03265nas a2200457 4500008004100000022001400041245012300055210006900178260001300247300001300260490000700273520196100280653000902241653002202250653001002272653002502282653002602307653002402333653001102357653002202368653001602390653001102406653002002417653003102437653000902468653002102477653001402498653002402512653001702536653002702553100001902580700002402599700002002623700002302643700002302666700001802689700002002707700002202727700002202749856003602771 2014 eng d a1758-535X00aPrognostic implications of microvascular and macrovascular abnormalities in older adults: cardiovascular health study.0 aPrognostic implications of microvascular and macrovascular abnor c2014 Dec a1495-5020 v693 a

BACKGROUND: Microvascular and macrovascular abnormalities are frequently found on noninvasive tests performed in older adults. Their prognostic implications on disability and life expectancy have not been collectively assessed.

METHODS: This prospective study included 2,452 adults (mean age: 79.5 years) with available measures of microvascular (brain, retina, kidney) and macrovascular abnormalities (brain, carotid, coronary, peripheral artery) in the Cardiovascular Health Study. The burden of microvascular and macrovascular abnormalities was examined in relation to total, activity-of-daily-living disability-free, and severe disability-free life expectancies in the next 10 years (1999-2009).

RESULTS: At 75 years, individuals with low burden of both abnormalities lived, on average, 8.71 years (95% confidence interval: 8.29, 9.12) of which 7.67 years (7.16, 8.17) were without disability. In comparison, individuals with high burden of both abnormalities had shortest total life expectancy (6.95 years [6.52, 7.37]; p < .001) and disability-free life expectancy (5.60 years [5.10, 6.11]; p < .001). Although total life expectancy was similarly reduced for those with high burden of either type of abnormalities (microvascular: 7.96 years [7.50, 8.42] vs macrovascular: 8.25 years [7.80, 8.70]; p = .10), microvascular abnormalities seemed to have larger impact than macrovascular abnormalities on disability-free life expectancy (6.45 years [5.90, 6.99] vs 6.96 years [6.43, 7.48]; p = .016). These results were consistent for severe disability-free life expectancy and in individuals without clinical cardiovascular disease.

CONCLUSIONS: Considering both microvascular and macrovascular abnormalities from multiple noninvasive tests may provide additional prognostic information on how older adults spend their remaining life. Optimal clinical use of this information remains to be determined.

10aAged10aAged, 80 and over10aAging10aAnkle Brachial Index10aDisability Evaluation10aElectrocardiography10aFemale10aFollow-Up Studies10aForecasting10aHumans10aLife Expectancy10aMagnetic Resonance Imaging10aMale10aMicrocirculation10aPrognosis10aProspective Studies10aRisk Factors10aVascular Malformations1 aKim, Dae, Hyun1 aGrodstein, Francine1 aNewman, Anne, B1 aChaves, Paulo, H M1 aOdden, Michelle, C1 aKlein, Ronald1 aSarnak, Mark, J1 aPatel, Kushang, V1 aLipsitz, Lewis, A uhttps://chs-nhlbi.org/node/636302534nas a2200181 4500008004100000022001400041245015900055210006900214260001600283300001200299490000600311520191100317100002302228700002302251700002302274700001902297856003602316 2020 eng d a2047-998000aPredicting Risk of Atherosclerotic Cardiovascular Disease Using Pooled Cohort Equations in Older Adults With Frailty, Multimorbidity, and Competing Risks.0 aPredicting Risk of Atherosclerotic Cardiovascular Disease Using  c2020 Sep 15 ae0160030 v93 a

Background Assessment of atherosclerotic cardiovascular disease (ASCVD) risk is crucial for prevention and management, but the performance of the pooled cohort equations in older adults with frailty and multimorbidity is unknown. We evaluated the pooled cohort equations in these subgroups and the impact of competing risks. Methods and Results In 4249 community-dwelling adults, aged ≥65 years, from the CHS (Cardiovascular Health Study), we calculated 10-year risk of hard ASCVD. Frailty was determined using the Fried phenotype. Latent class analysis was used to identify individuals with multimorbidity patterns using chronic conditions. We assessed discrimination using the C-statistic and calibration by comparing predicted ASCVD risks with estimated risk using cause-specific and cumulative incidence models, by multimorbidity patterns and frailty status. A total of 917 (21.6%) participants had an ASCVD event, and 706 (16.6%) had a competing event of death. C-statistic was 0.68 in men and 0.69 in women; calibration was good when compared with cause-specific and cumulative incidence estimated risks (males, -0.1% and 3.3%; females, 0.6% and 1.4%). Latent class analysis identified 4 patterns: minimal disease, cardiometabolic, low cognition, musculoskeletal-lung depression. In the cardiometabolic pattern, ASCVD risk was overpredicted compared with cumulative incidence risk in men (7.4%) and women (6.8%). Risk was underpredicted in men (-10.7%) and women (-8.2%) with frailty compared with cause-specific risk. Miscalibration occurred mostly at high predicted risk ranges. Conclusions ASCVD prediction was good in this cohort of adults aged ≥65 years. Although calibration varied by multimorbidity patterns, frailty, and competing risks, miscalibration was mostly present at high predicted risk ranges and thus less likely to alter decision making for primary prevention therapy.

1 aNguyen, Quoc, Dinh1 aOdden, Michelle, C1 aPeralta, Carmen, A1 aKim, Dae, Hyun uhttps://chs-nhlbi.org/node/8485