Trevisan Caterina, Capodaglio Giulia, Ferroni Eliana, Fedeli Ugo, Noale Marianna, Baggio Giovannella, Manzato Enzo, Maggi Stefania, Corti Maria Chiara, Sergi Giuseppe
Department of Medicine (DIMED), Geriatric Division, University of Padova, Padua, Italy.
Epidemiological System of the Veneto Region, Padova, Italy.
Eur J Ageing. 2021 Apr 12;19(1):37-47. doi: 10.1007/s10433-021-00620-y. eCollection 2022 Mar.
The age- and gender-related cardio-metabolic changes may limit the applicability of guidelines for the prevention of cardiovascular diseases (CVD) in older people. We investigated the association of cardiovascular risk profile with 20-year all-cause and CVD-mortality in older adults, focusing on age- and gender-specific differences. This prospective study involved 2895 community-dwelling individuals aged ≥65 years who participated in the Pro.V.A study. The sum of achieved target levels (smoking, diet, physical activity, body weight, blood pressure, lipids, and diabetes) recommended by the European Society of Cardiology 2016 guidelines was assessed in each participant. From this sum, cardiovascular risk profile was categorised as very high (0-2), high (3), medium (4), low (5), and very low (6-7 target levels achieved). All-cause and CV mortality data over 20 years were obtained from health registers. At Cox regression, lower cardiovascular risk profile was associated with reduced 20-year all-cause mortality in both genders, with stronger results for women (HR = 0.42 [95%CI:0.25-0.69] and HR = 0.61 [95%CI:0.42-0.89] for very low vs. very high cardiovascular risk profile in women and men, respectively). This trend was more marked for CVD mortality. Lower cardiovascular risk profile was associated with reduced all-cause and CVD mortality only in men < 75 years, while the associations persisted in the oldest old women. A lower cardiovascular risk profile, as defined by current guidelines, may reduce all-cause and CVD mortality in older people, with stronger and longer benefits in women. These findings suggest that personalised and life-course approaches considering gender and age differences may improve the delivery of preventive actions in older people.
The online version contains supplementary material available at 10.1007/s10433-021-00620-y.
与年龄和性别相关的心血管代谢变化可能会限制预防老年人心血管疾病（CVD）指南的适用性。我们调查了老年人心血管风险状况与20年全因死亡率和CVD死亡率之间的关联，重点关注年龄和性别特异性差异。这项前瞻性研究纳入了2895名年龄≥65岁的社区居住个体，他们参与了Pro.V.A研究。评估了每位参与者达到欧洲心脏病学会2016年指南推荐的目标水平（吸烟、饮食、身体活动、体重、血压、血脂和糖尿病）的总和。根据这个总和，心血管风险状况被分类为非常高（0 - 2）、高（3）、中（4）、低（5）和非常低（达到6 - 7个目标水平）。20年的全因死亡率和心血管死亡率数据来自健康登记册。在Cox回归分析中，较低的心血管风险状况与两性20年全因死亡率降低相关，女性的结果更强（女性中非常低与非常高心血管风险状况相比，HR = 0.42 [95%CI:0.25 - 0.69]；男性中HR = 0.61 [95%CI:0.42 - 0.89]）。这种趋势在CVD死亡率方面更为明显。较低的心血管风险状况仅与75岁以下男性的全因死亡率和CVD死亡率降低相关，而在年龄最大的老年女性中这种关联持续存在。按照当前指南定义的较低心血管风险状况可能会降低老年人的全因死亡率和CVD死亡率，对女性的益处更大且持续时间更长。这些发现表明，考虑性别和年龄差异的个性化和生命历程方法可能会改善老年人预防措施的实施。
在线版本包含可在10.1007/s10433 - 021 - 00620 - y获取的补充材料。
