Myocardial infarction: cardiovascular risk factors increased the risk in elderly people.

Clinical bottom line (level 1b)

  1. One in sixteen people aged 65 or more had a myocardial infarction in the next 5 years.
  2. The risk of a myocardial infarction was increased with
    • male sex
    • clinical cardiovascular disease
    • increasing systolic blood pressure
    • increasing glucose level
    • increasing age
    • reduced ejection fraction
    • low arm-ankle pressure index
    • thickened internal carotid arteries
Psaty et al: Archives of Internal Medicine 1999; 159: 1339-1347
Expires March 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: community, USA

4946 patients (aged mean 73, 60% female)

Excluded if
  • reported a previous myocardial infarction or evidence for a previous MI on ECG
  • institutionalised
  • expecting to leave area within 3 years
  • aged < 65




Multivariate analysis used to adjust for confounding factors.

?100% followed for mean 4.8 years
Outcomes studied:

first myocardial infarction


The evidence

outcome time to outcome number of patients/total number %
(95% CI)		 NNF
(95% CI)
first myocardial infarction mean 4.8 years 302/4946 6.1%
(5.4% to 6.8%)		 16
(15 to 18)

prognostic factor for
first myocardial infarction 		time to outcome adjusted RR
(95% CI)		 NNF+
(95% CI)
male sex mean 4.8 years 2.59
(2.04 to 3.28) 		10
(7 to 16)
clinical cardiovascular disease mean 4.8 years 1.89
(1.47 to 2.42) 		18
(12 to 35)
increasing systolic blood pressure (10 mmHg increase) mean 4.8 years 1.12
(1.07 to 1.18)
increasing glucose (per mmol/l) mean 4.8 years 1.11
(1.07 to 1.16)
increasing age mean 4.8 years 1.06
(1.04 to 1.08)
reduced ejection fraction on echocardiogram mean 4.8 years 1.70
(1.20 to 2.40) 		23
(12 to 82)
high levels of intimal-medial thickness of internal carotid artery mean 4.8 years 1.49
(1.23 to 1.8) 		33
(20 to 71)
normal ankle-arm pressure index mean 4.8 years 0.40
(0.21 to 0.76) 		-27
(-68 to -21)

Citation

  1. Psaty BM, Furberg CD, Kuller LH, et al: Traditional risk factors and subclinical disease measures as predictors of first myocardial infarction in older adults: the Cardiovascular Health Study. Archives of Internal Medicine 1999; 159: 1339-1347
Search Terms:
Contributor: Chris Ball and Clare Wotton, February 2000
Reviewer:

Clinical Question.
    Patient patients
    Intervention or Exposure risk factors
    Outcome myocardial infarction