Cited by 339Cardiovascular Health and Risk FactorsLipoproteins and Cardiovascular HealthFrailty in Older Adults

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Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study

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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.·2009·BMJ

DOI 10.1136/bmj.a3083PMC PMC2615548

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Abstract

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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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)
ORCID: Westendorp, R. G J
Assendelft, W. J J
Gussekloo, J.
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
DOI: 10.1136/bmj.a3083
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 › Cardiology and Cardiovascular Medicine › 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

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Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study

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