Heart risk check for elderly should be updated

Authors of a new study suggest that the system for assessing heart disease risk in older people should be replaced.

Writing on the website of the British Medical Journal, Dr Wouter de Ruijter of Leiden University Medical Center, The Netherlands, and colleagues state that the Framingham risk score, based on classic risk factors for cardiovascular disease, is still widely used.

However the predictive value of these classic risk factors reduces with age. "In very old age, classic risk factors as included in the Framingham risk score no longer predict five year cardiovascular mortality," they write, suggesting that new biomarkers may be more useful.

The researchers undertook a study of 215 women and 87 men aged 85 years or above, with no history of cardiovascular disease. Over five years, 35 of the participants died from cardiovascular causes.

"Classic risk factors did not predict cardiovascular mortality when used in the Framingham risk score or in a newly calibrated model," state the researchers. Among the new biomarkers studied – plasma homocysteine, folic acid, C-reactive protein and interleukin-6 – homocysteine had the most predictive power.

"A single homocysteine measurement could accurately identify older individuals who are at high risk of cardiovascular mortality," they report.

The authors conclude: "In very old people from the general population with no history of cardiovascular disease, concentrations of homocysteine alone can accurately identify those at high risk of cardiovascular mortality, whereas classic risk factors included in the Framingham risk score do not.

"These preliminary findings warrant validation in a separate cohort."

de Ruijter, W. et al. Use of Framingham risk score or new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study. The British Medical Journal, 2008;337:a3083.