Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study

doi:10.1136/bmj.a3083

Published 8 January 2009, doi:10.1136/bmj.a3083
Cite this as: BMJ 2009;338:a3083

Research

Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study

Wouter de Ruijter, general practitioner and clinical researcher¹, Rudi G J Westendorp, professor², Willem J J Assendelft, professor¹, Wendy P J den Elzen, clinical researcher¹, Anton J M de Craen, senior epidemiologist², Saskia le Cessie, statistician³, Jacobijn Gussekloo, professor¹

¹ Leiden University Medical Center, Department of Public Health and Primary Care (V0-P), PO Box 9600, 2300 RC Leiden, Netherlands, ² Leiden University Medical Center, Department of Gerontology and Geriatrics (C2-R), PO Box 9600, 2300 RC Leiden, Netherlands, ³ Leiden University Medical Center, Department of Medical Statistics (S5-P), PO Box 9600, 2300 RC Leiden, Netherlands

Correspondence to: W de Ruijter w.de_ruijter{at}lumc.nl

Objectives To investigate the performance of classic risk factors,and of some new biomarkers, in predicting cardiovascular mortalityin very old people from the general population with no historyof cardiovascular disease.

Design The Leiden 85-plus Study (1997-2004) is an observationalprospective cohort study with 5 years of follow-up.

Setting General population of the city of Leiden, the Netherlands.

Participants Population based sample of participants aged 85years (215 women and 87 men) with no history of cardiovasculardisease; no other exclusion criteria.

Main measurements Cause specific mortality was registered duringfollow-up. All classic risk factors included in the Framinghamrisk score (sex, systolic blood pressure, total and high densitylipoprotein cholesterol, diabetes mellitus, smoking and electrocardiogrambased left ventricular hypertrophy), as well as plasma concentrationsof the new biomarkers homocysteine, folic acid, C reactive protein,and interleukin 6, were assessed at baseline.

Results During follow-up, 108 of the 302 participants died;32% (35/108) of deaths were from cardiovascular causes. Classicrisk factors did not predict cardiovascular mortality when usedin the Framingham risk score (area under receiver operatingcharacteristic curve 0.53, 95% confidence interval 0.42 to 0.63)or in a newly calibrated model (0.53, 0.43 to 0.64). Of thenew biomarkers studied, homocysteine had most predictive power(0.65, 0.55 to 0.75). Entering any additional risk factor orcombination of factors into the homocysteine prediction modeldid not increase its discriminative power.

Conclusions In very old people from the general population withno history of cardiovascular disease, concentrations of homocysteinealone can accurately identify those at high risk of cardiovascularmortality, whereas classic risk factors included in the Framinghamrisk score do not. These preliminary findings warrant validationin a separate cohort.

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Rapid Responses:

Read all Rapid Responses

Fatty Acid Profiles, major factor, were omitted: Edward N. Siguel
bmj.com, 20 Jan 2009 [Full text]
Accurate and Ethical?: Chris C Gunstone, et al.
bmj.com, 24 Jan 2009 [Full text]
Does the ability of homocysteine to predict mortality of the very elderly merely reflects their reduced renal function?: Michael Bursztyn, et al.
bmj.com, 26 Jan 2009 [Full text]
Authors' Reply: Wouter de Ruijter, et al.
bmj.com, 29 Jan 2009 [Full text]
New markers predicting mortality in the elderly: Yoram Maaravi, et al.
bmj.com, 11 Feb 2009 [Full text]