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Abstract:
BACKGROUND:Accurate assessment of atherosclerotic cardiovascular disease (ASCVD) risk across heterogeneous populations is needed for effective primary prevention. Little is known about the performance of standard cardiovascular risk factors in older adults. OBJECTIVE:To evaluate the performance of the American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE) risk model, as well as the underlying cardiovascular risk factors, among adults older than 65 years. DESIGN AND SETTING:Retrospective cohort derived from a regional referral system's electronic medical records. PARTICIPANTS:A total of 25 349 patients who were 65 years or older at study baseline (date of the first outpatient lipid panel taken between 2007 and 2010). MEASUREMENTS:Exposures of interest were traditional cardiovascular risk factors, as defined by inclusion in the PCE model. The primary outcome was major ASCVD events, defined as a composite of myocardial infarctions, stroke, and cardiovascular death. RESULTS:The PCE and internally estimated models produced similar risk distributions for white men aged 65 to 74 years. For all other groups, PCE predictions were generally lower than those of the internal models, particularly for African Americans. Discrimination of the PCE was poor for all age groups, with concordance index (95% confidence interval) estimates of 0.62 (0.60-0.64), 0.56 (0.54-0.57), and 0.52 (0.49-0.54) among patients aged 65 to 74, 75 to 84, and 85 years and older, respectively. Reestimating relationships within these age groups resulted in better calibration but negligible improvements in discrimination. Blood pressure, total cholesterol, and diabetes either were not associated at all or had inverse associations in the older age groups. CONCLUSION:Traditional clinical risk factors for cardiovascular disease failed to accurately characterize risk in a contemporary population of Medicare-aged patients. Among those aged 85 years and older, some traditional risk factors were not associated with ASCVD events. Better risk models are needed to appropriately inform treatment decision making for the growing population of older adults.
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最新影响因子:7.538 | 期刊ISSN:0002-8614 | CiteScore:2.42 |
出版周期:Monthly | 是否OA:YES | 出版年份:1953 |
期刊官方网址:http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1532-5415
自引率:8.20% | 研究方向:医学-老年医学 |
出版地区:UNITED STATES |
SCI期刊coverage:Science Citation Index Expanded(科学引文索引扩展)
专业编辑在线一对一答疑及时解决您的问题
The primary goal of the Journal of the American Geriatrics Society is to publish articles that are relevant in the broadest terms to the clinical care of older persons. Such articles may span a variety of disciplines and fields and may be of immediate, intermediate, or long-term potential benefit to clinical practice.
《美国老年医学会杂志》的主要目标是出版与老年人临床护理最广泛相关的文章。这类文章可能涉及各种学科和领域,可能对临床实践具有即时、中期或长期的潜在益处。
大类(学科) | 小类(学科) | 学科排名 |
医学 |
GERONTOLOGY(老年医学) 1区 |
2/36 |
年度总发文量 | 年度论文发表量 | 年度综述发表量 |
373 | 357 | 16 |
引文计数(2018)
文献(2015-2017)
4386次引用
1809篇文献
序号 | 类别 | 排名 | 百分位 |
1 |
大类(学科):Medicine
小类(学科):Geriatrics and Gerontology
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发表一篇学和医学成像类SCI论文
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