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Assessment of cardiovascular risk factors in the elderly: the Framingham Heart Study
1Department of Preventive Epidemiology, Boston University School of Medicine, MA, USA.
Insights
Systolic blood pressure and smoking significantly increase cardiovascular disease risk in older adults. Age and male sex also elevate risk, with blood pressure impact greater in men.
Area of Science:
- Cardiovascular epidemiology
- Geriatric medicine
- Preventive cardiology
Background:
- Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in aging populations worldwide.
- Identifying and quantifying modifiable and non-modifiable risk factors is crucial for effective CVD prevention strategies.
Purpose of the Study:
- To investigate the influence of key risk factors on the development of cardiovascular disease over a ten-year period in elderly individuals.
- To assess the differential impact of these risk factors based on sex and other demographic variables.
Main Methods:
- Utilized multivariable proportional hazards models to analyze data from elderly Framingham men and women.
- Examined the association of systolic blood pressure, cigarette smoking, age, sex, body mass index, and serum cholesterol with incident CVD.
- Assessed both current and historical measurements of risk factors where applicable.
Main Results:
- Systolic blood pressure and smoking status were strong predictors of CVD risk. The effect of blood pressure on risk was more pronounced in men than in women.
- Increased age and male sex were significantly associated with higher CVD risk. Smoking elevated risk by 64%.
- Previous systolic blood pressure measurements predicted future risk, independent of current levels. Cholesterol's impact varied between diabetic and non-diabetic individuals.
Conclusions:
- Systolic blood pressure, smoking, age, and sex are critical determinants of cardiovascular disease risk in the elderly.
- The findings underscore the importance of managing blood pressure and smoking cessation for CVD prevention in older adults.
- Risk factor assessment, including historical data, provides valuable insights for personalized cardiovascular risk prediction.
Abstract:
In elderly Framingham men and women, systolic blood pressure and cigarette smoking status, as well as a subject's age and sex, strongly influenced the risk of developing cardiovascular disease during ten years of follow-up. Multivariable proportional hazards models were used to assess the roles of several primary risk factors and to examine their secondary effects. The first three factors were noted in both sexes, separately and combined, but the risk function for blood pressure was steeper in men than in women (hazard ratio, HR, 1.53 per 20 mmHg, 95 per cent confidence interval, CI, 1.33 to 1.75 in men; HR = 1.19, 95 per cent CI 1.07 to 1.33 in women). Systolic pressure measured ten years earlier also contributed to CVD risk (HR = 1.16 per 20 mmHg, 95 per cent CI 1.04 to 1.30). even after accounting for current level. Smoking was associated with a 64 per cent elevation in risk, male sex with a 51 per cent increase, and each 5 years increment in age with a 22 per cent increase. Body mass index measured 10 years ago had a modest association, but current body mass index did not. Among diabetic subjects, total serum cholesterol had an asymmetrical U-shaped risk function, the risk increasing to either side of sex-specific median values; diabetes per se, however, was not significant in the final model. In non-diabetic subjects, there was little change in CVD risk up to the median cholesterol values and a modest increase thereafter. None of the risk functions was age dependent.