Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study

Abstract

Objectives To investigate the performance of classic risk factors, and of some new biomarkers, in predicting cardiovascular mortality in very old people from the general population with no history of cardiovascular disease. Design The Leiden 85-plus Study (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) is an observational prospective cohort study with 5 years of follow-up. Setting General population of the city of Leiden, the Netherlands. Participants Population based sample of participants aged 85 years (215 women and 87 men) with no history of cardiovascular disease; no other exclusion criteria. Main measurements Cause specific mortality was registered during follow-up. All classic risk factors included in the Framingham risk score (sex, systolic blood pressure, total and high density lipoprotein cholesterol, diabetes mellitus, smoking and electrocardiogram based left ventricular hypertrophy), as well as plasma concentrations of the new biomarkers homocysteine, folic acid, C reactive protein, and interleukin 6, were assessed at baseline. Results During follow-up, 108 of the 302 participants died; 32% (35/108) of deaths were from cardiovascular causes. Classic risk factors did not predict cardiovascular mortality when used in the Framingham risk score (area under receiver operating characteristic curve 0.53, 95% confidence interval 0.42 to 0.63) or in a newly calibrated model (0.53, 0.43 to 0.64). Of the new biomarkers studied, homocysteine had most predictive power (0.65, 0.55 to 0.75). Entering any additional risk factor or combination of factors into the homocysteine prediction model did not increase its discriminative power. Conclusions In very old people from the general population with no history of cardiovascular disease, concentrations of homocysteine alone can accurately identify those at high risk of cardiovascular mortality, whereas classic risk factors included in the Framingham risk score do not. These preliminary findings warrant validation in a separate cohort.

Serum levels of lipid metabolites in age‐related macular degeneration

“…Our finding that addition of this second parameter did not improve our model is not surprising. In a similar manner, when C-reactive protein levels, known to be associated with an increased incidence of coronary heart disease, were added to the modified Framingham risk scores, only a limited improvement in the prediction of coronary heart disease was detected (55). In an ROC curve, the importance of both the sensitivity and the specificity of the biomarker are equally weighed.…”

Resting heart rate and incident heart failure and cardiovascular mortality in older adults: role of inflammation and endothelial dysfunction: the PROSPER study

“…3 However, resting heart rate appears to be a promising and modifiable cardiovascular risk factor in older adults, in whom traditional cardiovascular risk factors such as cholesterol level and blood pressure have a lower predictive capacity. 4 There are many hypothetical mechanisms through which elevated heart rate might directly affect cardiovascular or heart failure risk, including systemic inflammation and endothelial dysfunction. 5 Systemic inflammation as measured by inflammatory markers such as C-reactive protein (CRP) or interleukin-6 (IL-6) is an important factor in the pathogenesis of cardiovascular disease.…”

Cross-sectional and longitudinal association between homocysteine, vitamin B12 and physical performance in older persons

“…In the LASA (Longitudinal Aging Study Amsterdam), a representative sample of Dutch older persons, 46% of men and 29% of women, had a high homocysteine level, and 22% of men and 16% of women had a low vitamin B12 level (Dhonukshe-Rutten et al, 2005). Homocysteine and B vitamins have been associated with cardiovascular disease (especially stroke) (Homocysteine Studies Collaboration, 2002;Ntaios et al, 2009), cognitive decline and dementia (Haan et al, 2007;Ravaglia et al, 2007;Smith, 2008), fractures (McLean et al, 2004;van Meurs et al, 2004;Sato et al, 2005) and mortality (Connolly et al, 2009;de Ruijter et al, 2009;Zhang et al, 2010). In addition, elevated homocysteine has been associated with lower physical performance (Kado et al, 2002;Soumare et al, 2006;Gerdhem et al, 2007;Kuo et al, 2007;McDermott et al, 2007;Rolita et al, 2010).…”