The SCORE risk model applied to recent population surveys in Norway compared to observed mortality in the general population.

AIMS: To compare the predictions of the Systematic Coronary Risk Evaluation (SCORE) high- and low-risk functions applied to a recent population study with observed cardiovascular disease (CVD) mortality estimated from annual official mortality statistics in Norway. METHODS: Data were obtained from large epidemiological surveys conducted in five Norwegian counties in 2000-2003. RESULTS: A total of 32 251 men and women were investigated (aged 30-31, 40-41, 45-46, and 59-61). For men aged >or=59, more than 75% qualified for preventive treatment by having a 10-year risk >or=5%. Few women and practically no men younger than 46 years can be considered at high risk according to the SCORE risk prediction models. For men, the high-risk function overestimated and the low-risk model underestimated the CVD mortality as compared to the 10-year risks calculated from official mortality statistics (1999-2003). For women, however, both functions underestimated mortality in young individuals, whereas in the elderly an overestimation was observed. CONCLUSIONS: The risk predictions depended strongly on age and gender. The SCORE high-risk function overestimates the risk of fatal CVD for men in Norway, and before implementation in clinical practice, proper adjustments to national levels are required.     

Radiation-free regimens result in similar outcomes of allogeneic hematopoietic progenitor cell transplantation in patients aged >or=50 years compared to younger adults with low-risk disease

Age >or=50 years has been reported to be an adverse risk factor for allogeneic BMT, and consequently many of these patients are either not transplanted or treated on nonmyeloablative protocols. To study if older patients perform poorly relative to younger adults following myeloablative allogeneic transplants, we compared the outcomes of consecutive adults aged >or=50 years (n=51) to those <50 years (n=262) who received BU, CY+/-etoposide and allogeneic transplantation for AML, CML, MDS and NHL from 1984 to 2000. Median ages were 53 (range 50-66) and 35 (range 18-49) years for older and younger patients, respectively. Patients were low-risk if they had AML in CR1, CML in first chronic phase, refractory anemia, or NHL in remission or sensitive relapse at the time of transplantation. All others were high-risk. In patients with low-risk disease, there was no significant difference in overall survival (OS) between older and younger adults (P=0.64), while older patients tended to have a shorter OS among high-risk patients (P=0.06). The 3-year OS was 53% (95% CI, 29-77%) compared to 60% (95% CI, 50-69%) for older and younger patients with low-risk disease, respectively. The corresponding 3-year OS were 27% (95% CI, 11-43%) and 37% (95% CI, 25-45%) for high-risk patients. In low-risk patients, the incidence of acute and chronic graft-versus-host disease, and treatment-related mortality were similar in older and younger patients, while older patients experienced more treatment-related deaths by day 100. On multivariable analysis, age >or=50 years was a significant adverse factor only when high-risk patients were considered. We conclude that when radiation-free conditioning is used, age >or=50 years is not a significant adverse risk factor for allogeneic BMT in patients with low-risk disease, and that such patients should not be excluded from conventional myeloablative approaches until the efficacy of nonmyeloablative transplantation is better established.     

Evaluation of a recalibrated Systematic Coronary Risk Evaluation cardiovascular risk chart: results from Systematic Coronary Risk Evaluation Germany

BACKGROUND: A recalibrated cardiovascular disease (CVD) risk chart for the German population, Systematic Coronary Risk Evaluation (SCORE) Germany, was developed in 2005. We evaluated the risk prediction by SCORE Germany in two large population-based surveys. STUDY POPULATIONS AND METHODS: We applied the SCORE Germany risk function to men and women, aged 40-65 years, who participated in surveys of the Study of Health in Pomerania (SHIP), north-east Germany or the Cooperative Health Research in the Augsburg Region (KORA) study (southern Germany). The prevalence of single risk factor combinations and of the SCORE Germany risk prediction categories was assessed. The 10-year risk of fatal CVD predicted by SCORE Germany (P) was evaluated against the risk observed in the general population using official mortality data (O). RESULTS: Less than one in 25 women in the two studies had a high-predicted 10-year risk of fatal CVD (> or =5%), whereas one in three men in SHIP and about one in four men in KORA belonged to this risk group. The age-specific predicted risk of fatal CVD was consistently higher for men and women from SHIP than from KORA. On comparison, the P/O ratio of 10-year CVD risks was close to unity and tended to decline with higher age in the both studies. CONCLUSION: Overestimations of risks with the original SCORE model are reduced mostly with SCORE Germany. Differences in risk factors and CVD risk between populations within Germany are reflected properly by risk predictions with SCORE Germany. The recalibrated risk chart seems to be suited for use in German clinical practice.     

Effects of regular exercise on cardiovascular risk factors profile and oxidative stress in obese type 2 diabetic patients in regard to SCORE risk

AIM: The aim of the present study was to investigate not only the effects of aerobic exercise on overall cardiovascular risk factors profile and oxidative stress in obese, type 2 diabetic patients, but to elucidate if those effects depended on the previously estimated Systematic Coronary Risk Evaluation (SCORE) risk. SUBJECTS AND METHODS: Changes in several well-established cardiovascular risk factors and oxidative stress-defense parameters were measured in a total of 30 previously sedentary, obese type 2 diabetic patients, including 16 low-risk (SCORE < 5%, aged 48.8 +/- 6.0 years, with a mean BMI of 33.28 +/- 2.94 kg/m2) and 14 high-risk (SCORE > or = 5%, aged 56.3 +/- 6.9 years, with a mean BMI of 31.40 +/- 1.13 kg/m2) patients, in regard to the SCORE model, during six months of regular aerobic exercise, performed under supervision. RESULTS: Significant improvement was observed in the majority of cardiovascular risk factors, including body mass index, waist circumference, blood pressure, glycaemia, glycated haemoglobin, median blood glucose and lipid profile parameters in both diabetic subgroups during the exercise programme. However, the benefits of exercise on the majority of examined parameters became more evident in the low-risk subgroup, compared to the high-risk subgroup from baseline to 3 months. Regular exercise markedly reduced oxidative stress in both subgroups as well, as demonstrated for glutathione, plasma malondialdehyde, sulphydryl groups and catalase. CONCLUSION: Regular aerobic exercise, performed under supervision, has many beneficial effects in improving overall cardiovascular risk factors profile and reducing oxidative stress in both low-risk and high-risk (according to SCORE model), previously sedentary and obese type 2 diabetic patients.     

Effect of age on blood pressure parameters and risk of cardiovascular death in men

BACKGROUND: Elevated blood pressure (BP) is a risk factor for cardiovascular disease (CVD), but it remains unclear which component-alone or in combination-is the best predictor. We sought to determine which BP parameters are important predictors of CVD death across a wide age range. METHODS: We used a prospective cohort study design with 53,163 men followed for cause-specific death during a median of 5.7 years in the Physicians' Health Study enrollment cohort. Baseline age, systolic BP and diastolic BP were collected. We calculated relative risks (RRs) and their 95% confidence intervals using Cox proportional hazard models adjusting for major risk factors for CVD, and then stratified by age (39 to 49, 50 to 59, 60 to 69, and 70 to 84 years). RESULTS: There were 459 CVD deaths during follow-up. For each 10 mm Hg increase in systolic BP, the multivariable RRs by ascending age group were 1.46, 1.43, 1.24, and 1.13. The multivariable RRs for each 10 mm Hg increase in diastolic BP were 1.25, 1.20, 1.28, and 1.07. Compared with systolic BP, pulse pressure and mean arterial pressure were not consistent predictors across age ranges, and combining systolic BP with another parameter did not improve the model compared with using systolic BP alone in any age group (all P > .05). CONCLUSIONS: In this large cohort of healthy men with no history of hypertension, systolic BP was the most consistent and significant predictor of CVD death across all ages. Diastolic BP was not as strongly associated with risk. Our results support the continuing emphasis on using systolic BP in predicting cardiovascular risk.     

Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.

AIMS: The SCORE project was initiated to develop a risk scoring system for use in the clinical management of cardiovascular risk in European clinical practice. METHODS AND RESULTS: The project assembled a pool of datasets from 12 European cohort studies, mainly carried out in general population settings. There were 20,5178 persons (88,080 women and 11,7098 men) representing 2.7 million person years of follow-up. There were 7934 cardiovascular deaths, of which 5652 were deaths from coronary heart disease. Ten-year risk of fatal cardiovascular disease was calculated using a Weibull model in which age was used as a measure of exposure time to risk rather than as a risk factor. Separate estimation equations were calculated for coronary heart disease and for non-coronary cardiovascular disease. These were calculated for high-risk and low-risk regions of Europe. Two parallel estimation models were developed, one based on total cholesterol and the other on total cholesterol/HDL cholesterol ratio. The risk estimations are displayed graphically in simple risk charts. Predictive value of the risk charts was examined by applying them to persons aged 45-64; areas under ROC curves ranged from 0.71 to 0.84. CONCLUSIONS: The SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.     

Estimation of 10-year risk of fatal cardiovascular disease and coronary heart disease in Iceland with results comparable with those of the Systematic Coronary Risk Evaluation project.

BACKGROUND: No data are available on the comparison between an absolute 10-year risk of fatal cardiovascular disease (CVD) and coronary heart disease (CHD) morbidity using the risk assessments of the Systematic Coronary Risk Evaluation (SCORE) project. DESIGN: Data from the prospective Reykjavik Study of 15,782 patients were used to estimate the 10-year risk of fatal CVD and CHD morbidity in Iceland. METHODS: Survival to fatal CVD event was defined as in the SCORE project. Survival to CHD morbidity was defined as having a myocardial infarction, coronary artery bypass graft, or angioplasty. The statistical methodology of SCORE was used. RESULTS: Relative risk in Iceland was comparable with SCORE results but baseline risk was similar to the low-risk version of SCORE, which contradicted previous suggestions for the countries of northern Europe. Correlation between absolute risk of CHD morbidity and risk for fatal CVD was high (r=0.96), resulting in similar ranking of individuals by risk and discriminatory capacity. This is the first published comparison between total fatal CVD risk and CHD morbidity in a population-based cohort using the current risk assessment guidelines of the European Societies on Coronary Prevention. CONCLUSIONS: Risk for fatal CVD in Iceland has the same characteristics as those in a European nation with results varying in accordance with the SCORE project. The risk estimate to be used, CHD morbidity or fatal CVD, is a choice of clinical preference. The data, however, suggest that 5% high-risk threshold of fatal CVD corresponds to a 12% CHD-morbidity risk, which is a significant change from the conventional reference value of 20%.     

Late mortality in elderly patients surviving acute peptic ulcer bleeding.

Acute peptic ulcer bleeding is associated with a substantial short term mortality but it is generally assumed that in the modern era of effective medical treatment the longer term prognosis is good. This study evaluated 487 patients aged over 60 years who were discharged from Nottingham University and City Hospitals after admission for acute peptic ulcer bleeding during 1986-91 and 480 age and sex matched community controls. Follow up information was obtained from hospital and general practitioner records and from the National Health Service central register. Mortality was compared with control mortality and with rates expected for England and Wales. During a mean follow up of 34 months 142 (29%) of 487 patients died compared with 58 (12%) of 480 community controls and with 81.5 deaths expected (observed/expected (O/E) = 1.74, 95% confidence limits (CL) 1.5 to 2.1). Six years after admission the actuarial survival estimate was only 50% for ulcer patients compared with 76% for community controls and 69% expected. The increased mortality was similar in men and women and was greatest in the 60-74 year age group. Much of the excess mortality was accounted for by deaths from cancer (O/E 34/19.7 = 1.73; CL 1.2 to 2.4), from respiratory disease (O/E 28/10.9 = 2.57; CL 1.7 to 3.7), and in men from vascular disease (O/E 31/22.4 = 1.38; CL 0.9 to 2.0). Eight deaths resulted from recurrent ulcer complications and four deaths from gastric cancers undetected at the index admission. In conclusion, patients discharged after peptic ulcer bleeding had a substantially reduced life expectancy. The increased mortality was predominantly due to a variety of smoking related diseases rather than recurrent peptic ulcer complications. Deaths from recurrent peptic ulcer complications were infrequent and were less than reported in earlier years possibly reflecting prolonged and widespread used of H2 receptor antagonists.     

Cardiometabolic profile of people screened for high risk of type 2 diabetes in a national diabetes prevention programme (FIN-D2D)

AimsTo study screening of high-risk individuals as part of a national diabetes prevention programme in primary health care settings in Finland between 2003 and 2007, and evaluate the cardiometabolic risk profile of persons identified for intervention.MethodsHigh-risk individuals were identified by the Finnish Diabetes Risk Score (FINDRISC), history of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), cardiovascular disease (CVD), or gestational diabetes. Participants subsequently underwent an oral glucose tolerance test. CVD morbidity risk was estimated by the Framingham Study Risk Equation and CVD mortality risk by the Systematic Coronary Risk Evaluation Formula (SCORE).ResultsA high-risk cohort of 10,149 (of whom 30.3% men) was identified (mean age 54.7 for men, 53.0 for women). Altogether 18.8% of men and 11.5% of women had screen-detected diabetes. In total 68.1% of men and 49.4% of women had abnormal glucose tolerance (IFG, IGT or screen-detected diabetes). Furthermore, 43.2% and 41.5% of men, and 13.3% and 11.3% of women, respectively, had a high predicted risk of CVD morbidity or mortality.ConclusionPrevalence of dysglycemia including undiagnosed diabetes and the predicted risk for CVD was alarmly high in the identified high-risk cohort, particularly in men.     

A comparison of Framingham and SCORE-based cardiovascular risk estimates in participants of the German National Health Interview and Examination Survey 1998.

BACKGROUND: Overestimation of risk by Framingham risk functions not only in southern but also in northern European populations including Germany, has led to the development of the SCORE risk estimation model. DESIGN: Data of the German National Health Interview and Examination Survey 1998 was used to determine whether SCORE leads to lower estimates of the 10-year absolute risk of fatal cardiovascular disease and fatal coronary heart disease than a Framingham model. Predicted numbers of events were compared with approximations based on national mortality statistics. METHODS: Inclusion criteria followed the recommendations for the use of SCORE: age 30 to 69 years, no previous history of cardiovascular disease and no markedly raised levels of single risk factors (leaving 1811 men and 1955 women for analysis). RESULTS: The SCORE model for high-risk regions (SCORE-HIGH, which is recommended for Germany pending calibration with national data) predicted the highest number of events, followed by the estimations with mortality statistics, the Framingham model and SCORE-LOW (87 fatal cardiovascular disease events versus 77, 62 and 47; fatal coronary heart disease events 62 versus 46, 46 and 30). Agreement on high-risk status, defined as the 10-year risk of fatal cardiovascular disease of 5% or higher now or if extrapolated to age 60, was moderate for both men and women (kappa 0.52 and 0.42 for Framingham and SCORE-HIGH). CONCLUSIONS: Our results suggest that SCORE-HIGH may overestimate absolute risk of fatal coronary heart disease and cardiovascular disease in Germany and may need calibration. Furthermore, the limitations of current risk prediction tools emphasize the ongoing need for comprehensive, high-quality and timely European cohort data.     

Elderly haematological patients with chemotherapy-induced febrile neutropenia have similar rates of infection and outcome to younger adults: a prospective study of risk-adapted therapy

We prospectively evaluated 131 consecutive episodes of fever and chemotherapy-induced neutropenia in 85 adults with haematological malignancies to determine whether older patients (aged < 60 years) have different causes of fever and outcome than younger adults (aged < 60 years). Patients were stratified into high-risk and low-risk groups according to previously published criteria. High-risk patients received ceftazidime plus amikacin and low-risk patients received ceftazidime alone. All patients were hospitalized until fever and neutropenia resolved. Ninety one high-risk episodes were documented: 56 occurring in older patients (mean age 69 years) and 35 in younger adults (mean age 45 years). Non-Hodkgin's lymphoma and acute myeloid leukaemia were the most frequent underlying neoplasias in both age groups. Intensity of chemotherapy was similar in both age groups. Mean neutrophil count at entry, median duration of neutropenia, rate of documented infection, incidence of bacteraemia, response to therapy, overall mortality and infectious mortality were similar in the two high-risk age subgroups. The elderly subgroup had a trend to have more Gram-negative infections and the younger patients more Gram-positive infections. In addition, 40 low-risk episodes were registered: 29 in elderly patients (mean age 68 years) and 11 in younger patients (mean age 44 years). Elderly low-risk patients had more concurrent diseases that younger ones (P = 0.124). Mean neutrophil count at entry, median duration of severe neutropenia and rate of response were similar in the two age subgroups. All low-risk patients survived. In conclusion, elderly haematological cancer patients with febrile neutropenia show similar rates of infection and outcome to younger ones.     

Stratification of risk of cardiovascular complications in government employees and results of 10-year prospective observation

We investigated prognostic value of the SCORE scale in working age government employees with 3 or more risk factors (RF) of cardiovascular diseases (CVD) and metabolic syndrome (MS, 2001 criteria) according to results of 10-year prospective observation in a policlinic. The study comprised 268 practically healthy men: 168 patients with 3 or more RF of CVD (mean age 47.76+/-6.9 years) (group 1) and 100 patients with MS (mean age 47.73+/-7.97 years) (group 2). Prospective follow up of group I patients with low or moderate CVD risk calculated with the SCORE scale demonstrated concordance of predicted and actual rates of lethal outcomes. In the group of patients with MS and high CVD risk lowering of number and level of RF took place due to in-depth examination and high compliance to therapy. This resulted in lowering of CVD and postponement rate their later development.     

Cardiovascular disease risk profiles among 'healthy' siblings of patients with early-onset cardiovascular disease: application of the new SCORE system.

BACKGROUND: Cardiovascular disease (CVD) occurs more frequently in individuals with a family history of premature CVD. Within families the demographics of CVD are poorly described. DESIGN: We examined the risk estimation based on the Systematic Coronary Risk Evaluation (SCORE) system and the Joint British Guidelines (JBG) for older unaffected siblings of patients with premature CVD (onset 相似文献   

Joint effect of physical activity and blood lipid levels on all-cause and cardiovascular disease mortality: The Rural Chinese Cohort Study

Background and aimsWe aimed to evaluate the joint effect of physical activity (PA) and blood lipid levels on all-cause and cardiovascular disease (CVD) mortality.Methods and resultsWe analyzed 17,236 participants from the Rural Chinese Cohort Study. Cox's proportional-hazards regression models were used to assess the hazard ratios (HRs) and 95% confidence intervals (CIs) between the joint effect of PA and blood lipid levels and risk of all-cause and CVD mortality. Restricted cubic splines were used to estimate the dose–response relationship of PA with risk of all-cause and CVD mortality. During a median follow-up of 6.01 years there were 1106 deaths (484 from CVD) among participants. For all-cause mortality, compared with the group with dyslipidemia and extremely light PA (ELPA), the HRs with dyslipidemia and light PA (LPA), moderate PA (MPA), and heavy PA (HPA) were 0.56 (95% CI 0.45–0.70), 0.59 (0.46–0.75), and 0.59 (0.45–0.78), respectively, while the HRs of groups with normal lipid levels and ELPA, LPA, MPA, and HPA were 0.88 (0.72–1.04), 0.59 (0.48–0.73), 0.53 (0.41–0.67), and 0.38 (0.29–0.50), respectively. We observed similar effects on CVD mortality. Restricted cubic splines showed a curvilinear relationship between PA and risk of all-cause and CVD mortality with normal lipid levels and with dyslipidemia.ConclusionHigher PA reduces the risk of all-cause and CVD mortality. Higher levels of PA are needed in the population.     

Systematic COronary Risk Evaluation (SCORE) and 20-year risk of cardiovascular mortality and cancer

BackgroundCardiovascular disease (CVD) followed by cancer are the two leading causes of death worldwide. SCORE charts have been recommended in Europe to identify individuals at increased CVD risk. However, the SCORE ability to identify individuals at increased risk of cancer has not yet been evaluated. The aim of this study was to determine the SCORE chart calibration in a country with changing CVD epidemiology, and its discrimination ability to identify individuals at increased risk of cancer over 20-years.MethodsThe present analysis includes data from two cross-sectional independent surveys within the Czech post-MONICA study (randomly selected representative population samples of the Czech Republic, aged 25–64 years); 3209 individuals in 1997/98 and 3612 in 2006–2009.ResultsThe SCORE had reasonable discrimination to predict 10-year CVD mortality, but significantly overestimated the risk across all risk categories. During the 20-year follow up, high and very high-risk categories were associated with an increased risk of cancer morbidity (in particular colorectal, other gastrointestinal, lung and malignant skin) and cancer mortality, as compared to low risk category.ConclusionsThe present study shows that periodical calibration testing of SCORE charts is needed in countries with changing CVD epidemiology. Furthermore, we show that in middle-aged individuals, identified by SCORE charts as being at high or very high risk for CVD, cancer morbidity and cancer mortality is increased. Rigorous cancer screening may be appropriate in this group, especially in countries with falling CVD mortality, where relative proportion of cancer mortality is increasing.     

Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population.

AIMS: Chronic kidney disease (CKD) was found to be an independent risk factor for all-cause mortality as well as adverse cardiovascular disease (CVD) events in high-risk populations. Findings from population-based studies are scarce and inconsistent. We investigated the gender-specific association of CKD with all-cause mortality, cardiovascular mortality, and incident myocardial infarction (MI) in a population-based cohort. METHODS AND RESULTS: The study was based on 3860 men and 3674 women (aged 45-74 years) who participated in one of the three MONICA Augsburg surveys between 1984 and 1995. CKD was defined by an estimated glomerular filtration rate between 15 and 59 mL/min/1.73 m(2). Hazard ratios (HRs) were estimated from Cox proportional hazard models. In this study, 890 total deaths, 400 CVD deaths, and 321 incident MIs occurred in men up to 31 December 2002; the corresponding numbers in women were 442, 187, and 102. In multivariable analyses, the HR for women with CKD compared to women with preserved renal function was significant for incident MI [HR 1.67; 95% confidence interval (CI) 1.07-2.61] and CVD mortality (HR 1.60; 95% CI 1.17-2.18). In men, CKD was also significantly associated with incident MI (HR 1.51; 95% CI 1.09-2.10) and CVD mortality (HR 1.48; 95% CI 1.15-1.92) after adjustment for common CVD risk factors. In contrast, men and women with CKD had no significant increased risk of all-cause mortality. CONCLUSION: CKD was strongly associated with an increased risk of incident MI and CVD mortality independent from common cardiovascular risk factors in men and women from the general population.     

Identifying young adults at high risk of cardiometabolic disease using cluster analysis and the Framingham 30-yr risk score

Background and aimsCurrent strategies to reduce cardiovascular disease (CVD) risk in young adults are largely limited to those at extremes of risk. In cohort studies we have shown cluster analysis identified a large sub-group of adolescents with multiple risk factors. This study examined if individuals classified at ‘high-risk’ by cluster analysis could also be identified by their Framingham risk scores.Methods and resultsRaine Study data at 17- (n = 1048) and 20-years (n = 1120) identified high- and low-risk groups by cluster analysis using continuous measures of systolic BP, BMI, triglycerides and insulin resistance. We assessed:- CVD risk at 20-years using the Framingham 30 yr-risk-score in the high- and low-risk clusters, and cluster stability from adolescence to adulthood.Cluster analysis at 17- and 20-years identified a high-risk group comprising, 17.9% and 21.3%, respectively of the cohort. In contrast, only 1.2% and 3.4%, respectively, met the metabolic syndrome criteria, all of whom were within the high-risk cluster. Compared with the low-risk cluster, Framingham scores of the high-risk cluster were elevated in males (9.4%; 99%CI 8.3, 10.6 vs 6.0%; 99%CI 5.7, 6.2) and females (4.9%; 99%CI 4.4, 5.4 vs 3.2%; 99%CI 3.0, 3.3) (both P < 0.0001). A score >8 for males and >4 for females identified those at high CVD risk with 99% confidence.ConclusionCluster analysis using multiple risk factors identified ～20% of young adults at high CVD risk. Application of our Framingham 30 yr-risk cut-offs to individuals allows identification of more young people with multiple risk factors for CVD than conventional metabolic syndrome criteria.     

The effect of age on hypertension control and management

BACKGROUND: Despite guidelines recommending similar blood pressure (BP) treatment goals regardless of age, controversy exists regarding treating those > or = 80 years of age. Whether this affects current practice in terms of differences in BP control and number of prescribed antihypertensives by age is unknown. METHODS: This was a cross-sectional study of 59,207 outpatients with hypertension treated at 10 Veterans Health Administration sites. Outcome measures were BP control (< 140/90 mm Hg) and number of antihypertensive medications at the patient's last study visit. Uncontrolled BP was also categorized by whether systolic, diastolic, or both were elevated. RESULTS: Subjects 40 to 49 years and those 50 to 59 years of age had better BP control (adjusted odds ratios 1.35 [95% CI = 1.26 to 1.44] and 1.22 [CI = 1.17 to 1.28] respectively) compared with subjects 60 to 69 years of age; those 70 to 79 years of age and > or = 80 years had worse control (OR = 0.92 for both; respective CIs = 0.88 to 0.96 and 0.86 to 0.99). Antihypertensive medication use increased by successive decade to age 80 years, after which the trend reversed. Adjusted mean number of medications by age were: < 40 years, 2.60; 40 to 49, 2.82; 50 to 59, 2.91; 60 to 69, 3.01; 70 to 79, 3.03; > or = 80 years, 2.90 (P < .05 in pairwise comparisons). The trend of number of medications by age did not vary across hypertension categories, despite systolic hypertension increasing and diastolic hypertension decreasing with age. Subjects < 40 years of age were taking the fewest medications, followed by subjects > or = 80 years and then by those 40 to 49, 50 to 59, 70 to 79, and 60 to 69 years of age. CONCLUSIONS: The oldest hypertension patients, despite worse BP control, are being treated less aggressively with fewer medications than their younger counterparts (those 60 to 79 years of age). Our results suggest that current controversy in treating the oldest hypertensive patients is having an impact on actual practice.     

Association between brachial‐ankle pulse wave velocity and cardiovascular and cerebrovascular disease in different age groups

BackgroundTo investigate the association between brachial‐ankle pulse wave velocity (baPWV) and cardiovascular and cerebrovascular disease (CVD) in different age groups.MethodsA total of 39 417 people, receiving Kailuan physical examination, completing baPWV examination from 2010 to 2017, with no history of CVD and atrial fibrillation, were selected as the observation objects. The population was categorized into one age group per 10 years, namely the <50, 50–59, 60–69, 70–79, and ≥80‐year‐old groups, and the total population, and each group was further assigned into three classes according to the triple quartiles of baPWV. Kaplan–Meier method helped to calculate the cumulative incidence of CVD in different age groups. The effect of baPWV on CVD in different age groups was evaluated using the Cox proportional hazards regression model.ResultsKaplan–Meier survival curve indicated statistical significance (p < .05) in the cumulative incidence of CVD among the whole population, <50, 50–59, and 60–69‐year‐old groups, while the cumulative incidence of end‐point events among the baPWV subgroups of 70–79 and ≥80‐year‐old groups exhibited no statistical significance (p > .05). Compared with baPWV in the Q1 group, hazard ratio value (95% confidence interval [CI]) of CVD in the Q3 group was 4.14 (95% CI: 2.98–5.75) in the total population, 2.98 (95% CI: 1.08–8.21) in <50‐year‐old population, 4.49 (95% CI: 2.89–7.00) in 50–59‐year‐old population, 2.78 (95% CI: 1.76–4.39) in 60–69‐year‐old population, 1.39 (95% CI: 0.86–2.24) in 70–79‐year‐old population, and 1.15 (95% CI: 0.55–2.41) in ≥80‐year‐old population.ConclusionCVD risk attributed to increased arterial stiffness reduces with age.     

Predictive value C-reactive protein assessment level in women with arterial hypertension

Classic modifiable cardiovascular risk factors, such as blood pressure and dyslipidaemia are incorporated into clinical practice to estimate the 10-year risk of fatal cardiovascular disease (CVD): the SCORE project. To improve CVD risk estimation in women we compared predictive value of two models: risk chart based on the SCORE study and the Reynolds Risk Score in 134 women with hypertension to optimise risk stratification and preventive strategies in high-risk individuals. We concluded that Reynolds Risk model causes clinically relevant changes in risk category classification compared to risk chart SCORE and improves risk stratification. Addition of C-reactive protein to Reynolds Risk model improves it predictive value regardless of other risk factors. C-reactive protein is a strong marker of atherosclerosis, can be useful in women for risk stratification in daily practice regardless of risk prediction model.