A Risk Score for Cardiovascular Disease in Older Adults

心血管疾病是老年人死亡和发病的主要原因，老年人心血管疾病的初级预防是一个重要的公共卫生和政策问题。预防心血管疾病的第一步是评估心血管风险，因为预防干预的强度应该与个人的疾病风险相匹配。目前临床医生可用的风险评估工具(Framingham Risk Score)基于中青年，在老年人中表现不佳。此外，新的风险因素，如C-反应蛋白，不包括在Framingham风险评分中。因此，该项目的主要目标是开发专门为老年人设计的类似Framingham的风险评分；它将包括较新的风险因素，如C-反应蛋白，并使用适合老年人的风险因素权重。来自3个老年人队列(心血管健康研究、麦克阿瑟成功老龄化研究和兰乔·贝尔纳多研究)的纵向数据将用于开发、验证和测试预测心血管疾病风险的多风险因素评分。除了C反应蛋白，新的评分还将包括空腹血糖和中心性肥胖的测量，因为它们都与老年人发生心血管疾病的风险有很强的相关性。这项拟议的研究有望带来一个改进的评分系统，用于评估没有明确疾病的老年人的心血管风险，从而指导临床医生选择一级预防措施。从长远来看，这项研究应该会为手持电子设备带来袖珍图表和简单的软件，这些软件可以根据风险因素测量来计算患者的风险分数，并将该分数转化为发生疾病的绝对风险。公共卫生相关性：大量美国老年人没有临床公认的心血管疾病。他们中的许多人可能不需要积极的预防性干预。照顾这些老年人的老年病医生和其他初级保健医生一直在为是否开始使用他汀类药物和阿司匹林治疗而苦苦挣扎。拟议的研究将导致更好的风险评估和改善针对这些老年人的预防性干预措施。

Cardiovascular disease is a major cause of both mortality and morbidity in older adults, and primary prevention of cardiovascular disease in elderly individuals is an important public health and policy concern. The first step in preventing cardiovascular disease is the assessment of cardiovascular risk, since the intensity of preventive interventions should match the person's risk of disease. Risk assessment tools currently available to clinicians (the Framingham risk score) were based on middle-aged and younger adults, and do not perform well in older adults. Also, newer risk factors such as C-reactive protein are not included in the Framingham risk score. Therefore, the primary goal of this project is the development of a Framingham-like risk score specifically designed for use in older adults; it will include newer risk factors such as C-reactive protein, and use risk factor weights appropriate for older adults. Longitudinal data from 3 cohorts of older adults (Cardiovascular Health Study, MacArthur Study of Successful Aging, and Rancho Bernardo Study) will be used to develop, validate, and test a multiple-risk-factor score to predict the risk of incident cardiovascular disease. In addition to C-reactive protein, the new score will also include measures of fasting blood glucose and central obesity, as they both have strong associations with incident cardiovascular risk in older adults. The proposed research is expected to lead to an improved scoring system for assessment of cardiovascular risk in older adults without established disease that can guide clinicians in selecting interventions for primary prevention. In the long term, this research should lead to pocket charts and simple software for hand held electronic devices, that would compute a patient's risk score from risk factor measurements, and translate the score to absolute risk for incident disease. Public Health Relevance: A large number of older Americans do not have clinically recognized cardiovascular disease. Many of them probably do not need aggressive preventive interventions. Geriatricians and other primary care physicians taking care of such older adults have struggled with the question of whether or not to initiate therapy with statins and aspirin. The proposed research will lead to better risk assessment and to improved targeting of preventive interventions in these older adults.