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Subclinical disease as an independent risk factor for cardiovascular disease
L H Kuller1, L Shemanski, B M Psaty
1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
Insights
Subclinical cardiovascular disease significantly increases the risk of heart attack and death in older adults. Early detection of subclinical disease can help identify individuals for preventative interventions.
Area of Science:
- Cardiology
- Gerontology
- Preventive Medicine
Background:
- Cardiovascular Health Study (CHS) involves 5201 adults aged 65+.
- Focus on the relationship between subclinical and clinical cardiovascular disease.
Purpose of the Study:
- To determine the association between subclinical cardiovascular disease markers and the incidence of clinical cardiovascular events.
- To identify high-risk older individuals for proactive interventions.
Main Methods:
- Classified subclinical disease using ankle-brachial index, carotid imaging, ECG, echocardiography, and questionnaires.
- Followed participants for an average of 2.39 years.
Main Results:
- Subclinical disease presence significantly increased the risk of coronary heart disease (CHD) and total mortality.
- Increased risk for men: 2.0 for CHD, 2.9 for mortality.
- Increased risk for women: 2.5 for CHD, 1.7 for mortality.
- Risk remained significant after adjusting for other cardiovascular risk factors.
Conclusions:
- Measuring subclinical disease identifies older adults at high risk for clinical cardiovascular events.
- This approach supports targeted interventions to prevent cardiovascular disease progression.
Background:
The primary aim of the present study was to determine the relation between measures of subclinical cardiovascular disease and the incidence of clinical cardiovascular disease among 5201 adults 65 years of age or older who were participating in the Cardiovascular Health Study.
Methods And Results:
A new method of classifying subclinical disease at baseline examination in the Cardiovascular Health Study included measures of ankle-brachial blood pressure, carotid artery stenosis and wall thickness, ECG and echocardiographic abnormalities, and positive response to the Rose Angina and Claudication Questionnaire. Participants were followed for an average of 2.39 years (maximum, 3 years). For participants without evidence of clinical cardiovascular disease at baseline, the presence of subclinical disease compared with no subclinical disease was associated with a significant increased risk of incident total coronary heart disease including CHD deaths and nonfatal MI and angina pectoris for both men and women. For individuals with subclinical disease, the increased risk of total coronary heart disease was 2.0 for men and 2.5 for women, and the increased risk of total mortality was 2.9 for men and 1.7 for women. The increased risk changed little after adjustment for other risk factors, including lipoprotein levels, blood pressure, smoking, and diabetes.
Conclusions:
The measurement of subclinical disease provides an approach for identifying high-risk older individuals who may be candidates for more active intervention to prevent clinical disease.