Cardiovascular Health in Advanced Age

Abstract

New Zealand‘s population is ageing. Cardiovascular disease (CVD) may account for 53% of death in people aged 85+. Nevertheless, little is known about the cardiovascular health status of those in advanced age. The aim of the study is to assess cardiovascular health and examine the relationships between cardiovascular risk factors and presence of clinically manifest CVD in people of advanced age. This thesis reports a cross-sectional study of 108 participants aged 85 years (75-79 for Māori) from three locations (urban and rural) in New Zealand. Demography, medical history, nutritional risk and physical activity levels were established by interview. Height, weight, blood pressure, body composition, ultrasound of the carotid intima-media thickness (CIMT) and echocardiography were completed. Fasting blood samples were collected. Two-thirds of the sample (n=72) had clinically manifest CVD. The level of physical activity measured by the PASE scale was inversely associated with CVD [OR (95% CI): 0.990 (0.982– 0.999), p=0.028] controlling for sex, age-ethnicity, and smoking status. High-density lipoprotein level was inversely associated with CVD after adjusting for sex, ageethnicity, smoking status and waist circumference [OR (95% CI): 0.291 (0.086–0.986), p=0.047]. The study did not find an association between inflammatory markers and CVD. One-quarter of the sample has increased CIMT ( 1.206mm). Almost all of the participants (94%) had abnormal echocardiographic measures: 38% had left ventricular (LV) hypertrophy; 68% had enlarged left atrial area; and 5% had abnormal LV systolic function. The echocardiography results suggest that subclinical CVD may be prevalent among the very old. Findings from this study have to be interpreted with caution due to the cross-sectional nature of the study and the small sample size. However, this thesis forms the basis for ongoing longitudinal study and these results suggest that, in contrast to those in middle age, HDL appear to be more closely related to CVD than LDL. In this sample of those in advanced age, two-thirds have CVD. Level of physical activity and HDL concentration seems to be important risk factors associated with CVD. Larger prospective ii studies are needed to confirm these results. The clinical significance of increased CIMT and abnormalities of echocardiographic measures need to be determined in longitudinal studies.