Cardiovascular Health Study - CHS
A population based longitudinal study of coronary heart disease and stroke in adults aged 65 years and older
To determine the incidence, risk factors and outcomes associated with coronary heart disease and stroke in older adults.
Patients Enrolled: 5888
Mean Follow Up: up to 11 years
Mean Patient Age: 65-100 years
Resident of Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; or Pittsburgh, Pennsylvania. Age 65 years or older at the time of examination Noninstitutionalized Expected to remain in the area for the next 3 years Able to give informed consent and did not require a proxy respondent at baseline
Wheelchair-bound in the home at baseline Receiving hospice treatment, radiation therapy or chemotherapy for cancer at baseline
myocardial infarction, angina pectoris, congestive heart failure, peripheral vascular disease, stroke, TIA, all-cause mortality
Physical and laboratory evaluations were performed at baseline to identify the presence and severity of CVD risk factors such as hypertension, hypercholesterolemia and glucose intolerance; subclinical disease such as carotid artery atherosclerosis, left ventricular enlargement, and transient ischemia; and clinically overt CVD.
Predictors of first MI: The incidence of first myocardial infarction at average of 4.8 years follow-up was higher in men (20.7 per 1000 person-years) than women (7.9 per 1000 person-years). The incidence was strongly associated with age, increasing from 7.8 to 25.6 per 1000 person-years in subjects age 65-69 years vs >=85 years. 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. Predictors of development of CHF: During an average follow-up of 5.5 years, the incidence of development of CHF was 19.3/1,000 person-years. The incidence of CHF increased progressively across age groups and was greater in men than in women. On multivariate analysis, other independent predictors included prevalent coronary heart disease, stroke or transient ischemic attack at baseline, diabetes, systolic blood pressure, forced expiratory volume 1 s, creatinine >1.4 mg/dl, CRP, ankle-arm index <0.9, atrial fibrillation, ECG left ventricular mass, ECG ST-T segment abnormality, internal carotid artery wall thickness and decreased LV systolic function.
Systolic blood pressure, fasting glucose level, and selected subclinical disease measures were important correlates of MI in older adults. Uncontrolled high blood pressure may explain about one quarter of the coronary events in this population. The incidence of CHF is high in the elderly and is related mainly to age, gender, clinical and subclinical coronary heart disease, systolic BP and inflammation. The Cardiovascular Health Study is an extensive source of information on prevalence of coronary disease in the elderly and has identified numerous risk factors specific to this population.
Ann Epidemiol 1991;1:263-276. Study design JAMA 1998;279:585-592. Risk factors for 5-year mortality in older adults Arch Intern Med 1999 Jun 28;159(12):1339-47. Predictors of first myocardial infarction in older adults J Am Coll Cardiol 2000 May;35(6):1628-37. Predictors of CHF in the elderly Stroke 1998;29:887-894. Aspirin use and incident stroke A list of all published CHS trials is located at http://chs3.chs.biostat.washington.edu/chs/chsbio.htm
Keywords: Washington, Ischemic Attack, Transient, Coronary Disease, Blood Pressure, Risk Factors, Electrocardiography, Creatinine, Glucose, Pennsylvania, Maryland, Glucose Intolerance, California, Hypertension, Echocardiography, Inflammation, Myocardial Infarction, Stroke, Atherosclerosis, Lipids, Carotid Artery Diseases, Hypercholesterolemia, Carotid Artery, Internal, Smoking, Informed Consent, Fasting, Diabetes Mellitus, North Carolina
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