Abstract
The age- and gender-related cardio-metabolic changes may limit the applicability of guidelines for the prevention of cardiovascular diseases (CVD) in older people. We investigated the association of cardiovascular risk profile with 20-year all-cause and CVD-mortality in older adults, focusing on age- and gender-specific differences. This prospective study involved 2895 community-dwelling individuals aged ≥65 years who participated in the Pro.V.A study. The sum of achieved target levels (smoking, diet, physical activity, body weight, blood pressure, lipids, and diabetes) recommended by the European Society of Cardiology 2016 guidelines was assessed in each participant. From this sum, cardiovascular risk profile was categorised as very high (0–2), high (3), medium (4), low (5), and very low (6–7 target levels achieved). All-cause and CV mortality data over 20 years were obtained from health registers. At Cox regression, lower cardiovascular risk profile was associated with reduced 20-year all-cause mortality in both genders, with stronger results for women (HR = 0.42 [95%CI:0.25–0.69] and HR = 0.61 [95%CI:0.42–0.89] for very low vs. very high cardiovascular risk profile in women and men, respectively). This trend was more marked for CVD mortality. Lower cardiovascular risk profile was associated with reduced all-cause and CVD mortality only in men < 75 years, while the associations persisted in the oldest old women. A lower cardiovascular risk profile, as defined by current guidelines, may reduce all-cause and CVD mortality in older people, with stronger and longer benefits in women. These findings suggest that personalised and life-course approaches considering gender and age differences may improve the delivery of preventive actions in older people.
Highlights
Cardiovascular diseases (CVD) are the most frequent pathologies in adult and older age, and their prevalence is set to increase further due to longer lifespans in high-income countries (Christensen et al 2009; Global status report on noncommunicable diseases 2010 2011)
We tested the above association in participants free from CVD at baseline (n = 2256), and we explored the impact of single CV risk factors on mortality
Our study shows that achieving healthy target levels for CV risk factors, as proposed by the latest European Society of Cardiology (ESC) guidelines, is associated with lower 10- and 20-year all-cause and CV mortality rates, even in older people
Summary
Cardiovascular diseases (CVD) are the most frequent pathologies in adult and older age, and their prevalence is set to increase further due to longer lifespans in high-income countries (Christensen et al 2009; Global status report on noncommunicable diseases 2010 2011). The guidelines for CVD prevention of the European Society of Cardiology (ESC) define seven major cardiovascular (CV) risk factors, namely: smoking, diet, physical activity, body weight, blood pressure, lipids, and diabetes (Piepoli et al 2016). Target levels associated with a lower CV risk have been proposed. These recommendations are supported by a consolidated literature, the authors of such guidelines acknowledge that there are gaps in our knowledge, especially concerning older people and the female gender (Piepoli et al 2016). The target ranges for CV risk factors were generally determined from studies in which older people and women were underrepresented (Trevisan et al 2017), yet in light of age-related changes in the cardio-metabolic system, the same cutoffs might not be applicable to older individuals (Ruijter et al 2009; Störk et al 2006). Women after menopause become progressively more vulnerable to CVD, they are generally older than men at CVD onset and have more comorbidities and specific risk factor patterns (Trevisan et al 2017; Maas et al 2011)
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