Negative Risk Markers for Cardiovascular Events in the Elderly

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.