Abstract 16511: Coronary Artery Calcium and Risk of Death, Dementia and Disability in Older 80+ Year Old Individuals
We previously reported that extent of coronary artery calcium (CAC) measured in 1998-2000 was an independent predictor of total and coronary heart disease (CHD) mortality and brain magnetic resonance imaging abnormalities among individuals, mean age 80 at the time of their scans. The Cardiovascular Health Study-Cognition Study (CHS-CS) has followed 532 participants to incident dementia from 1998-1999 through 2012. We linked the CHS CAC study and the CHS-CS for 434 (82%) of the 532 participants in the CHS-CS to test the long term effects of CAC on total mortality, CHD death, dementia and disability. There were 97 (23%) blacks and 264 (61%) women. Blacks and women had lower CAC scores than whites and men. Levels of CAC were strongly related to both total and CHD mortality over 12 years of follow up. For women with <10 Agatston score, age-adjusted total mortality was 37/1000 person-years (PY) versus 73/1000 PY for those with >100 Agatston score and for men with <10 Agatston score, 31/1000 PY versus 70/1000 with >100 Agatston score (p<0.0001 for both men and women). Age-adjusted total and CHD mortality was very similar for older men and women within the same CAC categories. The CAC Agatston score remained an independent predictor of total mortality in Cox models along with age, and indices of hypertensive disease, i.e., brain natriuretic peptide or brain white matter grade. Incidence of dementia was less for women but not men with lower CAC scores, 52 (CI: 21-136)/1000 PY for women with CAC <10 versus 91 (CI: 57-146) (p=0.18) CAC >100. Women with lower CAC scores lived longer and prevalence of dementia during lifetime and dementia among those still alive was similar to those with high CAC scores: 44% of women with CAC scores <10 and 51% for those with CAC >100 developed incident dementia, 62% (31 of 51) alive with CAC score <10 are demented versus 63% (55 of 87) with CAC score >100. Few, 33 (12%) of 270 (mean current age of 89), survived free of dementia, disability and instrumental activities of daily living <2, which was weakly related to CAC but more strongly to numbers of blocks walked, never smoking and age. Cardiovascular research in the elderly needs to focus on the brain (dementia) as well as cardiovascular systems.
- © 2012 by American Heart Association, Inc.