Cardiovascular Disease Risk Factors in Older People with Intellectual Disabilities

markdownabstract__Abstract__ Chapter 1 General introduction There is an increasing group of older people with intellectual disability in The Netherlands, reaching almost the same life expectancy as the general population. Age-related diseases, such as cardiovascular disease, cancer and dementia are now the most encountered diseases and causes of death in older people with intellectual disabilities. Although cardiovascular disease is a major risk for older people with intellectual disabilities, no reliable information was available on cardiovascular disease risk factors, nor attention for prevention of cardiovascular disease was present prior to the start of the Healthy Ageing and Intellectual Disability (HA-ID) study. The HA-ID study aimed at gaining knowledge on healthy ageing by studying health and health risks in an older population of people with intellectual disabilities. Three large care organizations and two university departments participated in this study. Subthemes in the HA-ID study were: (1) Physical activity and fitness, (2) Nutrition and nutritional state, and (3) Mood and anxiety. By studying these themes and the interrelationships, a comprehensive concept of health and health-needs in aging people with intellectual disability would be created. Through physical examination, laboratory examination, and use of screening and diagnostic psychiatric interviews, data were collected on 1050 participants, aged 50 years and over with borderline to profound intellectual disability, which was a near- representative sample for the total older population using formal intellectual disability care. This study was performed to give more insight into the prevalence and associations of cardiovascular risk factors, and the subsequent development of atherosclerosis, in older people with intellectual disability in a large unbiased population sample. Chapter 2 Overweight and obesity As obesity is a major health problem associated with increased cardiovascular disease risks, the prevalence of overweight, obesity and body fat percentage in older people with intellectual disability through measurement of Body Mass Index (BMI), waist circumference, waist to hip ratio and skin fold thickness was studied and compared with prevalence of overweight and obesity in the general population. Associations of overweight and obesity with participant and treatment characteristics (gender, age, level of intellectual disability, Down syndrome, autism, independent living, smoking, (instrumental) activities of daily living, physical activity and use of atypical antipsychotic medication) were studied using regression analyses. Among 945 participants, overweight and obesity were highly prevalent, with more obesity (26%) than in the general Dutch older population (10%) as measured by BMI, and 46-48% obesity as measured by waist circumference and waist to hip ratio respectively. Women, people with Down syndrome, higher age, less severe ID, autism, people who are able to eat independently, preparing meals and doing groceries independently, people with physical inactivity and use of atypical antipsychotics were significantly more at risk of being overweight or obese. Chapter 3 Hypertension, hypercholesterolemia, diabetes and the metabolic syndrome Hypertension, hypercholesterolemia and diabetes are important cardiovascular disease risk factors. Together with abdominal obesity they form the metabolic syndrome, which indicates metabolic disturbances, consisting of insulin resistance and accounting for a severe risk of cardiovascular disease. We determined the prevalence of cardiovascular risk factors and compared this with the prevalence in the same-aged general population. Furthermore we determined how many risk factors had not been previously diagnosed, and identified correlates of CVD risk factors (gender, age, level of ID, Down syndrome, independent living, activities of daily living, mobility, instrumental activities of daily living, physical activity, use of atypical antipsychotics, central obesity), using logistic regression analyses. Ninehundred-eighty people participated in this study. Hypertension (53%), diabetes (14%) and metabolic syndrome (45%) were present similarly as in the general Dutch population. Hypercholesterolemia was present less often (23%). Fifty percent of the people with hypertension had not been not previously diagnosed with this condition. Percentages for diabetes, hypercholesterolemia, and the metabolic syndrome were 45, 46 and 94 respectively. People who were more at risk for CVD risk factors were women, older people, people with obesity, people who lived more independently and people who were able to do groceries or prepare a meal independently. Chapter 4 Peripheral arterial disease Peripheral arterial disease, atherosclerosis distal from the aortic bifurcation, is associated with increased cardiovascular morbidity and mortality. We determined the prevalence of peripheral arterial disease, the rate of prior diagnoses, and correlations with participant characteristics, and compared the prevalence with peripheral arterial disease in the general Dutch population. Peripheral arterial disease was defined as an ankle-brachial index