Background: Risk factors for cardiovascular mortality have barely been investigated in very elderly persons and there may be differences compared with younger individuals.
Methods: This is a cohort study of all inhabitants over 80 years of age in the city of Veranópolis, Brazil. The association of demographic, anthropometric, physical, and medical characteristics with mortality by any cause and by cardiovascular disease (CVD) was investigated by means of Cox regression models.
Results: The mean age of the participants was 83.6 ± 3.3 years. Vital status and cause of death was ascertained in 96.9% of the participants after a mean follow-up of 8.7 ± 3.8 years. Systolic and diastolic blood pressure showed a U-shape relationship with cardiovascular and total mortality. Blood pressure lower than 140/90 mmHg was associated with a higher risk for cardiovascular mortality (HR 4.76, 95% CI 1.56–14.28, p = 0.006). Duration of sleep was inversely associated with the risk of cardiovascular death (HR 0.83, 95% CI 0.73–0.95, p = 0.007), while apoA-I was inversely associated only with the risk of all-cause mortality (HR 0.99, 95% CI 0.98–1.00, p = 0.041). Anthropometric indexes, smoking, cholesterol, LDL-cholesterol, HDL-cholesterol, and other traditional risk factors were not associated with cardiovascular mortality.
Conclusion: Many traditional risk factors are not associated with cardiovascular mortality in the very elderly. Longer sleep duration is associated with lower cardiovascular mortality of very elderly individuals, while low blood pressure identifies very elderly individuals at higher risk of dying from cardiovascular causes.
KannelWB. Coronary heart disease risk factors in the elderly. Am J Geriatr Cardiol2002; 11: 101–107.
2.
OatesDJBerlowitzDRGlickmanMESillimanRABorzeckiAM. Blood pressure and survival in the oldest old. J Am Geriatr Soc2007; 55: 383–388.
3.
RastasSPirttilaTViramoPVerkkoniemiAHalonenPJuvaK. Association between blood pressure and survival over 9 years in a general population aged 85 and older. J Am Geriatr Soc2006; 54: 912–918.
4.
HakalaSMTilvisRSStrandbergTE. Blood pressure and mortality in an older population. A 5-year follow-up of the Helsinki Ageing Study. Eur Heart J1997; 18: 1019–1023.
5.
JensenEDehlinOHagbergBSamuelssonGSvenssonTLidfeldtJ. Blood pressure in relation to medical, psychological and social variables in a population of 80-year-olds. Survival during 6 years. J Intern Med1997; 241: 205–212.
6.
LangerRDGaniatsTGBarrett-ConnorE. Paradoxical survival of elderly men with high blood pressure. BMJ1989; 298: 1356–1358.
7.
LindholmLLankeJBengtssonB. U-shaped association between mortality and blood pressure in a thirteen-year prospective study. Fam Pract1986; 3: 3–8.
8.
OkumiyaKMatsubayashiKWadaTFujisawaMOsakiYDoiY. A U-shaped association between home systolic blood pressure and four-year mortality in community-dwelling older men. J Am Geriatr Soc1999; 47: 1415–1421.
9.
PortSGarfinkelABoyleN. There is a non-linear relationship between mortality and blood pressure. Eur Heart J2000; 21: 635–638.
10.
Weverling-RijnsburgerAWBlauwGJLagaayAMKnookDLMeindersAEWestendorpRG. Total cholesterol and risk of mortality in the oldest old. Lancet1997; 350: 1119–1123.
11.
Risk factors for all-cause and coronary heart disease mortality in the oldest-old. The Adventist Health Study. Arch Intern Med1997; 157: 2249–2258.
12.
MarafonLPda CruzIBSchwankeCHMoriguchiEH. Cardiovascular mortality predictors in the oldest old. Cad Saude Publica2003; 19: 799–807.
13.
TaylorHLJacobsDRJrSchuckerBKnudsenJLeonASDebackerG. A questionnaire for the assessment of leisure time physical activities. J Chronic Dis1978; 31: 741–755.
14.
LewingtonSClarkeRQizilbashNPetoRCollinsR. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet2002; 360: 1903–1913.
15.
SatishSFreemanDHJrRayLGoodwinJS. The relationship between blood pressure and mortality in the oldest old. J Am Geriatr Soc2001; 49: 367–374.
16.
van BemmelTHolmanERGusseklooJBlauwGJBaxJJWestendorpRG. Low blood pressure in the very old, a consequence of imminent heart failure: the Leiden 85-plus Study. J Hum Hypertens2009; 23: 27–32.
17.
Bejan-AngoulvantTSaadatian-ElahiMWrightJMSchronEBLindholmLHFagardR. Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials. J Hypertens2010; 28: 1366–1372.
18.
BeckettNSPetersRFletcherAEStaessenJALiuLDumitrascuD. HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med2008; 358: 1887–1898.
19.
ThompsonADaneshJ. Associations between apolipoprotein B, apolipoprotein AI, the apolipoprotein B/AI ratio and coronary heart disease: a literature-based meta-analysis of prospective studies. J Intern Med2006; 259: 481–492.
20.
ChirovskyDRFedirkoVCuiYSazonovV BarterP. Prospective studies on the relationship between high-density lipoprotein cholesterol and cardiovascular risk: a systematic review. Eur J Cardiovasc Prev Rehabil2009; 16: 404–423.
21.
BloomHGAhmedIAlessiCAAncoli-IsraelSBuysseDJKrygerMH. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc2009; 57: 761–789.
22.
IkeharaSIsoHDateCKikuchiSWatanabeYWadaY. (JACC Study Group) Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. Sleep2009; 32: 295–301.
23.
EguchiKPickeringTGSchwartzJEHoshideSIshikawaJIshikawaS. Short sleep duration as an independent predictor of cardiovascular events in Japanese patients with hypertension. Arch Intern Med2008; 168: 2225–2231.
24.
GangwischJEHeymsfieldSBBoden-AlbalaBBuijsRMKreierFOplerMG. Sleep duration associated with mortality in elderly, but not middle-aged, adults in a large US sample. Sleep2008; 31: 1087–1096.
