Cardiovascular Events in US Adults Aged ≥80 Years: Incidence, Risk Factors, and Outcomes.
Academic Article
Overview
abstract
BACKGROUND: Estimating risk and risk factors for cardiovascular disease (CVD) events and mortality following CVD events can inform strategies for lowering risk in older adults. METHODS: We estimated risk factors for the 5-year cumulative incidence of CVD events including nonfatal myocardial infarction, fatal coronary heart disease, stroke, and heart failure among adults aged <70, 70 to <80, and ≥80 years in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). The REGARDS study is a prospective cohort study with enrollment across the contiguous United States and adjudicated CVD events. Data on CVD risk factors were collected during a study interview and in-home study visit from 2013 to 2016. In addition, we estimated 1-year mortality after the first CVD event during follow-up. RESULTS: Among 4621, 4938, and 2450 participants aged <70, 70 to <80, and ≥80 years, the 5-year cumulative incidence of CVD events was 5.3% (95% CI, 4.7%-6.0%), 10.7% (95% CI, 9.9%-11.6%), and 17.2% (95% CI, 15.8%-18.8%), respectively. Diabetes and hypertension were associated with CVD events among participants aged <70 years (hazard ratio [HR], 1.42 [95% CI, 1.00-2.03] and 1.58 [95% CI, 1.19-2.09], respectively) and 70 to <80 years (HR, 1.41 [95% CI, 1.09-1.83] and 1.73 [95% CI, 1.43-2.08], respectively) but not among those aged ≥80 years (HR, 1.03 [95% CI, 0.81-1.32] and 1.07 [95% CI, 0.84-1.35], respectively). Among those aged ≥80 years, risk factors for CVD events included LDL-C (low-density lipoprotein-cholesterol) ≥100 mg/dL (HR, 1.24 [95% CI, 1.01-1.51]), hsCRP (high-sensitivity C-reactive protein) ≥3 mg/L (HR, 1.27 [95% CI, 1.03-1.55]), albuminuria (HR, 1.61 [95% CI, 1.30-1.98]), and a prior history of CVD (HR, 2.25 [95% CI, 1.84-2.76]). Among participants aged ≥80 years, the 1-year cumulative incidence of all-cause mortality following a CVD event was 53.1% (95% CI, 48.3%-57.8%) versus 5.7% (95% CI, 3.5%-7.9%) in age-matched participants who did not have a CVD event. CONCLUSIONS: The risk for CVD events in adults aged ≥80 years was high, and the association was stronger for albuminuria and inflammation versus hypertension and diabetes.
