Cardiovascular Disease In Older People Research Articles

Associations of Osteoarthritis with Prevalence and Incidence of Cardiovascular Disease over 10 Years in Community-Dwelling Older Adults: The Sydney Memory and Ageing Study

Introduction: The data are limited for the association between osteoarthritis (OA) and cardiovascular disease (CVD) in community-based older populations and whether there is sex difference. This study aimed to examine the relationship between OA and prevalence and incidence of CVD over 10 years in community-dwelling older adults. Methods: Data on self-reported OA, high cholesterol, hypertension, and type 2 diabetes were collected from 1,025 community-dwelling participants aged 70–90 years in the Sydney Memory and Ageing Study. The presence of CVD at baseline was defined as self-reported presence of stroke, heart attack, transient ischaemic attack, angina, aortic aneurysm, or claudication. The incidence of CVD was defined by a combination of incident self-reported CVD or CVD mortality at different follow-up timepoints over 10 years. Results: At baseline, 395 (38.5%) participants self-reported OA (252 [44.6%] women, 143 [31.1%] men). Self-reported OA was associated with increased prevalence of CVD in women (OR 1.67, 95% CI 1.12–2.47) but not men (1.26, 0.80–1.98). In the total population, self-reported OA at baseline was associated with increased incidence of CVD at 4 years (OR 1.77, 95% CI 1.10–2.83), 6 years (1.59, 1.03–2.46), 8 years (1.56, 1.02–2.38), and 10 years (1.66, 1.10–2.50), but not at 2 years (1.43, 0.79–2.57). Significant associations were observed in female participants at 4, 8, and 10 years, with no significant associations seen in male participants. Conclusion: OA was associated with increased prevalence at baseline and incidence of CVD over 10 years in community-based older adults, especially women. Identifying those with OA to target their cardiovascular risk factors while managing their OA has the potential to reduce the burden of CVD in older people, particularly women.

Burden of cardiovascular disease among elderly: based on the Global Burden of Disease Study 2019.

The burden of elderly cardiovascular disease (CVD) has received increasing attention with population ageing worldwide. We reported on the global CVD burden in elderly individuals over 70, 1990-2019. Based on the Global Burden of Disease Study 2019, elderly CVD burden data were analysed. Temporal burden trends were analysed with the joinpoint model. The slope index and concentration index were used to evaluate health inequality. From 1990 to 2019, the global elderly CVD incidence, prevalence, death, and disability-adjusted life year rates generally decreased. However, the current burden remains high. The rapid growth in burden in parts of sub-Saharan Africa and Asia is a cause for concern. Countries with a higher socio-demographic index (SDI) have generally seen a greater decrease in burden, while countries with a lower SDI have generally experienced increases or smaller declines in burden. Health inequality analysis confirmed that the burden was gradually concentrating towards countries with a low SDI. Among the different CVDs, ischaemic heart disease causes the greatest burden in elderly individuals. Most CVD burdens increase with age, but stroke and peripheral vascular disease show markedly different distributional characteristics. In addition, the burden of hypertensive heart disease shows an unusual shift towards high-SDI countries. High systolic blood pressure was consistently the leading risk factor for CVD among elderly individuals. The burden of CVD in older people remains severe and generally tends to shift to lower-SDI countries. Policymakers need to take targeted measures to reduce its harm.

Cardiovascular disease in older people with serious mental illness: Current challenges and future directions.

Cardiovascular disease in older people with serious mental illness: Current challenges and future directions.

Reducing the impact of cardiovascular disease in older people with cancer: a qualitative study of healthcare providers

PurposeCancer survivors are at greater risk of cardiovascular disease (CVD) than cancer-free controls. Despite evidence-based guidelines recommending CVD risk factor assessment, surveillance and risk-reduction, many people with cancer do not receive adequate CVD care. To address potential barriers and enablers of care, we examined healthcare professionals’ (HCPs) perceptions and experiences of CVD risk assessment and management in people with cancer.MethodsWe conducted one focus group and 12 individual interviews to examine HCPs’ perceptions and experiences of CVD care in care. We used reflexive thematic analysis to collect and analyse the qualitative data to construct and understand themes.ResultsTwenty-one HCPs participated (8 oncologists, 5 nurses, 3 general practitioners, 2 dietitians, 1 cardiologist, 1 haematologist and 1 physiotherapist). Majority of HCPs were aware of CVD risk in cancer but were concerned they could not deliver CVD care alone due to system-level barriers including lack of time and training. HCPs also perceived patient-level barriers including socioeconomic disadvantage and fatalistic outlook. Despite barriers, HCPs suggested diverse solutions for improving CVD care in cancer including new models-of-care, clinical pathways, risk assessment/management tools and education.ConclusionsThe diversity of perceived barriers and suggested solutions identified by HCPs suggests the need for a multilevel approach tailored to context. Future research involving people with cancer is needed to co-design acceptable interventions.Implications for Cancer SurvivorsImproved understanding of HCP’s perceptions can inform the development of new interventions to deliver CVD care to people with cancer to reduce morbidity and mortality.

Prior oral proton-pump inhibitor use is associated with reduced severity of aspirin-related upper gastrointestinal bleeding in older people.

Low-dose aspirin is commonly used for primary or secondary prophylaxis against cardiovascular disease in older people. However, the potential risk of upper gastrointestinal (UGI) ulceration and bleeding associated with low-dose aspirin use is often not appreciated by prescribers and older consumers. Among 133 serial patients with UGI bleeding, aspirin-users aged ≥70 years had a ninefold increased likelihood of overt UGI bleeding compared with non-users, reducing by 90% in regular proton-pump inhibitor users (adjusted odds ratio 0.10). We recommend risk-versus-benefit discussions when recommending aspirin to older people.

Statin use in older people primary prevention on cardiovascular disease: an updated systematic review and meta-analysis.

Evidence on statin use for primary prevention of cardiovascular disease (CVD) in older people needs to be extended and updated, aiming to provide further guidance for clinical practice. PubMed, EMBASE, Cochrane Library and Web of Science were searched for eligible observational studies comparing statin use vs. no-statin use for primary prevention of CVD in older people (age 65 years). The primary outcomes were all-cause mortality, CVD mortality, coronary heart disease (CHD)/myocardial infraction (MI), stroke and total CV events. Risk estimates of each relevant outcome were synthesized as a hazard ratio (HR) with 95% confidence interval (95% CI) using in the random-effects model. Twelve eligible observational studies (n = 1,627,434) were enrolled. The pooled results suggested that statin use was associated with a significantly decreased risk of all-cause mortality (HR: 0.54, 95% CI: 0.46-0.63), CVD mortality (HR: 0.51, 95% CI: 0.39-0.65), CHD/MI (HR: 0.83, 95% CI: 0.69-1.00), stroke (HR: 0.79, 95% CI: 0.68-0.92) and total CV events (HR: 0.75, 95% CI: 0.66-0.85). The association in all-cause mortality still remained obvious at higher ages ( 70 years old, HR: 0.56, 95% CI: 0.44-0.71; 75 years old, HR: 0.70, 95% CI: 0.60-0.80; 85 years old, HR: 0.85, 95% CI: 0.74-0.97), 20% (HR: 0.47, 95% CI: 0.35-0.62) and 20% diabetic populations (HR: 0.50, 95% CI: 0.40-0.64), and 50% (HR: 0.68, 95% CI: 0.59-0.79) and 50% hypertensive populations (HR: 0.38, 95% CI: 0.16-0.88). Statin use was related to a 46%, 49%, 17%, 21% and 25% risk reduction on all-cause mortality, CVD mortality, CHD/MI, stroke and total CV events in older patients, respectively. The significant association was also addressed in older patients and 75 years old individuals for CVD primary prevention.

Pharmacological Management of Hyperlipidemia in Older individuals.

To provide an up-to-date review of current hyperlipidemia guidelines and discuss pharmacotherapeutic management of hyperlipidemia in older individuals. A PubMed search of articles published through October 2020 was performed using a combination of the following words: older adults, hyperlipidemia, statin, ezetimibe, fibrate, fish oil, niacin, bile acid sequestrant, and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor. Relevant original research, review articles, and guidelines were assessed for the management of hyperlipidemia in the older individuals. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results. Hyperlipidemia is a common chronic disease state in the elderly population, though there is limited evidence for clinical outcomes in older people when compared withwith the general adult population. Statins have the most evidence for primary and secondary prevention of cardiovascular disease in older people, though ezetimibe and PCSK9 inhibitors have a role as add-on or monotherapy in patients who do not tolerate statins. Optimal management of hyperlipidemia in older people is important in order to avoid further complications and improve outcomes. Pharmacists can help improve management in the elderly by incorporating up-to-date evidence from guidelines and providing medication education specifically for this population.

Sodium and Potassium Intake and Cardiovascular Disease in Older People: A Systematic Review.

This review aims to examine the relationship of sodium and potassium intake and cardiovascular disease (CVD) among older people. Methods: We performed a literature search using PubMed and Web of Science (January 2015 to July 2020) without language restriction. Observational and experimental studies that reported the relationship between sodium, potassium, or sodium-to-potassium ratio with CVD among older adults aged higher than 60 years were included. The authors independently screened all identified studies, extracted information, and assessed the quality of included studies. Risk of bias was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) for observational studies and the revised Cochrane risk-of-bias tool (RoB 2 tool) for randomized trials. Results: We included 12 studies (6 prospective cohort studies, 5 cross-sectional studies, and 1 experimental study). Five of the studies reported on sodium-to-potassium ratio (n = 5), and the others on potassium and/or sodium intake. Cardiovascular events (e.g., stroke and heart failure) were the most reported outcome (n = 9). Of the 12 studies included, five observational studies had low bias risk and the randomized controlled trial was judged as uncertain risk of bias. We found inconsistent results for the effect of the reduction of sodium intake in this population for lower risk of CVD. We found that both the increase of potassium intake and the decrease of sodium-to-potassium ratio were associated with lower risk of hypertension and CVD, particularly stroke. Conclusion: The present review suggests that both higher potassium and lower sodium-to-potassium ratio are associated with lower risk of CVD.

Frailty as Cardiovascular Risk Factor (and Vice Versa).

The prevalence of frailty seems to be higher in people with cardiovascular disease (CVD) compared to those without, but also the prevalence of CVD is higher in people with frailty compared to robust ones. In longitudinal studies and meta-analyses dealing with the role of frailty as potential risk factor for incident CVD, we have an increasing literature suggesting that frailty increases the risk of these conditions, particularly of fatal events, and independently from several potential confounding factors. Among the domains usually included in the definition of physical frailty, exhaustion, low physical activity, slow gait speed and weakness are significantly associated with the onset of CVD in older people. However, also CVD can be considered as potential risk factor for incident frailty even if the literature is more limited. In this chapter, I will therefore report and discuss the most recent and relevant findings in this topic, of extreme importance in actual geriatric medicine.

Hearing Loss and Circulating Markers of Endothelial Dysfunction

Hearing loss is highly prevalent in older people, affecting around 25 percent of American adults aged 65 to 74 and 50 percent of those aged 75 and older (NIH, 2016). The number of people affected by this disability continues to rise, as does the associated cost that affects individuals in terms of their quality of life and society. Several co-morbidities often accompany age-related hearing loss, including endothelial dysfunction and increased cardiovascular risk, and there is evidence of significantly higher rates of cardiovascular disease among people with hearing loss (Circulation. 2016;134:A19010). Hearing loss has significantly negative effects on quality of life, mental health, and physical function. Therefore, finding potentially modifiable risk factors and markers for hearing loss should be a public health priority. Our world-first study investigated the association between hearing loss and circulating markers for endothelial dysfunction that are potentially modifiable through lifestyle and drug interventions (Otol Neurotol. 2018 Apr;39(4):e280).

Physical activity and cardiovascular aging: Physiological and molecular insights.

Aging is associated with significant changes in both cardiac and vascular structure and function that lower the threshold for clinical signs and symptoms, making older people more susceptible to cardiovascular diseases, morbidity and mortality. Understanding of age-related cardiovascular changes is necessary for effective and efficient prevention and treatment of cardiovascular disease in older people. Cardiac aging is associated with left ventricular remodelling marked by increased mass-to-volume ratio and accompanied by systolic and diastolic myocardial dysfunction, and reduced sensitivity to sympathetic stimuli that compromises myocardial contractility and pumping ability in older people. The vascular age-related remodelling is associated with increased arterial wall thickness, arterial stiffness, and an impaired endothelial vasoreactivity. Over the previous three decades of intensive research in cardiovascular aging, it became apparently clear that lifestyle factors such as physical activity and exercise play an important role in attenuating cardiovascular function decline with aging. This review highlights the effect of age on cardiac and vascular changes and their adaptations to exercise, providing physiological, molecular and cellular mechanisms that underlie diminished cardiovascular response in older age. It further describes cardiovascular differences between the individuals who maintain a physically active lifestyle, and who undergo exercise interventions in later life.

A 3-year follow-up study on cardiovascular disease and mortality in older people with intellectual disabilities

BackgroundWith increasing longevity and a similar or increased prevalence of cardiovascular disease risk factors (as compared to the general population), people with intellectual disabilities (IDs) are at risk of developing cardiovascular disease. However, prospective studies on incidence and influencing factors of cardiovascular disease and mortality are lacking. MethodsA three year follow-up study was undertaken to study the incidence and symptoms at presentation of myocardial accident, stroke and heart failure in older people with ID. Furthermore, the predictive value of cardiovascular disease risk factors on myocardial accident, stroke and heart failure and on all-cause mortality were studied. The baseline group consisted of the 1050 participants, aged 50 years and over, in the Dutch Healthy Ageing and Intellectual Disability (HA-ID) study. Baseline measurements were conducted between November 2008 and July 2010. Three years after baseline, medical files of 790 participants were studied. ResultsCardiovascular disease (myocardial infarction, stroke and heart failure) occurred in 5.9% of the population during 3 year follow-up, and 32% of them died due to the condition. Incidence of myocardial infarction is 2.8 per 1000 personyears, for stroke 3.2 per 1000 personyears and for heart failure 12.5 per 1000 personyears. Incidence of these conditions is probably underestimated, due to atypical symptom presentation. The use of atypical antipsychotics and a history of heart failure were predictive for myocardial infarction. Heart failure was predicted by abdominal obesity, chronic kidney disease and a history of heart failure. A total of cardiovascular disease (myocardial infarction, stroke or heart failure) was predicted by abdominal obesity, a history of stroke and a history of heart failure. A low body-mass index, peripheral arterial disease, chronic kidney disease and inflammation were predictive for 3-year all-cause mortality. ConclusionIncidence of cardiovascular disease in older people with ID is similar to that in the general population. A pro-active assessment and treatment of the presented cardiovascular disease risk factors may reduce cardiovascular disease and mortality in older people with ID.

PWE-104 Gamma-glutamyl transferase but not markers of hepatic fibrosis is associated with cardiovascular disease in older people with type 2 diabetes mellitus: the edinburgh type 2 diabetes study

<h3>Introduction</h3> Patients with chronic liver disease (CLD) and, in particular, non-alcoholic fatty liver disease (NAFLD) are known to have both higher all-cause mortality and cardiovascular (CV) mortality rates than the general population. Beyond investigation of GGT there has been little exploration of the relationship between CV disease (CVD) and other markers of liver disease (non-specific liver injury, steatosis, steatohepatitis, liver fibrosis or portal hypertension). We examined the association of prevalent and incident CV disease with CLD in a cohort of community-based people with type 2 diabetes (T2DM) in order to determine the relationship between these two important conditions. <h3>Method</h3> 1066 participants of the Edinburgh Type 2 Diabetes Study, a large, randomly-selected population of patients with T2DM aged 60–75 years were invited for liver assessment. A range of liver disease markers (non-specific liver injury – serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT); steatosis – liver ultrasound; steatohepatitis – serum cytokeratin-18; fibrosis – serum AST to Platelet Ratio Index (APRI), AST:ALT ratio, Enhanced Liver Fibrosis (ELF) panel, Fibrosis-4 Score, NAFLD Fibrosis Score; portal hypertension – platelet count) were measured. Subjects were followed-up using patient and GP questionnaires and record linkage for incident CV events (coronary artery disease (CAD), cerebrovascular disease and peripheral vascular disease). <h3>Results</h3> At baseline there were 372/1035 patients with prevalent CVD, including 319/1035 with CAD. After mean follow-up of 4.4 years there were 121/1035 incident CVD events, including 76/121 CAD events. There were 30/82 CVD related deaths. However, risk of dying from or developing CVD was no higher in subjects with steatosis than without (HR 1.31 95% CI 0.78–2.20, p &gt; 0.05). The only significant relationship was with GGT (U/L log₂incident CVD, adjusted HR 1.18 95% CI 1.00–1.39, p = 0.045; incident CAD, adjusted HR 1.24 95% CI 1.02–2.51, p = 0.032). <h3>Conclusion</h3> We conducted the first comprehensive population-based study of older people with T2DM and found no association between non-invasive markers of hepatic steatosis, steatohepatitis, or fibrosis with the development of, or mortality from, CVD. Our finding of a significant independent association between GGT and CVD warrants further evaluation as a potentially useful addition to current CV risk prediction models in T2DM. <h3>Disclosure of interest</h3> None Declared.

Prescribing for uncomplicated hypertension in the elderly

The treatment of older people with high blood pressure (BP) is a challenge as under- and over-treatment can lead to poorer outcomes. There is strong evidence from epidemiological and trial data to show that older people with high BP should be treated at the same threshold and to the same target BP (BP &lt;140/90 mmHg) as younger patients, with the exception of the very elderly (those over the age of 80 years), in whom a less aggressive treatment target is recommended (BP &lt;150/90 mmHg). With anti-hypertensive therapy, older people can experience orthostatic hypotension, drug–drug interactions and adverse drug reactions; older people often have complex co-morbidities and may have barriers to adherence to therapy. Drug therapy should be tailored to achieve a satisfactory BP reduction with minimal adverse effects. Other risk factors for cardiovascular disease in older people should be identified and addressed. Particular consideration should be given to the use of statins.

γ-Glutamyltransferase, but not markers of hepatic fibrosis, is associated with cardiovascular disease in older people with type 2 diabetes mellitus: the Edinburgh Type 2 Diabetes Study.

Aims/hypothesisWe examined the association of prevalent and incident cardiovascular disease (CVD) with chronic liver disease in a cohort of community-based people with type 2 diabetes, in order to clarify the relationship between these two important conditions.Methods1,066 participants with type 2 diabetes aged 60–75 years underwent assessment of a range of liver injury markers (non-specific injury, steatosis, steatohepatitis, fibrosis, portal hypertension). Individuals were followed up for incident cardiovascular events.ResultsAt baseline there were 370/1,033 patients with prevalent CVD, including 317/1,033 with coronary artery disease (CAD). After a mean follow-up of 4.4 years there were 44/663 incident CVD events, including 27/663 CAD events. There were 30/82 CVD-related deaths. Risk of dying from or developing CVD was no higher in participants with steatosis than in those without (HR 0.90; 95% CI 0.40, 2.00; p > 0.05). The only notable relationship was with γ-glutamyltransferase (GGT) (incident CVD: adjusted HR for doubling GGT 1.24 [95% CI 0.97, 1.59] p = 0.086; incident CAD: adjusted HR 1.33 [95% CI 1.00, 1.78] p = 0.053), suggesting that in our study population, chronic liver disease may have little effect on the development of, or mortality from, CVD.Conclusions/interpretationAn independent association between GGT and CVD warrants further exploration as a potentially useful addition to current cardiovascular risk prediction models in diabetes. However, overall findings failed to suggest that there is a clinical or pathophysiological association between chronic liver disease and CVD in elderly people with type 2 diabetes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-015-3575-y) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Associations of symptoms of anxiety and depression with diabetes and cardiovascular risk factors in older people with intellectual disability

Depression, anxiety, diabetes and cardiovascular risk factors are frequent health problems among older people with intellectual disability (ID). These conditions may be bidirectionally related. Depression and anxiety may have biological effects causing glucose intolerance, fat accumulation and also lifestyle changes causing metabolic syndrome. But also the effects of diabetes, metabolic syndrome and subsequent cardiovascular disease may affect mood and anxiety. This study investigated the association between depression, anxiety and diabetes and cardiovascular risk factors in older people with ID. The healthy ageing in intellectual disability-study (HA-ID study) is a cross-sectional study among people aged 50 years and over with ID, receiving formal ID care. Screening instruments for symptoms of anxiety and depression were completed and physical examination and vena-puncture were performed to establish components of the metabolic syndrome, peripheral arterial disease and c-reactive protein. Of the 990 people who participated, 17% had symptoms of depression and 16% had symptoms of anxiety. Type I diabetes was present in 1%, type II diabetes in 13% of the study population. Metabolic syndrome, central obesity, hypercholesterolemia and hypertension were present in 45%, 48%, 23% and 53% respectively. In a multivariate logistic regression analysis a significant association was found between increased anxiety symptoms and diabetes only (OR 2.4, 95%CI 1.2-4.9). Increased anxiety symptoms and diabetes are related in older people with ID. This association may be bidirectional. No other associations of depression and anxiety symptoms with cardiovascular risk factors could be proven to be significant. Therefore, more research is needed to unravel the mechanisms of stress, mood disorders and cardiovascular disease in older people with ID. To provide comprehensive care for older people with ID, screening for diabetes and components of the metabolic syndrome in people with anxiety or mood disorders, and screening for symptoms of anxiety or depression in people with diabetes is warranted.

Serum IGF1, metabolic syndrome, and incident cardiovascular disease in older people: a population-based study

High as well as low levels of IGF1 have been associated with cardiovascular diseases (CVD). The relationship of IGF1 with (components of) the metabolic syndrome could help to clarify this controversy. The aims of this study were: i) to investigate the association of IGF1 concentration with prevalent (components of) the metabolic syndrome; and ii) to examine the role of (components of) the metabolic syndrome in the relationship between IGF1 and incident CVD during 11 years of follow-up. Data were used from the Longitudinal Aging Study Amsterdam, a cohort study in a representative sample of the Dutch older population (≥65 years). Data were available in 1258 subjects. Metabolic syndrome was determined using the definition of the US National Cholesterol Education Program Adult Treatment Panel III. CVD were ascertained by self-reports and mortality data. Levels of IGF1 in the fourth quintile were associated with prevalent metabolic syndrome compared with the lowest quintile (odds ratio: 1.59, 95% confidence interval (CI) 1.09-2.33). The middle up to the highest quintile of IGF1 was positively associated with high triglycerides in women. Metabolic syndrome was not a mediator in the U-shaped relationship of IGF1 with CVD. Both subjects without the metabolic syndrome and low IGF1 levels (hazard ratio (HR) 1.75, 95% CI 1.12-2.71) and subjects with the metabolic syndrome and high IGF1 levels (HR 2.28, 95% CI 1.21-4.28) demonstrated increased risks of CVD. In older people, high-normal IGF1 levels are associated with prevalent metabolic syndrome and high triglycerides. Furthermore, this study suggests the presence of different pathomechanisms for both low and high IGF1 levels and incident CVD.

Apolipoprotein E Genotype and Cardiovascular Diseases in the Elderly

The apolipoprotein E (APOE) genotype is a genetic risk factor for dementia, Alzheimer’s disease, and cardiovascular disease (CVD). It includes three alleles (e2, e3, e4) that are located on chromosome 19q3.2. The e3 allele is the most common and is more common in people of Northern European ancestry and less common in those of Asian ancestry. Those with at least one e4 allele are at increased risk for CVD outcomes. It is well established that the presence of an e4 allele is linked to higher low-density lipoprotein cholesterol levels, even at young ages. Even though most CVD occurs in older people, there are few studies of the effects of APOE on CVD in older people. This review addresses recent research on the links between APOE, CVD, and vascular mechanisms by which APOE may affect CVD in the elderly.

Obesity and Atherogenic Dyslipidemia

Obesity is associated with an increased risk of coronary heart disease, in part due to its strong association with atherogenic dyslipidemia, characterized by high triglycerides and low high-density lipoprotein (HDL) cholesterol. There has been substantial research effort focused on the mechanisms of the link between obesity and atherogenic dyslipidemia, both in the absence and presence of insulin resistance. After a brief overview of the epidemiology of atherogenic dyslipidemia, this article details the known molecular mechanisms of adipocyte function and its relationship to apoB-containing lipoprotein assembly and metabolism, both in the healthy as well as in the obese states. We also discuss the pathophysiology of low HDL cholesterol in obesity and the implications for cardiovascular disease risk.

Metabolic Syndrome and Cardiovascular Disease in Older People: The Cardiovascular Health Study

To assess the prospective association between metabolic syndrome (MetS) and cardiovascular disease (CVD) in older people and to evaluate the effect of lowering the threshold for impaired fasting glucose (IFG) on the prevalence of IFG and MetS and the risk of CVD. Prospective cohort study. Four field centers in U.S. communities. Three thousand five hundred eighty-five subjects in the Cardiovascular Health Study free of diabetes mellitus and CVD at baseline (mean age 72, 62% female, 14% black). Baseline measures of MetS components and adjudicated incident CVD events. MetS (2001) was defined first using the original criteria from the Third Adult Treatment Panel Report of the National Cholesterol Education Program (> or =3 of the following: large waist circumference (women >88 cm, men >102 cm), elevated triglycerides (> or =1.70 mmol/L), low high-density lipoprotein cholesterol (men <1.04 mmol/L, women <1.30 mmol/L), elevated fasting glucose (6.1-6.9 mmol/L), and high blood pressure (> or =130/85 mmHg or self-reported use of medications for hypertension). Subjects were also classified according to the revised definition of the MetS (2005) that applies the lower threshold for fasting glucose (5.6-6.9 mmol/L). During follow-up (median 11 years), 818 coronary heart disease (CHD), 401 stroke, and 554 congestive heart failure (CHF) events occurred. Age- and race-adjusted hazard ratios (HRs) for CHD, stroke, and CHF were 1.30 (95% confidence interval (CI) = 1.07-1.57), 0.94 (95% CI = 0.73-1.21), and 1.40 (95% CI = 1.12-1.76) for women and 1.35 (95% CI = 1.10-1.66), 1.51 (95% CI = 1.08-2.12), and 1.47 (95% CI = 1.14-1.90) for men, respectively. Overall, women and men with MetS (2005) were 20% to 30% more likely to experience any CVD event than subjects without MetS (2005). Using the lower cut-point for IFG resulted in a near tripling in IFG prevalence (16% to 46%) and an additional 9% classified with MetS (2005) but HRs similar to those estimated from the original MetS (2001) criteria. High blood pressure was the component most strongly associated with incident CHD. Results from this study of an elderly, population-based cohort provide support for earlier investigations in primarily middle-aged populations that link the presence of MetS with the development of CVD and further underscore the importance of recognizing and treating its individual components, particularly high blood pressure.