-
Views
-
Cite
Cite
Karen Andersen-Ranberg, Kaare T. Fjederholt, Adnan Madzak, Mads Nybo, Bernard Jeune, Cardiovascular diseases are largely underreported in Danish centenarians, Age and Ageing, Volume 42, Issue 2, March 2013, Pages 249–253, https://doi.org/10.1093/ageing/afs108
Close - Share Icon Share
Abstract
Background: the substantial decline in oldest old mortality has led to more people surviving to very old age. As morbidity and disability generally increases with age epidemiological research in ageing has focused on the health of oldest olds. However, most studies are based on self-reported or physician-reported information, not objective health information.
Objective: to estimate and compare the prevalence of cardiovascular diseases (CVDs) in Danish centenarians using three different sources of information: self-reported, physician-reported and objective data.
Design: the population-based clinical-epidemiological study of 100-year-old Danes.
Methods: all eligible participants were interviewed (self-report) in their domicile and offered a clinical examination, including an electrocardiogram (ECG) and blood pressure measurement. Further health information was retrieved from general practitioners' medical files and the Danish National Discharge Register (physician report).
Results: out of 276 eligible, 207 (75%) participated. Blood pressure and ECG were measured in 76 and 69%, respectively. There was poor agreement between self-reported and physician-reported CVDs, and between physician-reported CVDs and clinical objective CVD diagnoses. Only angina pectoris reached a Kappa value of 0.5. ECG revealed twice as many cases of myocardial infarction and ischaemia compared with physician-reported. Using both physician-reported and ECG 95 (46%) of the centenarians suffered from at least one of the diseases myocardial infarction, angina pectoris or atrial fibrillation. Adding physician-reported heart failure and hypertension increased the prevalence of CVD to 80%.
Conclusion: self-reported information largely underestimates the CVD life-time prevalence in Danish centenarians. Objective clinical examinations are necessary to evaluate true disease prevalence in oldest old.
Comments
We read the article by Andersen-Ranberg and colleagues (1) with interest as we have also sought to investigate the prevalence of cardiovascular disease in the very elderly (those aged 80 years and over) and agree it is difficult to acquire robust data. With the rising percentage of very elderly in the Australian population (2) it is important to develop an understanding of prevalence of disease and potential health needs. In order to assess the prevalence of cardiovascular disease in the age ranges 20-39, 40-59, 60-79 and 80-99 years we performed a retrospective review of autopsy data from victims of motor vehicle collisions in which death had occurred rapidly as a result of clearly lethal injuries. The assessment of the amount of atheroma, myocardial fibrosis and valve disease was based on macroscopic observations. Statistical analysis for difference between the groups was performed by ANOVA. The study was approved by the Forensic Science SA Research and Development committee. Thirty cases in the age group 80 years and over were identified; it was possible to find 60 cases in the age group 60-79 years. Cases in the 40-59 and 20-39 year old groups were taken at random over the study period (1994 - 2010) until 90 cases were obtained in each group. There was no statistically significant difference between the 60-79 and the 80-99 year age groups for the average aorta atheroma score, average maximal coronary artery stenosis, mean number of coronary arteries with greater than 50% stenosis and percent with myocardial fibrosis, but the levels of disease were greater than observed in the younger subjects (Table 1). However, the prevalence of valvular disease was only significantly higher in the 80-99 year group compared to the other groups. Although the methodology was not ideal (being retrospective and selected), the findings are in keeping with the observation that the very elderly are not spared from cardiovascular disease (3), but it is interesting that the very elderly group (80-99 years) appears not to have significantly worse atherosclerotic cardiovascular disease than those in the 60-79 year group. The higher prevalence of heart valve disease in the 80-99 year age group may reflect degenerative valvular processes (4) or changes in the incidence and severity of rheumatic heart disease (5). Although objective data of the prevalence of disease in the elderly may be obtained from review of autopsy reports future studies may need to be cohort based to dissect the effects of age from era of birth. If the prevalence of cardiovascular disease in the elderly is similar to that in the very elderly this would have implications for provision of health care in the future.
References: 1. Andersen-Ranberg K, Fjederholt KT, Madzak A, Nybo M, Jeune B. Cardiovascular diseases are largely underreported in Danish centenarians. Age Ageing. 2012:0.1093/ageing/afs108. 2. Richmond RL. The changing face of the Australian population: growth in centenarians. Med J Aust. 2008;188:720 - 3. 3. Waller BF, Roberts WC. Cardiovascular disease in the very elderly. Analysis of 40 necropsy patients aged 90 years or over. American Journal of Cardiology. 1983;51:403 - 21. 4. Carabello BA, Paulus WJ. Aortic stenosis. Lancet. 2009;373:956 - 66. 5. Marijon E, Mirabel M, Celermajer DS, Jouven X. Rheumatic heart disease. Lancet. 2012;379:953 - 64.
Table 1. Demographics and findings in the study groups.
Age group 20 - 39 40 - 59 60 - 79 80 - 99
Number of cases 90 90 60 30
Male 72 65 37 18 * Female 18 25 23 12 *
Average age (years) 31.2 48.0 68.9 84.5
Cardiovascular parameters
Average heart weight(g) 347 393 440 412 * Average aorta atheroma score 0.19 0.59 1.58 2.00 Average maximal coronary stenosis (%) 10.7 13.6 37.5 40.0 Mean number of coronaries with >50% stenosis 0.14 0.28 1.00 1.13 Percent with myocardial fibrosis 1.11 3.33 21.7 20.0 Percent with valve disease 2.22 4.44 10.0 26.7
* not statistically different between groups
Conflict of Interest:
None declared