title: Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years.
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.
  
  
  OBJECTIVE
  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).
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: kullerl@edc.pitt.edu.
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.affiliation: Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Oscar L
authors.initials: OL
authors.lastname: Lopez
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Mackey
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Caterina
authors.initials: C
authors.lastname: Rosano
authors.affiliation: Department of Medicine, Section of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Daniel
authors.initials: D
authors.lastname: Edmundowicz
authors.affiliation: Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: James T
authors.initials: JT
authors.lastname: Becker
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D003704:Dementia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: aging; ankle brachial index; carotid intimal medial thickness; coronary artery calcium; mortality