Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study
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OBJECTIVES: To investigate the performance of classic risk factors, and of some new biomarkers, in predicting cardiovascular mortality in very old people from the general population with no history of cardiovascular disease. DESIGN: The Leiden 85-plus Study (1997-2004) is an observational prospective cohort study with 5 years of follow-up. SETTING: General population of the city of Leiden, the Netherlands. PARTICIPANTS: Population based sample of participants aged 85 years (215 women and 87 men) with no history of cardiovascular disease; no other exclusion criteria. Main measurements Cause specific mortality was registered during follow-up. All classic risk factors included in the Framingham risk score (sex, systolic blood pressure, total and high density lipoprotein cholesterol, diabetes mellitus, smoking and electrocardiogram based left ventricular hypertrophy), as well as plasma concentrations of the new biomarkers homocysteine, folic acid, C reactive protein, and interleukin 6, were assessed at baseline. RESULTS: During follow-up, 108 of the 302 participants died; 32% (35/108) of deaths were from cardiovascular causes. Classic risk factors did not predict cardiovascular mortality when used in the Framingham risk score (area under receiver operating characteristic curve 0.53, 95% confidence interval 0.42 to 0.63) or in a newly calibrated model (0.53, 0.43 to 0.64). Of the new biomarkers studied, homocysteine had most predictive power (0.65, 0.55 to 0.75). Entering any additional risk factor or combination of factors into the homocysteine prediction model did not increase its discriminative power. CONCLUSIONS: In very old people from the general population with no history of cardiovascular disease, concentrations of homocysteine alone can accurately identify those at high risk of cardiovascular mortality, whereas classic risk factors included in the Framingham risk score do not. These preliminary findings warrant validation in a separate cohort.
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The elevation of homocysteine concentration in the blood is a risk factor not just for CAD but also for stroke and PAD.
“The elevation of homocysteine concentration in the blood has been reported to be a risk factor not just for CAD but also for stroke and PAD287–289).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [289]
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- Authors
- de Ruijter, W., Westendorp, R. G. J., Assendelft, W. J. J., den Elzen, W. P. J., de Craen, A. J. M., le Cessie, S., & Gussekloo, J.
- Affiliations
- Leiden University Medical Center (NL)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2009-01-08
- Volume
- 338
- Issue
- jan08 2
- Pages
- a3083-a3083
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2615548
- OpenAlex
- W2107794933
- Cited by
- 339
- References
- 87
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 8 · 2023: 13 · 2022: 6 · 2021: 18 · 2020: 20 · 2019: 14 · 2018: 14 · 2017: 25 · 2016: 22 · 2015: 24 · 2014: 34 · 2013: 24 · 2012: 30
- FWCI
- 22.52
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- cardiovascular mortality, oldest old, Framingham risk score, cardiovascular risk factors, homocysteine, biomarkers, C-reactive protein, interleukin-6, folic acid, left ventricular hypertrophy, risk prediction, Leiden 85-plus Study
- MeSH terms
- Aged, 80 and over, Cardiovascular Diseases, Female, Humans, Male, Netherlands, Risk Factors, Cohort Studies, Biomarkers, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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