10-year follow-up of subclinical cardiovascular disease and risk of coronary heart disease in the Cardiovascular Health Study

Arch Intern Med. 2006 Jan 9;166(1):71-8. doi: 10.1001/archinte.166.1.71.


Background: The incidence of coronary heart disease (CHD) is very high among individuals 65 years or older.

Methods: We evaluated the relationships between measurements of subclinical disease at baseline (1989-1990) and at the third-year follow-up examination (1992-1993) and subsequent incidence of cardiovascular disease and total mortality as of June 2001. Approximately 61% of the participants without clinical cardiovascular disease at baseline had subclinical disease based on our previously described criteria from the Cardiovascular Health Study.

Results: The incidence of CHD was substantially increased for participants with subclinical disease compared with those who had no subclinical disease: 30.5 per 1000 person-years with and 16.3 per 1000 person-years without for white individuals, and 31.2 per 1000 person-years with and 12.5 per 1000 person-years without for black individuals. The risk persisted over the entire follow-up period. Incidence rates were higher for men than for women with or without subclinical disease, but there was little difference in rates for black individuals and white individuals.

Conclusions: In multivariable models, subclinical disease at baseline remained a significant predictor of CHD in both men and women; the hazard ratios (95% confidence intervals) of their relative risks were 1.64 (1.30-2.06) and 1.49 (1.21-1.84), respectively. The presence of subclinical disease substantially increased the risk of subsequent CHD for participants with hypertension, diabetes mellitus, or elevated C-reactive protein. In summary, subclinical disease is very prevalent among older individuals, is independently associated with risk of CHD even over a 10-year follow-up period, and substantially increases the risk of CHD among participants with hypertension or diabetes mellitus.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • African Continental Ancestry Group
  • Aged
  • Blood Chemical Analysis
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / diagnostic imaging
  • Cardiovascular Diseases / epidemiology
  • Comorbidity
  • Coronary Disease / blood
  • Coronary Disease / diagnostic imaging
  • Coronary Disease / epidemiology*
  • Echocardiography
  • European Continental Ancestry Group
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Multivariate Analysis
  • Prevalence
  • Proportional Hazards Models
  • Regression Analysis
  • Risk Factors
  • Sex Distribution
  • United States / epidemiology