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The Cardiovascular Health Study

Bruce M. Psaty, MD, PhD; Curt D. Furberg, MD, PhD; Lewis H. Kuller, MD, DrPH; Diane E. Bild, MD, MPH; Pentti M. Rautaharju, MD, PhD; Joseph F. Polak, MD, MPH; Edwin Bovill, MD; John S. Gottdiener, MD

Arch Intern Med. 1999;159:1339-1347.

Background  Risk factors for myocardial infarction (MI) have not been well characterized in older adults, and in estimating risk, we sought to assess the individual and joint contributions made by both traditional risk factors and measures of subclinical disease.

Methods  In the Cardiovascular Health Study, we recruited 5888 adults aged 65 years and older from 4 US centers. At baseline in 1989-1990, participants underwent an extensive examination that included traditional risk factors such as blood pressure and fasting glucose level and measures of subclinical disease as assessed by electrocardiography, carotid ultrasonography, echocardiography, pulmonary function, and ankle-arm index. Participants were followed up with semiannual contacts, and all cardiovascular events were classified by the Morbidity and Mortality Committee. The main analytic technique was the Cox proportional hazards model.

Results  At baseline, 1967 men and 2979 women had no history of an MI. After follow-up for an average of 4.8 years, there were 302 coronary events, which included 263 patients with MI and 39 with definite fatal coronary disease. The incidence was higher in men (20.7 per 1000 person-years) than women (7.9 per 1000 person-years). In all subjects, the incidence was strongly associated with age, increasing from 7.8 per 1000 person-years in subjects aged 65 to 69 years to 25.6 per 1000 person-years in subjects aged 85 years and older. Glucose level and systolic blood pressure were associated with the incidence of MI, but smoking and lipid measures were not. After adjustment for age and sex, the significant subclinical disease predictors of MI were borderline or abnormal ejection fraction by echocardiography, high levels of intimal-medial thickness of the internal carotid artery, and a low ankle-arm index. Forced vital capacity and electrocardiographic left ventricular mass did not enter the stepwise model. Excluding subjects with clinical cardiovascular diseases such as prior angina or congestive heart failure at baseline had little effect on these results. Risk factors were generally similar in men and women.

Conclusions  After follow-up of 4.8 years, systolic blood pressure, fasting glucose level, and selected subclinical disease measures were important predictors of the incidence of MI in older adults. Uncontrolled high blood pressure may explain about one quarter of the coronary events in this population.

From the Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Wash (Dr Psaty); Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC (Drs Furberg and Rautaharju); Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Kuller); Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Bild); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (Dr Polak); Department of Pathology, University of Vermont, Colchester (Dr Bovill); Division of Cardiology, Georgetown University Medical Center, Washington, DC (Dr Gottdiener). A list of participating institutions and principal staff of the Cardiovascular Health Study appears at the end of the article.

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