Heart disease risk factors depend on age, study finds


THE IMPORTANCE of various risk factors for coronary heart disease differs depending on a person's age, Irish doctors have found.

Speaking at the Congress of the European Society for Cardiology (ESC) yesterday, researchers from the department of cardiology at the Adelaide, Meath and National Children's Hospital (AMNCH), Tallaght, Dublin, said in general cholesterol levels and obesity matter less as a person gets older.

But Prof Ian Graham, consultant cardiologist at Tallaght emphasised that smoking remains a potent risk factor for developing coronary artery disease throughout a person's life. And having lower levels of "good" cholesterol (HDL) "is bad news in older women", he said.

Using data from the pan-European Systematic Coronary Risk Evaluation (Score) study, which assessed the risk of cardiac disease in 218,000 people from 11 countries, Dr Mary Therese Cooney, research cardiologist at AMNCH, looked at the effect of risk factors in a sub group of patients who were aged over 65.

She and her colleagues found that estimating cardiac risk thresholds for older people was less appropriate than using the Score system in people aged 40-65. She said it may be more appropriate to aim preventive treatment in older people at specific individual targets.

Dr Alexandra Dudina, also a research cardiologist at Tallaght, told doctors that a person's weight, assessed using body mass index (BMI), was a significant factor in determining the likelihood of dying from all causes, and not just a result of coronary heart disease.

"BMI was strongly related to total mortality, especially in women," she said.

Based on data from Score, the greater risk of death from any cause was especially marked in women who were either very obese (BMI 35-40) or severely obese (BMI >40). A similar trend was evident in men but not to the same degree.

Interestingly, Dr Dudina found that people who were overweight (BMI 25-30) had the lowest risk of death. Both men and women who were underweight (BMI \- the Euroaspire III study - showed that people at high risk of developing heart disease were not modifying their lifestyles in response.

Prof Guy de Backer, of the department of public health at University Hospital Ghent in Belgium, told the meeting that four out of five patients studied were either overweight or obese.

"Some 37 per cent of men and 43 per cent of women (at high risk of heart disease) didn't exercise on a regular basis and did not intend to do so," he said.

The 4,360 people, all of whom had either Type II diabetes or were being treated for high blood pressure and high cholesterol, had blood pressure and cholesterol levels higher than European guidelines recommend.

Blood pressure was not within guideline limits in 71 per cent of volunteers even though eight in every 10 were using blood pressure lowering drugs. Just 31 per cent of those treated for high cholesterol was on target.

"These lifestyle and risk factor results clearly demonstrate a challenging gap between what is recommended in the guidelines, based on scientific evidence, and what is achieved in daily practice in high risk individuals," Prof de Backer said.

"Primary prevention needs a comprehensive, multidisciplinary approach involving the high-risk population, their GPs and other health professionals, a health insurance system dedicated to prevention and all this complemented by a population strategy involving the community at large," the preventive cardiology expert concluded.