title: Risk factors for cardiovascular disease across the spectrum of older age: the Cardiovascular Health Study.
abstract: OBJECTIVE
  The associations of some risk factors with cardiovascular disease (CVD) are attenuated in older age; whereas others appear robust. The present study aimed to compare CVD risk factors across older age.
  
  
  METHODS
  Participants (n = 4883) in the Cardiovascular Health Study free of prevalent CVD, were stratified into three age groups: 65-74, 75-84, 85+ years. Traditional risk factors included systolic blood pressure (BP), LDL-cholesterol, HDL-cholesterol, obesity, and diabetes. Novel risk factors included kidney function, C-reactive protein (CRP), and N-terminal pro-B-type natriuretic peptide (NT pro-BNP).
  
  
  RESULTS
  There were 1498 composite CVD events (stroke, myocardial infarction, and cardiovascular death) over 5 years. The associations of high systolic BP and diabetes appeared strongest, though both were attenuated with age (p-values for interaction = 0.01 and 0.002, respectively). The demographic-adjusted hazard ratios (HR) for elevated systolic BP were 1.79 (95% confidence interval: 1.49, 2.15), 1.59 (1.37, 1.85) and 1.10 (0.86, 1.41) in participants aged 65-74, 75-84, 85+, and for diabetes, 2.36 (1.89, 2.95), 1.55 (1.27, 1.89), 1.51 (1.10, 2.09). The novel risk factors had consistent associations with the outcome across the age spectrum; low kidney function: 1.69 (1.31, 2.19), 1.61 (1.36, 1.90), and 1.57 (1.16, 2.14) for 65-74, 75-84, and 85+ years, respectively; elevated CRP: 1.54 (1.28, 1.87), 1.33 (1.13, 1.55), and 1.51 (1.15, 1.97); elevated NT pro-BNP: 2.67 (1.96, 3.64), 2.71 (2.25, 3.27), and 2.18 (1.43, 3.45).
  
  
  CONCLUSIONS
  The associations of most traditional risk factors with CVD were minimal in the oldest old, whereas diabetes, eGFR, CRP, and NT pro-BNP were associated with CVD across older age.
authors.affiliation: School of Biological and Population Health Sciences, Oregon State University, 141B Milam Hall, Corvallis, 97331 OR, USA. Electronic address: Michelle.Odden@oregonstate.edu.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Odden
authors.affiliation: Department of General Internal Medicine, San Francisco VA Medical Center, USA; Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: Departments of Medicine and Ophthalmology, Duke University Medical Center, Durham, NC, USA; Durham VA Medical Center, Geriatrics Research Education and Clinical Center, Durham, NC, USA.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Whitson
authors.affiliation: Kidney Research Institute, University of Washington, Seattle, WA, USA.
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: Department of Epidemiology & Public Health, University College Cork, Ireland.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Kearney
authors.affiliation: Division of Cardiovascular Medicine, University of Maryland, Baltimore, MD, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: defilippi
authors.affiliation: Division of Nephrology, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Shani
authors.initials: S
authors.lastname: Shastri
authors.affiliation: Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA; Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA; New York Academy of Medicine, New York, NY, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.affiliation: Department of Medicine, University of Vermont, Burlington, VT, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA; Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA; Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D048909:Diabetes Complications / Q000175:diagnosis; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications; D007668:Kidney / Q000378:metabolism; D007674:Kidney Diseases / Q000097:blood / Q000150:complications; D008055:Lipids / Q000097:blood; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D009765:Obesity / Q000097:blood / Q000150:complications; D010446:Peptide Fragments / Q000378:metabolism; D012307:Risk Factors
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008055:Lipids; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: Aging; Epidemiology; Risk factors