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.
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