Cardiovascular risk in the elderly population of Spain. The EPICARDIAN risk score

Abstract

Background and objectivesCardiovascular risk estimation in people over 70 years of age is problematic. Most scores have been created based on cohorts of middle-aged people, with an underrepresentation of older adults. The predictive power of classical cardiovascular risk factors declines with age. The aim of this work is to develop a specific score for estimating cardiovascular risk among the elderly population in Spain. MethodsThis work is a population-based cohort established in 1995. Setting: Three geographical areas of Spain (Madrid, Ávila, and Lugo). Participants: 3,729 people older than 64 years with no cardiovascular diseases (CVD) at baseline. Measurements: Suspected fatal and nonfatal CVD (both coronary heart disease and stroke) were investigated annually and confirmed using the WHO-MONICA criteria. All participants were followed-up on until occurrence of a first CVD event, until death, or until December 31, 2015. ResultsAge was the strongest predictor of CVD at 10 years in both men and women. In men, variables associated with CVD were high blood pressure treatment (HR: 1.35; 95% CI: 1.067–1.710), diabetes (HR: 1.359; 95% CI: 0.997–1.852), and smoking (HR: 1.207; 95% CI: 0.945–1.541) and in women, the variables were smoking (HR: 1.881; 95% CI: 1.356–2.609) and diabetes (HR: 1.285; 95% CI: 0.967–1.707). Total cholesterol did not increase the risk of CVD in men or women. However, total cholesterol levels >200 mg/dL were inversely associated with 10-year risk of CVD in men and women. ConclusionsIn elderly Spanish men, total CVD at 10 years is significantly increased by age, diabetes, and antihypertensive treatment and in elderly Spanish women by diabetes and smoking. Total cholesterol levels did not increase the risk of CVD, particularly in males.