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

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=4,883) 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 1,498 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.

Risk Factors for Stroke among Young-Old and Old-Old Community-Dwelling Adults in Japan: The Ohasama Study

“…This finding supports the argument that the associations between traditional risk factors and stroke are attenuated with advancing age 6, 7) . There are two possible explanations for this finding 6) . First, survivors with risk factors in the old-old age group may differ through selection.…”

“…Because the incidence of stroke rises markedly with age 2) , older people may receive more absolute benefits from the prevention of stroke than younger people. A few prospective cohort studies have shown significant associations between traditional risk factors and stroke among older people 3–5) , but these associations become progressively weaker with increasing age 6, 7) .…”

Methyl-γ-butyrobetaine decreases levels of acylcarnitines and attenuates the development of atherosclerosis

“…Thus, this study demonstrates that the acylcarnitine concentration-lowering compound methyl-GBB attenuates the development of atherosclerosis by inhibiting activation of immune cells, decreasing their secretion of pro-inflammatory cytokines and possibly by reducing deleterious effects of acylcarnitines on the vascular endothelium. Postprandial hypertriglyceridaemia and elevated LDL levels are risk factors for the development of atherosclerosis [5,21]. Methyl-GBB treatment induced decrease in TG concentration, thus, the decrease of TG concentration could contribute the attenuation of development of atherosclerosis.…”

Clinical Evaluation of Different Revascularization Strategies: Unlabelled Use

“…Consistent with our work, in the Odden et al study, diabetes mellitus eliminates the protective effect in women, thereby increasing coronary heart disease risk in this group. Furthermore, it was demonstrated that diabetic females had a lower treatment for modifiable CVRF in proportion to males [14] . We have not found any differences between both populations considering the number of affected vessels nor the location of injuries with the exception of those detected in the LMA which were more frequent among the diabetic population.…”