Age Aspects of Cardiovascular Disease

Cardiovascular disease is the leading cause of death in our part of the world. Cardiovascular risk is strongly associated with age. Atherosclerotic vascular disease is rather unusual in males below age of 35 years and females below age of 45 and the prevalence gradually increases thereafter. Identification of patients at risk for cardiovascular events in all age groups is very important in the efforts to improve prevention, prediction, diagnosis, and prognosis and thereby decrease the burden of disease and the related cost. The overall main theme of the thesis is to improve prediction of cardiovascular disease and it ́s complications in different age settings and in particular groups of individuals and patients.I will be presenting four papers concerning age-related risk factors and relation to cardiovascular disease (three published and one manuscript). In the first paper we wanted to test if traditional risk factor pattern in midlife differs between patients who develop early versus late myocardial infarction. Exposure to cholesterol and family history of MI in midlife more strongly predicts onset of MI at younger ages, suggesting that MI in younger subjects is preceded by a different risk factor pattern than MI presenting in older subjects.In the second paper we evaluated the proportion of cardiovascular disease (CVD) incidence that is explained by genetic variation at chromosome 9p21 and to test whether such variation adds incremental information with regard to CVD prediction, beyond traditional risk factors. We found that a) The variation of chromosome 9p21 has a high population attributable risk suggesting that future interventions interfering with downstream mechanisms of the genetic variation may affect CVD incidence over a broad range of ages. b) Variation of chromosome 9p21 alone does not add clinically meaningful information in terms of CVD prediction beyond traditional risk factors at any age.c) despite a decline in the proportion of CVD incidence attributable to the chromosome 9p21 with increasing age, the actual number of events increased with age, suggesting that any future intervention to inhibit the consequences of the chromosome 9p21 risk variant may in fact prevent more CVD events amongst older than younger individuals.In the third paper we wanted to determine whether statin treatment is effective and safe in very elderly (80 years and older) acute myocardial infarction (AMI) patients. In a large register based study in The “Register of Information and Knowledge about Swedish Heart Intensive care Admission”(RIKSHIA) we found that statin treatment is associated with lower cardiovascular mortality in very elderly post-infarction patients without increasing the risk of the development of cancer. Along with an aging population heart failure is increasing worldwide. New tools and biomarkers are needed to identify individuals at risk. In paper four, we examine if plasma concentration of a Cterminal fragment of the Endothelin-1 precursor hormone (CT-proET-1) predicts heart failure among elderly patients without history of CAD (coronary artery disease) on top of established risk factors. The study shows that CT-proET-1 strongly and independently predicts HF development in an older population free of CAD. The association was independent of traditional CVD risk factors, natriuretic peptide level and renal function.