The accuracy of risk estimates depends on knowing the incidence of morbidity or mortality in a population.

Because cardiovascular disease (CVD) swamps all other causes of disability and death among the elderly, it

• is particularly important to understand
• its distribution and determinants in the community
• to identify targets for interventions
• to estimate the potential benefits of possible treatments
• and to construct health services that match need.

Lifelong observation is the ideal way to quantify risk and identify the factors that account for variation in event occurrence (probabilities) in chronic diseases.

As a practical matter, however, the elegantly designed and carefully executed Cardiovascular Health Study proves that the very good can be an excellent stand-in for the perfect.

In this issue of the AJH, Nathan Wong and distinguished colleagues found, during a 15-year study of a representative sample of older Americans, that nearly half of 4,300 subjects (mean age 72.5 years) experienced either a cardiac (70%) or a cerebrovascular (20%) event.

Controlling, to the extent possible, for the limitations of observational study—which may actually lead to underestimation of calculated associations—the authors report that lipid abnormalities and blood pressure ≥120/80 mm Hg, individually and in combination, increased risk of CVD.

Of further note, more that half (53%) of these 65–98-year-olds, who were free of cardiovascular disease at entry, had either metabolic syndrome or diabetes.

In 1989–1990, 39% reported taking antihypertensive medications, and only 4.4% reported receiving lipid-lowering therapy.

By 2004 those figures had increased to 52% and 8%, respectively.

Most CVD events occurred not among those with the least favorable lipid or blood pressure levels but among those whose levels of one or more measures were at or below those frequently considered “normal.”

The findings suggest that there is substantial potential for extending healthy life after age 65 through more aggressive risk-factor reduction.

The authors are careful to point out, however, that evidence of associations, so well described here, is not grounds for clinical intervention.

Nonetheless, these welcome data send a strong signal that properly designed clinical trials may provide powerful tools for enhancing and Extending those “golden years.”

See page 161

American Journal of Hypertension 2010; 23 2, 105–106. doi:10.1038/ajh.2009.248