Effects of Primary Cardiovascular Prevention on Vascular Risk in Older Adults

Bussel, Emma F. van; Hoevenaar‐Blom, Marieke P.; Busschers, Wim B.; Richard, Edo; Peters, Ron J.G.; Gool, Willem A. van; Charante, Eric P. Moll van

doi:10.1016/j.amepre.2018.04.048

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…In addition, blood pressure treatment in the very old (N80 years) has been found to be beneficial in reducing the risk of CVD [11]. In a recent study of a nurse-led multicomponent primary CVD prevention program in older adults aged 70 to 78 years, positive results on systolic blood pressure (2.39 mmHg (95% CI 0.87-3.90)) and cigarette smoking −1.85 (95% CI −3.36-0.35) were found in the intervention group [12]. Nevertheless, the intervention did not affect the SCORE-OP risk profile at six years follow-up.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Systematic COronary Risk Evaluation - Older Persons (SCORE-OP) in the EPIC-Norfolk prospective population study

Verweij

Peters

Reimer

et al. 2019

International Journal of Cardiology

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Background: The Systematic COronary Risk Evaluation -Older Persons (SCORE-OP) algorithm is developed to assess 10-year risk of death due to cardiovascular disease (CVD) in individuals aged ≥65 years. We studied the performance of SCORE-OP in the European Prospective Investigation of Cancer Norfolk (EPIC-Norfolk) prospective population cohort. Methods: 10-year CVD mortality as predicted by SCORE-OP was compared with observed CVD mortality among individuals in the EPIC-Norfolk cohort. Persons aged 65-79 years without known CVD were included in the analysis. CVD mortality was defined as death due to ischemic heart disease, cardiac failure, cerebrovascular disease, peripheral-artery disease or aortic aneurysm. Predicted 10-year CVD mortality was calculated by the SCORE-OP algorithm, and compared to observed mortality rates. The area under the receiver operator characteristics curve (AUROC) was calculated to evaluate discriminative power. Calibration was evaluated by calculating ratios of predicted vs observed mortality and by Hosmer-Lemeshow tests. Results: A total of 6590 individuals (45.8% men), mean age 70.2 years (standard deviation 3.3) were included. The predicted mortality by SCORE-OP was 9.84% (95% confidence interval (CI) 9.76-9.92) and observed mortality was 10.2% (95% CI 9.52-11.04), ratio 0.96. AUROC was 0.63 (95% CI 0.60-0.65), and X 2 was 3.3 (p = 0.92). Conclusion: SCORE-OP overall accurately estimates the rate of CVD mortality in a general population aged 65-79 years. However, while calibration is excellent, the discriminative power of the SCORE-OP is limited, and as such cannot be readily implemented in clinical practice for this population.

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Section: Discussionmentioning

confidence: 99%

Validation of the Systematic COronary Risk Evaluation - Older Persons (SCORE-OP) in the EPIC-Norfolk prospective population study

Verweij

Peters

Reimer

et al. 2019

International Journal of Cardiology

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“…For the present post hoc analyses, all preDIVA participants without a history of CVD at baseline were included. Since no effect of the intervention was found on CVD, neither in the total study population nor in the participants without a history of CVD, the population was considered a cohort . The preDIVA study was approved by the Medical Ethics Committee of the Academic Medical Center, Amsterdam (MEC 05/093 06.17.0640).…”

Section: Methodsmentioning

confidence: 99%

A cardiovascular risk prediction model for older people: Development and validation in a primary care population

Bussel

Richard

Busschers

et al. 2019

J of Clinical Hypertension

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Cardiovascular risk prediction is mainly based on traditional risk factors that have been validated in middle‐aged populations. However, associations between these risk factors and cardiovascular disease (CVD) attenuate with increasing age. Therefore, for older people the authors developed and internally validated risk prediction models for fatal and non‐fatal CVD, (re)evaluated the predictive value of traditional and new factors, and assessed the impact of competing risks of non‐cardiovascular death. Post hoc analyses of 1811 persons aged 70‐78 year and free from CVD at baseline from the preDIVA study (Prevention of Dementia by Intensive Vascular care, 2006‐2015), a primary care‐based trial that included persons free from dementia and conditions likely to hinder successful long‐term follow‐up, were performed. In 2017‐2018, Cox‐regression analyses were performed for a model including seven traditional risk factors only, and a model to assess incremental predictive ability of the traditional and eleven new factors. Analyses were repeated accounting for competing risk of death, using Fine‐Gray models. During an average of 6.2 years of follow‐up, 277 CVD events occurred. Age, sex, smoking, and type 2 diabetes mellitus were traditional predictors for CVD, whereas total cholesterol, HDL‐cholesterol, and systolic blood pressure (SBP) were not. Of the eleven new factors, polypharmacy and apathy symptoms were predictors. Discrimination was moderate (concordance statistic 0.65). Accounting for competing risks resulted in slightly smaller predicted absolute risks. In conclusion, we found, SBP, HDL, and total cholesterol no longer predict CVD in older adults, whereas polypharmacy and apathy symptoms are two new relevant predictors. Building on the selected risk factors in this study may improve CVD prediction in older adults and facilitate targeting preventive interventions to those at high risk.

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“…No significant effects were reported for the primary outcomes. However, although the intervention reduced systolic blood pressure ( 69 ) and benefits were observed in participants with elevated and untreated blood pressure at baseline and that initiated antihypertensive treatment as part of the intervention ( 55 ), no beneficial effect was reported for any of the other risk factors considered ( 69 ).…”

Section: Multidomain Trials and Contextual Approachesmentioning

confidence: 99%

Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions

et al. 2021

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The first WHO guidelines for risk reduction of cognitive decline and dementia marked an important milestone in the field of dementia prevention. In this paper, we discuss the evidence reviewed as part of the guidelines development and present the main themes emerged from its synthesis, to inform future research and policies on dementia risk reduction. The role of intervention effect-size; the mismatch between observational and intervention-based evidence; the heterogeneity of evidence among intervention trials; the importance of intervention duration; the role of timing of exposure to a certain risk factor and interventions; the relationship between intervention intensity and response; the link between individual risk factors and specific dementia pathologies; and the need for tailored interventions emerged as the main themes. The interaction and clustering of individual risk factors, including genetics, was identified as the overarching theme. The evidence collected indicates that multidomain approaches targeting simultaneously multiple risk factors and tailored at both individual and population level, are likely to be most effective and feasible in dementia risk reduction. The current status of multidomain intervention trials aimed to cognitive impairment/dementia prevention was also briefly reviewed. Primary results were presented focusing on methodological differences and the potential of design harmonization for improving evidence quality. Since multidomain intervention trials address a condition with slow clinical manifestation—like dementia—in a relatively short time frame, the need for surrogate outcomes was also discussed, with a specific focus on the potential utility of dementia risk scores. Finally, we considered how multidomain intervention could be most effectively implemented in a public health context and the implications world-wide for other non-communicable diseases targeting common risk factors, taking into account the limited evidence in low-middle income countries. In conclusion, the evidence from the first WHO guidelines for risk reduction of cognitive decline and dementia indicated that “one size does not fit all,” and multidomain approaches adaptable to different populations and individuals are likely to be the most effective. Harmonization in trial design, the use of appropriate outcome measures, and sustainability in large at-risk populations in the context of other chronic disorders also emerged as key elements.

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Effects of Primary Cardiovascular Prevention on Vascular Risk in Older Adults

Cited by 10 publications

References 22 publications

Validation of the Systematic COronary Risk Evaluation - Older Persons (SCORE-OP) in the EPIC-Norfolk prospective population study

Validation of the Systematic COronary Risk Evaluation - Older Persons (SCORE-OP) in the EPIC-Norfolk prospective population study

A cardiovascular risk prediction model for older people: Development and validation in a primary care population

Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions

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