What is the clinical evidence from this study?

Study design: Cohort. Population: Community-dwelling older adults without baseline cardiovascular disease or functional decline (n=7456). Intervention: High absolute CVD risk (≥20%) vs. Low absolute CVD risk (<10%). Primary outcome: Functional disability incidence (HR 1.44, 95% CI 1.18-1.77).

December 16, 2021Open Access

Absolute Cardiovascular Disease Risk Assessed in Old Age Predicts Disability and Mortality: A Retrospective Cohort Study of Community‐Dwelling Older Adults

Q: What are the key findings of this study?

High absolute cardiovascular disease risk (≥20%) predicted higher incidence of functional disability (HR 1.44; 95% CI 1.18-1.77) and all-cause mortality (HR 2.02; 95% CI 1.45-2.80) over 5 years.

Key Result

High absolute cardiovascular disease risk (≥20%) predicted higher incidence of functional disability (HR 1.44; 95% CI 1.18-1.77) and all-cause mortality (HR 2.02; 95% CI 1.45-2.80) over 5 years.

Study Design

Type

Cohort (n=7,456)

Multicenter

Yes

Structured PICO

Does higher absolute CVD risk predict disability and mortality in community-dwelling older adults without prior CVD?

Population

7,456 community-dwelling older adults (mean age 73.7 years) without cardiovascular disease and functional decline at baseline, living in Japan.

Intervention

Mid (10% to <20%) or high (≥20%) absolute CVD risk estimated using the revised World Health Organization CVD risk estimation charts

Comparator

Low (<10%) absolute CVD risk

Outcome

Functional disability incidence and all-cause mortality over 5 yearshard clinical

Absolute CVD risk estimated by WHO charts in older adults without prior CVD predicts 5-year incidence of functional disability and all-cause mortality.

Main Result

Effect estimate: HR 1.44 (95% CI 1.18-1.77)

Abstract

Background Evidence is limited on the predictive validity of absolute cardiovascular disease (CVD) risk, estimated by multivariable assessments in old age, for disability and mortality. We aimed to examine the longitudinal associations of absolute CVD risk assessed using region-specific risk estimation charts with disability and mortality among community-dwelling people aged ≥65 years. Methods and Results This retrospective cohort study included 7456 community-dwelling people aged ≥65 years (mean age, 73.7 years) without CVD and functional decline at baseline. They lived in either Obu City or Midori Ward of Nagoya City, Aichi Prefecture, Japan. We estimated absolute CVD risk using the revised World Health Organization CVD risk estimation charts and stratified risk levels into 3 categories: low (<10%), mid (10% to <20%), and high (≥20%). We followed up the functional disability incidence and all-cause mortality monthly for 5 years. The prevalence of each CVD risk level based on the laboratory-based model was as follows: low CVD risk, 1096 (14.7%); mid CVD risk, 5510 (73.9%); and high CVD risk, 850 (11.4%). During follow-up, the incidence rates of disability and mortality were 33.4 per 1000 and 12.4 per 1000 person-years, respectively. Cox regression analysis showed that the adjusted hazard ratios (95% CIs) for disability incidence were 1.32 (1.13-1.56) and 1.44 (1.18-1.77) in mid and high CVD risk levels, respectively (reference: low CVD risk level); for mortality incidence, they were 1.53 (1.16-2.01) and 2.02 (1.45-2.80) in mid and high CVD risk levels, respectively (reference: low CVD risk level). Conclusions Absolute CVD risk was associated with both disability and mortality in people aged ≥65 years. Estimated CVD risk levels may be useful surrogate markers for disability and mortality risks even when assessed in old age.