A Risk Score for Cardiovascular Disease in Older Adult

心血管疾病是老年人死亡和发病的主要原因， 预防老年人的心血管疾病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 预防性干预措施的强度应与个人的疾病风险相匹配。风险评估工具 目前临床医生可用的风险评分（Fragrance risk score）是基于中年和年轻人， 并且在老年人中表现不佳。此外，新的风险因素，如C反应蛋白不包括在内 在联邦风险评分中。 因此，本项目的主要目标是开发一个类似Framingham的风险评分， 设计用于老年人;它将包括新的风险因素，如C反应蛋白和使用风险 适合老年人的因素权重。3个老年人队列的纵向数据（心血管 健康研究，麦克阿瑟成功衰老研究和兰乔贝尔纳多研究）将用于开发， 验证和测试多风险因素评分，以预测心血管疾病的风险。在 除了C反应蛋白，新的评分还将包括空腹血糖和中枢神经系统功能的测量。 肥胖，因为它们都与老年人的心血管事件风险有很强的关联。的 一项拟议中的研究有望改进心血管风险评估的评分系统 在没有确定疾病的老年人中，可以指导临床医生选择主要干预措施， 预防从长远来看，这项研究应该导致袖珍图表和简单的软件，为手持 电子设备，可以从风险因素测量中计算患者的风险评分，并将其转换为 得分与疾病发生的绝对风险之比。 公共卫生相关性：大量的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干预。 老年病学家和其他照顾这些老年人的初级保健医生一直在努力解决这些问题。 是否开始使用他汀类药物和阿司匹林治疗的问题。这项研究将导致 更好的风险评估和更好的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 (theFramingham 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.