Risk Factors for Cardiovascular Disease in Older Adults

This literature review analyzes the risk factors that increase the risk of cardiovascular disease in older adults, including type 2 diabetes, high blood pressure, and obesity. The study highlights the importance of early detection and intervention to prevent the development of CVD.

Running head: ASSESSMENT TASK 3
What are the risk-factors that increase the risk of cardiovascular disease in older people?
Name of the Student
Name of the University
Author Note

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ASSESSMENT TASK 3
Significance of the study
According to the Australian Government Department of Health (2016), cardiovascular
disease is the leading cause of death and disease burden in Australia. The total number of
people who are living with cardiovascular disease (CVD) is increasing gradually. According
to the reports during the tenure of 2014 to 2015, 4.2 million Australian adults are reported to
be suffering from CVD. Of them 1.2 million people are detected with complex CVD
condition like stroke and heart disease and 2.6 million adult Australian are reported of having
hypertension and 430,000 have indicated of having heart attack at certain point of time
(Australian Government Department of Health, 2016). The research conducted by Halter et
al. (2014), stated that prevalence of CVD increases with age driven in certain parts through
an absolute rise in the incidence of CVD among adults who are over 65-year of age.
However, the exact mechanisms and the associated risk factor underlying the age-associated
increase in risk of CVD among older adults remain poorly understood. Proper analysis of the
risk factor behind the CVD development among the older adults will help frame proper
interventions before hand and thereby helping to promote health related quality of life of the
those individuals (Halter et al., 2014; Afilalo et al., 2014).
Key terms
Cardiovascular disease: This is the type of heart disease which leads to malfunction of the
heart due to the damage of the arteries
Hypertension: It is the long-term condition where the blood pressure of the arteries is
persistently elevated
Obesity: Again of uncontrollable body fat is defined as obesity

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Type 2 Diabetes mellitus: Lifestyle disease common among older adults which is insulin
resistance and is characterized by high level of blood glucose
Question for literature review
What are the risk-factors that increase the risk of cardiovascular disease in older people?
Search strategy
The online search of the literary articles through electronic database was done in
Medline, CINHAL and Scopus. These databases were selected because these are available
from the University of Wollongong Library. Based in the scope of the research question, the
election of the keywords was done in order to increase the number of hits of relevant search
(Parahoo, 2014). The main keywords which were use for the search of the scholarly articles
online are highlighted below:
Keyword 1 Boolean
Operator
Keyword 2 Boolean
Operator
Keyword 3
Cardiovascular
disease
AND Older adults AND Risk Factor
Boolean
Operator
OR OR
Heart disease Elderly
Table: Combination of Keywords Used
Source: Created by author
The Boolean search operators (AND/OR) were use in order to combine the keywords
and to perform various permutation and combination with keywords. According to Chaudhuri

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et al. (2014), use of Boolean operators help to refine the search results. The main inclusion
criteria which were selected for the search include papers which are published on or after
2014 and communicated in English. The filter of 2014 to 2018 was chosen in order to focus
on the latest progress in the research in CVD. The main exclusion criterion was the papers
which were published before 2014. Other exclusion criteria include studies conducted over
young adults or adolescence.
The total number of articles selected after the use of keywords 147
Number of redundant articles 40
Number of articles omitted after title scrutiny 50
Number of articles omitted after abstract scrutiny 30
Number of articles omitted after fill-text analysis 20
Final article selected 10
Table: Search statistics
Source: Created by author
Summary of evidence (600)
The analysis of the articles which were retrieved through electronic database
highlighted three potential factors which increases the risk of developing cardiovascular
disease among the older adults and this include (a) Type 2 Diabetes, (b) High blood pressure
or hypertension and (c) Obesity
Type 2 Diabetes Mellitus (T2DM)
According to Aune, Norat, Leitzmann, Tonstad and Vatten (2015), CVD is a common
co-morbidity among the older adults with T2DM. In this domain, Einarson, Acs, Ludwig and

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Panton (2018) conducted a systematic review over the literature which are published in-
between 2007 to 2017 over the topics like stroke, myocardial infarction, angina pectoris,
ischemic heart disease, coronary heart disease and heart failure. The analysis of the 57
selected articles highlighted that prolong past history of T2DM increase the risk of
developing CVD among the older adults. The coronary artery disease and the stroke are
highlighted as the major contributor towards high risk of mortality. Shah et al. (2015)
conducted cohort study in order to elucidate the effect of the risk factor, T2DM over the
progress of CVD. Their aim was to study the association between T2DM and incident of
CVD. Their cohort included 1921260 individuals. The analysis of the results highlighted that
peripheral arterial disease and heart failure are most common and initial manifestation of
CVD diseases among T2DM population. The relative risk of mortality increases with age.
The association between T2DM and CVD was shown inversely through the observational
population study conducted by Hayward et al. (2015). Their 10 years of follow-up study
elucidated that patients with T2DM who are randomly assigned to intensive glycemic control
for 5.6 years had fewer reported cases of CVD in comparison to the control group who
received no specific treatments for glycemic control.
High Blood Pressure
Hypertension or high blood pressure is also regarded as a potential risk factor behind
the development of CVD among the older adults. Wu et al. (2015) conducted a large cohort
study over 77,389 community dwelling older adults who are age more than 65-years in order
to study the effect of high blood pressure behind the development of CVD during the tenure
of 2006 to 2010. The analysis of the hazard ratio among the three different hypertension
group revealed that high systolic blood pressure is associated with higher mortality rate and
increase in the vulnerability of developing CVD. The significance of the data was highlighted
with the statistical analysis with confidence interval of 95%. Yong, Lin and Tan (2017)

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conducted a study over the older adults of China in order to study the primary prevention
method of CVD. The main primary prevention model targeted by the study includes
hypertension, in the form of high blood pressure management, anti-hypertension medication
and dyslipidemia or the management of hypercholesterolemia. The analysis of the results
highlighted that the effective management of the high blood pressure helps in reducing the
mortality and the morbidity rate associated with CVD. These results showed that high level
of blood pressure or hypertension is a potential risk factor behind the development of CVD
among the older adults. Miller, Navar, Roubin and Oparil (2016) conducted a similar study
like Yong, Lin and Tan (2017) over the older adults in order to analyze the primary
prevention mode of CVD and cardiac arrest. The analysis of the results highlighted that the
early detection and the treatment of the hypertension or high blood pressure helps to decrease
the severity of the disease and the vulnerability of encountering cardiac accident or strokes.
This analysis further highlighted that the group of population who have prolong history of
unmanaged high blood pressure are more vulnerable towards developing CVD.
Obesity
Dhana et al. (2016) conducted a population based observational study over the older
adults in order to study in order to elucidate the impact of obesity and over-weight over the
life expectancy of the older adults and the risk of developing CVD. They developed
multistate tables in order to calculate the prevalence, incidence rate and the hazard ratio. The
analysis of this data for a 12 year of follow-up highlighted that obesity has no direct relation
with the life-expectancy of the older adults but increases the risk of developing CVD.
Amarya, Singh and Sabharwal (2014) conducted a systematic review and meta-analysis in
order to study the health consequences of obesity among the older adults. The qualitative
analysis of the data collected from the literary articles highlighted that the population of the
older adults who are obese are more predispose towards the development of type 2 diabetes

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ASSESSMENT TASK 3
mellitus and hypertension, which in turn increases the risk of developing CVD leading to
stroke.
Critical review of literature
Generally methodology selected for the selected study was fair. While majority of the
study were cohort or population based observational study, few are systematic review and
meta-analysis. The selection of the online literary articles failed to highlight any randomised
control trial which coincided with the scope of the research. According to Deaton and
Cartwright (2018) the analysis of the randomised control trial is a rigorous way of
determining the cause-effect relation between the overall treatment and the outcome of the
study. Sherman et al. (2014) are of the opinion that the double or the single blinded
randomised control trials are powerful experimental design that helps to provide medical
information, which are unbiased. So lack of incorporation of the randomised control trial can
be highlighted as a drawback of this review. Incorporation of the secondary research is
another drawback of the study as Moher et al. (2015) are of the opinion that systematic
reviews, which are not based on the randomised control trial has so specific design of
selection and thus the outcome of the data are at times biased. Apart from this the review was
succinct and compact. The study conducted by Mandviwala, Khalid and Deswal (2016) also
highlighted that obesity is an important marker against the development of cardiovascular
disease. Obesity invites in several metabolic syndrome like T2DM and hypertension which
are further characterised as independent risk factor behind the development of T2DM.
Mandviwala, Khalid and Deswal (2016) further highlighted in their review that proper
calculation of the obesity paradox helps in proper assessment of CVD.

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Strength and limitation
The review of the literature was based on analysis of the factors contributing towards
the development of the cardiovascular disease among the older adults. The selected studies
for the review of literature were mainly based on large sample size and focus was analysis of
the selected risk factors towards the contribution of the disease development. However, there
are few limitations of the study; one selected group of study was focused over the China
population. According to Lewis (2015) results obtained through a study which are directed
towards any particular population might not be applicable over the global scale and this might
be highlighted as a limitation.
Relevance and impact of findings and identified gaps
The main relevance of the findings is, the study successful highlighted the three
potential factors which are the main contributors towards the development of the CVD
among the older adults. This analysis of the risk factor is helpful towards the effective
prevention of such chronic diseases from the grass-root level. The detection of the risk factor
during the early stage helps to prevent the disease development and thereby helping to
improve the better-quality of life. Proper elucidation of the risk factors helps the healthcare
professionals to devise the intervention plan accordingly. However, the review of literature
failed to highlight the lifestyle factors which are responsible to the development of the CVD
due to lack of time and word count. According to Colpani et al. (2018) lifestyle factors like
smoking, drinking, unhealthy diet and lack of proper physical exercise increases the risk of
developing CVD irrespective of the age bracket. The analysis of these unhealthy lifestyle
factors help in framing proper intervention for the disease.

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Conclusion
Thus from the above discussion it can be concluded that CVD is an important reason
underlying the high risk of mortality and morbidity among the older adults of Australia. The
development of the CVD hampers the quality of life and well-being of the older adults. The
analysis of the literatures which are published online highlighted that three main factors
underlying the disease development is previous disposition of type 2 diabetes mellitus, high
blood pressure or hypertension and obesity. The main implication of the research is analysis
of the risk factors of CVD helps in the framing of the proper interventions for the effective
treatment of the disease. However, the review of literature failed to incorporate the
randomised control trails in the analysis and also failed to encompass the unhealthy lifestyle
habits which contribute towards the disease development.

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References
Afilalo, J., Alexander, K. P., Mack, M. J., Maurer, M. S., Green, P., Allen, L. A., ... &
Forman, D. E. (2014). Frailty assessment in the cardiovascular care of older
adults. Journal of the American College of Cardiology, 63(8), 747-762.
DOI: 10.1016/j.jacc.2013.09.070
Amarya, S., Singh, K., & Sabharwal, M. (2014). Health consequences of obesity in the
elderly. Journal of Clinical Gerontology and Geriatrics, 5(3), 63-67.
https://doi.org/10.1016/j.jcgg.2014.01.004
Aune, D., Norat, T., Leitzmann, M., Tonstad, S., & Vatten, L. J. (2015). Physical activity and
the risk of type 2 diabetes: a systematic review and dose–response meta-analysis.
https://doi.org/10.1007/s10654-015-0056-z
Australian Government Department of Health. (2016). Cardiovascular disease. Access date:
27th October. Retrieved from:
http://www.health.gov.au/internet/main/publishing.nsf/content/chronic-cardio
Chaudhuri, S., Clochard, M., & Solar-Lezama, A. (2014, January). Bridging boolean and
quantitative synthesis using smoothed proof search. In ACM SIGPLAN Notices (Vol.
49, No. 1, pp. 207-220). ACM. doi>10.1145/2535838.2535859
Colpani, V., Baena, C. P., Jaspers, L., van Dijk, G. M., Farajzadegan, Z., Dhana, K., ... &
Chowdhury, R. (2018). Lifestyle factors, cardiovascular disease and all-cause
mortality in middle-aged and elderly women: a systematic review and meta-analysis.
doi: 10.1007/s10654-018-0374-z

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Deaton, A., & Cartwright, N. (2018). Understanding and misunderstanding randomized
controlled trials. Social Science & Medicine, 210, 2-21.
https://doi.org/10.1016/j.socscimed.2017.12.005
Dhana, K., Berghout, M. A., Peeters, A., Ikram, M. A., Tiemeier, H., Hofman, A., ... &
Franco, O. H. (2016). Obesity in older adults and life expectancy with and without
cardiovascular disease. International journal of obesity, 40(10), 1535. doi:
10.1038/ijo.2016.94
Einarson, T. R., Acs, A., Ludwig, C., & Panton, U. H. (2018). Prevalence of cardiovascular
disease in type 2 diabetes: a systematic literature review of scientific evidence from
across the world in 2007–2017. Cardiovascular diabetology, 17(1), 83.
https://doi.org/10.1186/s12933-018-0728-6
Halter, J. B., Musi, N., Horne, F. M., Crandall, J. P., Goldberg, A., Harkless, L., ... &
Schmader, K. E. (2014). Diabetes and cardiovascular disease in older adults: current
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https://doi.org/10.2337/db14-0020
Hayward, R. A., Reaven, P. D., Wiitala, W. L., Bahn, G. D., Reda, D. J., Ge, L., ... &
Emanuele, N. V. (2015). Follow-up of glycemic control and cardiovascular outcomes
in type 2 diabetes. New England Journal of Medicine, 372(23), 2197-2206. DOI:
10.1056/NEJMoa1414266
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five
approaches. Health promotion practice, 16(4), 473-475.

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Mandviwala, T., Khalid, U., & Deswal, A. (2016). Obesity and cardiovascular disease: a risk
factor or a risk marker?. Current atherosclerosis reports, 18(5), 21.
https://doi.org/10.1007/s11883-016-0575-4
Miller, A. P., Navar, A. M., Roubin, G. S., & Oparil, S. (2016). Cardiovascular care for older
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Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., ... & Stewart, L.
A. (2015). Preferred reporting items for systematic review and meta-analysis
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Parahoo, K. (2014). Nursing research: principles, process and issues. Macmillan
International Higher Education.
Shah, A. D., Langenberg, C., Rapsomaniki, E., Denaxas, S., Pujades-Rodriguez, M., Gale, C.
P., ... & Hemingway, H. (2015). Type 2 diabetes and incidence of cardiovascular
diseases: a cohort study in 1· 9 million people. The lancet Diabetes &
endocrinology, 3(2), 105-113. https://doi.org/10.1016/S2213-8587(14)70219-0
Sherman, R. E., Anderson, S. A., Dal Pan, G. J., Gray, G. W., Gross, T., Hunter, N. L., ... &
Shuren, J. (2016). Real-world evidence—what is it and what can it tell us. N Engl J
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%20What%20Is%20It%20and%20What%20Can%20It%20Tell%20Us.pdf

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Wu, C. Y., Hu, H. Y., Chou, Y. J., Huang, N., Chou, Y. C., & Li, C. P. (2015). High blood
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Running head: ASSESSMENT TASK 3
Appendix:
Description Research design Outcomes Your
judgmen
t
Reference
details
Research aims
and objectives
Nature
of
interven
tions
Study
population
Research
design type
Data
collection
methods
Findings/
results
Conclusio
ns
Assumptio
ns
Limitations Usefuln
ess
informat
ion
source
for topic
Article:
Type 2
diabetes and
incidence of
cardiovascul
ar diseases:
Name o
authors:
Shah, A. D.,
Langenberg,
C.,
Rapsomanik
Association
between
T2DM and
CVD
Healthy
lifestyle
Primary
care
hospital
patients
Cohort Study Data
collection
from cohort
population
Peripheral
arterial
disease
and heart
failure are
most
T2DM
increases
the risk of
developin
g CVD
T2DM has
relation
with CVD
developm
ent
The
limitation
of the study
is only
1.8% of the
selected
T2DM
increasi
ng
vulnerab
ility of

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ASSESSMENT TASK 3
a cohort
study in 1· 9
million
people. Nam
e of the
Journal: The
lancet
Diabetes &
endocrinolo
gy, Volume:
3. Number:
2,
i, E.,
Denaxas, S.,
Pujades-
Rodriguez,
M., Gale, C.
P., ... &
Hemingway,
H. Year of
publication:
2015.
Country:
UK.
Number of
population:
1 921 260
common
and initial
manifestat
ion of
CVD
diseases
among
T2DM
population
group of
population
had T2DM
CVD
Critical
appraisal of
your
Q1: Yes Q2: Yes Q3: Yes Q4: Yes Q5: Yes Q6: Yes Q7: Yes Q8: Yes Q9 Q10

2
ASSESSMENT TASK 3
analysis
Article: 2
High blood
pressure and
all-cause
and
cardiovascul
ar disease
mortalities
in
community-
dwelling
older adults.
Name of
Journal:
Medicine.
Volume: 94.
Number: 47
Name of the
authors:
Wu, C. Y.,
Hu, H. Y.,
Chou, Y. J.,
Huang, N.,
Chou, Y. C.,
& Li, C. P.
Year of
publication:
2015. Place:
Taipei
Veterans
General
Hospital.
Population:
77,389
The effect of
high blood
pressure
behind the
development
of CVD
during the
tenure of 2006
to 2010
Decreas
e in high
blood
pressure
77,389
communit
y dwelling
older
adults
who are
age more
than 65-
years
Cohort study The data
collected via
observation
during the
time-span of
2006 to
2010 and
data was
analysed
through
The
analysis of
the hazard
ratio
among the
three
different
hypertensi
on group
revealed
that high
systolic
blood
pressure is
associated
with
higher
High
systolic
blood
pressure is
associated
with
higher
mortality
rate of
CVD
There is a
relation
between
hypertensi
on and
developm
ent of
CVD
Long
follow-up
period lead
to decrease
in the
overall
sample size
at the end
of final
data
analysis
There is
a direct
relation
with the
sample
size and
develop
ment of
CVD

3
ASSESSMENT TASK 3
community
dwelling
older
mortality
rate and
increase in
the
vulnerabili
ty of
developin
g CVD
Critical
appraisal of
your
analysis
Q1: Yes Q2: Yes Q3: Yes Q4: Yes Q5: Yes Q6: Yes Q7: Yes Q8: Yes Q9 Q10
Article: 3.
Obesity in
older adults
and life
expectancy
with and
Name of the
authors:
Dhana, K.,
Berghout,
M. A.,
Peeters, A.,
Elucidate the
impact of
obesity and
over-weight
over the life-
expectancy of
Healthy
lifestyle
habits
and the
control
of
6636
individual
s (3750
women)
aged 55
years and
Population
based
observational
study
Tabular
collection of
observationa
l data
The
analysis of
this data
for a 12
year of
follow-up
Obesity is
an
important
determina
nt of CVD
among
There is a
relation
between
obesity
and
developm
Long
follow-up
study leads
to decrease
the sample
size.
The risk
factor
with
obesity
and
CVD

4
ASSESSMENT TASK 3
without
cardiovascul
ar disease.
Name of the
journal:
Internationa
l journal of
obesity.
Volume: 40.
Number: 10
Ikram, M.
A.,
Tiemeier,
H., Hofman,
A., ... &
Franco, O.
H.. Year of
publication:
2016. Place:
Netherlands
and
Australia,
Population:
6636
individuals
the older
adults and the
risk of
developing
CVD
weight older highlighte
d that
obesity
has no
direct
relation
with the
life-
expectanc
y of the
older
adults but
increases
the risk of
developin
g CVD.
older
adults
ent of
CVD
among
older
adults
Leading to
biased
outcome
was
establish
ed
Critical
appraisal of
Q1: Yes Q2: Yes Q3: Yes Q4: Yes Q5: Yes Q6: Yes Q7: Yes Q8: Yes Q9 Q10

5
ASSESSMENT TASK 3
your
analysis

Running head: ASSESSMENT TASK 3