Epidemiology of Cardiovascular Diseases in The Elderly

BACKGROUND: Cardiovascular disease is the leading cause of mortality in older persons in the United States. Nearly two-thirds of all deaths in men and women 65 years of age or older are due to some manifestation of cardiovascular disease. Further, cardiovascular disease is a major cause of disability in the elderly. Although there is relatively extensive epidemiologic data on risk factors for cardiovascular disease in younger individuals, particularly younger men, in 1986 when the study was initiated, relatively little information existed on the prevalence and antecedents of cardiovascular disease in men and women over 65 years of age. Further, the data that did exist tended to be contradictory. From a public health perspective, it was important to identify risk factors for cardiovascular disease in older individuals for several reasons. The numbers and proportion of elderly persons in the U.S. were growing, and would continue to grow well into the next century. This segment of our society, which comprised 12 percent of the population in 1986, accounted for one third of our health care costs. Older Americans will continue to make significant demands on the health care system in the coming decades. The identification of risk factors for this major public health problem (e.g., cardiovascular disease) may lead to interventions which would improve the health of older Americans and thus benefit the entire society. Data for this project have been gathered since 1975 by the Dunedin Program, a population-based geriatric health-screening program. This Program was designed to screen persons 65 years of age or older for a wide variety of medical disorders. It was situated in Dunedin, Florida, which is on the mid-west Gulf coast. Each participant was seen at the clinic once a year. The clinic visit consisted of registration, a physical examination, and questionnaire/medication form. Data were available on family history of illnesses, illnesses of participant, smoking history, alcohol use, emotional status, coffee consumption, dietary habits, current symptoms, social activities, exercise, attitudes towards health care, height, weight, blood pressure, carotid artery auscultation, electrocardiogram, lipid levels, blood chemistries and blood counts, diabetes, urine samples, and medication use. In 1986, a total of 5,085 persons had completed the first screening examination and 1,540 had completed a full eight years of screening. DESIGN NARRATIVE: In the first phase, follow-up time for each participant was computed and changes in risk factor status analyzed. Cardiovascular disease incidence and mortality rates were calculated. In the second phase, incidence rates of cardiovascular disease were computed by category of risk factor level at baseline. The relative risk of cardiovascular disease was calculated for each risk factor. Multivariable analyses were carried out in the third phase. Regression models were used to determine independent and interactive effects of the identified risk factors on the incidence of and mortality from cardiovascular disease. The study completion date listed in this record was obtained from the "End Date" entered in the Protocol Registration and Results System (PRS) record.