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Assessing Cardiovascular Risk in Geriatric Patients Without Atherosclerotic Cardiovascular Disease
Witold Żurański1, Justyna Nowak2, Aleksander Danikiewicz3
1Third Department of Cardiology, Silesian Center for Heart Disease, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
Insights
Most elderly individuals over 70 face high atherosclerotic cardiovascular disease (ASCVD) risk, often exceeding thresholds. Age and hypertension are key factors, alongside common issues like malnutrition and polypharmacy.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Public Health
Background:
- Age is a primary risk factor for atherosclerotic cardiovascular disease (ASCVD).
- Nearly all individuals aged 70 and older exceed conventional 10-year ASCVD risk thresholds.
- ASCVD risk modifiers like malnutrition, polypharmacy, and comorbidities are crucial considerations in older adults.
Purpose of the Study:
- To estimate the 10-year ASCVD risk in apparently healthy elderly individuals (aged 70+).
- To characterize this population using biochemical and clinical indicators.
- To evaluate the prevalence of ASCVD risk modifiers in this demographic.
Main Methods:
- The study enrolled 253 apparently healthy elderly individuals (70+ years) without established ASCVD.
- The Systemic Coronary Risk Estimation 2-Older Persons (SCORE2-OP) model was used to assess 10-year ASCVD risk.
- Biochemical and clinical indicators were evaluated to characterize the participants.
Main Results:
- 16.2% were high risk, and 83.8% were very high risk for ASCVD; no participants had low risk.
- The median 10-year ASCVD risk was 23%, with risk significantly increasing with age (75+ years).
- Age (≥75 years) was strongly associated with very high ASCVD risk (C-statistic 0.92, PPV 99%, NPV 52%).
Conclusions:
- Elderly individuals without established ASCVD are a heterogeneous group, with most at very high risk.
- Age and hypertension are the predominant contributors to ASCVD risk in this population.
- Malnutrition, polypharmacy, and multimorbidity are frequently observed ASCVD risk modifiers.
Abstract:
Introduction: Age is a major risk factor that affects the likelihood of developing atherosclerotic cardiovascular disease (ASCVD). The anticipated 10-year ASCVD risk for nearly all individuals aged 70 years and older surpasses conventional risk thresholds. When considering treatment for risk factors, it is important to take into account ASCVD risk modifiers, such as malnutrition, polypharmacy, and comorbidities. Objectives: The aim of this study was to estimate ASCVD risk in apparently healthy (without established ASCVD) elderly persons. We also evaluated several biochemical and clinical indicators to better characterize the studied population. Patients and methods: A total of 253 elderly individuals aged 70 years and older, who were apparently healthy and did not have established atherosclerotic cardiovascular disease (ASCVD), were enrolled in the study. The Systemic Coronary Risk Estimation 2-Older Persons (SCORE2-OP) model was utilized to assess their 10-year risk of developing ASCVD. Results: Among the 253 participants, 41 (16.2%) were classified as high risk, while 212 (83.8%) were categorized as very high risk. No individuals had a low ASCVD risk (defined as less than 7.5%). The median 10-year risk of developing ASCVD for the study group was 23% (ranging from 17% to 32%). The number of individuals identified as very high risk increased significantly with age, with nearly all participants aged 75 years and older being considered very high risk. An age of 75 years or older is associated with a very high risk for ASCVD, supported by a C-statistic of 0.92, which reflects a positive predictive value (PPV) of 99% and a negative predictive value (NPV) of 52% (p < 0.001). Conclusions: Elderly individuals without established ASCVD constitute a varied group. The majority were identified as being at very high risk for ASCVD. Age and hypertension were the primary factors contributing to this risk. Furthermore, modifiers of ASCVD risk, including malnutrition, polypharmacy, and multimorbidity, were commonly observed.
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