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To examine the longitudinal risk of vision loss (VL) or hearing loss (HL) for experiencing suicidal ideation in older adults.
The Three-City study, examining data from three waves of follow-up (2006–2008, 2008–2010, and 2010–2012).
Community-dwelling older French adults.
N = 5,438 adults aged 73 years and over.
Suicidality was assessed by the Mini-International Neuropsychiatric Interview, Major Depressive Disorder module. Mild VL was defined as Parinaud of 3 or 4 and severe VL as Parinaud >4. Mild HL was self-reported as difficulty understanding a conversation and severe HL as inability to understand a conversation.
Severe VL was associated with an increased risk of suicidal ideation at baseline (OR = 1.59, 95% CIs = 1.06–2.38) and over five years (OR = 1.65, 95% CIs = 1.05–2.59). Mild and severe HL were associated with an increased risk of suicidal ideation, both at baseline (OR = 1.29, 95% CIs = 1.03–1.63; OR = 1.78, 95% CIs = 1.32–2.40) and over five years (OR = 1.47, 95% CIs = 1.17–1.85; OR = 1.97, 95% CIs = 1.44–2.70).
Sensory losses in late life pose a risk for suicidal ideation. Suicidality requires better assessment and intervention in this population.
Numerous observational studies suggest that blood pressure management with antihypertensive drugs may be effective in reducing dementia risk.
To quantify dementia risk in relation to diuretic medication use.
Electronic databases were searched until June 2015. Eligibility criteria: population, adults without dementia at baseline from primary care, community cohort, residential/institutionalized or randomized controlled trial (RCT); exposure, diuretic medication; comparison, no diuretic medication, other or no antihypertensive medication, placebo-control; outcome, incident dementia in accordance with standardized criteria. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were pooled in fixed-effects models with RevMan 5.3. The overall quality and strength of evidence was rated with GRADE criteria.
Fifteen articles were eligible comprising a pooled sample of 52,599 persons and 3444 incident dementia cases (median age 76.1 years, 40% male) with a median follow-up of 6.1 years. Diuretic use was associated with 17% reduction in dementia risk (HR 0.83; 95% CI 0.75 to 0.90) and a 21% reduction in Alzheimer's disease risk (HR 0.79; 95% CI 0.68 to 0.93). GRADE was rated as moderate. Risk estimates were consistent comparing monotherapy versus combination therapy, study design and follow-up. Meta-regression did not suggest that age, gender, systolic blood pressure, attrition, mortality rate, education, cognitive function, stroke, Apolipoprotein E allele, heart failure or diabetes altered the primary results.
Diuretic medication was associated with a consistent reduction in dementia and Alzheimer's disease risk and the absence of heterogeneity points to the generalizability of these findings.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Substantial healthcare resources are devoted to panic disorder (PD) and coronary heart disease (CHD); however, the association between these conditions remains controversial. Our objective was to conduct a systematic review of studies assessing the association between PD, related syndromes, and incident CHD.
Relevant studies were retrieved from Medline, EMBASE, SCOPUS and PsycINFO without restrictions from inception to January 2015 supplemented with hand-searching. We included studies that reported hazard ratios (HR) or sufficient data to calculate the risk ratio and 95% confidence interval (CI) which were pooled using a random-effects model. Studies utilizing self-reported CHD were ineligible. Twelve studies were included comprising 1 131 612 persons and 58 111 incident CHD cases.
PD was associated with the primary incident CHD endpoint [adjusted HR (aHR) 1.47, 95% CI 1.24–1.74, p < 0.00001] even after excluding angina (aHR 1.49, 95% CI 1.22–1.81, p < 0.00001). High to moderate quality evidence suggested an association with incident major adverse cardiac events (MACE; aHR 1.40, 95% CI 1.16–1.69, p = 0.0004) and myocardial infarction (aHR 1.36, 95% CI 1.12–1.66, p = 0.002). The risk for CHD was significant after excluding depression (aHR 1.64, 95% CI 1.45–1.85) and after depression adjustment (aHR 1.38, 95% CI 1.03–1.87). Age, sex, length of follow-up, socioeconomic status and diabetes were sources of heterogeneity in the primary endpoint.
Meta-analysis showed that PD was independently associated with incident CHD, myocardial infarction and MACE; however, reverse causality cannot be ruled out and there was evidence of heterogeneity.
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