10-Year follow-up of subclinical cardiovascular disease and risk of coronary heart disease in the cardiovascular health study

Lewis H. Kuller, Alice M. Arnold, Bruce M. Psaty, John A Robbins, Daniel H. O'Leary, Russell P. Tracy, Gregory L. Burke, Teri A. Manolio, Paolo H M Chaves

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)71-78
Number of pages8
JournalArchives of Internal Medicine
Volume166
Issue number1
DOIs
StatePublished - Jan 9 2006

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Coronary Disease
Cardiovascular Diseases
Health
Incidence
Diabetes Mellitus
Hypertension
Cerebral Palsy
C-Reactive Protein
Confidence Intervals
Mortality

ASJC Scopus subject areas

  • Internal Medicine

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10-Year follow-up of subclinical cardiovascular disease and risk of coronary heart disease in the cardiovascular health study. / Kuller, Lewis H.; Arnold, Alice M.; Psaty, Bruce M.; Robbins, John A; O'Leary, Daniel H.; Tracy, Russell P.; Burke, Gregory L.; Manolio, Teri A.; Chaves, Paolo H M.

In: Archives of Internal Medicine, Vol. 166, No. 1, 09.01.2006, p. 71-78.

Research output: Contribution to journalArticle

Kuller, Lewis H. ; Arnold, Alice M. ; Psaty, Bruce M. ; Robbins, John A ; O'Leary, Daniel H. ; Tracy, Russell P. ; Burke, Gregory L. ; Manolio, Teri A. ; Chaves, Paolo H M. / 10-Year follow-up of subclinical cardiovascular disease and risk of coronary heart disease in the cardiovascular health study. In: Archives of Internal Medicine. 2006 ; Vol. 166, No. 1. pp. 71-78.
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abstract = "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.",
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N2 - 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.

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