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Ideal Cardiovascular Health, Mortality, and Vascular Events in Elderly Subjects: The Three-City Study
Bamba Gaye1, Marianne Canonico2, Marie-Cécile Perier1
1INSERM U970, Paris Cardiovascular Research Centre (PARCC), Department of Sudden death and Cardiovascular Epidemiology, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
Insights
Maintaining ideal cardiovascular health (CVH) significantly reduces mortality and vascular event risks in older adults. This study highlights the benefits of achieving higher CVH metrics for longevity and healthspan in the elderly population.
Area of Science:
- Gerontology
- Cardiovascular Health
- Public Health
Background:
- Ideal cardiovascular health (CVH) benefits are known in middle-aged individuals.
- The elderly population faces high comorbidity and polypharmacy rates, potentially diminishing CVH benefits.
Purpose of the Study:
- To investigate the association between ideal CVH and mortality, coronary heart disease (CHD), and stroke in community-dwelling elderly individuals.
- To analyze the impact of varying levels of ideal cardiovascular health metrics on health outcomes in older adults.
Main Methods:
- A cohort of 9,294 noninstitutionalized individuals aged 65+ from the Three-City Study (1999-2001) was followed for vascular events and mortality.
- Cox proportional hazard models were used to estimate hazard ratios (HRs), comparing participants with 5-7 ideal CVH metrics to those with 0-2.
Main Results:
- Only 5% of participants achieved ≥5 ideal CVH metrics.
- After a median follow-up of 10.9 years, 1,987 deaths and 680 vascular events occurred.
- Higher ideal CVH status was associated with significantly reduced risks: 29% for all-cause mortality and 67% for combined CHD/stroke events in those with ≥5 ideal metrics versus ≤2 (HR: 0.71 and 0.33, respectively).
Conclusions:
- Elevated cardiovascular health status confers substantial protection against mortality and vascular events, even in the elderly.
- Promoting ideal CVH in older adults is crucial for improving health outcomes and reducing disease burden.
Background:
The benefit of ideal cardiovascular health (CVH) on health-related outcomes in middle-aged patients is firmly established. In the growing elderly population, the high prevalence of comorbidities and medications for chronic diseases may offset such benefit.
Objectives:
This study analyzed the association of ideal CVH with mortality, incident coronary heart disease, and stroke events in elderly individuals from the community.
Methods:
Between 1999 and 2001, 9,294 men and women, noninstitutionalized and aged 65 years and over were examined, and thereafter followed up for the occurrence of vascular events and mortality within the Three-City Study. Hazard ratios (HRs) were estimated by Cox proportional hazard model and compared subjects with 3 to 4 and subjects with 5 to 7 ideal metrics with those with 0 to 2 ideal metrics, respectively.
Results:
The mean age was 73.8 ± 5.3 years, and 36.7% were men. Only 5% of the participants had ≥5 metrics at the ideal level. After a median follow-up of 10.9 years and 8.6 years, respectively 1,987 deaths and 680 adjudicated coronary heart disease or stroke events had occurred. In multivariate analysis, the risk of mortality and of vascular events decreased across the categories of ideal metrics. In particular, in subjects with ≥5 metrics at the ideal level (compared with those with ≤2), there was a 29% (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.55 to 0.90) decreased risk of all-cause mortality and 67% (HR: 0.33; 95% CI: 0.19 to 0.57) for coronary heart disease and stroke combined (p for trend <0.001).
Conclusions:
Even in the elderly, higher CVH status is highly beneficial regarding mortality and vascular event risks.
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