The absolute rate of new-onset cardiovascular disease events increases significantly after men and women turn 65 years old, according to a database analysis. However, the researchers also found that a large percentage of events occurred before age 65.
Lead researcher Allan D. Sniderman, MD, of McGill University in Montreal, and colleagues published their results online in JAMA Cardiology on May 18.
The researchers conducted their analysis from Nov. 1, 2015, to Jan. 19, 2016. They used data from the American Heart Association's 2015 heart disease and stroke statistical update and the National Health and Nutrition Examination Survey.
Among men, the number of new-onset cardiovascular events per age decade remained approximately the same until 85 years old. The researchers found that approximately one-fourth of new-onset cardiovascular events in men occurred before age 55 and approximately half occurred before age 65.
Among women, the number of new-onset cardiovascular events progressively increased with age. For instance, approximately one-seventh of the events occurred before age 55 and one-third occurred before age 65.
The researchers added that patients who are older than 84 have the highest incidence rate, but the number of events after age 84 represents a small fraction of the total.
“This analysis demonstrates that [cardiovascular disease] is not only a disease that affects older individuals,” the researchers wrote. “For those with premature cardiovascular events, their personal, family and societal contributions are cut short or diminished earlier, their earnings losses are greater and, for those who survive, their period of care is longer.”
The researchers said that the healthcare industry should identify individuals who are younger than 60 years old who are candidates for preventive therapies. They suggested lowering the risk threshold to the 5 percent level with the lipid guidelines or adopting age- and sex-specific thresholds.
They also recommended considering other risk factors such as a low-density lipoprotein (LDL) cholesterol level of 160 mg/dl or more, a family history of premature cardiovascular disease, elevated C-reactive protein level, high calcium score, low ankle brachial index or high lifetime risk of cardiovascular disease.
In addition, they mentioned possibly adopting the benefit model of prevention, which takes into account the improved benefits of statins when patients have higher levels of LDL cholesterol. The model also includes a greater number of patients with higher levels of LDL cholesterol without inflating the maximum number needed to treat, according to the researchers.
“Given the limited knowledge of long-term medication use and the lower absolute risk of [cardiovascular disease] at younger ages, indiscriminate use of medications is not reasonable,” the researchers wrote. “Any preventive strategy must include health promotion across the life span, enhancing societal efforts to eradicate CVD, and new strategies to prevent premature cardiovascular events.”