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Lewis H. Kuller, MD, DrPH; Alice M. Arnold, PhD; Bruce M. Psaty, MD, PhD; John A. Robbins, MD; Daniel H. O’Leary, MD; Russell P. Tracy, PhD; Gregory L. Burke, MD, MS; Teri A. Manolio, MD, PhD; Paolo H. M. Chaves, MD

Arch Intern Med. 2006;166:71-78.

Background  The incidence of coronary heart disease (CHD) is very high among individuals 65 years or older.

Methods  We evaluated the relationships between measurements of subclinical disease at baseline (1989-1990) and at the third-year follow-up examination (1992-1993) and subsequent incidence of cardiovascular disease and total mortality as of June 2001. Approximately 61% of the participants without clinical cardiovascular disease at baseline had subclinical disease based on our previously described criteria from the Cardiovascular Health Study.

Results  The incidence of CHD was substantially increased for participants with subclinical disease compared with those who had no subclinical disease: 30.5 per 1000 person-years with and 16.3 per 1000 person-years without for white individuals, and 31.2 per 1000 person-years with and 12.5 per 1000 person-years without for black individuals. The risk persisted over the entire follow-up period. Incidence rates were higher for men than for women with or without subclinical disease, but there was little difference in rates for black individuals and white individuals.

Conclusions  In multivariable models, subclinical disease at baseline remained a significant predictor of CHD in both men and women; the hazard ratios (95% confidence intervals) of their relative risks were 1.64 (1.30-2.06) and 1.49 (1.21-1.84), respectively. The presence of subclinical disease substantially increased the risk of subsequent CHD for participants with hypertension, diabetes mellitus, or elevated C-reactive protein. In summary, subclinical disease is very prevalent among older individuals, is independently associated with risk of CHD even over a 10-year follow-up period, and substantially increases the risk of CHD among participants with hypertension or diabetes mellitus.

Author Affiliations: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Kuller); Departments of Biostatistics (Dr Arnold), Medicine (Dr Psaty), and Epidemiology (Dr Psaty), University of Washington, Seattle; Division of General Medicine, University of California–Davis, Sacramento (Dr Robbins); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (Dr O’Leary); Departments of Pathology and Biochemistry, University of Vermont, Colchester (Dr Tracy); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (Dr Burke); Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Manolio); Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, Md (Dr Chaves).

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