Mary P. Kotlarczyk

Elevated oxidative stress in the aortic media of patients with bicuspid aortic valve

Objective: Congenital bicuspid aortic valve (BAV) is distinctly associated with the development of ascending aortopathy in adulthood, portending risk of both ascending aortic aneurysm and dissection. Our previous work implicated deficiency in oxidative stress response as a mediator of the BAV‐associated aortopathy. We hypothesize that reactive oxygen species generation invokes elevated local oxidative tissue damage in ascending aorta of patients with BAV. Methods: Ascending aortic specimens were obtained from patients undergoing elective aortic replacement and/or aortic valve replacement and during heart transplant operations. Levels of superoxide anion were measured via high‐pressure liquid chromatography–based detection of 2‐hydroxyethidium in aortic specimens. Lipid peroxidation and enzymatic activity of superoxide dismutase and peroxidase were quantified in aortic specimens. Results: Superoxide anion production was elevated in aortic specimens from patients with nonaneurysmal BAV (n = 59) compared with specimens from patients with the morphologically normal tricuspid aortic valve (TAV, n = 38). Total superoxide dismutase activity was similar among aortic specimens from patients with TAV versus BAV (n = 27 and 26, respectively), whereas peroxidase activity was increased in aortic specimens from patients with BAV compared with specimens from patients with TAV (n = 14 for both groups). Lipid peroxidation was elevated in aortic specimens from BAV patients compared with TAV patients (n = 14 and 11, respectively). Conclusions: Superoxide anion accumulation and increased lipid peroxidation demonstrate that, despite increased peroxidase activity, the ascending aortopathy of patients with BAV involves oxidative stress. In addition, the absence of increased superoxide dismutase activity in BAV specimens indicates a deficiency in antioxidant defense. This suggests that the characteristic smooth muscle cell loss observed in BAV aortopathy may be a consequence of superoxide‐mediated cell damage.

Non-tricyclic and Non-selective Serotonin Reuptake Inhibitor Antidepressants and Recurrent Falls in Frail Older Women

OBJECTIVE To determine the risk of recurrent falls associated with antidepressants other than tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRIs) among frail older women. METHODS This is a secondary analysis of the Zoledronic acid in frail Elders to STrengthen bone, or ZEST, trial data treated as a longitudinal cohort in 181 frail, osteoporotic women aged ≥65 years in long-term care. The primary exposure was individual non-TCA/non-SSRI antidepressants (i.e., serotonin norepinephrine reuptake inhibitors, mirtazapine, trazodone, and bupropion) at baseline and 6 months. The main outcome was recurrent (at least two) falls within 6 months after antidepressant exposure. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were derived using a generalized estimating equations model. RESULTS At least 15% of women experienced recurrent falls between 0-6 and 6-12 months. At baseline and 6 months, 18.2% and 6.9% had a non-TCA/non-SSRI antidepressant, respectively. Adjusting for demographics, health status, and other drugs that increase risk of falls, non-TCA/non-SSRI antidepressant exposure significantly increased the risk of recurrent falls (AOR: 2.14; 95% CI: 1.01-4.54). Fall risk further increased after removing bupropion from the non-TCA/non-SSRI antidepressant group in sensitivity analyses (AOR: 2.73; 95% CI: 1.24-6.01). CONCLUSIONS Other antidepressant classes may not be safer than TCAs/SSRIs with respect to recurrent falls in frail older women.

Identifying Sarcopenia in Female Long‐Term Care Residents: A Comparison of Current Guidelines

To establish the prevalence of sarcopenia in a long‐term care population, assess agreement among different consensus sarcopenia diagnostic criteria, and examine agreement of a self‐reported questionnaire with consensus guidelines.

The Role of the Environment in Sedentary Behavior in Community-Dwelling Older Adults

ABSTRACT To compare amounts of sedentary behavior and physical activity in adults residing in planned group residential settings to those residing in private homes, this study recruited 31 older adults who resided in planned group residential settings (n = 13) and in private homes (n = 18). Daily activities were measured using the SenseWear Armband for 7 days. Estimates of the duration of daily activities performed across sedentary, light, and moderate-to-vigorous intensities were captured. It was found that participants in planned group residential settings were older (age 85.9 ± 3.5 vs. 78.3 ± 7.2; p = 0.001) and spent more time in sedentary behaviors (12.7 ± 1.5 vs. 11.3 ± 1.6; p = 0.02) than participants in private homes. The difference was attenuated slightly after controlling for age and wear time (adjusted difference 1.2 ± 0.6 hours, p = 0.06). Thus, adults residing in planned group residential settings, which provide supportive services, were more sedentary than adults residing in private homes. The environment in which older adults live may contribute to sedentary behavior.

Accuracy of Objective Physical Activity Monitors in Measuring Steps in Older Adults

Objective: The aim of this study is to evaluate accuracy of research activity monitors in measuring steps in older adults with a range of walking abilities. Method: Participants completed an initial assessment of gait speed. The accuracy of each monitor to record 100 steps was assessed across two walking trials. Results: In all, 43 older adults (age 87 ± 5.7 years, 81.4% female) participated. Overall, the StepWatch had the highest accuracy (99.0% ± 1.5%), followed by the ActivPAL (93.7% ± 11.1%) and the Actigraph (51.4% ± 35.7%). The accuracy of the Actigraph and ActivPAL varied according to assistive device use, and the accuracy of all three monitors differed by gait speed category (all p < .05). StepWatch was highly accurate (⩾97.7) across all conditions. Discussion: The StepWatch and ActivPAL monitor were reasonably accurate in measuring steps in older adults who walk slowly and use an assistive device. The Actigraph significantly undercounted steps in those who walk slow or use an assistive device. Researchers should consider gait speed and the use of assistive devices when selecting an activity monitor.

Congenital: Basic scienceElevated oxidative stress in the aortic media of patients with bicuspid aortic valve

Objective: Congenital bicuspid aortic valve (BAV) is distinctly associated with the development of ascending aortopathy in adulthood, portending risk of both ascending aortic aneurysm and dissection. Our previous work implicated deficiency in oxidative stress response as a mediator of the BAV‐associated aortopathy. We hypothesize that reactive oxygen species generation invokes elevated local oxidative tissue damage in ascending aorta of patients with BAV. Methods: Ascending aortic specimens were obtained from patients undergoing elective aortic replacement and/or aortic valve replacement and during heart transplant operations. Levels of superoxide anion were measured via high‐pressure liquid chromatography–based detection of 2‐hydroxyethidium in aortic specimens. Lipid peroxidation and enzymatic activity of superoxide dismutase and peroxidase were quantified in aortic specimens. Results: Superoxide anion production was elevated in aortic specimens from patients with nonaneurysmal BAV (n = 59) compared with specimens from patients with the morphologically normal tricuspid aortic valve (TAV, n = 38). Total superoxide dismutase activity was similar among aortic specimens from patients with TAV versus BAV (n = 27 and 26, respectively), whereas peroxidase activity was increased in aortic specimens from patients with BAV compared with specimens from patients with TAV (n = 14 for both groups). Lipid peroxidation was elevated in aortic specimens from BAV patients compared with TAV patients (n = 14 and 11, respectively). Conclusions: Superoxide anion accumulation and increased lipid peroxidation demonstrate that, despite increased peroxidase activity, the ascending aortopathy of patients with BAV involves oxidative stress. In addition, the absence of increased superoxide dismutase activity in BAV specimens indicates a deficiency in antioxidant defense. This suggests that the characteristic smooth muscle cell loss observed in BAV aortopathy may be a consequence of superoxide‐mediated cell damage.

Elevated Oxidative Stress in the Aortic Media of Bicuspid Aortic Valve Patients

Objective: Congenital bicuspid aortic valve (BAV) is distinctly associated with the development of ascending aortopathy in adulthood, portending risk of both ascending aortic aneurysm and dissection. Our previous work implicated deficiency in oxidative stress response as a mediator of the BAV‐associated aortopathy. We hypothesize that reactive oxygen species generation invokes elevated local oxidative tissue damage in ascending aorta of patients with BAV. Methods: Ascending aortic specimens were obtained from patients undergoing elective aortic replacement and/or aortic valve replacement and during heart transplant operations. Levels of superoxide anion were measured via high‐pressure liquid chromatography–based detection of 2‐hydroxyethidium in aortic specimens. Lipid peroxidation and enzymatic activity of superoxide dismutase and peroxidase were quantified in aortic specimens. Results: Superoxide anion production was elevated in aortic specimens from patients with nonaneurysmal BAV (n = 59) compared with specimens from patients with the morphologically normal tricuspid aortic valve (TAV, n = 38). Total superoxide dismutase activity was similar among aortic specimens from patients with TAV versus BAV (n = 27 and 26, respectively), whereas peroxidase activity was increased in aortic specimens from patients with BAV compared with specimens from patients with TAV (n = 14 for both groups). Lipid peroxidation was elevated in aortic specimens from BAV patients compared with TAV patients (n = 14 and 11, respectively). Conclusions: Superoxide anion accumulation and increased lipid peroxidation demonstrate that, despite increased peroxidase activity, the ascending aortopathy of patients with BAV involves oxidative stress. In addition, the absence of increased superoxide dismutase activity in BAV specimens indicates a deficiency in antioxidant defense. This suggests that the characteristic smooth muscle cell loss observed in BAV aortopathy may be a consequence of superoxide‐mediated cell damage.