Cardiovascular Events in US Adults Aged ≥80 Years: Incidence, Risk Factors, and Outcomes

Estimating risk and risk factors for cardiovascular disease (CVD) events and mortality following CVD events can inform strategies for lowering risk in older adults.

We estimated risk factors for the 5-year cumulative incidence of CVD events including nonfatal myocardial infarction, fatal coronary heart disease, stroke, and heart failure among adults aged <70, 70 to <80, and ≥80 years in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The REGARDS study is a prospective cohort study with enrollment across the contiguous United States and adjudicated CVD events. Data on CVD risk factors were collected during a study interview and in-home study visit from 2013 to 2016. In addition, we estimated 1-year mortality after the first CVD event during follow-up.

Among 4621, 4938, and 2450 participants aged <70, 70 to <80, and ≥80 years, the 5-year cumulative incidence of CVD events was 5.3% (95% CI, 4.7%-6.0%), 10.7% (95% CI, 9.9%-11.6%), and 17.2% (95% CI, 15.8%-18.8%), respectively. Diabetes and hypertension were associated with CVD events among participants aged <70 years (hazard ratio [HR], 1.42 [95% CI, 1.00-2.03] and 1.58 [95% CI, 1.19-2.09], respectively) and 70 to <80 years (HR, 1.41 [95% CI, 1.09-1.83] and 1.73 [95% CI, 1.43-2.08], respectively) but not among those aged ≥80 years (HR, 1.03 [95% CI, 0.81-1.32] and 1.07 [95% CI, 0.84-1.35], respectively). Among those aged ≥80 years, risk factors for CVD events included LDL-C (low-density lipoprotein-cholesterol) ≥100 mg/dL (HR, 1.24 [95% CI, 1.01-1.51]), hsCRP (high-sensitivity C-reactive protein) ≥3 mg/L (HR, 1.27 [95% CI, 1.03-1.55]), albuminuria (HR, 1.61 [95% CI, 1.30-1.98]), and a prior history of CVD (HR, 2.25 [95% CI, 1.84-2.76]). Among participants aged ≥80 years, the 1-year cumulative incidence of all-cause mortality following a CVD event was 53.1% (95% CI, 48.3%-57.8%) versus 5.7% (95% CI, 3.5%-7.9%) in age-matched participants who did not have a CVD event.

The risk for CVD events in adults aged ≥80 years was high, and the association was stronger for albuminuria and inflammation versus hypertension and diabetes.