Absolute Cardiovascular Disease Risk Assessed in Old Age Predicts Disability and Mortality: A Retrospective Cohort Study of Community-Dwelling Older Adults

Background Evidence is limited on the predictive validity of absolute cardiovascular disease (CVD) risk, estimated by multivariable assessments in old age, for disability and mortality. We aimed to examine the longitudinal associations of absolute CVD risk assessed using region-specific risk estimation charts with disability and mortality among community-dwelling people aged >= 65 years. Methods and Results This retrospective cohort study included 7456 community-dwelling people aged >= 65 years (mean age, 73.7 years) without CVD and functional decline at baseline. They lived in either Obu City or Midori Ward of Nagoya City, Aichi Prefecture, Japan. We estimated absolute CVD risk using the revised World Health Organization CVD risk estimation charts and stratified risk levels into 3 categories: low (<10%), mid (10% to <20%), and high (>= 20%). We followed up the functional disability incidence and all-cause mortality monthly for 5 years. The prevalence of each CVD risk level based on the laboratory-based model was as follows: low CVD risk, 1096 (14.7%); mid CVD risk, 5510 (73.9%); and high CVD risk, 850 (11.4%). During follow-up, the incidence rates of disability and mortality were 33.4 per 1000 and 12.4 per 1000 person-years, respectively. Cox regression analysis showed that the adjusted hazard ratios (95% CIs) for disability incidence were 1.32 (1.13-1.56) and 1.44 (1.18-1.77) in mid and high CVD risk levels, respectively (reference: low CVD risk level); for mortality incidence, they were 1.53 (1.16-2.01) and 2.02 (1.45-2.80) in mid and high CVD risk levels, respectively (reference: low CVD risk level). Conclusions Absolute CVD risk was associated with both disability and mortality in people aged >= 65 years. Estimated CVD risk levels may be useful surrogate markers for disability and mortality risks even when assessed in old age.

Automated summary

Limited evidence exists on the predictive validity of absolute cardiovascular disease (CVD) risk in predicting disability and mortality in old age. This study of over 7000 community-dwelling individuals aged 65 and older found that higher levels of absolute CVD risk were associated with increased risks of disability and mortality, suggesting that estimated CVD risk levels may serve as surrogate markers for these outcomes even in old age.