Changes in Cardiovascular Risk Factors and Cardiovascular Events in the Elderly Population

Abstract

Background This study examines changes in the ideal cardiovascular health (CVH) status and whether these changes are associated with incident cardiovascular disease (CVD) and mortality in the elderly Asian population. Methods and Results In the Korea National Health Insurance Service-Senior cohort aged ≥60 years, 208 673 participants without prior CVD, including 109 431 who showed changes in CVH status, were assessed. The association of the changes in cardiovascular risk factors with incident CVD was assessed from 2004 to 2014 in the elderly (aged 60-74 years) and very elderly (≥75 years) groups. During the follow-up period (7.1 years for CVD and 7.2 years for mortality), 19 429 incident CVD events and 24 225 deaths occurred. In both the elderly and very elderly participants, higher CVH status resulted in a lower risk of CVD and mortality. In the very elderly participants, compared with consistently low CVH, consistently high CVH (subhazard ratio, 0.41; 95% CI, 0.23-0.73) was associated with a lower risk of CVD. This trend was consistently observed in the elderly population. In the very elderly participants, total cholesterol level was not informative enough for the prediction of CVD events. In both the elderly and very elderly groups, body mass index and total cholesterol were not informative enough for the prediction of all-cause mortality. Conclusions In both the elderly and very elderly Asian populations without CVD, a consistent relationship was observed between the improvement of a composite metric of CVH and the reduced risk of CVD. Body mass index and total cholesterol were not informative enough for the prediction of all-cause mortality in both the elderly and very elderly groups.

Keywords: cardiovascular disease; cardiovascular health; elderly; mortality.

Figure 1. Heatmap of the unadjusted incidence rates of cardiovascular disease (CVD) (A) and all‐cause mortality (B) according to the patterns of change in cardiovascular health between the first and second examinations in the elderly (60–74 years) and very elderly (≥75 years) populations.

Values indicate the percentage of participants in each category, and colors indicate rate per 1000 person‐years.

Figure 2. Heatmap of the unadjusted incidence rates of cardiovascular disease (CVD) and all‐cause mortality according to the patterns of change in cardiovascular health between the first and second examinations for comparison between women and men (A and B) and between high and low‐to‐moderate economic status (C and D).

Values indicate the percentage of participants in each category, and black and gray indicate rate per 1000 person‐years.

Figure 3. Hazard ratios of cardiovascular disease (green dots) and all‐cause mortality (red dots) according to the pattern of change in the cardiovascular health status between the first and second health examinations in the elderly (60–74 years) (A) and very elderly (≥75 years) (B) populations.