Although older individuals have the highest absolute risk for cardiovascular disease (CVD) events, U.S. cholesterol and blood pressure guidelines recommend lower-intensity, less-aggressive treatment in this high- risk population based on limited clinical trial data and potential for more side effects. The current risk prediction equation does not include individuals aged >79 years, nor does it include heart failure (HF), a more common CVD event in older individuals than myocardial infarction or stroke. Recent trials have demonstrated greater absolute CVD risk reduction in older high-risk participants, underscoring the need for improved risk assessment to inform treatment decisions and patient?physician discussions regarding therapy. Cardiac biomarkers have been shown to identify higher-risk individuals and to improve HF risk prediction beyond traditional risk factors in middle-aged adults in the Atherosclerosis Risk in Communities (ARIC) Study. In the proposed work, we will develop risk prediction tools for atherosclerotic CVD and HF tailored for very old adults, including cardiac biomarker measurements, to provide more comprehensive CVD risk assessment and to allow more precise assessment of potential benefits and risks of therapy as well as midlife lifestyle, demographic, and clinical factors that lead to healthy cardiovascular aging. In addition to data on traditional risk factors and CVD events from ARIC, we propose to measure biomarkers of cardiac injury, stress, fibrosis, and inflammation in all ARIC participants who attended the most recent visit (visit 5: 2011?2013; most aged ?70 years) and the upcoming visits (visit 6: n=4,214, 2016?2017, most aged ?75 years; visit 7: n=3,827, 2018?2019) to address our aims: 1: To assess the performance of the Pooled Cohort Equation risk calculator for atherosclerotic CVD in very old adults and to develop an improved risk calculator using the best circulating biomarkers and risk factor panel; 2: To quantify and compare risk of HF versus atherosclerotic CVD, develop risk prediction tools for incident HF in very old adults and a comprehensive tool for HF, myocardial infarction, and stroke for primary prevention; 3: To identify major midlife factors leading to ?healthy cardiovascular aging,? defined as the absence of clinical CVD events and elevated cardiac biomarkers.

Public Health Relevance

Despite the high prevalence of cardiovascular disease (CVD) events, especially heart failure (HF), in older individuals, current risk assessment and treatment algorithms have major gaps in evidence for this high-risk population. Using data from the Atherosclerosis Risk in Communities (ARIC) Study, we propose to develop risk prediction tools for atherosclerotic CVD and HF tailored for very old adults, to provide more comprehensive CVD risk assessment and to allow more precise assessment of potential benefits and risks of therapy. In addition to traditional risk factors, we propose to measure biomarkers of cardiac injury, stress, fibrosis, and inflammation to refine risk assessment and to identify factors that lead to healthy cardiovascular aging.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL134320-02
Application #
9277554
Study Section
Cancer, Heart, and Sleep Epidemiology A Study Section (CHSA)
Program Officer
Wright, Jacqueline
Project Start
2016-09-01
Project End
2020-06-30
Budget Start
2017-07-01
Budget End
2018-06-30
Support Year
2
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Baylor College of Medicine
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
051113330
City
Houston
State
TX
Country
United States
Zip Code
77030
Fretz, Anna; McEvoy, John W; Rebholz, Casey M et al. (2018) Relation of Lifestyle Factors and Life's Simple 7 Score to Temporal Reduction in Troponin Levels Measured by a High-Sensitivity Assay (from the Atherosclerosis Risk in Communities Study). Am J Cardiol 121:430-436
Rebholz, Casey M; Selvin, Elizabeth; Liang, Menglu et al. (2018) Plasma galectin-3 levels are associated with the risk of incident chronic kidney disease. Kidney Int 93:252-259
Saeed, Anum; Nambi, Vijay; Sun, Wensheng et al. (2018) Short-Term Global Cardiovascular Disease Risk Prediction in Older Adults. J Am Coll Cardiol 71:2527-2536
Roetker, Nicholas S; MacLehose, Richard F; Hoogeveen, Ron C et al. (2018) Prospective Study of Endogenous Hormones and Incidence of Venous Thromboembolism: The Atherosclerosis Risk in Communities Study. Thromb Haemost 118:1940-1950
Fashanu, Oluwaseun E; Folsom, Aaron R; Oyenuga, Abayomi et al. (2017) Galectin-3 and the incidence of abdominal aortic aneurysm: the atherosclerosis risk in communities (ARIC) study. Am J Cardiovasc Dis 7:114-121
Fashanu, Oluwaseun E; Heckbert, Susan R; Aguilar, David et al. (2017) Galectin-3 and Venous Thromboembolism Incidence: the Atherosclerosis Risk in Communities (ARIC) Study. Res Pract Thromb Haemost 1:223-230