The population in the U.S. is aging. Data are sparse on cardiovascular disease in older adults, especially the oldest old, who are expected to number 18 million by 2050. The age at first myocardial infarction (MI) is increasing substantially, now to about age 71, and most of the cardiovascular disease (CVD) deaths in the U.S. occur in older individuals. CVD is the single most important cost of medical care in the US. In the early 1990s, the Cardiovascular Health Study (CHS), an NHLBI-supported cohort study of risk factors for coronary heart disease (CHD) and stroke in adults 65 years or older, recruited 5888 participants, who underwent extensive examinations at baseline and annually until 1999. Examinations included traditional risk factors as well as measures of subclinical disease. Since 1990, CHS has made major contributions to the understanding of CVD in older individuals, including the risks associated with subclinical disease, inflammation, diabetes, hypertension and renal disease. In 2008, CHS has the unique opportunity of evaluating clinical CHD in the oldest old-- MI, angina, heart failure (HF), atrial fibrillation-- and their contributions to both morbidity and mortality. In this competing continuation, the primary aim is to evaluate the incidence and determinants of cardiovascular disease and health in 1964 surviving participants aged 80 or older. The incidence of CVD in the oldest old will be related to demographic variables;measures of disability, physical functioning, and cognitive function;measures of subclinical disease;and traditional and novel clinical risk factors as well as their change over time. The data collection proposed in this application will increase the number of events in those 80 years and older by about 50% to 75% for stroke, CHD and HF. Power for assessing associations with stroke, CHD and HF is increased by 15 to 30%. The continued assessment of cardiovascular events is essential to identify determinants of successful cardiovascular aging among the oldest old.
Additional knowledge about the determinants of cardiovascular health and disease in older adults will help physicians and their patients make diagnostic, prognostic, and therapeutic decisions. PROJECT/
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