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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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Figures

Fig 1 Cumulative cardiovascular mortality depending on tertiles of risk obtained from classic risk factors, weighted on the basis of Framingham risk score, or newly calibrated risk score from the Leiden 85-plus Study
Fig 1 Cumulative cardiovascular mortality depending on tertiles of risk obtained from classic risk factors, weighted on the basis of Framingham risk score, or newly calibrated risk score from the Leiden 85-plus StudyCC BY-NC · PubMed Central
Fig 2 Cumulative cardiovascular mortality depending on tertiles of risk obtained from prediction models using homocysteine, folic acid, C reactive protein and interleukin 6
Fig 2 Cumulative cardiovascular mortality depending on tertiles of risk obtained from prediction models using homocysteine, folic acid, C reactive protein and interleukin 6CC BY-NC · PubMed Central
Fig 3 Receiver operating characteristic curves showing performance of three prediction models for 5 year cardiovascular mortality based on Framingham risk score, homocysteine concentrations only, and homocysteine concentrations plus Framingham risk score
Fig 3 Receiver operating characteristic curves showing performance of three prediction models for 5 year cardiovascular mortality based on Framingham risk score, homocysteine concentrations only, and homocysteine concentrations plus Framingham risk scoreCC BY-NC · PubMed Central

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Research works printed but not linked: 1

  1. Sattar N, Murray H, Blauw G, Bollen E, Buckley B, Cobbe S, et al. CRP and risk of vascular events in PROSPER. Circulation 2006;114:143.

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Metadata

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
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
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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