Cardiovascular Risk Factor Burden in Veterans and Non-Veterans with Parkinson Disease

Abstract

Background Medical comorbidities, including cardiovascular risk factors such as hypertension and diabetes, influence disease progression in Parkinson disease (PD) and may be variably present in different clinical populations. Objective/Methods We conducted a retrospective nested case-control study of 29 Veterans with PD and 29 non-Veteran PD controls. The groups were matched for age, gender, and disease duration. Both groups underwent clinical and imaging testing as part of their participation in a larger cross-sectional PD observational study at our research center. Veterans were recruited primarily from movement disorders neurology clinics at the Ann Arbor Veterans Affairs (VA) Health System. Non-Veterans were recruited primarily from analogous clinics at the University of Michigan Health System. We explored differences in cardiovascular risks factor burden between the groups. Results Veterans with PD showed higher scores on the simplified Framingham 10-year general cardiovascular disease risk calculator (FR score; 27.3% (11.5) vs. 20.7% (6.8); t = −2.66, p = 0.011) and fewer years of self-reported education (14.5 (2.5) vs. 16.7 (2.6); t = 3.33, p = 0.002). After adjusting for age, disease duration, education, and the use of antihypertensive medications, Veterans showed higher FR scores (t = 2.95, p = 0.005) and a higher intra-subject ratio of FR score to age-and-gender normalized FR score (t = 2.49, p = 0.016), representing an elevated component of modifiable cardiovascular risk factor burden. Conclusion Cardiovascular comorbidities are common in Veterans with PD and may be more severe than in non-Veteran PD populations. These findings merit replication in other representative cohorts. Veterans may be a preferred population for clinical trials evaluating cardiovascular risk factor management on PD progression.

Standardizing Care Coordination Within the Department of Veterans Affairs

“…As compared to non-Veterans, Veterans have a greater number of comorbidities that need to be considered and well-coordinated when receiving health care. [6][7][8][9][10][11] To address and mitigate these risks, VA has developed two initiatives aimed at helping Veterans navigate the intricacies of an increasingly complex and diverse provider network: the VA Office of Community Care (OCC) Care Coordination Model, and the collaborative Care Coordination and Integrated Case Management (CC&ICM) Initiative. These initiatives stand up a framework by which internal VA case managers and care coordinators work together and with facility community care office care coordinators to ensure transitions of care inside VA and in the community are well-organized and focus on highrisk Veterans.…”

Assessment and Management of Cardiovascular Risk Factors Among US Veterans With Prostate Cancer

“…To address this knowledge gap, we performed a cross-sectional analysis of US veterans diagnosed with prostate cancer from January 1, 2010, to December 31, 2017, to characterize rates and determinants of baseline CVRF assessment and management. US veterans have a high burden of both prostate cancer and cardiac disease, with more than 15 000 cases of prostate cancer diagnosed annually within the Veterans Affairs (VA) network . We hypothesized that a significant proportion of veterans with prostate cancer do not receive CVRF assessment and management concordant with consensus recommendations and that uncontrolled modifiable CVRFs are prevalent in this population.…”

Age and Life-Sustaining Treatment Preferences in Parkinson Disease

“…[7][8][9] We surveyed patients with PD from a Veterans Affairs (VA) hospital to better understand the association between advanced age and life-sustaining treatment preferences in several different hypothetical future illness states. In this VA cohort, commonly affected by a substantial comorbidity burden, 10 we hypothesized that older age would correlate with more interest in lifesustaining treatment preferences even after controlling for potential confounders.…”