Prevalence of Subclinical Atherosclerosis and Cardiovascular Disease and Association with Risk Factors in the Cardiovascular Health Study

TLDR

Older adults with subclinical atherosclerosis may be at high risk for clinical cardiovascular events, suggesting targeted preventive interventions. The study assessed 5,201 adults aged ≥65 years using a composite index of ECG, echocardiography, carotid ultrasound, ankle‑brachial index, and Rose questionnaire to define subclinical atherosclerosis. Subclinical disease was present in 36% of women and 38.7% of men, rising with age, and was associated with LDL, systolic blood pressure, glucose, and smoking (and inversely with HDL), mirroring risk factors for clinical disease in younger adults, particularly among women.

Abstract

The prevalence of subclinical atherosclerosis and cardiovascular disease was evaluated among the 5,201 adults aged ≥65 years in four communities participating in the Cardiovascular Health Study from June 1989 through May 1990. A combined index based on electrocardiogram and echocardiogram abnormalities, carotid artery wall thickness and stenosis based on carotid ultrasound, decreased ankle-brachial blood pressure, and positive response to a Rose Questionnaire for angina or intermittent claudication defined subclinical disease. The prevalence of subclinical disease was 36% in women and 38.7% in men and increased with age. Among women, low-density lipoprotein cholesterol, systolic blood pressure, blood glucose, and cigarette smoking were positively associated, and high-density lipoprotein cholesterol negatively associated, with subclinical disease. In men, systolic blood pressure, blood glucose, and ciga-rette smoking were independent risk factors in multiple logistic regression analyses. The risk factors for subclinical disease are, therefore, similar to those for clinical disease at younger ages, especially among women. It is possible that older individuals with subclinical disease are at very high risk of developing clinical disease and that more aggressive interventions to prevent clinical disease should be oriented to individuals with subclinical disease.