People are living longer today; however, the older a person is, the higher the risk of cardiovascular disease, heart attack or stroke. Despite this fact, prevention guidelines for cardiovascular events are the least aggressive for those 75 years and above due to limited clinical data. Researchers at Baylor College of Medicine and Johns Hopkins University are using data from the long-term study Atherosclerosis Risk in Communities (ARIC) to pinpoint the best recommendations for prediction, treatment and prevention for the aging population.
“It is an interesting paradox that there is the least amount of information available on how to treat a group of people who are at the greatest risk. In fact, the most commonly used calculator that predicts risk of a cardiovascular event doesn’t have results for people over the age of 80,” said Dr. Christie Ballantyne, professor of medicine and chief of the section of cardiology at Baylor. “What is needed is a personalized approach that takes into account the different risk factors that a person in this age group might face.”
Ballantyne has been awarded a grant for more than $3 million from the National Institutes of Health to use data from the ARIC study (designed to investigate the causes of atherosclerosis and its clinical outcomes) to improve the Pooled Cohort Equation risk calculator for cardiovascular disease to include older populations, to improve risk prediction and prevention of heart failure in this same group, and to identify factors in middle aged people who have gone on to have healthy cardiovascular aging. His co-investigator is Dr. Elizabeth Selvin with Johns Hopkins Bloomberg School of Public Health.
There is evidence from recent studies that this aging population, despite other health and risk factors, still benefit from aggressive treatments, Ballantyne said. One recent study by an unrelated group involving people with high blood pressure showed that lower target levels of blood pressure were more beneficial to long-term outcomes including heart failure and death for those 75 years or older. Another study looked at those with high cholesterol and found similar results for the prevention of heart attack. Ballantyne said these types of results show that there is still a way to properly treat an aging population.
“These studies show that older groups are getting the most benefits, yet we have guidelines that don’t really tell us how best to treat this group,” he said. “So our first goal of the current study is to reevaluate the risk calculator.”
The long term ARIC study provides information on participants dating back almost 30 years to present day. Some participants are now in their 90s, so researchers will be able to see what risk factors were present, how treatments affected each person and what has been most beneficial over time at different stages of life.
Once an increased risk in cardiovascular disease and other heart events like heart failure can be properly identified and evaluated in an older population, finding the best prevention methods is the next step.
“You don’t treat every older person simply because they are at an increased risk due to age, but you find those that have some risk factor that you might be able to improve either with medications or lifestyle modifications,” Ballantyne said. “We want to be able to more precisely say, ‘This is the person with the highest risk,’ or ‘This person is really not at great risk.’ This information will be helpful to both patients and health care professionals to determine which changes in lifestyle and medication would be beneficial to each individual.”
The data from the long-term ARIC study also is being used to evaluate those individuals who experience healthy aging.
“There are those people who age but never develop cardiovascular disease. What is protecting them? Is there something there genetically? We are looking at biomarkers, lifestyle choices and other factors to try to answer those questions,” Ballantyne said.
Researchers also will investigate how other health issues such as diabetes and cognitive disorders or declines are related to cardiovascular disease.
"Understanding this information will help to design future studies to find out exactly what affects the health of the aging population and what types of medications, therapies or lifestyle changes are needed for each individual,” Ballantyne said. “Our goals aren’t just focused on a person living a longer life, but on living a good quality of life.”
Ballantyne also is the director of the Maria and Alando J. Ballantyne Atherosclerosis Clinical Research Laboratory at Baylor, director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart Center and co-director of the Lipid Metabolism and Atherosclerosis Clinic at Houston Methodist. He also holds the J. S. Abercrombie Chair in Atherosclerosis and Lipoprotein Research at Baylor.
The Atherosclerosis Risk in Communities 374 Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C).
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