Abstract 13442: Aging, Risk Factors and Progression of Coronary Atherosclerosis
Background: Increasing age is associated with greater morbidity and mortality from cardiovascular disease. The relationship between aging, burden and progression of coronary atherosclerosis (CAD) and the impact of risk factors in age groups is not well established.
Methods: 3479 CAD patients from 7 clinical trials with serial intravascular ultrasound were stratified according to age (Group 1: 1423 patients < 55, Group 2: 1288 patients 55–65, Group 3: 768 patients > 65). The impact of aging, risk factors and treatment strategies on disease burden and progression were evaluated.
Results: Increasing age was associated with greater percent atheroma volume (PAV: 37.7±9.3 vs. 39.0±8.9 vs. 39.8±8.9 % in groups 1, 2 and 3 respectively, p<0.001), luminal narrowing (lumen volume: 307.2 ± 107.2 vs. 296.1 ± 113.6 vs. 292.6 ± 108.0 mm3 in groups 1, 2 and 3 respectively, p<0.001) and plaque calcification (% of images with Calcium: 24.8 vs. 31.8 vs. 36.2 % in groups 1, 2 and 3 respectively, p<0.001). On multivariable analysis, aging was a predictor of disease progression independent of comorbidities (p value for change in PAV = 0.0087). While the impact of diabetes and blood pressure on disease progression decreased with aging, dyslipidemia continued to be a strong predictor for disease progression (table). Achieving low-density lipoprotein levels below 80 mg/dL was associated with the slowest rates of disease progression in all age groups (p=0.001; 0.02 and 0.009 for change in PAV in patients <55; 55–65 and >65 year old respectively).
Conclusions: Aging is associated with greater progression of atherosclerosis, independent of the presence of comorbidities. The impact of most major risk factors decreases with age. The benefit of intensive lipid lowering in all age groups supports the need for intensive modification of risk in all patients regardless of age.
- © 2010 by American Heart Association, Inc.