As indicated by a study conducted on several hundred people without the history of cardiovascular disease, aged 85 over, over a five-year period, to see which of them succumbed to events like stroke and heart disease, by Dutch researchers, the traditional system for assessing the risk of cardiovascular disease amongst older people needs replacement with some new and more accurate tests.
The Framingham Risk Score system, which has been in use for decades to predict the 10-year risk of developing coronary heart disease in people with no history of cardiovascular disease, uses classic risk factors including sex, systolic blood pressure, cholesterol, diabetes, and smoking.
According to the researchers, the ability of these classic risk factors to identify a person at high risk of heart disease diminishes as the age advances.
They reveal that several new biomarkers for cardiovascular disease have recently been shown to be effective at indicating high risk of such disease, including C-reactive protein and homocysteine.
During the Dutch research, 302 people without the history of cardiovascular disease—215men and 87 women—were studied. The subjects were participating in the existing Leiden 85-plus Study, and were followed up for five years.
As well as using the Framingham Risk Score, the researchers also measured plasma levels of the new biomarkers homocysteine, folic acid, C-reactive protein and interleukin-6 in the people.
Of the 302 participants, 108 died during the follow-up period, 32 percent of the deaths were from cardiovascular disease.
The researchers found that classic risk factors were unable to predict cardiovascular deaths accurately, neither by using the Framingham Risk Score nor by using the classic risk factors in a newly calibrated model.
From the new biomarkers used, homocysteine had the best ability to predict deaths.
The research team reported that of the 35 people who succumbed to cardiovascular disease during the five years studied, the Framingham Risk Score had classified just 12 people as being at high risk.
However, the homocysteine-based model had classified 20 people as being high risk—nearly a quarter more of all individuals who died from cardiovascular disease.
Based on their observations, the researchers came to the conclusion that single homocysteine measurement could accurately identify very elderly people who are at high risk of dying from cardiovascular disease.
They call for a larger study to be carried out as their findings could lead to a change to current guidelines.
"Possibly, plasma homocysteine, and not classic risk factors, could be used to select very elderly people for primary preventive interventions," the researchers say.
The study appears in the online edition of the British Medical Journal.