Predicción del riesgo cardiovascular en población de 75 o más años del Mediterráneo

Abstract

The increase of elderly population in Spain is one of the most important challenges for their caregivers, healthcare professionals, and the society in general. The elderly population has the highest incidence rate of cardiovascular disease (CVD) and a high prevalence of cardiovascular risk factors, such as dyslipidaemia (altered lipid levels). Reducing the low-density lipoprotein cholesterol (LDL-C) levels is the primary goal in CVD risk reduction. However, the role of LDL-C in the incidence of CVD events needs to be better defined for elderly in primary prevention (PP). Therefore, the study of the relation of LDL-C with the incidence of CVD in the elderly population is important for the prevention of these diseases.

The approach to the elderly patient in PP includes a clinical assessment and estimation of cardiovascular risk. The Systemic Coronary Risk Estimation 2 (SCORE2 Older Persons, SCORE2-OP) model is recommended for estimating 5- and 10-year risks of fatal and non-fatal CVD events in adults aged >70 years. However, Mediterranean countries are poorly represented in its external validation. Therefore, it is possible that SCORE2-OP estimates do not adjust to the cardiovascular risk of our population. In this scenario, there arises the need to derive and validate a cardiovascular risk function for the Mediterranean population aged 75 years and older.

To address the objectives of this thesis, we designed two retrospective cohorts using data from the Sistema d'Informació per al Desenvolupament de la Recerca en Atenció Primària (SIDIAP). In a population aged 75 years or older with no history of CVD and no lipid-lowering treatment, a 1-mmol/L increase in LDL-C was associated with a 16% increased risk of coronary heart disease, with an absolute difference of 1 event per 1,000 person-years. That increased risk was higher in men than in women. We did not observe a significant association with ischaemic cerebrovascular disease.

In addition, the SCORE2-OP risk function predictions did not match the observation analysed in our study population, and thus, may not be appropriate for regions of low cardiovascular risk. Therefore, we developed a specific function for men and women aged 75 years and older to estimate the risk of CVD events at 10 years. The function is called CARDIORISK.CAT and includes variables collected in routine clinical practice: age, current smoking, systolic blood pressure (SBP), total cholesterol, high-density lipoprotein cholesterol (HDL-C) and diabetes. CARDIORISK.CAT showed moderate discrimination and could be a helpful tool in primary care clinical practice for predicting the risk of these diseases in elderly people