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Clinical Trial
. 2016 Mar 8;67(9):1013-1022.
doi: 10.1016/j.jacc.2015.12.034.

Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years

Lewis H Kuller  1 , Oscar L Lopez  2 , Rachel H Mackey  3 , Caterina Rosano  3 , Daniel Edmundowicz  4 , James T Becker  5 , Anne B Newman  3
Affiliations
Clinical Trial

Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years

Lewis H Kuller et al. J Am Coll Cardiol. .

Abstract

Background: The successful prevention and treatment of coronary heart disease (CHD) and stroke has resulted in a substantial increase in longevity, with subsequent growth in the population of older people at risk for dementia.

Objectives: The authors evaluated the relationship of coronary and other peripheral atherosclerosis to risk of death, dementia, and CHD in the very elderly. Because the extent of vascular disease differs substantially between men and women, sex- and race-specific analyses were included, with a specific focus on women with low coronary artery calcium (CAC) Agatston scores.

Methods: We evaluated the relationship between measures of subclinical cardiovascular disease (CAC, carotid intimal medial thickness, stenosis, and ankle brachial index) and risk of dementia, CHD, and total mortality in 532 participants of the Cardiovascular Health Study-Cognition Study from 1998/1999 (mean age, 80 years) to 2012/2013 (mean age, 93 years).

Results: Thirty-six percent of participants had CAC scores >400. Women and African-Americans had lower CAC scores. Few men had low CAC scores. CAC score and number of coronary calcifications were directly related to age-adjusted total mortality and CHD. The age-specific incidence of dementia was higher than for CHD. Only about 25% of deaths were caused by CHD and 16% by dementia. Approximately 64% of those who died had a prior diagnosis of dementia. White women with low CAC scores had a significantly decreased incidence of dementia.

Conclusions: In subjects 80+ years of age, there is a greater incidence of dementia than of CHD. CAC, as a marker of atherosclerosis, is a determinant of mortality, and risk of CHD and myocardial infarction. White women with low CAC scores had a significantly decreased risk of dementia. A very important unanswered question, especially in the very elderly, is whether prevention of atherosclerosis and its complications is associated with less Alzheimer disease pathology and dementia. (Cardiovascular Health Study [CHS]; NCT00005133).

Keywords: aging; ankle brachial index; carotid intimal medial thickness; coronary artery calcium; mortality.

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Conflict of interest statement

All authors have no financial relationships, conflicts of interest, or relationships with industry to disclose.

Figures

Figure 1
Figure 1. Central Illustration. Cumulative Incidence of Dementia, 1998-99 to 2013 for White Women and Men by CAC 0-10 and 400+
Incidence of dementia is similar in men and women. Men with low CAC 0-10 have low cumulative incidence of dementia. CAC, coronary artery calcium; CHD, coronary heart disease
Figure 2
Figure 2. CAC Scores in 1998–99 in Relationship to Age-Adjusted Incident CHD Through 2014 By Race and Sex
CHD incidence, even in the very old, is higher in men than women and positively related to CAC score, especially low rates (0 CAC). CAC, coronary artery calcium; CHD, coronary heart disease
Figure 3
Figure 3. Cumulative Incidence of Dementia, 1998–99 to 2013 for White Women and Men by CAC 0–10 and 400+
Cumulative incidence of CHD is higher in men than women. Both white men and women with lower CAC scores have reduced risk of CHD. CAC, coronary artery calcium; CHD, coronary heart disease
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