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Fundus Photography as a Convenient Tool to Study Microvascular Responses to Cardiovascular Disease Risk Factors in Epidemiological Studies
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Negative Risk Markers for Cardiovascular Events in the Elderly.

Martin Bødtker Mortensen1, Valentin Fuster2, Pieter Muntendam3

  • 1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

Journal of the American College of Cardiology
|July 6, 2019
PubMed
Summary
This summary is machine-generated.

Identifying elderly individuals with low cardiovascular risk is crucial to avoid statin overtreatment. Coronary artery calcium (CAC) scores of 0 or less than 10, low galectin-3, and absence of carotid plaque effectively identify low-risk elderly patients.

Keywords:
elderlygalectin-3preventionrisk predictionstatinssubclinical atherosclerosis

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Area of Science:

  • Cardiology
  • Geriatrics
  • Preventive Medicine

Background:

  • Cardiovascular disease (CVD) risk escalates with age, making many elderly individuals eligible for statin therapy.
  • Identifying elderly individuals at genuinely low risk is essential to prevent overtreatment and associated side effects.

Purpose of the Study:

  • To discover "negative" risk markers that can identify elderly individuals at low short-term risk for coronary heart disease (CHD) and overall cardiovascular disease (CVD).

Main Methods:

  • The study evaluated 13 candidate negative risk markers in 5,805 BioImage participants (mean age 69).
  • Markers included coronary artery calcium (CAC) scores (0 or ≤10), absence of carotid plaque, and specific biomarker levels (e.g., galectin-3 <25th percentile).
  • Performance was assessed using diagnostic likelihood ratios (DLR) and net reclassification index (NRI).

Main Results:

  • Coronary artery calcium (CAC) = 0 and CAC ≤10 were the most potent negative risk markers, significantly reducing estimated CHD and CVD risk.
  • Low galectin-3 levels and absence of carotid plaque also demonstrated effectiveness in identifying lower-risk individuals.
  • CAC = 0 and CAC ≤10 showed the largest accurate downward risk reclassification for statin eligibility.

Conclusions:

  • Elderly individuals with CAC = 0, CAC ≤10, low galectin-3, or no carotid plaque exhibit remarkably low cardiovascular risk.
  • These findings challenge the universal 'treat-all' approach to statin therapy in the elderly population.
  • Utilizing these negative risk markers can help personalize preventive strategies and avoid unnecessary medication.