The relative utility of conventional and novel risk factors in predicting cardiovascular
disease (CVD) in relation to age remains unclear. We examined the discriminative ability
of C-reactive protein (CRP) and Framingham risk score across young (35 to 50 years),
middle (51 to 65 years), and older (≥65 years) aged participants from the Scottish
Health Surveys (n = 5,944, 44.5% men). CRP data and conventional risk factors were
collected at baseline. During an average follow-up of 7.1 years, 308 CVD events (a
composite of fatal and nonfatal events incorporating acute myocardial infarction,
coronary artery bypass surgery, percutaneous coronary angioplasty, stroke, and heart
failure) occurred. The log CRP/SD predicted the risk of CVD events in middle-age (hazard
ratio 2.20, 95% confidence interval 1.34 to 3.61) and older (hazard ratio 1.85, 95%
confidence interval 1.23 to 2.78) participants, after adjustment for the Framingham
risk score. Using receiver operating characteristic (ROC) curves, the area under the
curve for the Framingham risk factor model for predicting CVD events was greater in
the younger (ROC 0.78) and middle-age (ROC 0.72) participants than in the older participants
(ROC 0.59), although the discriminative ability was not substantially improved by
adding the CRP data. In conclusion, our results have demonstrated the steadily decreasing
predictive value of conventional risk factors with advancing age, although CRP has
limited additive value for CVD risk stratification. Our results provide validation
of the recently devised Framingham risk factor algorithm for use in primary care in
participants <65 years old.
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Article info
Publication history
Published online: June 22, 2009
Accepted:
April 11,
2009
Received in revised form:
April 11,
2009
Received:
March 18,
2009
Footnotes
This study was funded by the British Heart Foundation, London, United Kingdom, and the National Institute for Health Research, London, United Kingdom.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
