Carotid Plaque Score and Risk of Cardiovascular Mortality in the Oldest Old: Results from the TOOTH Study.
OBJECTIVE
Accumulating evidence suggests that predictability of traditional cardiovascular risk factors declines with advancing age. We investigated whether carotid plaque scores (CPSs) were associated with cardiovascular disease (CVD) death in the oldest old, and whether asymmetrical dimethylarginine (ADMA), a marker of endothelial dysfunction, moderated the association between the CPS and CVD death.


METHODS
We conducted a prospective cohort study of Japanese subjects aged ≥85 years without CVD at baseline. We followed this cohort for 6 years to investigate the association of CPS with CVD death via multivariable Cox proportional hazard analysis. We divided participants into three groups according to CPS (no, 0 points; low, 1.2-4.9 points; high, ≥5.0 points). The predictive value of CPS for estimating CVD death risk over CVD risk factors, including ADMA, was examined using C-statistics.


RESULTS
We analyzed 347 participants (151 men, 196 women; mean age, 87.6 years), of which 135 (38.9%) had no carotid plaque at baseline, and 48 (13.8%) had high CPS. Of the total, 29 (8.4%) participants experienced CVD-related death during the study period. Multivariable analysis revealed a significant association of high CPS with CVD-related mortality relative to no CPS (hazard ratio, 3.90; 95% confidence interval: 1.47-10.39). ADMA was not associated with CVD death, but the significant association between CPS and CVD death was observed only in lower ADMA level. The addition of CPS to other risk factors improved the predictability of CVD death (p=0.032).


CONCLUSIONS
High CPS correlated significantly with a higher CVD death risk in the oldest old with low cardiovascular risk. Ultrasound carotid plaque evaluation might facilitate risk evaluations of CVD death in the very old.
Center for Supercentenarian Medical Research, Keio University School of Medicine.
Takumi
T
Hirata
Center for Supercentenarian Medical Research, Keio University School of Medicine.
Yasumichi
Y
Arai
Center for Preventive Medicine, Keio University School of Medicine.
Michiyo
M
Takayama
Center for Supercentenarian Medical Research, Keio University School of Medicine.
Yukiko
Y
Abe
Department of Radiology, Keio University School of Medicine.
Kiyoshi
K
Ohkuma
Department of Preventative Medicine and Public Health, Keio University School of Medicine.
Toru
T
Takebayashi
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001120:Arginine / Q000031:analogs & derivatives / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality*; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
C018524:N,N-dimethylarginine; D001120:Arginine
Asymmetrical dimethylarginine; Cardiovascular disease; Carotid plaque score; Epidemiology; Oldest old