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Prevalence of cardiovascular diseases among older adults. The Cardiovascular Health Study
M B Mittelmark1, B M Psaty, P M Rautaharju
1Department of Public Health Sciences, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC.
Insights
Self-reported cardiovascular diseases in older adults may underestimate actual prevalence. Many participants with definite myocardial infarction or angina did not report these conditions, highlighting the need for objective assessments.
Area of Science:
- Cardiology
- Epidemiology
- Gerontology
Background:
- The Cardiovascular Health Study (CHS) is a significant population-based longitudinal study.
- It focuses on cardiovascular health in adults aged 65 years and older.
- Understanding disease prevalence in this demographic is crucial for public health.
Purpose of the Study:
- To ascertain the prevalence of major cardiovascular diseases in older adults.
- To compare self-reported disease data with objective medical findings.
- To evaluate the accuracy of self-reporting in estimating cardiovascular disease prevalence.
Main Methods:
- A cohort of 5,201 older adults was studied.
- Prevalent cardiovascular diseases including myocardial infarction, angina, heart failure, peripheral artery disease, stroke, and transient ischemic attack were assessed.
- Data collection involved medical history, nitrate use, electrocardiograms, ankle-arm blood pressure studies, and medical record review.
Main Results:
- Prevalence rates for definite myocardial infarction and angina varied by age and sex.
- Significant underreporting was observed: 23% of men and 38% of women with electrocardiographic evidence of myocardial infarction did not report it.
- Self-reported disease was classified as "definite" if confirmed by examination or records; "unreported" if documented by examination but not self-reported.
Conclusions:
- Prevalent cardiovascular disease estimates relying solely on self-report may significantly underestimate the true prevalence in older Americans.
- Objective diagnostic methods are essential for accurate epidemiological assessments in elderly populations.
- The findings underscore the importance of comprehensive medical evaluations beyond patient recall for cardiovascular health surveillance.
Abstract:
The Cardiovascular Health Study is a population-based longitudinal study of 5,201 adults aged 65 years and older. Prevalences of myocardial infarction, angina pectoris, congestive heart failure, peripheral artery disease, stroke, and transient ischemic attack were ascertained between June 1989 and May 1990 in participants recruited from Forsyth County, North Carolina; Washington County, Maryland; Sacramento County, California; and Pittsburgh, Pennsylvania. A medical history was taken to obtain self-reports of prevalent disease. For all participants, use of nitrates was ascertained to document angina, electrocardiograms were used to document prevalent myocardial infarction, and ankle-arm blood pressure studies were used to document peripheral artery disease. Self-reports of disease that were not confirmed by examination findings were further investigated by examination of medical records. Reported disease that was confirmed by examination findings or by medical records was classified as "definite." Disease that was documented by examination, but not reported by the participant, was classified as "unreported." The prevalence rates of definite myocardial infarction and angina were 11% and 15%, respectively, among men aged 65-69 years, 18% and 17% among men aged 80-84 years, 4% and 8% among women aged 65-69 years, and 3% and 13% among women aged 80-84 years. Twenty-three percent of men and 38% of women with electrocardiographic evidence of myocardial infarction did not report it. These results suggest that prevalent disease estimates based only on self-report may underestimate the prevalence of cardiovascular diseases in older Americans.