Traditional risk factors for incident cardiovascular events have limited importance in later life compared with the health in men study cardiovascular risk score
Background and Purpose- This study aimed to determine, among older men, the risk and independent significant baseline prognostic factors for first-ever stroke and MI. Methods- We performed a prospective cohort study of 4382 community-dwelling older men (mean age, 75.4±4.2 years) with no history of s...
| Main Authors: | , , , , , |
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| Format: | Journal Article |
| Published: |
2011
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| Online Access: | http://hdl.handle.net/20.500.11937/29279 |
| _version_ | 1848752760717049856 |
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| author | Beer, C. Alfonso, Helman Flicker, L. Norman, P. Hankey, G. Almeida, O. |
| author_facet | Beer, C. Alfonso, Helman Flicker, L. Norman, P. Hankey, G. Almeida, O. |
| author_sort | Beer, C. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background and Purpose- This study aimed to determine, among older men, the risk and independent significant baseline prognostic factors for first-ever stroke and MI. Methods- We performed a prospective cohort study of 4382 community-dwelling older men (mean age, 75.4±4.2 years) with no history of stroke or MI. Baseline data comprised questionnaire responses, clinical measurements, and comorbidity. Results- After a median of 6 years (interquartile range, 5.2-7.2) of follow-up, the overall rate of stroke/MI was 2.61 (95% CI, 2.42-2.81) per 100 person-years. Among major traditional risk prediction variables, only age and smoking were significantly associated with stroke/MI. In our final multivariate model, the independent significant predictors of stroke/MI were age (HR for age older than 85, 3.18; 95% CI, 2.05-4.93), diastolic blood pressure <70 mm Hg (Hazard ratio [HR], 1.45; 95% CI, 1.18-1.78), high-sensitivity C-reactive protein >3 mg/L (HR, 1.29; 95% CI, 1.05-1.59), homocysteine >15 umol/L (HR, 1.35; 95% CI, 1.09-1.67), waist-to-hip ratio >1 (HR, 1.47; 95% CI, 1.20-1.18), and fair or poor self-reported health (HR, 1.52; 95% CI, 1.19-1.94). A new risk model incorporating these variables performed well compared with the Framingham risk equation (Harrell C of 0.660 versus C of 0.620; integrated discrimination improvement of 1.85%; z=4.95; P<0.001; net reclassification index of 0.08; z=2.0; P=0.023). The model was used to develop an 8- point clinical risk score comprising the independent predictors of stroke/MI among this population. Conclusions- Traditional vascular risk factors did not optimally predict stroke/MI among this cohort of community-dwelling older men. We have constructed a new risk score that requires validation in other data sets. © 2011 American Heart Association. All rights reserved. |
| first_indexed | 2025-11-14T08:13:45Z |
| format | Journal Article |
| id | curtin-20.500.11937-29279 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T08:13:45Z |
| publishDate | 2011 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-292792017-09-13T15:23:05Z Traditional risk factors for incident cardiovascular events have limited importance in later life compared with the health in men study cardiovascular risk score Beer, C. Alfonso, Helman Flicker, L. Norman, P. Hankey, G. Almeida, O. Background and Purpose- This study aimed to determine, among older men, the risk and independent significant baseline prognostic factors for first-ever stroke and MI. Methods- We performed a prospective cohort study of 4382 community-dwelling older men (mean age, 75.4±4.2 years) with no history of stroke or MI. Baseline data comprised questionnaire responses, clinical measurements, and comorbidity. Results- After a median of 6 years (interquartile range, 5.2-7.2) of follow-up, the overall rate of stroke/MI was 2.61 (95% CI, 2.42-2.81) per 100 person-years. Among major traditional risk prediction variables, only age and smoking were significantly associated with stroke/MI. In our final multivariate model, the independent significant predictors of stroke/MI were age (HR for age older than 85, 3.18; 95% CI, 2.05-4.93), diastolic blood pressure <70 mm Hg (Hazard ratio [HR], 1.45; 95% CI, 1.18-1.78), high-sensitivity C-reactive protein >3 mg/L (HR, 1.29; 95% CI, 1.05-1.59), homocysteine >15 umol/L (HR, 1.35; 95% CI, 1.09-1.67), waist-to-hip ratio >1 (HR, 1.47; 95% CI, 1.20-1.18), and fair or poor self-reported health (HR, 1.52; 95% CI, 1.19-1.94). A new risk model incorporating these variables performed well compared with the Framingham risk equation (Harrell C of 0.660 versus C of 0.620; integrated discrimination improvement of 1.85%; z=4.95; P<0.001; net reclassification index of 0.08; z=2.0; P=0.023). The model was used to develop an 8- point clinical risk score comprising the independent predictors of stroke/MI among this population. Conclusions- Traditional vascular risk factors did not optimally predict stroke/MI among this cohort of community-dwelling older men. We have constructed a new risk score that requires validation in other data sets. © 2011 American Heart Association. All rights reserved. 2011 Journal Article http://hdl.handle.net/20.500.11937/29279 10.1161/STROKEAHA.110.603480 unknown |
| spellingShingle | Beer, C. Alfonso, Helman Flicker, L. Norman, P. Hankey, G. Almeida, O. Traditional risk factors for incident cardiovascular events have limited importance in later life compared with the health in men study cardiovascular risk score |
| title | Traditional risk factors for incident cardiovascular events have limited importance in later life compared with the health in men study cardiovascular risk score |
| title_full | Traditional risk factors for incident cardiovascular events have limited importance in later life compared with the health in men study cardiovascular risk score |
| title_fullStr | Traditional risk factors for incident cardiovascular events have limited importance in later life compared with the health in men study cardiovascular risk score |
| title_full_unstemmed | Traditional risk factors for incident cardiovascular events have limited importance in later life compared with the health in men study cardiovascular risk score |
| title_short | Traditional risk factors for incident cardiovascular events have limited importance in later life compared with the health in men study cardiovascular risk score |
| title_sort | traditional risk factors for incident cardiovascular events have limited importance in later life compared with the health in men study cardiovascular risk score |
| url | http://hdl.handle.net/20.500.11937/29279 |