Aging Clinical and Experimental Research

, Volume 8, Issue 2, pp 75–89 | Cite as

Coronary heart disease risk factors in older persons

  • M-C. Corti
  • J. M. Guralnik
  • C. Bilato
Review Article


In most Western nations, coronary heart disease (CHD) is the leading cause of death and one of the most important causes of physical disability in persons over 65 years of age. The importance of traditional CHD risk factors has been well documented in middle-aged populations, whereas their role in older populations is still under debate. This paper reviews the epidemiologic evidence from observational studies and randomized clinical trials that established risk factors for CHD predict level of risk of CHD, and identify high risk individuals among older men and women. Hypertension and cigarette smoking have been clearly associated with an increased risk of CHD events, and their modification has been proven to be highly effective in the primary and secondary prevention of CHD in older persons. For other highly prevalent risk factors, such as lipid abnormalities, obesity and physical inactivity, evidence of an independent association with CHD risk has been demonstrated by the majority of observational studies. However, definitive proof from controlled clinical trials of the beneficial effects of their modification is still lacking in the older population. The role of estrogen replacement therapy in the primary and secondary prevention of CHD in older women is still an open question. In evaluating the impact of these risk factors in older persons, elements such as comorbidity, frailty, and age-related changes in risk profile should also be taken into consideration. Given the complexity of the relationship between risk factors and multiple disease statuses, other important outcomes, such as osteoporosis, cancer, falls and physical disability, should be considered when evaluating the risks and benefits of risk factor modifications in older persons.

Key words

Aged atherosclerosis cardiovascular disease coronary heart disease risk factors 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    National Center for Health Statistics: Vital statistics of the United States, 1989. Vol II. Mortality. Part A. Government Printing Office, Washington, D.C., (DHHS publication n. (PHS), 93–1101, 1993.Google Scholar
  2. 2.
    Ettinger W.H., Fried L.P., Harris T., Shemansky L., Schulz R., Robbins J.: Self-reported causes of physical disability in older people: the Cardiovascular Health Study. J. Am. Geriatr. Soc. 42: 1035–1044, 1994.PubMedGoogle Scholar
  3. 3.
    National Center for Health Statistics. Health, United States, 1994. Public Health Service, Hyattsville, Maryland, 1995.Google Scholar
  4. 4.
    LaCroix A.Z., Omenn G.S.: Older adults and smoking. Clin. Geriatr. Med. 8: 69–87, 1992.PubMedGoogle Scholar
  5. 5.
    Mellstrom D., Rundgren A., Jagemburg R., Steen B., Svanborg A.: Tobacco smoking, ageing and health among the elderly: a longitudinal population study of 70-year-old men and an age cohort comparison. Age Ageing 11: 45–58, 1982.PubMedGoogle Scholar
  6. 6.
    Belloc N., Breslow L.: Relationship of physical health status and health practice. Prev. Med. 71: 4189–4191, 1972.Google Scholar
  7. 7.
    Department of Health and Human Services: The health consequences of smoking: cardiovascular disease: a report of the Surgeon General. Government printing office, Washington, D.C. (DHHS publication no. (PHS) 84-50204), 1983.Google Scholar
  8. 8.
    Cupples L.A., D’Agostino R.B.: Some risk factors related to the annual incidence of cardiovascular disease and death using pooled repeated biennial measurements: Framingham Heart Study, 30 year follow-up. Section 34 of the Framingham Study: an epidemiological investigation of cardiovascular disease. NIH publication no. (NIH) 87–2703, 1987.Google Scholar
  9. 9.
    Harris T., Cook E.F., Kannel W.B., Goldman L.: Proportional hazard analysis of risk factors for coronary heart disease in individual aged 65 or older: the Framingham Heart Study. J. Am. Geriatr. Soc. 36: 1023–1028, 1988.PubMedGoogle Scholar
  10. 10.
    Gordon T., Castelli W.P., Hjortland M.C., Kannel W.B., Dawber T.R.: Predicting coronary heart disease in middle-aged and older persons. The Framingham study. JAMA 238: 497–499, 1977.PubMedGoogle Scholar
  11. 11.
    Benfante R., Reed D., MacLean C.J., Yano K.: Risk factors in middle age that predict early and late onset of coronary heart disease. J. Clin. Epidemiol. 42: 95–104, 1989.PubMedGoogle Scholar
  12. 12.
    Benfante R., Reed D., Frank J.: Do coronary heart disease risk factors measured in the elderly have the same predictive roles as in middle-aged? Ann. Epidemiol. 2: 273–282, 1992.PubMedGoogle Scholar
  13. 13.
    Jaijich C.L., Ostfeld A.M., Freeman D.H. jr.: Smoking and coronary heart disease mortality in the elderly. JAMA 252: 2831–2834, 1984.Google Scholar
  14. 14.
    Siegel D., Kuller L., Lazarus N.B., Black D., Feigal D., Hughes G., Schoemberg J.A., Hulley S.B.: Predictors of cardiovascular events and mortality in the Systolic Hypertension in the Elderly Program pilot project. Am. J. Epidemiol. 126: 385–399, 1987.PubMedGoogle Scholar
  15. 15.
    Aronow W.S., Herzig A.H., Etienne F., D’Alba P., Ronquillo J.: 41-month follow-up of risk factors correlated with new coronary events in 708 elderly patients. J. Am. Geriatr. Soc. 37: 501–506, 1989.PubMedGoogle Scholar
  16. 16.
    Hermanson B., Omenn G.S., Kronmal R.A., Gersh B.J.: Beneficial six-year outcome of smoking cessation in older men and women with coronary artery disease. Results from the CASS registry. N. Engl. J. Med. 319: 1365–1369, 1988.PubMedGoogle Scholar
  17. 17.
    Kannel W.B., Vokonas P.S.: Primary risk factors for coronary heart disease in the elderly: the Framingham study. In: Wenger N.K., Furberg C.D., Pitt E. (Eds.), Coronary heart disease in the elderly. Elsevier Science Publishing Co., New York, Amsterdam, London, 1985, pp. 60–95.Google Scholar
  18. 18.
    Nissinen A., Pekkanen J., Porath A., Punsar S., Karvonen M.J.: Risk factors for cardiovascular disease among 55 to 74 years old Finnish men: a 10-year follow up. Ann. Inter. Med. 21: 239–240, 1989.Google Scholar
  19. 19.
    LaCroix A.Z., Lang J., Scherr P., Wallace R.B., Cornoni-Huntley J., Berkman L., Curb J.D., Evans D., Hennekens C.H.: Smoking and mortality among older men and women in three communities. N. Engl. J. Med. 324: 1619–1625, 1991.PubMedGoogle Scholar
  20. 20.
    Weintraub W., Klein L., Seelaus P. Agarwal J.B., Helfant R.H.: Importance of total life consumption of cigarettes as a risk factor for coronary artery disease. Am. J. Cardiol. 55: 669–672, 1985.PubMedGoogle Scholar
  21. 21.
    Bots M.L., Grobbee D.E., Hofman A.: High blood pressure in the elderly. Epidemiol. Rev. 13: 294–314, 1991.PubMedGoogle Scholar
  22. 22.
    Foster T.A., Hale W.E., Srinivasan S.R., Cresanta J.L., Berenson G.S.: Levels of selected cardiovascular risk factors in a sample of geriatric participants. The Dunedin program. J. Gerontol. 42: 241–245, 1987.PubMedGoogle Scholar
  23. 23.
    Borhani N.O.: Isolated systolic hypertension in the elderly. J. Hypertens. 6: 15–19, 1988.Google Scholar
  24. 24.
    Crow M.T., Boluyt M.O., Lakatta E.G.: Molecular and cellular aspects of cardiovascular aging. In: Holbrook N., Martin G.R., Lockshin R.A. (Eds.), Cellular Aging and Cell Death. Wiley-Liss, Inc., New York, 1996, pp. 81–107.Google Scholar
  25. 25.
    Carvalho J.J., Baruzzi R.G., Howard P.F., Poulter N., Alpers M.P., Franco L.J., Marcopito L.F., Spooner V.J., Dyer A.R., Elliott P., Stamler J., Stamler R.: Blood pressure in four remote populations in the INTERSALT Study. Hypertension 14: 238–246, 1989.PubMedGoogle Scholar
  26. 26.
    Final report of the subcommittee on definition and prevalence of the 1984 Joint National Committee. Hypertension prevalence and the states of awareness, treatment, and control in the United States. Hypertension 7: 457–468, 1985.Google Scholar
  27. 27.
    Whelton P.K., King M.J.: Epidemiology of high blood pressure. Clin. Geriatr. Med. 5: 639–655, 1989.PubMedGoogle Scholar
  28. 28.
    Dannenberg A.L., Garrison R.J., Kannel W.B.: Incidence of hypertension in the Framingham Study. Am. J. Public Health 78: 676–679, 1985.Google Scholar
  29. 29.
    Hsu P.H., Mathewson F.A.L., Rabkin S.W.: Blood pressure and body mass index patterns. A longitudinal study. J. Chronic Dis. 30: 93–113, 1977.PubMedGoogle Scholar
  30. 30.
    Pan W-H., Nanas S., Dyer A., Liu K., McDonald A., Schoenberger J.A., Shekelle R.B., Stamler R., Stamler J.: The role of weight in the positive association between age and blood pressure. Am. J. Epidemiol. 124: 612–623, 1986.PubMedGoogle Scholar
  31. 31.
    Folsom A.R., Prineas R.J., Kaye S.A., Murger R.G.: Incidence of hypertension and stroke in relation to body fat distribution and other risk factor in older women. Stroke 21: 701–706, 1990.PubMedGoogle Scholar
  32. 32.
    Grobbee D.E., Van Hemert A.M., Vandenbrouke J.P., Hofman A., Volkemburg H.A.: Importance of body weight in determining rise and level of blood pressure in postmenopausal women. J. Hypertens. 6: S614–S616, 1988.Google Scholar
  33. 33.
    Grobbee D.E., Hofman A.: Does sodium restriction lower blood pressure? Br. Med. J. 293: 27–29, 1986.Google Scholar
  34. 34.
    Luft F.C., Weinberger M.H., Fineberg N.S., Miller J.Z., Grim C.E.: Effects of age on renal sodium homeostasis and its relevance to sodium sensitivity. Am. J. Med. 82: 9–15, 1987.PubMedGoogle Scholar
  35. 35.
    Zemel M.B., Sowers J.R.: Salt-sensitivity and systemic hypertension in the elderly. Am. J. Cardiol. 61: 7H–12H, 1988.PubMedGoogle Scholar
  36. 36.
    Khaw K.T., Barrett-Connor E.: The association between blood pressure, age, and dietary sodium and potassium: a population study. Circulation 77: 53–61, 1988.PubMedGoogle Scholar
  37. 37.
    Ekelund L.G., Haskell W.L., Johnson J.L., Whaley F.S., Criqui M.H., Sheps D.S.: Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. N. Engl. J. Med. 319: 1379–1384, 1988.PubMedGoogle Scholar
  38. 38.
    Mac Mahon S., Peto R., Cutler J., Collins R., Sorlie P., Neaton J., Abbott R., Godwin J., Dyer A., Stamler J.: Blood pressure, stroke, and coronary heart disease. Part 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335: 765–774, 1990.Google Scholar
  39. 39.
    Applegate W.B.: Managing the older patient with hypertension. Am. J. Hypertens. 6: 277S–282S, 1993.PubMedGoogle Scholar
  40. 40.
    Report of the Joint National Committee in Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 237: 255–261, 1977.Google Scholar
  41. 41.
    Hypertension Detection and Follow-up Program Cooperative Group. Effect of stepped care on the incidence of myocardial infarction and angina pectoris. Hypertension 6: 196–206, 1984.Google Scholar
  42. 42.
    Kannel W.B., Wolf P.A., McGee DL, Dawber T.R., McNamara P., Castelli W.P.: Systolic blood pressure, arterial rigidity and risks of stroke. JAMA 245: 1225–1229, 1981.PubMedGoogle Scholar
  43. 43.
    Stamler J., Neaton J.D., Wenthworth D.N.: Blood pressure (systolic and diastolic) and risk of fatal coronary heart disease. Hypertension 13: 12–112, 1989.Google Scholar
  44. 44.
    Stamler J., Stamler R., Neaton J.D.: Blood pressure, systolic and diastolic, and cardiovascular risk: US population data. Arch. Intern. Med. 153: 598–615, 1993.PubMedGoogle Scholar
  45. 45.
    Garland C., Barrett-Connor E., Suarez L., Criqui M.H.: Isolated systolic hypertension and mortality after age 60 years. Am. J. Epidemiol. 118: 365–376, 1983.PubMedGoogle Scholar
  46. 46.
    Kannel W.B., Dawber T.R., McGee D.L.: Perspectives on systolic hypertension. The Framingham Study. Circulation 61: 1179–1182, 1980.PubMedGoogle Scholar
  47. 47.
    SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 265: 3255–3264, 1991.Google Scholar
  48. 48.
    Amery A., Birkenhager W., Brixko R., Bulpitt C., Clement D., Deruyttere M., De Schaepdryver A., Dollery C., Fagard R., Forette F., Forte J., Hamdy R., Henry J.F., Joossens J.V., Leonetti G., Lund-Johansen P., O’Malley K., Petrie J.C., Strasser T., Tuomilehto J., Williams B.: Efficacy of antihypertensive drug treatment according to age, sex, blood pressure, and previous cardiovascular disease in patients over the age of 60. Lancet 2: 589–592, 1986.PubMedGoogle Scholar
  49. 49.
    Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. Br. Med. J. 304: 405–412, 1992.Google Scholar
  50. 50.
    Dahlof B., Hansson L., Lindholm L.H., Schersten B., Ekbom T., Wester P.O.: Swedish Trial in Old Patients with Hypertension (STOP-Hypertension): Analyses performed up to 1992. Clin. Exp. Hypertens. 15:925–939, 1993.PubMedGoogle Scholar
  51. 51.
    Amery A., Birkenhager W., Brixko R., Bulpitt C., Clement D., Deruyttere M., De Schaepdryver A., Dollery C., Fagard R., Forette F., Forte J., Hamdy R., Henry J.F., Joossens J.V., Leonetti G., Lund-Johansen P., O’Malley K., Petrie J., Strasser T., Tuomilheto J., Williams B.: Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial. Lancet 1: 1349–1354, 1985.PubMedGoogle Scholar
  52. 52.
    Management Committee: Treatment of mild hypertension in the elderly. Med. J. Aust. 2: 398–402, 1981.Google Scholar
  53. 53.
    Coope J., Warrender T.S., McPherson K.: The prognostic significance of blood pressure in the elderly. J. Hum. Hypertens. 2: 79–88, 1988.PubMedGoogle Scholar
  54. 54.
    Taylor J.O., Cornoni-Huntley J., Curb J.D., Manton K.G., Ostfed A.M., Scherr P., Wallace W.P.: Blood pressure and mortality risk in the elderly. Am. J. Epidemiol. 134: 489–501, 1991.PubMedGoogle Scholar
  55. 55.
    Harris T.: How might heterogeneity in the older population increase the risk of J-shaped curves in clinical trials? In: Wenger N.K. (Ed.), Proceedings of the Workshop: Inclusion of elderly individuals in clinical trials: cardiovascular disease and cardiovascular therapy as a model. Kansas City, 1993, pp. 25–37.Google Scholar
  56. 56.
    Glynn R.J., Field T.S., Rosner B., Hebert P.R., Taylor J.O., Hennekens C.H.: Evidence for a positive linear relation between blood pressure and mortality in elderly people. Lancet 345: 825–829, 1995.PubMedGoogle Scholar
  57. 57.
    National Cholesterol Education Program Expert Panel: Second report of the National Cholesterol Education Program Expert Panel on detection, evaluation and treatment of high blood cholesterol in adults (adult treatment Panel II). Circulation 89: 1329–1445, 1994.Google Scholar
  58. 58.
    Stamler J., Wentworth D., Neaton J.D.: Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 256: 2823–2828, 1986.PubMedGoogle Scholar
  59. 59.
    Anderson K.M., Castelli W.P., Levy D.: Cholesterol and mortality: 30 years of follow-up from the Framingham Study. JAMA 257: 2176–2180, 1987.PubMedGoogle Scholar
  60. 60.
    Stampfer M.J., Sacks F.M., Salvini S., Willett W.C., Hennekens C.H.: A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N. Engl. J. Med. 325: 373–381, 1991.PubMedGoogle Scholar
  61. 61.
    Hulley S.B., Newman T.B.: Cholesterol in the elderly. Is it important? JAMA 272: 1372–1373, 1994.PubMedGoogle Scholar
  62. 62.
    Krumholz H.M., Seeman T.E., Merrill S.S., Mendes de Leon C.S., Vaccarino V., Silverman D.I., Tsukahara R., Ostfeld A.M., Berkman L.F.: Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. JAMA 272: 1335–1340, 1994.PubMedGoogle Scholar
  63. 63.
    Ettinger W.H., Wahl P.W., Kuller L.H., Bush T.L., Tracy R.P., Manolio T.A., Borhani N.O., Wong N.D., O’Leary D.H. for the CHS Collaborative Research Group.: Lipoprotein lipids in older people. Results from the Cardiovascular Health Study. Circulation 86: 858–869, 1992.PubMedGoogle Scholar
  64. 64.
    Denke M.A., Grundy S.M.: Hypercholesterolemia in elderly persons: resolving the treatment dilemma. Ann. Inter. Med. 112: 780–792, 1990.Google Scholar
  65. 65.
    Sempos C.T., Cleeman J.I., Carroll M.E., Johnson C.M., Bachorick P.S., Gordon D.J., Burt V.L., Briefel R.R., Brown C.D., Lippel K., Rifkind B.M.: Prevalence of high blood cholesterol among US adults. JAMA 269: 3009–3014, 1993.PubMedGoogle Scholar
  66. 66.
    Miller N.E., Nanjee M.N.: Hyperlipidemia in the elderly: metabolic changes underlying the increase in plasma cholesterol and triglycerides during aging. Cardiovasc. Risk Factors 2: 158–169, 1992.Google Scholar
  67. 67.
    Denke M.A., Winker M.A.: Cholesterol and coronary heart disease in older adults. No easy answers. JAMA 274: 575–577, 1995.PubMedGoogle Scholar
  68. 68.
    The Lipids Research Clinic Program Epidemiology Committee: Plasma lipid populations in selected North America populations. Circulation 60: 427–439, 1979.Google Scholar
  69. 69.
    Curb J.D., Reed D.M., Yano K., Kautz J., Albers J.J.: Plasma lipids and lipoproteins in elderly Japanese-American men. J. Am. Geriatr. Soc. 34: 773–780, 1986.PubMedGoogle Scholar
  70. 70.
    Rubin S.M., Sidney S., Black D.M., Browner W.S., Hulley S.B., Cummings S.R.: High blood cholesterol in elderly men and excess risk for coronary heart disease. Ann. Intern. Med. 113: 916–920, 1990.PubMedGoogle Scholar
  71. 71.
    Reed D., Benfante R.: Lipid and lipoprotein predictors of coronary heart disease in elderly men in the Honolulu Heart Program. Ann. Epidemiol. 2: 29–34, 1992.PubMedGoogle Scholar
  72. 72.
    Sorkin J.D., Andres R., Muller D.C., Baldwin H.L., Fleg J.L.: Cholesterol as a risk factor for coronary heart disease in elderly men. Ann. Epidemiol. 2: 59–67, 1992.PubMedGoogle Scholar
  73. 73.
    Barrett-Connor E.: Hypercholesterolemia predicts early death from coronary heart disease in elderly men but not women. The Rancho Bernardo Study. Ann. Epidemiol. 2: 77–83, 1992.PubMedGoogle Scholar
  74. 74.
    Corti M-C., Guralnik J.M., Salive M.E., Harris T., Field T.S., Wallace R.B., Berkman L.F., Seeman T.E., Glynn R.J., Hennekens C.H., Havlik R.J.: HDL cholesterol predicts coronary heart disease mortality in older persons. JAMA 274: 539–544, 1995.PubMedGoogle Scholar
  75. 75.
    Zimetbaum P., Frishman W.H., Ooi W.L., Derman M.P., Aronson M., Gidez L.I., Eder H.A.: Plasma lipids and lipoproteins and the incidence of cardiovascular disease in the very elderly. Arterioscler. Thromb. 12: 416–423, 1992.PubMedGoogle Scholar
  76. 76.
    Scanu A.S., Fless G.M.: Lipoprotein (a): heterogeneity and biological relevance. J. Clin. Invest. 85: 1709–1715, 1990.PubMedCentralPubMedGoogle Scholar
  77. 77.
    Cambillau M., Simon A., Amar J., Giral P., Atger V., Segond P., Levenson J., Merli I., Megnien J.L., Plainfosse M.C., Moatti N., and the PCVMETRA group.: Serum Lp(a) as discriminant marker of early atherosclerotic plaque at three extracoronary sites in hypercholesterolemic men. Arterioscler. Thromb. 12: 1346–1352, 1992.PubMedGoogle Scholar
  78. 78.
    Jovicic A., Ivanisevivc V., Ivanovic I.: Lipoprotein (a) in patients with carotid atherosclerosis and ischemic cerebrovascular disorders. Atherosclerosis 98: 59–65, 1993.PubMedGoogle Scholar
  79. 79.
    Simons L., Friedlander Y., Simons J., McCallum J.: Lipoprotein (a) is not associated with coronary heart disease in the elderly: cross-sectional data from the Dubbo study. Atherosclerosis 99: 2540–2544, 1993.Google Scholar
  80. 80.
    Kario K., Matsuo T., Imiya M., Kayaba K., Kuroda T., Nago N., Matsuo H., Shimada K.: Close relation between lipoprotein (a) levels and atherothrombotic disease in Japanese subjects >75 years of age. Am. J. Cardiol. 73: 1187-1190, 1994.Google Scholar
  81. 81.
    Shepherd J., Corbe S.M., Ford I., Isles C.G., Lorimer A.R., McFarlane P.W., McKillop J.H., Packard C.J., for the West of Scotland Coronary Prevention Study Group.: Prevention of coronary heart disease with pravastatin in men with hy-percholesterolemia. N. Engl. J. Med. 333: 1301–1307, 1995.PubMedGoogle Scholar
  82. 82.
    Scandinavian Simvastatin Survival Study Group: Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4S). Lancet 344: 1383–1389, 1994.Google Scholar
  83. 83.
    Hubert H.B., Feinleib M., McNamara P.M., Castelli W.P.: Obesity as independent risk factor for cardiovascular disease: a 26 year follow-up of participants in the Framingham Heart Study. Circulation 67: 968–977, 1983.PubMedGoogle Scholar
  84. 84.
    Manson J.E., Colditz G.A., Stampfer M.J., Willett W.C., Rosner B., Manson R.R., Speizer F.E., Hennekens C.H.: A prospective study of obesity and risk of coronary heart disease in women. N. Engl. J. Med. 322: 882–889, 1990.PubMedGoogle Scholar
  85. 85.
    Manson J.E., Tosteson H., Ridker P.M., Satterfield S., Hebert P., O’Connor G.T., Buring J.E., Hennekens CH.: The primary prevention of myocardial infarction. N. Engl. J. Med. 326: 1406–1416, 1992.PubMedGoogle Scholar
  86. 86.
    Simopoulos A.P., Van Itallie T.B.: Body weight, health, and longevity. Ann. Intern. Med. 100: 285–295, 1984.PubMedGoogle Scholar
  87. 87.
    Seeman T., Mendes de Leon C., Berkman L., Ostfeld A.: Risk Factors for coronary heart disease among older men and women: a prospective study of community-dwelling elderly. Am. J. Epidemiol. 138: 1037–1049, 1993.PubMedGoogle Scholar
  88. 88.
    Barrett-Connor E., Suarez L., Khaw K-T., Criqui H., Wingard D.L.: Ischemic heart disease risk factors after age 50. J. Chronic Dis. 37: 903–908, 1984.PubMedGoogle Scholar
  89. 89.
    Harris T., Cook E.F., Garrison R., Higgins M., Kannel W., Goldman L.: Body mass index and mortality among non smoking older persons. The Framingham Heart Study. JAMA 259: 1520–1524, 1988.PubMedGoogle Scholar
  90. 90.
    Manson J.E., Willett W.C., Stampfer M.J., Colditz G.A., Hunter D.J., Hankinson S.E., Hennekens C.H., Speizer F.E.: Body weight and mortality among women. N. Engl. J. Med. 333: 677–685, 1995.PubMedGoogle Scholar
  91. 91.
    Launer L.J., Harris T., Rumpel C., Madans J.: Body mass index, weight change, and risk of mobility disability in middle-aged and older women. The epidemiologic follow-up study of NHANES I. JAMA 271: 1093–1098, 1994.PubMedGoogle Scholar
  92. 92.
    Andres R.: Aging, diabetes, and obesity: standards of normality. Mt. Sinai J. Med. 48: 489–495, 1981.PubMedGoogle Scholar
  93. 93.
    De Fronzo R.A.: Glucose intolerance and aging. Diabetes Care 4: 493–501, 1981.Google Scholar
  94. 94.
    Jackson R.A.: Mechanisms of age-related glucose intolerance. Diabetes Care 13: 9–19, 1990.Google Scholar
  95. 95.
    Fink R.I., Kolterman O.G., Griffin J., Olefsky J.M.: Mechanisms of insulin resistance in aging. J. Clin. Invest. 71: 1523–1535, 1983.PubMedCentralPubMedGoogle Scholar
  96. 96.
    National Diabetes Data Group. Diabetes in America. U.S Dept. of Health and Human Services, Public Health Service. NIH Publication No. 85–1468, August 1985.Google Scholar
  97. 97.
    Kannel W.B., McGee D.L.: Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham Study. Diabetes Care 2: 120–126, 1979.PubMedGoogle Scholar
  98. 98.
    Butler W.J., Ostrander L.D. jr., Carman W.J., Lamphiear D.E:. Mortality from coronary heart disease in Tecumseh Study: long-term effect of diabetes mellitus, glucose tolerance and other risk factors. Am. J. Epidemiol. 121: 541–547, 1985.PubMedGoogle Scholar
  99. 99.
    Barrett-Connor E., Wingard D.L.: Sex differential in ischemic heart disease mortality in diabetics: a prospective population-based study. Am. J. Epidemiol. 118: 489–496, 1983.PubMedGoogle Scholar
  100. 100.
    Kannel W.B., McGee D.L.: Diabetes and cardiovascular disease: the Framingham Study. JAMA 241: 2035–2038, 1979.PubMedGoogle Scholar
  101. 101.
    Burack R., Keller J., Higgins M.: Cardiovascular risk factors and obesity: are baseline levels of blood pressure, glucose, cholesterol and uric acid elevated prior to weight gain? J. Chronic Dis. 38: 865–872, 1985.PubMedGoogle Scholar
  102. 102.
    Tell G.S., Rutan G.H., Kronmal R.A., Polak J.F., Wong N.D., Borhani N.O.: Correlates of blood presssure in community-dwelling older adults. The Cardiovascular Heath Study. Cardiovascular Health Study (CHS) Collaborative Research Group. Hypertension 23: 59–67, 1994.PubMedGoogle Scholar
  103. 103.
    The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 329: 977–986, 1993.Google Scholar
  104. 104.
    Gossain V.V., Carella M.J., Rovner D.R.: Management of diabetes in the elderly: a clinical perspective. J. Assoc. Acad. Minor. Phys. 5: 22–31, 1994.PubMedGoogle Scholar
  105. 105.
    Manson J.E., Colditz G.A., Stampfer M.J., Willett W.C., Krolewski A.S., Rosner B., Arky R.A., Speizer F.E., Hennekens C.H.: Maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch. Intern. Med. 151: 1141–1147, 1991.PubMedGoogle Scholar
  106. 106.
    Kannel W.B.: Metabolic risk factors for coronary heart disease in women: perspective from the Framingham Study. Am. Heart J. 114: 413–419, 1987.PubMedGoogle Scholar
  107. 107.
    Kannel W.B., Hjortland M.C., McNamara P.M., Gordon T.: Menopause and the risk of cardiovascular disease: the Framingham Study. Ann. Intern. Med. 85: 447–452, 1976.PubMedGoogle Scholar
  108. 108.
    Wilson P.W.F., Garrison R.J., Castelli W.P.: Post-menopausal estrogen use, cigarette smoking, and cardiovascular morbidity in women over 50. N. Engl. J. Med. 313: 1038–1043, 1985.PubMedGoogle Scholar
  109. 109.
    Bush T.L., Barrett-Connor E., Cowan L.D., Criqui M.H., Wallace R.B., Suchindran C.M., Tyroler H.A., Rifkind B.M.: Cardiovascular mortality and non-contraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-Up Study. Circulation 75: 1102–1109, 1987.PubMedGoogle Scholar
  110. 110.
    Barrett-Connor E., Wingard D.L., Criqui M.H.: Postmenopausal estrogen use and heart disease risk factors in the 1980s. JAMA 261: 2095–2100, 1989.PubMedGoogle Scholar
  111. 111.
    Stampfer J.M., Colditz G.A., Willett W.C., Manson J.E., Rosner B., Speizer F.E., Hennekens C.H.: Postmenopausal estrogen therapy and cardiovascular disease. N. Engl. J. Med. 325: 756–762, 1991.PubMedGoogle Scholar
  112. 112.
    Miller-Bass K., Bush T.L.: Estrogen therapy and cardiovascular risk in women. J. Louisiana State Med. Soc. 143: 33–39, 1991.Google Scholar
  113. 113.
    Barrett-Connor E., Bush T.L.: Estrogen and coronary heart disease in women. JAMA 265: 1861–1867, 1991.PubMedGoogle Scholar
  114. 114.
    Rossouw J.E., Finnegan L.P., Harlan W.R., Pinn V.W., Clifford C., McGowan J.A.: The evolution of the Women’s Health Initiative: perspectives from the NIH. J. Am. Med. Wom. Assoc. 50: 50–55, 1995.PubMedGoogle Scholar
  115. 115.
    Bush T.L., Miller V.T.: Effects of pharmacological agents used during menopause: impact on lipids and lipoproteins. In: Mishell D.R. jr. (Ed.), Menopause: physiology and pharmacology. Year Book Medical Publishers Inc, Chicago, IL, 1987, pp. 187–208.Google Scholar
  116. 116.
    The Writing Group for the PEPI Trial: Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/ Progestin Interventions trial. JAMA 273: 199–208, 1995.Google Scholar
  117. 117.
    Stampfer M.J., Colditz G.A.: Estrogen replacement therapy and coronary heart disease: quantitative assessment of the epidemiologic evidence. Prev. Med. 20: 47–63, 1991.PubMedGoogle Scholar
  118. 118.
    Manolio T.A., Furberg C.D., Shemanski L., Psaty B.M., O’Leary D.H., Tracy R.P., Bush T.L., for the CHS Collaborative Research Group: Association of postmenopausal estrogen use with cardiovascular disease and its risk factors in older women. Circulation 88: 2163–2171, 1993.PubMedGoogle Scholar
  119. 119.
    Berlin J.A., Colditz G.A.: A meta-analysis of physical activity in the prevention of coronary heart disease. Am. J. Epidemiol. 132: 612–628, 1990.PubMedGoogle Scholar
  120. 120.
    Donahue R.P., Abbott R.D., Reed D.M., Yano K.: Physical activity and coronary heart disease in middle-aged and elderly men: the Honolulu Heart Program. Am. J. Public Health 78: 683–685, 1988.PubMedGoogle Scholar
  121. 121.
    Paffenbarger R.S. jr., Hyde R.T., Wing A.L., Hsieh C.C.: Physical activity, all-cause mortality and longevity of college alumni. N. Engl. J. Med. 314: 605–613, 1986.PubMedGoogle Scholar
  122. 122.
    O’Connor G.T., Hennekens C.H., Willett W.C., Goldhaber S.Z., Paffenbarger R.S., Breslow J.L., Lee I-M., Buring J.E.: Physical exercise and reduced risk of nonfatal myocardial infarction. Am. J. Epidemiol. 142: 1147–1156, 1995.PubMedGoogle Scholar
  123. 123.
    O’Connor G.T., Buring J.E., Yusuf S., Goldhaber S.Z., Olmstead B.A., Paffenbarger R.S., Hennekens C.H.: An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 80: 234–244, 1989.PubMedGoogle Scholar
  124. 124.
    Simonsick E.M., Lafferty M.E., Phillips C.L., Mendes de Leon C.F., Kasl S.V., Seeman T.E., Fillenbaum G., Hebert P., Lemke J.H.: Risk due to inactivity in physically capable older adults. Am. J. Public Health 83: 1443–1450, 1993.PubMedGoogle Scholar
  125. 125.
    Kaplan G.A., Seeman T.E., Cohen R.D., Knudesen L.P., Guralnik J.M.: Mortality among the elderly in the Alameda County Study: behavioral and demographic risk factors. Am. J. Public Health 77: 307–312, 1987.PubMedGoogle Scholar
  126. 126.
    Tinetti M.E., Baker D.I., McAvay G., Claus E.B., Garrett P., Gottschalk M., Koch M.L., Trainor K., Horwitz R.I.: A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N. Engl. J. Med. 331: 821–827, 1994.PubMedGoogle Scholar
  127. 127.
    LaCroix A.Z., Guralnik J.M., Berkman L.F., Wallace R.B., Satterfield S.: Maintaining mobility in late life. II. Smoking, alcohol consumption, physical activity and body mass index. Am. J. Epidemiol. 137: 858–869, 1993.PubMedGoogle Scholar
  128. 128.
    Wilhelmsen L., Svardsudd K., Korsan-Bengtsen K., Larsson B., Welin L., Tibblin G.: Fibrinogen as a risk factor for stroke and myocardial infarction. N. Engl. J. Med. 311: 501–505, 1984.PubMedGoogle Scholar
  129. 129.
    Maede T.W., Mellows S, Brozovic M., Miller G.J., Chakrabarti R.R., North W.R., Haines A.P., Stirling Y., Imeson J.D., Thompson S.G.: Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet 2: 533–537, 1986.Google Scholar
  130. 130.
    Kannel W.B., Wolf P.A., Castelli W.P., D’Agostino R.B.: Fibrinogen and risk of cardiovascular disease. The Framingham Study. JAMA 258: 1183–1186, 1987.PubMedGoogle Scholar
  131. 131.
    Yarnell J.W., Baker I.A., Sweetnam P.M., Bainton D., O’Brien J.R., Whitehead P.J., Elwood P.C.: Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease. The Caerphilly and Speedwell collaborative heart studies. Circulation 83: 836–844, 1991.PubMedGoogle Scholar
  132. 132.
    Brand F.N., McGee D.L., Kannel W.B., Stokes J. III, Castelli W.P.: Hyperuricemia as a risk factor of coronary heart disease: the Framingham Study. Am. J. Epidemiol. 121: 11–18, 1985.PubMedGoogle Scholar
  133. 133.
    Levine W., Dyer A.R., Cheekily R.B., Schoenberger J.A., Stamler J.: Serum uric acid and 11.5-year mortality of middle-aged women: findings of the Chicago Heart Association Detection Project in Industry. J. Clin. Epidemiol. 42: 257–267, 1989.PubMedGoogle Scholar
  134. 134.
    Rathmann W., Hauner H., Dannehl K., Gries F.A.: Association of elevated serum uric acid with coronary heart disease in diabetes mellitus. Diabetes Metab. 19: 159–166, 1993.Google Scholar
  135. 135.
    Sullivan J.L.: The iron paradigm of ischemic heart disease. Am. Heart J. 117: 1177–1188, 1989.PubMedGoogle Scholar
  136. 136.
    McCord J.M.: Is Iron sufficiency a risk factor in ischemic heart disease? Circulation 83: 1112–1113, 1991.PubMedGoogle Scholar
  137. 137.
    Salonen J.T., Nyssonen K., Korpela H., Tuomilehto J., Seffanen R., Slonen R.: High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish Men. Circulation 86: 803–811, 1992.PubMedGoogle Scholar
  138. 138.
    Corti M-C., Guralnik J.M., Salive M.E., Ferrucci L., Pahor M., Wallace R.B., Hennekens C.H.: Serum iron and coronary heart disease mortality in older persons. Circulation 92 (I): 152, 1995 (Abstract).Google Scholar
  139. 139.
    Phillips A., Shaper A.G., Whincup P.H.: Association between serum albumin and mortality from cardiovascular disease, cancer and other causes. Lancet 1: 1434–1436, 1989.Google Scholar
  140. 140.
    Kuller L.H., Eichner J.E., Orchard T.J.: The relationship between serum albumin levels and risk of coronary heart disease in Multiple Risk Factor Intervention Trial. Am. J. Epidemiol. 134: 1266–1277, 1991.PubMedGoogle Scholar
  141. 141.
    Gillum R.F., Makuc D.M.: Serum albumin, coronary heart disease and death. Am. Heart J. 123: 507–513, 1992.PubMedGoogle Scholar
  142. 142.
    Corti M-C., Salive M.E., Guralnik J.M.: Serum albumin and physical function as predictors of coronary heart disease incidence and mortality in older persons. J. Clin. Epidemiol. 1996 (in press).Google Scholar
  143. 143.
    Boushey C.J., Beresdorf S.A.A., Omenn G.S., Motulsky A.G.: A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. JAMA 274: 1049–1057, 1995.PubMedGoogle Scholar
  144. 144.
    Beard J.T.: Serum uric acid and coronary heart disease. Am. Heart J. 106: 397–400, 1983.PubMedGoogle Scholar
  145. 145.
    Ernst E.: Fibrinogen as a cardiovascular risk factor. Interrelationship with infection and inflammation. Eur. Heart J. 14 (K): 82–87, 1993.PubMedGoogle Scholar
  146. 146.
    Nygard O., Vollset S.E., Refsum H., Stensfold I., Tverdal A., Nordrehaug J.E., Ueland P.M., Kvale G.: Total plasma homocysteine and cardiovascular risk profile: the Hordaland Homocysteine Study. JAMA 274: 1526–1533, 1995PubMedGoogle Scholar
  147. 147.
    Caird F.I., Kennedy R.D.: Epidemiology of heart disease in older age. In: Caird F.I., Dall J.L.C., Kennedy R.D. (Eds.), Cardiology in old age. Plenum Press, New York, London, 1976, pp.1–10.Google Scholar
  148. 148.
    Kronmal R.A., Cain K.C., Ye Z., Omenn G.S.: Total serum cholesterol levels and mortality risk as a function of age. A report based on Framingham data. Arch. Intern. Med. 153: 1065–1073, 1993.PubMedGoogle Scholar
  149. 149.
    Gordon D.J., Rifkind B.M.: Treating high blood cholesterol in the older patient. Am. J. Cardiol. 63: 48H–52H, 1989.PubMedGoogle Scholar
  150. 150.
    Garber A.M., Sox H.C., Littemberg B.: Screening symptomatic adults for cardiac risk factors: the serum cholesterol levels. Ann. Int. Med. 110: 622–639, 1989.PubMedGoogle Scholar
  151. 151.
    Malenka D.J., Baron J.A.: Cholesterol and coronary heart disease. The importance of patient-specific attributable risk. Arch. Intern. Med. 148: 2247–2252, 1988.PubMedGoogle Scholar
  152. 152.
    Wolinsky F.D., Arnold C.L.: A different perspective on health and health services utilization. In: Lawton M.P., Maddox G. (Eds.), Annual review of gerontology and geriatrics. Springer, New York, 1988, pp. 71–101.Google Scholar
  153. 153.
    Harris T., Feldman J.J.: Implications of health status in analysis of risk in older persons. J. Aging Health 3: 263–284, 1991.Google Scholar
  154. 154.
    Kuller L., Borhani N., Furberg C., Gardin J., Manolio T., O’Leary D., Psaty B., Robbins J.: Prevalence of subclinical atherosclerosis and cardiovascular disease and association with risk factors in the Cardiovascular Health Study. Am. J. Epidemiol. 139: 1164–1179, 1994.PubMedGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 1996

Authors and Affiliations

  • M-C. Corti
    • 1
  • J. M. Guralnik
    • 1
  • C. Bilato
    • 2
  1. 1.Epidemiology, Demography, Biometry Program, National Institute on AgingNational Institutes of HealthBethesdaUSA
  2. 2.Vascular Biology Unit, Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on AgingNational Institutes of HealthBaltimoreUSA

Personalised recommendations