To the Editor,
We appreciate the observations made by Naharci et al.1 We have evaluated two approaches to address their concerns regarding medication use in our original publication.2 First, we have included the use of ACE-inhibitors, beta-blockers, calcium channel blockers, oral hypoglycemic agents, HMG-CoA reductase inhibitors (statins), and insulin as confounding factors in our full models. Second, we adjusted for individual antihypertensive classes and statins but excluded participants who received oral hypoglycemic agents or insulin.
To summarize, these changes made no difference in any of our conclusions.
After adjusting for Angiotensin-converting enzyme (ACE)-inhibitors, beta-blockers, calcium channel blocker, oral hypoglycemic agents, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins), and insulin, the effect estimate for frailty was 1.18 (95%CI = 1.04–1.34; p = 0.01) per SD increment and 1.38 (95%CI = 1.01–1.89; p = 0.04) across extreme tertiles of Non-esterified fatty acids (NEFAs). For disability, it was 1.11 (95%CI = 1.05–1.17; p = 0.0002) per SD increment and 1.12 (95%CI = 0.99–1.27; p = 0.08) across extreme tertiles. The corresponding estimates for mobility limitation were 1.14 (95%CI = 1.07–1.21; p < 0.0001) and 1.21 (95%CI = 1.04–1.41; p = 0.01). These estimates were all nearly identical with adjustment for antihypertensive class and statin use in the subset of participants receiving no glucose-lowering treatment. Thus, non-esterified fatty acids remain consistently and robustly associated with key geriatric outcomes in older adults.
ACKNOWLEDGMENTS
SPONSOR’S ROLE
This research was funded by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grants U01HL080295 and U01HL130114 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG053325 and R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org.
Footnotes
CONFLICT OF INTEREST
None of the authors have any conflict of interest to disclose.
REFERENCES
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