Abstract
Introduction
Age is traditionally considered a major cardiovascular (CV) risk factor, but its real weight in the absence of other modifiable risk factors is not clear.
Aim
To compare the prevalence of subclinical carotid atherosclerosis, and its association with the main CV risk factors, between older adults and hypertensive adults.
Methods
Cross-sectional study on 210 consecutive patients: 70 older adults (age ≥ 80 years), and 140 hypertensive adults having at least another CV risk factor. Patients had no history of peripheral artery disease or major CV events.
Results
Mean age was 54.2 ± 7.2 years in hypertensive adults and 88.5 ± 5.5 years in older adults with a female prevalence in the latter group. Dyslipidemia and smoking were more prevalent in hypertensive adults, while chronic kidney disease was more prevalent in older adults. Prevalence of carotid plaques did not differ between hypertensive adults and older adults (48.2% vs 55.6%, respectively, p = 0.311). Age ≥ 80 years was not associated with a higher risk of carotid plaques even after adjusting for other risk factors (p = 0.204). Hypertension and dyslipidemia were the risk factors more strongly associated with carotid plaques in older adults and hypertensive adults, respectively. When older adults with hypertension were excluded from the analysis, prevalence of carotid plaques was significantly higher in hypertensive adults (p = 0.042).
Conclusion
Hypertension and dyslipidemia are the major determinant of atherosclerosis regardless of age in our study. Our findings support the concept that aging is not necessarily synonymous with atherosclerosis and highlight the key role played by superimposed CV risk factors on arterial ‘‘bad aging’’.
Similar content being viewed by others
References
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet. 2004;364(9438):937–52.
Spannella F, Giulietti F, Di Pentima C, Sarzani R. Prevalence and control of dyslipidemia in patients referred for high blood pressure: the disregarded “double-trouble” lipid profile in overweight/obese. Adv Ther. 2019;36(6):1426–37.
Sarzani R, Bordicchia M, Spannella F, Dessi-Fulgheri P, Fedecostante M. Hypertensive heart disease and obesity: a complex interaction between hemodynamic and not hemodynamic factors. High Blood Press Cardiovasc Prev. 2014;21(2):81–7.
Wang JC, Bennett M. Aging and atherosclerosis: mechanisms, functional consequences, and potential therapeutics for cellular senescence. Circ Res. 2012;111(2):245–59.
Kontis V, Bennett JE, Mathers CD, Li G, Foreman K, Ezzati M. Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble. Lancet. 2017;389(10076):1323–35.
Oliver WJ, Cohen EL, Neel JV. Blood pressure, sodium intake, and sodium related hormones in the Yanomamo Indians, a “no-salt” culture. Circulation. 1975;52(1):146–51.
Nilsson PM. Early vascular aging (EVA): consequences and prevention. Vasc Health Risk Manag. 2008;4(3):547–52.
Kaplan H, Thompson RC, Trumble BC, Wann LS, Allam AH, Beheim B, et al. Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study. Lancet. 2017;389(10080):1730–9.
Aboyans V, Ricco JB, Bartelink MEL, Bjorck M, Brodmann M, Cohnert T, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763–816.
von Reutern GM, Goertler MW, Bornstein NM, Del Sette M, Evans DH, Hetzel A, et al. Grading carotid stenosis using ultrasonic methods. Stroke. 2012;43(3):916–21.
Martin SS, Blaha MJ, Elshazly MB, Toth PP, Kwiterovich PO, Blumenthal RS, et al. Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. Jama. 2013;310(19):2061–8.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.
Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2016;37(39):2999–3058.
Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, et al. Mannheim carotid intima-media thickness and plaque consensus (2004–2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34(4):290–6.
Hollander W. Role of hypertension in atherosclerosis and cardiovascular disease. The Am J Cardiol. 1976;38(6):786–800.
Du W, Wong C, Song Y, Shen H, Mori D, Rotllan N, et al. Age-associated vascular inflammation promotes monocytosis during atherogenesis. Aging Cell. 2016;15(4):766–77.
Zhan C, Shi M, Yang Y, Pang H, Fei S, Bai L, et al. Prevalence and Risk factors of carotid plaque among middle-aged and elderly adults in rural Tianjin, China. Sci Rep. 2016;6:23870.
Fabris F, Zanocchi M, Bo M, Fonte G, Poli L, Bergoglio I, et al. Carotid plaque, aging, and risk factors. A study of 457 subjects. Stroke. 1994;25(6):1133–40.
Hillen T, Nieczaj R, Munzberg H, Schaub R, Borchelt M, Steinhagen-Thiessen E. Carotid atherosclerosis, vascular risk profile and mortality in a population-based sample of functionally healthy elderly subjects: the Berlin ageing study. J Intern Med. 2000;247(6):679–88.
Homma S, Hirose N, Ishida H, Ishii T, Araki G. Carotid plaque and intima-media thickness assessed by b-mode ultrasonography in subjects ranging from young adults to centenarians. Stroke. 2001;32(4):830–5.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2018;36(12):2284–309.
Stork S, van den Beld AW, von Schacky C, Angermann CE, Lamberts SW, Grobbee DE, et al. Carotid artery plaque burden, stiffness, and mortality risk in elderly men: a prospective, population-based cohort study. Circulation. 2004;20(3):344–8.
Craven TE, Ryu JE, Espeland MA, Kahl FR, McKinney WM, Toole JF, et al. Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case–control study. Circulation. 1990;82(4):1230–42.
Johnsen SH, Mathiesen EB, Joakimsen O, Stensland E, Wilsgaard T, Lochen ML, et al. Carotid atherosclerosis is a stronger predictor of myocardial infarction in women than in men: a 6-year follow-up study of 6226 persons: the Tromso Study. Stroke. 2007;38(11):2873–80.
Inaba Y, Chen JA, Bergmann SR. Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis. Atherosclerosis. 2012;220(1):128–33.
Mortensen MB, Fuster V, Muntendam P, Mehran R, Baber U, Sartori S, et al. Negative risk markers for cardiovascular events in the elderly. J Am Coll Cardiol. 2019;74(1):1–11.
Balietti P, Spannella F, Giulietti F, Rosettani G, Bernardi B, Cocci G, et al. Ten-year changes in ambulatory blood pressure: the prognostic value of ambulatory pulse pressure. J Clin Hypertens. 2018;20(9):1230–7.
Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887–98.
Beckett N, Peters R, Leonetti G, Duggan J, Fagard R, Thijs L, et al. Subgroup and per-protocol analyses from the hypertension in the very elderly trial. J Hypertens. 2014;32(7):1478–87 (discussion 87).
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6–245.
Howard G, Manolio TA, Burke GL, Wolfson SK, O’Leary DH. Does the association of risk factors and atherosclerosis change with age? An analysis of the combined ARIC and CHS cohorts. The Atherosclerosis Risk in Communities (ARIC) and Cardiovascular Health Study (CHS) investigators. Stroke. 1997;28(9):1693–701.
Lakatta EG. So! What’s aging? Is cardiovascular aging a disease? J Mol Cell Cardiol. 2015;83:1–13.
Lind L, Sundstrom J, Arnlov J, Lampa E. Impact of aging on the strength of cardiovascular risk factors: a longitudinal study over 40 years. J Am Heart Assoc. 2018;7:1.
Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459–72.
Spannella F, Giulietti F, Balietti P, Cocci G, Landi L, Lombardi FE, et al. Renin-Angiotensin system blockers and statins are associated with lower in-hospital mortality in very elderly hypertensives. J Am Med Dir Assoc. 2018;19(4):342–7.
Cholesterol Treatment Trialists C. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials. Lancet. 2019;393(2):407–15.
Giral P, Neumann A, Weill A, Coste J. Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France. Eur Heart J. 2019;20:20.
Ranieri P, Rozzini R, Franzoni S, Barbisoni P, Trabucchi M. Serum cholesterol levels as a measure of frailty in elderly patients. Exp Aging Res. 1998;24(2):169–79.
Robinson JG, Williams KJ, Gidding S, Boren J, Tabas I, Fisher EA, et al. Eradicating the Burden of atherosclerotic cardiovascular disease by lowering apolipoprotein B lipoproteins earlier in life. J Am Heart Assoc. 2018;16(20):e009778.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
The authors declare that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Spannella, F., Di Pentima, C., Giulietti, F. et al. Prevalence of Subclinical Carotid Atherosclerosis and Role of Cardiovascular Risk Factors in Older Adults: Atherosclerosis and Aging are Not Synonyms. High Blood Press Cardiovasc Prev 27, 231–238 (2020). https://doi.org/10.1007/s40292-020-00375-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40292-020-00375-0