Abstract 039: A Comparison of Novel and Traditional Risk Factors for Cardiovascular Disease Across the Spectrum of Older Age: The Cardiovascular Health Study

Abstract

Introduction: There is evidence that some traditional cardiovascular risk factors have weaker associations with outcomes in elderly adults; whereas, some novel risk factors appear important in old age. Whether the risk factors for cardiovascular disease differ in the oldest old compared with younger elders is uncertain. Hypothesis: The associations of traditional risk factors - systolic blood pressure, LDL-cholesterol, HDL-cholesterol, obesity, and diabetes - will be attenuated with age, whereas the associations of novel risk factors - kidney disease, inflammation, and cardiac stiffness - will be robust across older age. Methods: Participants in the Cardiovascular Health Study ≥65 years (n=4,853), were stratified into three age cohorts: 65-74, 75-84, 85+ years based on the age at the time of risk factor measure (baseline, 3, 7, or 16 years of follow-up). Proportional hazards models were used to assess the associations of the risk factors assessed at the most recent visit and a composite outcome of incident stroke, myocardial infarction, and cardiovascular death over 5 years. Results: There were 1,481 events. In adults 65-84 years, systolic blood pressure, HDL-cholesterol, diabetes, kidney disease, inflammation, and cardiac stiffness were associated with the composite outcome, after adjustment for demographic factors. In adults 85+ years, only the novel risk factors were associated with the outcome in demographic-adjusted analyses (Figure). In fully adjusted models, only inflammation was associated with the outcome across the age spectrum. HDL-cholesterol was independently associated with the outcome in adults <75 years; systolic blood pressure, diabetes, cardiac stiffness, and kidney disease were associated with the outcome in adults <85 years. Conclusions: The associations of traditional risk factors with cardiovascular outcomes appear attenuated in adults ≥85 years; this could impact optimal prevention strategies in the oldest old. Inflammation is a robust risk factor across the spectrum of old age.