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Risk factors for cardiovascular disease across the spectrum of older age: the Cardiovascular Health Study.

ABSTRACT: 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.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).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).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.

SUBMITTER: Odden MC

PROVIDER: S-EPMC4254262 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Risk factors for cardiovascular disease across the spectrum of older age: the Cardiovascular Health Study.

Odden Michelle C MC Shlipak Michael G MG Whitson Heather E HE Katz Ronit R Kearney Patricia M PM defilippi Chris C Shastri Shani S Sarnak Mark J MJ Siscovick David S DS Cushman Mary M Psaty Bruce M BM Newman Anne B AB

Atherosclerosis 20140930 1

<h4>Objective</h4>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.<h4>Methods</h4>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. ...[more]

PMID: 25303772

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Project description:Objectives The Cardiovascular Health Study (CHS) is a study of risk factors for development and progression of CHD and stroke in people aged 65 years and older. The objectives of the Cardiovascular Health Study are to: 1) quantify associations of conventional and hypothesized risk factors with CHD and stroke; 2) assess the associations of non-invasive measures of subclinical disease with the incidence of CHD and stroke; 3) quantify the associations of risk factors with subclinical disease; 4) characterize the natural history of CHD and stroke, and identify factors associated with clinical course; and 5) describe the prevalence and distributions of risk factors, non-invasive measures of subclinical disease, and clinical CHD and stroke. Background The study originated in 1988 from the recommendations of an NHLBI workshop on the management of CHD in the elderly. This is the most extensive study undertaken by the NHLBI to study CVD exclusively in an elderly population. Initially funded for six years, it was renewed for a second six year period in 1994 and recently was renewed with limited support for the Coordinating Center, the Laboratory and the Steering Committee. Grant funding from several sources has supported an additional clinic visit in 2005-2006 and continued morbidity and mortality follow-up. Subjects The 5,888 study participants were recruited from four U.S. communities and have undergone extensive clinic examinations for evaluation of markers of subclinical cardiovascular disease. The original cohort totaled 5,201 participants. A new cohort was recruited in 1992. The 687 participants in the new cohort are predominately African-American and were recruited at three of the four field centers. Design The 2,962 women and 2,239 men were examined yearly from 1989 through 1999. The added minority cohort of 256 men and 431 women was examined from 1992 to 1999. Examination components have included medical history questionnaires, measurement of ankle-brachial index, abdominal and carotid ultrasound studies, echocardiograms, ambulatory electrocardiograms, cerebral magnetic resonance imaging, spirometry and retinal photographs over the past decade. The most extensive evaluations were at study entry (baseline) and again in 1992-1993 to assess change in subclinical disease measures. CHS has undertaken extensive follow-up for ascertainment of cardiovascular events including incident claudication, myocardial infarction, congestive heart failure, stroke and death. Genetic Research The Cardiovascular Health Study has expanded its research mission into the study of genetic factors underlying CVD and other disorders using DNA that was collected from blood samples from most participants. Subsets of CHS participants have been genotyped in large-scale genotyping projects, including thousands of SNP genotypes for candidate gene regions as part of the NHLBI Candidate gene Association Resource (CARe) and genome-wide genotyping as part of the NHLBI SNP Typing for Association with Multiple Phenotypes from Existing Epidemiologic Data (STAMPEED). The Cardiovascular Health Study Cohort is utilized in the following dbGaP substudies. To view genotypes, analysis, expression data, other molecular data, and derived variables collected in these substudies, please click on the following substudies below or in the "Substudies" box located on the right hand side of this top-level study page phs000287 Cardiovascular Health Study Cohort. <li><a href="./study.cgi?study_id=phs000301">phs000301</a> PAGE: CaLiCo: Cardiovascular Health Study</li> <li><a href="./study.cgi?study_id=phs000377">phs000377</a> CARe Cardiovascular Health Study</li>

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Risk factors for cardiovascular disease across the spectrum of older age: the Cardiovascular Health Study.

Publications

Risk factors for cardiovascular disease across the spectrum of older age: the Cardiovascular Health Study.

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