Traditional Risk Factors Predictive of Cardiovascular Disease Mortality in the Elderly

Authors

Keywords:

older adult, cardiovascular disease, risk factors, mortality.

Abstract

Introduction: Cardiovascular disease mortality in older adults is highly attributable to an increased burden of identified risk factors.

Objectives: To evaluate the association between traditional risk factors and cardiovascular mortality and to internally validate a predictive model to estimate the probability of death from cardiovascular causes.

Methods: An observational, analytical, case-control study was carried out in older adult patients belonging to three health areas of the municipality of Santiago de Cuba during the year 2021. The cases were those who died of atherosclerotic cardiovascular disease and another group of living elderly patients with no history of such diseases (controls). The sample consisted of 182 cases and 546 controls, with the ratio of cases to controls (1:3). Data analysis was based on the construction of a multivariate model (multivariable logistic regression) to identify predictors of mortality.

Results: Smoking [OR = 4.129;(2.462-6.924); p = 0.000], unhealthy diet [OR = 2.825; (1.753-4.552); p = 0.000], sedentary lifestyle [OR = 3.092; (1.898-5.037); p = 0.000], diabetes mellitus [OR = 1.883; (1.141-3.109); p = 0.013] and chronic kidney disease [OR = 2.217; (1.289-3.811); p = 0.004] are the five predictors that were part of the model.

Conclusions: Traditional risk factors such as smoking, diabetes mellitus and underlying risk factors such as sedentary lifestyle, unhealthy diet and chronic kidney disease are powerful risk predictors of CVD mortality in older adults. The proposed model showed good calibration ability and performance.

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References

Oficina Nacional de Estadística e Información (ONEI). El envejecimiento de la población. Cuba y sus territorios 2020. Centro de estudios de población y desarrollo. Cuba. 2021 [acceso 17/02/2022]. Disponible en: 000_envejecimiento_de_la_poblacion.2020.pdf (gob.cu)

Paramio A, Aguilera-García L, Carrazana-Garcés E, Hernández-Navas M. Riesgo cardiovascular global en tres casas de abuelos del municipio Boyeros. Rev. Cuba. de Medicina Gen. Integral. 2021 [acceso 17/02/2022];37(4):e1417. Disponible en: http://www.revmgi.sld.cu/index.php/mgi/article/view/1417

Neumann JT, Thao LTP, Callander E, Chowdhury E, Williamson JD, Nelson MR, et al. Cardiovascular riskprediction in healthyolderpeople. Geroscience. 2022 [acceso 17/02/2022];44(1):403-13. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34762275

Ministerio de Salud Pública. Dirección nacional de registros médicos y estadísticas de salud. Anuario estadístico. 2020 [acceso 17/02/2022]. Disponible en: https://temas.sld.cu/.../2021/08/11/anuario-estadistico-de-salud-2020

Díaz A, Rodríguez A, García R, Carbonell I, Achiong F. Resultados de una intervención para la mejora del control de la hipertensión arterial en cuatro áreas de salud. Rev. Finlay. 2018 [acceso 17/02/2022];8(3):180-9. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2221-24342018000300002&lng=es

Dyakova M, Shantikumar S, Colquitt JL, Drew C, Sime M, MacIver J, et al. Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2016. [acceso 17/02/2022];(1):CD010411. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494380/

Van EF, Hoevenaar MP, Pobretvliet RKE, Gussekloo J, Van JV, Van WA. Predictive value of traditional risk factors for cardiovascular disease in older people: A systematic review. Preventive Med. 2020 [acceso 17/02/2022];132:105986. Disponible en: https://www.sciencedirect.com/science/article/pii/S0091743520300104?via%3Dihub

Dalton JE, Rothberg MB, Dawson NV, Krieger NI, Zidar DA, Perzynski AT. Failure of Traditional Risk Factors to Adequately Predict Cardiovascular Events in Older Populations. AGS. 2020 [acceso 17/02/2022];68(4):754-61. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156319/

Núñez E, Steyerberg EW, Núñez J. Estrategias para la elaboración de modelos estadísticos de regresión. Rev Esp Cardiol. 2011;64(6):501-7. DOI: https://doi.org/10.1016/j.recesp.2011.01.019

De Jong VM, Eijkemans MJ, Van Calster B, Timmerman D, Moons KG, Steyerberg EW, et al. Sample size considerations and predictive performance of multinomial logistic prediction models. Statist Med. 2019;38(9):1601-19. DOI: https://doi.org/10.1002/sim.8063

Schröder H, Fitó M, Estruch R, Martínez MA, Corella D, Salas J, et al. A Short Screener Is Valid for Assessing Mediterranean Diet Adherence among Older Spanish Men and Women. J Nutr. 2011; 141(6):1140-5. DOI: https://doi.org/10.3945/jn.110.135566 .

Asociación Médica Mundial. Declaración de Helsinki de la Asociación Médica Mundial - Principios éticos para las investigaciones médicas en seres humanos. Fortaleza: 64a Asamblea General, octubre 2013. 2013 [acceso 17/02/2022]. Disponible en: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/

Espinosa AD. Revalorando el papel de las guías de práctica clínica. Rev Finlay. 2017 [acceso 17/02/2022];7(2):128-40. Disponible en: http://www.revfinlay.sld.cu/index.php/finlay/article/vie w/473

Orkaby AR, Onuma O, Qazi S, Gaziano JM, Driver JA. Preventing cardiovascular disease in older adults: one size does not fit all. Cleve Clin J Med 2018 [acceso 17/02/2022];85:55-64. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29328899

Maciel de Lima AP, Schneider BC, Bertoldi AD, Tomasi E, González MC, Demarco FF, et al. Behavior al risk factors for NCDs and mortality among older adults in Brazil. Clin Nutr ESPEN. 2021 [acceso 17/02/2022];45:462-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34620356

Ferreira TC, Coimbra AM, Falsarella GR, Costallat LT, Coimbra IB. Mortality in Brazilian community-dwelling older adults: 7 years of follow up in primar ycare. Geriatr Gerontol Int 2016 [acceso 17/02/2022];16(7):804e9. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26245155

Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies from 90 Countries. 2016;134(6):441-50. DOI: https://doi.org/10.1161/CIRCULATIONAHA.115.018912

Mons U, Muezzinler A, Gellert C, Schottker B, Abnet CC, Bobak, M, et al. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ. 2015 [acceso 17/02/2022];350:1551. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25896935

Bays HE, Kulkarni A, German CH, Satish P, Iluyomade A, Dudum R, et al. Ten things to know about ten cardiovascular disease risk factors–2022. American Journal of Preventive Cardiology. 2022 [acceso 22/08/2022];10: 100342. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9061634/

Chia YC, Lim HM, Ching SM. Use of chronic kidney disease to enhance prediction of cardiovascular risk in those at medium risk. PLoS One. 2015 [acceso 17/02/2022];10:e0141344. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26496190

Benetos A, Bulpitt CJ, Petrovic M, Ungar A, Rosei EA, QuerubinÍn A, et al. An expert opinion from the European society of hypertension-European Union Geriatric Medicine Society Working Group on the Management of Hypertension in veryo ld, Frail Subjects. Hypertension 2016 [acceso 17/02/2022];67(5):820-5. Disponible en: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.115.07020?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Oates DJ, Berlowitz DR, Glickman ME, Silliman RA, Borzecki AM. Bloodpressure and survival in theoldestold. J Am Geriatr Soc. 2007 [acceso 17/02/2022];55:383-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/17341240

Kagiyama S, Fukuhara M, Ansai T, et al. Association between blood pressure and mortality in 80-year-old subjects from a prospective population-based study in Japan. Hypertens Res. 2008 [acceso 17/02/2022];31:265-70. Disponible en: https://pubmed.ncbi.nlm.nih.gov/18360046

Chang O, Figueredo K, Murillo T. Hipercolesterolemia en el adulto mayor. Rev. Cuba. de Medicina Gen. Integral. 2020 [acceso 17/02/2022];36(3). Disponible en: http://www.revmgi.sld.cu/index.php/mgi/article/view/1211

Rodondi N, Locatelli I, Aujesky D, Butler J, Vittinghoff E, Simonsick E, et al. Framingham risk score and alternatives for prediction of coronary heart disease in older adults. PLoS ONE. 2012 [acceso 17/02/2022];7(3):e34287. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314613/

Sperrin M, Martin GP, Pate A, Van T, Peek N, Buchan I. Using marginal structural models to adjust for treatment drop-in when developing clinical prediction models. Stat. Med. 2018 [acceso 17/02/2022];37(28):4142-54. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282523

Lind L, Sundstrom J, Arnlov J, Lampa E. Impact of Aging on the Strength of Cardiovascular Risk Factors: A Longitudinal Study Over 40 Years. J Am Heart Assoc. 2018; 7(1):e007061. DOI: 10.1161/JAHA.117.007061

Ahmadi SF, Streja E, Zahmatkesh G, Streja D, Kashyap M, Moradi H, et al. Reverse epidemiology of traditional cardiovascular risk factors in the geriatric population. J. Am. Med. Dir. Assoc. 2015 [acceso 17/02/2022];16(11):933-9. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636955/

Triantafyllou A, Douma E. Evaluación del riesgo cardiovascular en ancianos sin enfermedad ECV manifiesta. ¿Podrían los factores de riesgo tradicionales encajar en todas las edades? JCH. 2019 [acceso 17/02/2022];21(8):1153-4. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13616

Simons LA, Simons J, Friedlander Y, McCallum J, Palaniappan L. Risk functions for prediction of cardiovascular disease in elderly Australians: the Dubbo Study. Med J Aust. 2003 [acceso 17/02/2022];178(3):113-6.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133925/

Fried LP, Kronmal RA, Newman AB, Bild DE, Mittelmark MB, Polak JF, et al. Risk factorsf or 5-year mortality in older adults: the Cardiovascular Health Study. JAMA. 1998 [acceso 17/02/2022];279(8):585-92. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/187277

Benetos A, Petrovic M, Strandberg T. Hypertension management in older and frail older patients. Circ Res. 2019 [acceso 17/02/2022];124(7):1045-60.Disponible en: https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.118.313236?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org.

Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Back M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-337. DOI: 10.1093/eurheartj/ehab484

Published

2023-09-24

How to Cite

1.
Hierrezuelo Rojas N, del Rio Caballero G, Hernández Magdariaga A, Bonal Ruiz R. Traditional Risk Factors Predictive of Cardiovascular Disease Mortality in the Elderly. Rev. cuba. cardiol. cir. cardiovasc. [Internet]. 2023 Sep. 24 [cited 2025 Mar. 9];29(3):e2189. Available from: https://revcardiologia.sld.cu/index.php/revcardiologia/article/view/2189

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