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a,b , for the TULIPS Consortium Objectives: While randomized controlled trials have proven the benefits of blood pressure (BP) lowering in participating octogenarians, population-based observational studies suggest an association between low systolic blood pressure (SBP) and faster overall decline. This study investigates the effects of BP-lowering treatment, a history of cardiovascular diseases (CVD), and cognitive and physical fitness on the associations between SBP and health outcomes in the very old.Methods: Five cohorts from the Towards Understanding Longitudinal International older People Studies (TULIPS) consortium were included in a two-step individual participant data meta-analysis (IPDMA). We pooled hazard ratios (HR) from Cox proportional-hazards models for 5year mortality and estimates of linear mixed models for change in cognitive and functional decline. Models were stratified by BP-lowering treatment, history of CVD, Mini-Mental State Examination scores, grip strength (GS) and body mass index (BMI).Results: Of all 2480 participants (59.9% females, median 85 years), median baseline SBP was 149 mmHg, 64.3% used BP-lowering drugs and 47.3% had a history of CVD. Overall, higher SBP was associated with lower all-cause mortality (pooled HR 0.91 [95% confidence interval 0.88-0.95] per 10 mmHg). Associations remained irrespective of BP-lowering treatment, history of CVD and BMI, but were absent in octogenarians with above-median MMSE and GS. In pooled cohorts, SBP was not associated with cognitive and functional decline. Conclusion:While in the very old with low cognitive or physical fitness a higher SBP was associated with a lower all-cause mortality, this association was not evident in fit octogenarians. SBP was not consistently associated with cognitive and functional decline.

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Objectives Previous findings suggest a vascular foundation underlying apathy, but transdiagnostic and prospective evidence on vascular apathy is scarce. This study examines the association between vascular disease and the presence and development of apathy symptoms in the very old. Methods Four cohorts of the Towards Understanding Longitudinal International older People Studies (TULIPS)‐consortium were included in a two‐staged, individual participant data meta‐analysis using generalized linear mixed models. Vascular disease was defined as a history of any clinical atherosclerotic pathology (angina pectoris, myocardial infarction, intermittent claudication, transient ischemic attack, stroke or related surgeries) and was related to apathy symptoms as repeatedly measured by the Geriatric Depression Scale (GDS‐3A ≥2) over a maximum of 5 years. Results Of all 1868 participants (median age 85 years old), 53.9% had vascular disease and 44.3% experienced apathy symptoms. Participants with vascular disease had a 76% higher risk of apathy symptoms at baseline (odds ratio (OR) 1.76, 95% confidence interval (CI) 1.32–2.35), irrespective of depressive symptoms and only partially explained by stroke. Conversely, there was no association of vascular disease with the occurrence of apathy symptoms longitudinally, both in those with apathy at baseline (OR 1.00, 95% CI 0.84–1.20) and without (OR 0.96, 95% CI 0.84–1.09). Conclusions Vascular disease in the very old is associated with apathy symptoms cross‐sectionally, but not proven longitudinally, independent of depressive symptoms. These findings query a vascular cause underlying apathy symptoms. However, the consistency of our cross‐sectional findings in direction and magnitude across the TULIPS‐consortium do emphasize international relevance of the interplay of vascular factors and apathy in advanced age, which meaning needs further unravelling.

Background In the general population an increase in low-density lipoprotein cholesterol (LDL-C) predicts higher cardiovascular disease risk, and lowering LDL-C can prevent cardiovascular disease and reduces mortality risk. Interestingly, in cohort studies that include very old populations, no or inverse associations between LDL-C and mortality have been observed. This study aims to investigate whether the association between LDL-C and mortality in the very old is modified by a composite fitness score. Methods A two-stage meta-analysis of individual participant data from the five observational cohort studies. The composite fitness score was operationalized by performance on a combination of four markers: functional ability, cognitive function, grip strength, and morbidity. We pooled hazard ratios (HR) from Cox proportional-hazards models for five-year mortality risk for 1 mmol/L increase in LDL-C. Models were stratified by high/low composite fitness score. Results Composite fitness scores were calculated for 2,317 participants (median 85 years, 60% females), of which 994 (42.9%) had a high composite fitness score, and 694 (30.0%) had a low composite fitness score. There was an inverse association between LDL-C and five-year mortality risk (HR 0.87 [95%CI 0.80-0.94]; p< 0.01), most pronounced in participants with a low composite fitness score (HR 0.85 [95%CI 0.75-0.96]; p=0.01), compared to those with a high composite fitness score (HR= 0.98 [95%CI 0.83-1.15]; p=0.78), the test for subgroups differences was not significant. Conclusion In this very old population, there was an inverse association between LDL-C and all-cause mortality, which was most pronounced in participants with a low composite fitness score.