Related Experiment Video
Updated: Jun 12, 2026
Software for Analysis of Heart Rate and Blood Pressure Time-series Data from the Valsalva Maneuver
Published on: June 27, 2025
Prediction of cardiovascular events in subjects in the second Australian National Blood Pressure study
Mark R Nelson1, Philip Ryan, Andrew M Tonkin
1Menzies Research Institute, Hobart, Tasmania, Australia. Mark.Nelson@utas.edu.au
Insights
Current cardiovascular disease (CVD) risk calculators are not suitable for older adults. New risk equations are needed for the hypertensive aged to accurately predict CVD events in this population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Epidemiology
Background:
- Estimating absolute cardiovascular disease (CVD) risk is superior to blood pressure measurement alone for guiding medical intervention.
- Existing CVD risk calculators, like the Framingham Heart Study model, lack representation of individuals over 74 years old, despite age being a key risk determinant.
- This age-related limitation necessitates evaluation of current risk prediction models in older populations.
Purpose of the Study:
- To assess the predictive accuracy of three established risk equations for CVD endpoints in an older cohort.
- To determine the suitability of existing CVD risk calculators for individuals aged 74 and above.
Main Methods:
- Utilized the Second Australian National Blood Pressure study cohort (mean age 71.9 years).
- Evaluated three risk equations (Framingham, Pocock, Dubbo) using 5-year CVD incidence rates, chi(2) goodness-of-fit, and Harrell C statistics.
- Performed recalibration analysis to assess equation applicability to the study population.
Main Results:
- All tested risk equations showed significant chi(2) goodness-of-fit statistics for various CVD endpoints across different age groups and sexes.
- Discrimination for predicting coronary heart disease, stroke, and overall CVD morbidity/mortality was modest across all algorithms.
- Recalibration analyses indicated that applying these existing risk equations to the Second Australian National Blood Pressure study population is inappropriate.
Conclusions:
- Current CVD risk prediction equations demonstrate limitations in accurately assessing risk in older adults.
- There is a critical need for the development of novel CVD risk equations specifically for the hypertensive elderly population.
- Future research should focus on creating tailored risk assessment tools for this demographic to improve clinical decision-making and patient outcomes.
Abstract:
Estimating absolute risk rather than measurement of blood pressure alone is considered the best way to identify those who would most likely benefit from medical intervention. Risk calculators used to estimate risk in those without previous cardiovascular disease (CVD) events are based on the Framingham Heart Study, which had no person >74 years of age at baseline. This needs to be addressed, because age is the most important determinant of risk. We estimated the predictive value of 3 risk equations for CVD end points in the Second Australian National Blood Pressure study cohort (mean age: 71.9 years at baseline). Observed and predicted 5-year incidence rates, chi(2) goodness-of-fit tests, and Harrell C statistic and area under the receiver operator characteristic curve were used to assess the ability of the equations to predict CVD outcomes over 5 years. A recalibration analysis was undertaken. Significant (P<0.05) chi(2) goodness-of-fit statistics were observed using each of the risk equations for myocardial infarction, coronary heart disease, stroke, or CVD morbidity or mortality across age groups and both sex. All of the overall C statistics or the area under the receiver operator characteristic curve indicated modest discrimination of the algorithms for prediction of the outcomes for coronary heart disease and CVD morbidity and mortality, myocardial infarction, or stroke (Framingham); cardiac death (Pocock); and CVD events (Dubbo). Recalibration analyses showed that it would be inappropriate to apply the risk equations to the Second Australian National Blood Pressure study population. New risk equations for CVD events in the hypertensive aged are needed.
Related Concept Videos
01:23Assessment of blood pressure in brachial artery(two-step method)
01:21Sites for measuring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:28Factors affecting Blood pressure
Physiological Factors:
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:17Measurement of Blood Pressure