What are the negative risk markers for CVD events in older patients?

  • Mortensen MB & al.
  • J Am Coll Cardiol
  • 9 Jul 2019

  • International Clinical Digest
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Takeaway

  • In older patients, a coronary artery calcium (CAC) score of 0 or ≤10, low galectin-3, or absence of carotid plaques mark low atherosclerotic cardiovascular disease (CVD) risk.

Why this matters

  • Despite stark increases in CVD risk with age and conventional wisdom that statins apply to almost every elderly patient, some people in this age group may still have low risk.
  • These patients may not need to be folded into the “treat-all approach” typically applied in this population, say the authors.

Key results

  • With CAC of 0 or ≤10, diagnostic likelihood ratios (DLRs) were both 0.20 for coronary heart disease (CHD).
  • They also were associated, respectively, with DLRs of 0.41 and 0.48 for CVD.
  • Galectin-3 was also associated with derisking: with values th percentile, DLRs for CHD and CVD were 0.44 and 0.43, respectively.
  • No carotid plaque was associated with DLRs of 0.39 and 0.65, respectively, for CHD and CVD.
  • Biomarkers showing no derisking association included no family history of CVD, normal ankle-brachial index.

Study design

  • Evaluation of 13 possible CVD biomarkers in 5805 BioImage study participants (mean age, 69 years; median follow-up, 2.7 years).
  • Funding: Multiple industry funders.

Limitations

  • Event rates lower than anticipated.

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