(Circulation. 1995;92:720-726.)
© 1995 American Heart Association, Inc.
Articles |
Subclinical Disease as an Independent Risk Factor for Cardiovascular Disease
From the Department of Epidemiology, Graduate School of Public Health (L.H.K.), University of Pittsburgh, Pittsburgh, Pa; School of Medicine (L.S., B.M.P., N.O.B.), University of Washington, (Seattle); Division of Cardiology (J.G.), University of California-Irvine (Davis); Department of Internal Medicine (M.N.H.), University of California-Sacramento; Division of Radiology (D.H.O'L.), Geisinger Medical Center, Danville, Pa; DECA (P.J.S.), National Heart, Lung, and Blood Institute, Bethesda, Md; Department of Public Health Sciences (G.S.T.), Bowman Gray School of Medicine, Winston-Salem, NC; and Department of Pathology-Biochemistry (R.T.), University of Vermont (Colchester).
Correspondence to Lewis H. Kuller, MD, DrPH, University of Pittsburgh, Department of Epidemiology, GSPH, 130 DeSoto St, Pittsburgh, PA 15261.
Background The primary aim of the present study was to determine the relation between measures of subclinical cardiovascular disease and the incidence of clinical cardiovascular disease among 5201 adults 65 years of age or older who were participating in the Cardiovascular Health Study.
Methods and Results A new method of classifying subclinical disease at baseline examination in the Cardiovascular Health Study included measures of ankle-brachial blood pressure, carotid artery stenosis and wall thickness, ECG and echocardiographic abnormalities, and positive response to the Rose Angina and Claudication Questionnaire. Participants were followed for an average of 2.39 years (maximum, 3 years). For participants without evidence of clinical cardiovascular disease at baseline, the presence of subclinical disease compared with no subclinical disease was associated with a significant increased risk of incident total coronary heart disease including CHD deaths and nonfatal MI and angina pectoris for both men and women. For individuals with subclinical disease, the increased risk of total coronary heart disease was 2.0 for men and 2.5 for women, and the increased risk of total mortality was 2.9 for men and 1.7 for women. The increased risk changed little after adjustment for other risk factors, including lipoprotein levels, blood pressure, smoking, and diabetes.
Conclusions The measurement of subclinical disease provides an approach for identifying high-risk older individuals who may be candidates for more active intervention to prevent clinical disease.
Key Words: cardiovascular diseases • morbidity • mortality • risk factors • aging
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