Risk factors for cardiovascular disease across the spectrum of older age: The Cardiovascular Health Study |
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| Authors: | Michelle C. Odden Michael G. Shlipak Heather E. Whitson Ronit Katz Patricia M. Kearney Chris defilippi Shani Shastri Mark J. Sarnak David S. Siscovick Mary Cushman Bruce M. Psaty Anne B. Newman |
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| Affiliation: | 1. School of Biological and Population Health Sciences, Oregon State University, 141B Milam Hall, Corvallis, 97331 OR, USA;2. Department of General Internal Medicine, San Francisco VA Medical Center, USA;3. Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, USA;4. Departments of Medicine and Ophthalmology, Duke University Medical Center, Durham, NC, USA;5. Durham VA Medical Center, Geriatrics Research Education and Clinical Center, Durham, NC, USA;6. Kidney Research Institute, University of Washington, Seattle, WA, USA;g Department of Epidemiology & Public Health, University College Cork, Ireland;h Division of Cardiovascular Medicine, University of Maryland, Baltimore, MD, USA;i Division of Nephrology, University of Texas Southwestern, Dallas, TX, USA;j Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA;k Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA;l Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA;m New York Academy of Medicine, New York, NY, USA;n Department of Medicine, University of Vermont, Burlington, VT, USA;o Department of Health Services, University of Washington, Seattle, WA, USA;p Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA;q Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA |
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| Abstract: | Objective: The associations of some risk factors with cardiovascular disease (CVD) are attenuated in older age; whereas others appear robust. The present study aimed to compare CVD risk factors across older age. Methods: Participants (n = 4883) in the Cardiovascular Health Study free of prevalent CVD, were stratified into three age groups: 65–74, 75–84, 85+ years. Traditional risk factors included systolic blood pressure (BP), LDL-cholesterol, HDL-cholesterol, obesity, and diabetes. Novel risk factors included kidney function, C-reactive protein (CRP), and N-terminal pro-B-type natriuretic peptide (NT pro-BNP). Results: There were 1498 composite CVD events (stroke, myocardial infarction, and cardiovascular death) over 5 years. The associations of high systolic BP and diabetes appeared strongest, though both were attenuated with age (p-values for interaction = 0.01 and 0.002, respectively). The demographic-adjusted hazard ratios (HR) for elevated systolic BP were 1.79 (95% confidence interval: 1.49, 2.15), 1.59 (1.37, 1.85) and 1.10 (0.86, 1.41) in participants aged 65–74, 75–84, 85+, and for diabetes, 2.36 (1.89, 2.95), 1.55 (1.27, 1.89), 1.51 (1.10, 2.09). The novel risk factors had consistent associations with the outcome across the age spectrum; low kidney function: 1.69 (1.31, 2.19), 1.61 (1.36, 1.90), and 1.57 (1.16, 2.14) for 65–74, 75–84, and 85+ years, respectively; elevated CRP: 1.54 (1.28, 1.87), 1.33 (1.13, 1.55), and 1.51 (1.15, 1.97); elevated NT pro-BNP: 2.67 (1.96, 3.64), 2.71 (2.25, 3.27), and 2.18 (1.43, 3.45). Conclusions: The associations of most traditional risk factors with CVD were minimal in the oldest old, whereas diabetes, eGFR, CRP, and NT pro-BNP were associated with CVD across older age. |
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| Keywords: | Aging Epidemiology Risk factors |
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