title: Subclinical vascular disease burden and risk for death and cardiovascular events in older community dwellers.
abstract: BACKGROUND
  Individual measures and previous composite measures of subclinical vascular disease defined high risk for cardiovascular events, but did not detect low and modest risk. A different approach might better describe the spectrum from low to high risk. Methods and Results. In the Cardiovascular Health Study, 3,252 participants without history of clinical cardiovascular disease (M ± SD 74.3 years ± 5.1, 63% women, 17% African Americans) had noninvasive vascular assessments in 1992-1993. We assigned a score of 0, 1, or 2 (no, mild, or severe abnormalities) to ankle-arm index, electrocardiogram, and common carotid intima-media thickness, based on clinical cutoffs. A summary index (range 0-6, absent to severe disease) summed individual scores. Abdominal aortic ultrasound and brain magnetic resonance imaging were collected in a subsample. Mortality and incident cardiovascular events were identified through June 2008. Event and death rates increased across index grades. Comparing grades 1 to 5+ with absent disease, and adjusting for demographics, hazard ratios for cardiovascular events within 8 years ranged from 1.1 (95% confidence interval 0.8-1.6) to 4.7 (3.4-6.9) and, for mortality, from 1.5 (1.0-2.3) to 5.0 (3.3-7.7) (p for trend across grades <.001 for both outcomes). Adjustment for cardiovascular risk factors did not substantially change the associations. The index improved mortality risk classification over demographics and risk factors in participants who did not die during the follow-up. Including in the index the aortic ultrasound and the brain magnetic resonance imaging further improved risk classification.
  
  
  CONCLUSIONS
  Older adults with minimal subclinical vascular disease had low cardiovascular events risk and mortality. This approach might more fully account for vascular burden.
authors.affiliation: Pere Virgili Hospital and Institute on Aging, Autonomous University of Barcelona, C Esteve Terrades 30, Barcelona, Spain. minzitari@perevirgili.catsalut.net
authors.forename: Marco
authors.initials: M
authors.lastname: Inzitari
authors.forename: Alice M
authors.initials: AM
authors.lastname: Arnold
authors.forename: Kushang V
authors.initials: KV
authors.lastname: Patel
authors.forename: Laina D
authors.initials: LD
authors.lastname: Mercer
authors.forename: Arun
authors.initials: A
authors.lastname: Karlamangla
authors.forename: Jingzhong
authors.initials: J
authors.lastname: Ding
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Williamson
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D012306:Risk; D014652:Vascular Diseases / Q000150:complications* / Q000401:mortality