Background: Risk scores for prediction of coronary heart disease
(CHD) in older adults are needed.
Objective: To develop a sex-specific CHD risk prediction model
for older adults that accounts for competing risks for death.
Design: 2 observational cohort studies, using data from 4946
participants in the Cardiovascular Health Study (CHS) and 4303 participants in
the Rotterdam Study (RS).
Setting: Community settings in the United States (CHS) and
Rotterdam, the Netherlands (RS).
Participants: Persons aged 65 years or older who were free of
Measurements: A composite of nonfatal myocardial infarction and
Results: During a median follow-up of 16.5 and 14.9 years,
1166 CHS and 698 RS participants had CHD events, respectively. Deaths from
noncoronary causes largely exceeded the number of CHD events, complicating
accurate CHD risk predictions. The prediction model had moderate ability to
discriminate between events and nonevents (c-statistic, 0.63 in both U.S. and
European men and 0.67 and 0.68 in U.S. and European women). The model was
well-calibrated; predicted risks were in good agreement with observed risks.
Compared with the Framingham point scores, the prediction model classified
elderly U.S. persons into higher risk categories but elderly European persons
into lower risk categories. Differences in classification accuracy were not
consistent and depended on cohort and sex. Adding newer cardiovascular risk
markers to the model did not substantially improve performance.
Limitation: The model may be less applicable in nonwhite
populations, and the comparison Framingham model was not designed for adults
older than 79 years.
Conclusion: A CHD risk prediction model that accounts for deaths
from noncoronary causes among older adults provided well-calibrated risk
estimates but was not substantially more accurate than Framingham point scores.
Moreover, adding newer risk markers did not improve accuracy. These findings
emphasize the difficulties of predicting CHD risk in elderly persons and the
need to improve these predictions.
Primary Funding Source: National Heart, Lung, and Blood Institute; National
Institute of Neurological Disorders and Stroke; The Netherlands Organisation
for Scientific Research; and the Netherlands Organisation for Health Research