View Abstract

A4947 - Prospective Association of Respiratory and Neurodegenerative Multi-Morbidity Pattern with Cardiovascular Mortality in Postmenopausal Women
Author Block: P. Koo1, A. J. Curtin2, M. Roberts2, A. Shadyab3, O. Zaslavsky4, G. Corbie-Smith5, B. Cannell6, R. Wallace7, C. B. Eaton8; 1Respiratory, Critical Care, and Sleep Medicine, Baroness Erlanger Hospital, Chattanooga, TN, United States, 2Primary Care Center, Memorial Hospital of Rhode Island, Pawtucket, RI, United States, 3Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States, 4Biobehaviorial Nursing and Health Informatics, University of Washington, Seattle, WA, United States, 5Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 6Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, United States, 7Epidemiology, The University of Iowa, Iowa City, IA, United States, 8Family Medicine and Epidemiology, Memorial Hospital of Rhode Island, Pawtucket, RI, United States.
Rationale
Multi-morbidity, the presence of at least three coexisting chronic diseases, is associated with poorer quality of life and functional capacity in the aging population compared to those without multi-morbidity. Examining the aggregate effect - interactions of certain chronic diseases - rather than the additive effect of these diseases would be helpful in developing prevention strategies for a particular pattern of diseases (cluster). The association between the respiratory and neurodegenerative multi-morbidity pattern and cardiovascular mortality in postmenopausal women is under-researched. We investigated whether postmenopausal women with the proposed pattern of diseases is associated with increased cardiovascular mortality compared to those without the pattern.
Methods
We performed a prospective study of postmenopausal women between the ages of 50-79 years at baseline in the Women’s Health Initiative who were recruited during 1993-1998 from 40 clinical sites in the United States. They were followed through 2015. The respiratory and neurodegenerative multi-morbidity pattern was identified using a hierarchical clustering approach with a stepwise procedure. Diseases in the pattern included Alzheimer’s disease, peptic ulcer disease, liver disease, asthma, emphysema, lupus, and Parkinson’s disease. We employed Cox proportional hazard regression adjusted for age, race, diabetes, hypertension, smoking status, obesity defined as BMI ≥ 30 kg/m2, atrial fibrillation, and coronary heart disease.
Results
The full cohort of 161,808 postmenopausal women was included in the study. The respiratory/neurodegenerative disease cluster contained 23,086 women. In the age-adjusted model, it was significantly associated with increased risk of cardiovascular mortality (HR=1.62, 95% CI 1.53-1.72) compared to those without the cluster. After fully adjusting the model, the effect estimate was attenuated, but it remained significant (HR=1.30, 95% CI 1.22-1.38).
Conclusions
The respiratory and neurodegenerative multi-morbidity pattern is associated with increased cardiovascular mortality. Consideration in developing preventions strategies to reduce cardiovascular risk in patients with this multi-morbidity pattern would be helpful.