This proposal, the 2nd revision of a competing continuation last reviewed in March 2000, is an ancillary study to the Cardiovascular Health Study (CHS), a cohort study of risk factors for coronary disease and stroke in 5888 older adults. This revision addresses questions such confounding and interpretation raised by the Study Section. In CHS, medical conditions are well characterized, and participants are followed closely for events. CHS clinic visits, where medication data had been collected, ended in 1999, and the NHLBI plans to provide full support only for events follow-up for an additional 5 years. This project provides support to 4 Field Centers to continue to collect medication data by telephone interview and to CHS scientists to continue analyses of these data. In a pilot study of 74 subjects, agreement between in-clinic and telephone- interview medication inventories was excellent. The purpose is to assess use of cardiovascular medications and their associations with outcomes among older adults. To date, the project is associated with 26 publications and 7 presentations.
The aims, which focus on the use of cardiovascular medications and their association with events, are consistent with PA99-097 entitled, """"""""Diversity in Medication Use and Outcomes in Aging Populations."""""""" One innovative feature of this study is the age of the cohort. At baseline in 1989-90, the mean age of the CHS cohort was 72.8 years, and as of Oct 1999, the mean age of the survivors was 81.2 years: 2290 (55.9 percent) of the 4095 surviving CHS participants are 80 years of age or older. Over the last several decades, the results of randomized clinical trials and meta-analyses have helped to define optimal care for patients with cardiovascular disease or with risk factors for cardiovascular disease. Guidelines have been formulated for the care of patients with coronary disease or with risk factors such as elevated levels of cholesterol or blood pressure. But information about the implementation of guidelines or the effect of clinical trials on practice patterns is often lacking for older adults; and we also lack information about the efficacy and safety of most medications for older adults, especially the oldest old, who are the fastest growing segment of the US population.
The aim of this project is to describe the use of various cardiovascular medications and their association with outcomes among older adults. The project has good to excellent power for a number of hypotheses, including: the use of ACE inhibitors and beta- blockers in subjects with heart failure or coronary disease and their association with total mortality; the use of warfarin in patients with atrial fibrillation and their association with stroke or death; the use of blood pressure and lipid lowering medications and their association with cardiovascular events and cognitive function.
Showing the most recent 10 out of 59 publications
