key Words: calcium Ⅲ coronary diseases Ⅲ aging E lectron beam computed tomography (EBT) can rapidly and noninvasively detect and quantify calcified atherosclerotic plaque in the coronary arteries. 1 A higher quantity of coronary artery calcium (CAC) is associated with the likelihood of obstructive lesions by angiography, 1 and it is also associated with an increased risk of future cardiovascular disease (CVD) in middle-aged, referred populations. 2 The value of screening the elderly is in question because autopsy 3 and clinical 4 studies suggest that coronary artery atherosclerosis and calcification are almost universal in those with advanced old age. No study has yet defined the "typical" levels of CAC found in unreferred populations of older adults, whether a sex difference persists into old age, or whether CAC would predict a higher risk of CVD events or mortality in this age group. Risk factors measured late in life have rather poor discrimination for determining highest risk of CVD events in old age. 5,6 CAC has been proposed as a potential method to improve risk discrimination. 1 In fact, noninvasive measures of disease have been proposed to account for the effect of age in prediction models of CVD risk. 7 We examined CAC in an elderly cohort. We hypothesized there would be a strong relationship between calcification and age and that CAC would be associated with CVD. This report describes the distribution of CAC in late life and associations with CVD and CVD risk factors. Methods Study Population Participants from the Pittsburgh, Pennsylvania, field center of the Cardiovascular Health Study were recruited for EBT between May 1998 and June 2000. 8 This study was established to determine the risk factors for CVD in older adults. 9,10 Of 727 participants contacted at the last examination in 1998 to 1999, 614 participants (84%) underwent EBT scanning. Of the 113 nonparticipants, 16% died before the scan, 45% were ill, 16% could not travel, and 23% refused. Nonparticipants were of similar age, sex, and race as participants. All participants gave informed consent for examination and follow-up. The protocol was approved by the Institutional Review Board at the University of Pittsburgh. Coronary Artery Calcification CAC was assessed using an Imatron C-150 EBT scanner and the Agatston scoring method, 11 as described previously. 8 Demographic and Cardiovascular Risk Factors Age was assessed at the time of the EBT scan, and cardiovascular risk factors were assessed between 1992 to 1993 in both the original and added minority cohorts. Hypertension was defined as a participant having an average seated systolic blood pressure Ͼ160 mm Hg or an average seated diastolic blood pressure Ͼ95 mm Hg or

Journal of Vascular Surgery, 2009

RVT after DVT may be a prothrombotic state. The presence or absence of RVT after treatment for DV... more RVT after DVT may be a prothrombotic state. The presence or absence of RVT after treatment for DVT is therefore potentially useful for evaluating optimal duration of oral anticoagulant treatment (OAT). In this study, patients with the first episode of DVT and treated with OAT for 3 months were managed with respect to RVT findings. After 3 months of OAT, those with RVT were randomized to either stop or continue anticoagulants for 9 additional months. In those without RVT, OAT was stopped. Outcome events were recurrent DVT or major bleeding, or both. There were 258 patients. RVT was detected in 180 (69.8%). In those with RVT, recurrent events occurred in 27.2% of those (25 of 92) who discontinued OAT, and recurrent events occurred in 19.3% of those (17 of 88) who continued OAT. The adjusted hazard ratio was 1.58 (95% confidence interval [CI], 0.85-2.93; P ϭ .145). In the 78 patients without RVT, only one had recurrent VTE. Adjusted hazard ratio of patients with RVT vs those without RVT was 24.9 (95% CI, 3.4-183.6; P ϭ .002). One major bleeding event (1.1%) occurred in patients who stopped OAT (0.53% person-years), and two bleeding events (2.3%) occurred in those who continued OAT (1.1% person-years). Comment: The results suggest assessment for RVT is useful in evaluating risk of DVT recurrence after stopping OAT after a first episode of DVT. This trial included patients with both provoked and idiopathic DVT. Many of the patients without RVT after OAT had had an initially provoked DVT. However, no differences in outcomes were noted when patients with provoked DVT were compared with those with idiopathic DVT. In patients with RVT, recurrence is high even if the index DVT was provoked. This trial should help identify patients with initial episode of DVT who are very adequately treated with a short period of anticoagulation.

Background: Cardiovascular diseases are the primary causeofdeathinolderadults.Amongthosewithoutcl... more Background: Cardiovascular diseases are the primary causeofdeathinolderadults.Amongthosewithoutclini- cal disease, high levels of subclinical disease are associ- ated with poor survival. The effect of the extent of sub- clinical cardiovascular disease on the quality of the remaining years has not been defined. Methods:Inalongitudinalcohortstudy,2932menand women aged 65 years and older were followed up for 8 years to determine the likelihood of maintaining intact health and functioning. Successful aging was defined as remaining free of cardiovascular disease, cancer, and chronic obstructive pulmonary disease and with intact physical and cognitive functioning. Results: Younger age at study entry and a lower extent of subclinical cardiovascular disease were indepen- dentlyassociatedwiththelikelihoodofmaintainingsuc- cessfulaging.Inage-stratifiedsummaries,thosewithsub- clinical disease had a trajectory of decline similar to subjects 5 years older without subclinical vascular dis- ease. ...

Journal of the American Geriatrics Society, 2008

OBJECTIVES: To evaluate the risk of incident physical disability and the decline in gait speed ov... more OBJECTIVES: To evaluate the risk of incident physical disability and the decline in gait speed over a 6‐year follow‐up associated with a low ankle‐arm index (AAI) in older adults.DESIGN: Observational cohort study.SETTING: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania.PARTICIPANTS: Four thousand seven hundred five older adults, 58% women and 17.6% black, participating in the Cardiovascular Health Study.MEASUREMENTS: AAI was measured in 1992/93 (baseline). Self‐reported mobility, activity of daily living (ADL), and instrumental activity of daily living (IADL) disability and gait speed were recorded at baseline and at 1‐year intervals over 6 years of follow‐up. Mobility disability was defined as any difficulty walking half a mile and ADL and IADL disability was defined as any difficulty with 11 specific ADL and IADL tasks. Individuals with mobility, ADL, or IADL disability at baseline were excluded from t...

Journal of the American Geriatrics Society, Mar 1, 2000

BACKGROUND: Coronary artery calcification (CAC) reflects the extent of coronary artery atheroscle... more BACKGROUND: Coronary artery calcification (CAC) reflects the extent of coronary artery atherosclerosis. The extent of coronary artery calcification is not well described in older adults. OBJECTIVE: To determine the extent of CAC in older adults participating in a large population study of cardiovascular disease (CVD), especially those characterized as having minimal clinical or subclinical cardiovascular disease. DESIGN An observational epidemiologic study. POPULATION Participants in the Cardiovascular Health Study Cohort, mean age 78 years, who had electron beam computed tomography (EBT) scan of the heart (n = 133); included were 106 persons with no prior evidence of clinical or subclinical CVD. MEASUREMENTS: Total CAC score was measured using cardiac EBT. Cardiovascular disease and risk factors, as well as carotid ultrasound, electrocardiogram, echocardiogram, and ankle-arm index, had been measured previously to define subclinical disease. Previous cerebral magnetic resonance imaging was also evaluated. RESULTS: Overall, the CAC scores were higher in those with clinical cardiovascular disease or evidence of subclinical cardiovascular disease than in those with no evidence of disease. For the 106 participants without evidence of clinical or subclinical disease, the median score was 176, compared with 367 in those with subclinical disease and 923 in those with clinical CVD. Seventeen persons had scores of zero. There was little difference in risk factors across quartiles of CAC in the subgroup of 106 with prior characterization of minimal CVD despite the broad range of CAC scores. There was a higher proportion of those with white matter grade zz 2 by magnetic resonance imaging among those with higher CAC scores (P = .025). Infarct-like lesions prevalence ranged from 12.5% in the lowest group to 47.1% in the highest CAC group (P = .019). CONCLUSIONS: Older adults with evidence of clinical or subclinical CVD have higher total CAC scores. Though the

Circulation, 2001

0001 Coronary artery calcification (CAC) appears to increase with age to at least age 75, but has... more 0001 Coronary artery calcification (CAC) appears to increase with age to at least age 75, but has not been studied in adults well beyond this age. Between 1998-2000, 614 of 767 participants from the Pittsburgh cohort of the Cardiovascular Health Study, mean age 80 years (range 67-99), had CAC measured by electron beam tomography (total Agatson score). All had prior clinical exams, non-invasive exams of carotid wall thickness, ankle-arm index, and ECG to detect subclinical CVD (’94- 95), and baseline risk factor assessment (’89- 90). Of the 614, 367 (60%) were women and 247(40%) were men; 23% were African American. The prevalence of clinical CVD at scan was 33%, and another 33% had at least one marker of subclinical CVD. CAC scores were skewed towards low scores, with a median of 625 for men and 202 for women. Median CAC score increased with age, were usually higher in men than women regardless of the presence or absence of clinical or subclinical CVD ( Table). No detectable CAC was ...

Circulation, 2001

P23 Aortic stiffness increases with age and blood pressure, even when the population prevalence o... more P23 Aortic stiffness increases with age and blood pressure, even when the population prevalence of atherosclerosis is low. The extent to which atherosclerosis may exacerbate the aortic stiffening of aging remains unclear. Aortic stiffness was measured by carotid to femoral pulse wave velocity (PWV) and atherosclerosis by coronary artery calcification score (CCS) and aortic calcification score (ACS) by electron beam tomography in 484 participants (42% men, 23% black) aged 70-96 years (mean=79.4) from the Pittsburgh site of the Cardiovascular Health Study. The distributions of PWV (898, 851, 366-2183 cm/sec) (mean, median, range), CCS (676, 327, 0-4954) and ACS (5183, 3040, 0-57,950) were log-transformed when used as continuous variables. Median PWV and ACS were not different by gender but CCS was higher for men than women (median 637 vs. 187, p<0.01). Median PWV did not differ by race. Median CCS and ACS were higher in white participants (392 vs. 132; 3865 vs. 1154, p<0.01 for ...

and cardiovascular response to exercise, especially heart rate re-covery,5-8 have been shown in m... more and cardiovascular response to exercise, especially heart rate re-covery,5-8 have been shown in middle-aged adults to predict cardio-vascular and total mortality. Ex-tendedwalking tests have been used to assess exercise capacity inmedically ill populations.9-12 The long-distance cor-ridor walk is similar to the 6-minute walk test,13 which has been shown to predict mortality in patients with con-gestive heart failure.14 Both the 6-minute and the long-distance corridor walk test are associ-atedwith several long-term health con-ditions and measures of subclinical disease including cardiovascular, mus-culoskeletal, and neurological condi-tions.15,16 Performance on extended walking tests of varying times and dis-tances have been shown to be strongly related to directly measured oxygen consumption.17-19 Potentially, such tests Author Affiliations are listed at the end of this article.

Journal of the American College of Cardiology, 1999

OBJECTIVES The purpose of this study was to evaluate the prevalence and prognostic importance of ... more OBJECTIVES The purpose of this study was to evaluate the prevalence and prognostic importance of lower extremity arterial disease (LEAD) in patients with multivessel coronary artery disease. BACKGROUND The presence of clinically evident LEAD increases the risk of death in patients with known coronary artery disease. Because studies have lacked noninvasive measures of subclinical LEAD, the true prognostic importance of lower extremity atherosclerosis in this population has probably been underestimated. METHODS Ankle blood pressures were measured in 405 consecutive patients with angiographically documented multivessel coronary disease from seven Bypass Angioplasty Revascularization Investigation (BARI) sites and a parallel study site within 3 years of enrollment. Lower extremity arterial disease was defined as an ankle/arm systolic blood pressure ratio of 0.90 or less. RESULTS Among patients studied, 69 (17%) had LEAD. These patients were more likely to be current smokers, treated for diabetes, older and present with unstable angina compared with patients without LEAD. Among patients who underwent coronary arterial bypass grafting, major complications occurred in 2.8% of those without LEAD compared with 20.7% of those with LEAD (p ϭ 0.002). Five-year mortality rates were similar for symptomatic LEAD (14%) and asymptomatic LEAD (14%). Patients without LEAD had a 3% mortality. After adjusting for baseline differences, the relative risk of death was 4.9 times greater for patients with LEAD compared with those without (95% confidence interval [CI]: 1.8, 13.4, p Ͻ 0.01). CONCLUSIONS Patients with LEAD have a significantly higher risk of death than patients without LEAD, regardless of the presence of symptoms. An abnormal ankle/arm index is a strong predictor of mortality and can be used to further stratify risk among patients with multivessel coronary artery disease.

Journal of Occupational and Environmental Medicine, 2008

Learning Objectives • Identify those elements of the Highmark Wellness Program that gained the mo... more Learning Objectives • Identify those elements of the Highmark Wellness Program that gained the most participants in the course of the 4-year study period. • Compare employees who chose to take part in the program with riskmatched non-participants in regard to total healthcare expenditures, annual increases in healthcare expenditures, and return on investment. • Recall whether and in what way participation in wellness programs influenced spending for preventive care. Objective: To determine the return on investment (ROI) of Highmark Inc.'s employee wellness programs. Methods: Growth curve analyses compared medical claims for participants of wellness programs versus risk-matched nonparticipants for years 2001 to 2005. The difference was used to define savings. ROI was determined by subtracting program costs from savings and alternative discount rates were applied in a sensitivity analysis. Results: Multivariate models estimated health care expenses per person per year as $176 lower for participants.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2008

Background. In older adults, there is often substantial undiagnosed chronic disease detectable on... more Background. In older adults, there is often substantial undiagnosed chronic disease detectable on noninvasive testing, not accounted for by most comorbidity indices. We developed a simple physiologic index of comorbidity by scoring five noninvasive tests across the full range of values. We examined the predictive validity of this index for mortality and disability. Methods. There were 2928 (mean age 74.5 years, 60% women, 85% white, and 15% black) participants in the Cardiovascular Health Study (1992-1993) who had carotid ultrasound, pulmonary function testing, brain magnetic resonance scan, serum cystatin-C, and fasting glucose. These were combined into a single physiologic index of comorbid chronic disease on a scale of 0-10. Cox proportional hazard models were used to predict mortality, mobility limitation, and activities of daily living (ADL) difficulty after a maximum of 9 years. Results. The range of the physiologic index was quite broad, with very few individuals having total scores of either 0 or 10. Those with an index of 7-10 had a hazard ratio of 3.80 (95% confidence interval, 2.82-5.13) for mortality compared to those with scores of 0-2, after adjustment for demographics, behavioral risk factors, and clinically diagnosed conditions. Associations with mobility limitation and ADL difficulty were also significant. The index explained about 40% of the age effect on mortality risk. Conclusion. Older adults with low levels of markers of chronic disease are rather rare but have remarkably good health outcomes. The ability of such an index to distinguish usual from low risk might provide an opportunity to better understand optimal health in old age.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2008

Background. In older adults without clinical cardiovascular disease, coronary artery calcium (CAC... more Background. In older adults without clinical cardiovascular disease, coronary artery calcium (CAC) is associated with other subclinical vascular diseases, which, in turn, predict physical dysfunction. However, the association between CAC and physical function is unstudied. Methods. In 387 older community-dwellers from the Cardiovascular Health Study without clinical cardiovascular diseases (mean age 6 standard deviation ¼ 78.7 6 3.7, 35% men, 22% African Americans), CAC was measured using electron beam tomography, and physical performance was assessed by usual pace gait speed, chair stand, and tandem stand. Differences in physical performance across CAC quartiles were investigated in the whole cohort and by gender. Associations with gait speed (m/s) were assessed in multivariable models using both the continuous form of CAC score (log(CAC)) and quartiles of CAC, adjusting for demographics and comorbidities. Results. No differences in physical performance were observed across CAC quartiles in the whole group. In genderstratified analyses, a significant association was shown among women, who had progressively lower gait speed across CAC quartiles: Those with CAC. 220 walked more than 0.1 m/s slower than those with CAC , 35 (age-adjusted p trend ¼ .017). After multivariable adjustment, the association remained statistically significant for women in both linear (log(CAC) and gait speed, p ¼ .025) and logistic models: Each of the top three CAC quartiles (35-220, 221-659, and !660) had a more than twofold odds of walking slower than 1 m/s, compared to the lowest CAC quartile (, 35; p ¼ .021). Conclusions. In this sample of older community-dwellers without overt cardiovascular disease, CAC was inversely related to gait speed in women, but not in men.

Journal of Clinical Epidemiology, 2001

The prevalence of intermittent claudication (IC) in older adults by questionnaire is less than 5%... more The prevalence of intermittent claudication (IC) in older adults by questionnaire is less than 5% while the prevalence of peripheral arterial disease (PAD) by non-invasive testing is 2-4-fold higher. Comorbid conditions may result in under-reporting intermittent claudication (IC) as assessed by the Rose Questionnaire. We examined characteristics of those who report leg pain in relationship to other comorbid conditions and disability in 5888 participants of the Cardiovascular Health Study (CHS). Older adults with exertional leg pain, not meeting criteria for IC, had a higher prevalence of PAD on non-invasive testing with the ankle-arm index than those without pain, as well as a higher prevalence of arthritis. The pattern of responses suggested that pain for both conditions was reported together. The Rose Questionnaire for IC is specific for PAD, but a negative questionnaire does not indicate a lack of symptoms, rather the presence of PAD along with other conditions that can cause pain.

Journal of the American Geriatrics Society, 2005

To evaluate the association between coronary atherosclerosis and subclinical brain magnetic reson... more To evaluate the association between coronary atherosclerosis and subclinical brain magnetic resonance imaging (MRI) abnormalities and between coronary atherosclerosis and abnormal cognitive function (dementia/mild cognitive impairment).

Controlled Clinical Trials, 1996

Arteriosclerosis, Thrombosis, and Vascular Biology, Mar 1, 2002

Arteriosclerosis, Thrombosis, and Vascular Biology, Oct 1, 2002

Circulation, Nov 27, 2001

Journal of Vascular Surgery, 2009

Journal of the American Geriatrics Society, 2008

Journal of the American Geriatrics Society, Mar 1, 2000

Circulation, 2001

Journal of the American College of Cardiology, 1999

Journal of Occupational and Environmental Medicine, 2008

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2008

Journal of Clinical Epidemiology, 2001

Journal of the American Geriatrics Society, 2005

Controlled Clinical Trials, 1996