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Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study.

Driver JA, Djoussé L, Logroscino G, Gaziano JM, Kurth T - BMJ (2008)

Bottom Line: The decrease in incidence of cancer late in life seemed largely due to a decline in cancers usually detected by screening.This may be due to decreased detection of disease and reporting of symptoms and increased resistance to disease in those who survive to old age.Accurate estimates of disease risk in an aging population require adjustment for competing risks of mortality.

View Article: PubMed Central - PubMed

Affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. jdriver@partners.org

ABSTRACT

Objective: To investigate the influence of increasing age on the incidence and remaining lifetime risk of cardiovascular disease and cancer in a cohort of older men.

Design: Prospective cohort study.

Setting: United States.

Participants: 22,048 male doctors aged 40-84 who were free of major disease in 1982.

Main outcome measures: Incidence and remaining lifetime risk of major cardiovascular disease (myocardial infarction, stroke, and death from cardiovascular disease) and cancer.

Results: 3252 major cardiovascular events and 5400 incident cancers were confirmed over 23 years of follow-up. The incidence of major cardiovascular disease continued to increase to age 100. Beginning at age 80, however, major cardiovascular disease was more likely to be diagnosed at death. The incidence of cancer peaked in those aged 80-89 and then declined. Cancers detected by screening accounted for most of the decline, whereas most cancers for which there was no screening continued to increase to age 100. Unadjusted cumulative incidence overestimated the risk of cardiovascular disease by 16% and cancer by 8.5%. The remaining lifetime risk of cancer at age 40 was 45.1% (95% confidence interval 43.8% to 46.3%) and at age 90 was 9.6% (7.2% to 11.9%). The remaining lifetime risk of major cardiovascular disease at age 40 was 34.8% (33.1% to 36.5%) and at age 90 was 16.7% (12.9% to 20.6%).

Conclusions: In this prospective cohort of men, the incidence of new cardiovascular disease continued to increase after age 80 but was most often diagnosed at death. The decrease in incidence of cancer late in life seemed largely due to a decline in cancers usually detected by screening. These findings suggest that people aged 80 and older have a substantial amount of undiagnosed disease. The remaining lifetime risk of both diseases approached a plateau in the 10th decade. This may be due to decreased detection of disease and reporting of symptoms and increased resistance to disease in those who survive to old age. Accurate estimates of disease risk in an aging population require adjustment for competing risks of mortality.

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Fig 3 Age specific crude incidence of major cardiovascular disease compared with angina and revascularisation procedures as first cardiovascular disease events. Curve for all cardiovascular disease includes angina and revascularisation in addition to major end points. Participants were considered to have cardiovascular disease at first end point reported
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fig3: Fig 3 Age specific crude incidence of major cardiovascular disease compared with angina and revascularisation procedures as first cardiovascular disease events. Curve for all cardiovascular disease includes angina and revascularisation in addition to major end points. Participants were considered to have cardiovascular disease at first end point reported

Mentions: Whereas cardiovascular disease diagnosed at death increased dramatically with age, the incidence of non-fatal myocardial infarction declined, and the incidence of non-fatal stroke increased only slightly after age 89 (fig 2). Revascularisation procedures and angina declined noticeably with age as the first manifestation of cardiovascular disease, whereas the rate of confirmed major cardiovascular disease events continued to increase with age (fig 3). Table 2 shows the age specific incidence of cardiovascular disease by subtypes.


Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study.

Driver JA, Djoussé L, Logroscino G, Gaziano JM, Kurth T - BMJ (2008)

Fig 3 Age specific crude incidence of major cardiovascular disease compared with angina and revascularisation procedures as first cardiovascular disease events. Curve for all cardiovascular disease includes angina and revascularisation in addition to major end points. Participants were considered to have cardiovascular disease at first end point reported
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2600919&req=5

fig3: Fig 3 Age specific crude incidence of major cardiovascular disease compared with angina and revascularisation procedures as first cardiovascular disease events. Curve for all cardiovascular disease includes angina and revascularisation in addition to major end points. Participants were considered to have cardiovascular disease at first end point reported
Mentions: Whereas cardiovascular disease diagnosed at death increased dramatically with age, the incidence of non-fatal myocardial infarction declined, and the incidence of non-fatal stroke increased only slightly after age 89 (fig 2). Revascularisation procedures and angina declined noticeably with age as the first manifestation of cardiovascular disease, whereas the rate of confirmed major cardiovascular disease events continued to increase with age (fig 3). Table 2 shows the age specific incidence of cardiovascular disease by subtypes.

Bottom Line: The decrease in incidence of cancer late in life seemed largely due to a decline in cancers usually detected by screening.This may be due to decreased detection of disease and reporting of symptoms and increased resistance to disease in those who survive to old age.Accurate estimates of disease risk in an aging population require adjustment for competing risks of mortality.

View Article: PubMed Central - PubMed

Affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. jdriver@partners.org

ABSTRACT

Objective: To investigate the influence of increasing age on the incidence and remaining lifetime risk of cardiovascular disease and cancer in a cohort of older men.

Design: Prospective cohort study.

Setting: United States.

Participants: 22,048 male doctors aged 40-84 who were free of major disease in 1982.

Main outcome measures: Incidence and remaining lifetime risk of major cardiovascular disease (myocardial infarction, stroke, and death from cardiovascular disease) and cancer.

Results: 3252 major cardiovascular events and 5400 incident cancers were confirmed over 23 years of follow-up. The incidence of major cardiovascular disease continued to increase to age 100. Beginning at age 80, however, major cardiovascular disease was more likely to be diagnosed at death. The incidence of cancer peaked in those aged 80-89 and then declined. Cancers detected by screening accounted for most of the decline, whereas most cancers for which there was no screening continued to increase to age 100. Unadjusted cumulative incidence overestimated the risk of cardiovascular disease by 16% and cancer by 8.5%. The remaining lifetime risk of cancer at age 40 was 45.1% (95% confidence interval 43.8% to 46.3%) and at age 90 was 9.6% (7.2% to 11.9%). The remaining lifetime risk of major cardiovascular disease at age 40 was 34.8% (33.1% to 36.5%) and at age 90 was 16.7% (12.9% to 20.6%).

Conclusions: In this prospective cohort of men, the incidence of new cardiovascular disease continued to increase after age 80 but was most often diagnosed at death. The decrease in incidence of cancer late in life seemed largely due to a decline in cancers usually detected by screening. These findings suggest that people aged 80 and older have a substantial amount of undiagnosed disease. The remaining lifetime risk of both diseases approached a plateau in the 10th decade. This may be due to decreased detection of disease and reporting of symptoms and increased resistance to disease in those who survive to old age. Accurate estimates of disease risk in an aging population require adjustment for competing risks of mortality.

Show MeSH
Related in: MedlinePlus