From the Guidelines
Cardiovascular disease (CVD) risk calculation for adults over 60 should utilize the Pooled Cohort Equations (PCE) or SCORE2 calculators, as they incorporate age as a significant risk factor, to guide personalized preventive strategies and improve quality of life. For individuals over 60, these tools evaluate factors including blood pressure, cholesterol levels, diabetes status, and smoking history to estimate 10-year risk of cardiovascular events 1. When using these calculators for older adults, clinicians should consider additional factors like frailty, life expectancy, medication burden, and comorbidities that may influence treatment decisions. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend CVD risk assessment for all adults with hypertension, especially those with stage 1 hypertension, using the PCE to estimate 10-year ASCVD risk 1.
The European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines also recommend estimating 10-year CVD risk using the Systematic Coronary Risk Evaluation (SCORE) system for adults without existing CVD, type 1 or 2 diabetes mellitus, or very high levels of individual CVD risk factors 1. The benefit of preventive therapies, such as statins, blood pressure management, aspirin therapy, and lifestyle modifications, may be greater in older adults with existing risk factors since absolute risk increases with age, though the time needed to achieve benefit should be balanced against life expectancy 1. Regular reassessment of risk and treatment goals is essential as patients age, with decisions increasingly focused on quality of life and avoiding medication-related adverse effects.
Key considerations in CVD risk calculation for adults over 60 include:
- Using the PCE or SCORE2 calculators to estimate 10-year CVD risk
- Considering additional factors like frailty, life expectancy, and comorbidities
- Personalized preventive strategies, including statins, blood pressure management, and lifestyle modifications
- Balancing the benefits of preventive therapies against life expectancy and potential adverse effects
- Regular reassessment of risk and treatment goals to prioritize quality of life.
From the Research
CVD Risk Calculation Above Age 60
- The assessment of atherosclerotic cardiovascular disease (ASCVD) risk is crucial for primary ASCVD prevention, and it begins with the use of a traditional 10-year risk calculator 2.
- The 10-year risk calculator can be further refined through the consideration of risk-enhancing factors and subclinical atherosclerosis testing, such as coronary artery calcium (CAC) testing 2.
- For individuals above age 60, the ASCVD risk assessment can be categorized into different risk categories, including low, borderline, intermediate, and high 3.
- The ASCVD Risk Estimator Plus can be used to assess the 10-year CVD risk, and it takes into account various risk factors, including age, sex, blood pressure, and lipid profile 3.
- The Million Hearts Longitudinal ASCVD Risk Assessment Tool can also be used to estimate longitudinal risks and benefits from cardiovascular preventive therapies among Medicare patients, including those above age 60 4.
- Accurate ASCVD risk assessment is crucial for the appropriate targeting of preventive therapies to reduce ASCVD risk, and it should be based on global risk scores, risk-enhancing factors, and subclinical atherosclerosis testing 5.
Risk Factors and Assessment Tools
- Risk factors for ASCVD include age, sex, blood pressure, lipid profile, and lifestyle habits, such as smoking and alcohol consumption 3.
- The ASCVD Risk Estimator Plus and the Million Hearts Longitudinal ASCVD Risk Assessment Tool are examples of assessment tools that can be used to estimate ASCVD risk 3, 4.
- Coronary artery calcium (CAC) testing can be used to further inform the treatment decision if uncertain based on the above strategies 2, 5.
- The clinician-patient risk discussion focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies is central to the ASCVD risk assessment process 5.
Age-Specific Considerations
- Individuals above age 60 are considered to be at higher risk for ASCVD, and they should be assessed and managed accordingly 2, 3.
- The ASCVD risk assessment should take into account age-specific risk factors, such as increased blood pressure and lipid profile changes 3.
- The treatment approach for ASCVD prevention should be individualized based on the patient's age, risk factors, and overall health status 5.