{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:27:16Z","timestamp":1789741636381,"version":"4.0.1"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,6,3]]},"abstract":"<jats:sec id=\"jah310554-sec-0001\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Guidelines emphasize using atherosclerotic cardiovascular disease (ASCVD) risk prediction models for treatment decisions, but risk of cognitive impairment is an equally important concern in older adults. Current ASCVD risk prediction models were derived in younger adults and do not include holistic measures of health or predict cognitive impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"jah310554-sec-0002\" xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We utilized data from the Framingham, Framingham Offspring, CHS (Cardiovascular Health Study), and ARIC (Atherosclerosis Risk in Communities) cohorts to derive and validate 2 Selective Functional Prediction models to estimate an older person's (aged \u226575\u2009years) risk within 5\u2009years of developing incident: (1) cognitive impairment; and (2) ASCVD, while accounting for the competing risk of death. Variable selection, including functional status, was based on the least absolute shrinkage and selection operator method. The cognitive impairment (N=3466) and ASCVD (N=4403) model populations were split into derivation and validation cohorts with external validation, then performed in MESA (Multi\u2010Ethnic Study of Atherosclerosis).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"jah310554-sec-0003\" xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">In the derivation and external validation cohorts (median age, 79\u2009years), 579 (16.7%) and 67 (15.3%) participants developed incident cognitive impairment, respectively; 748 (17.0%) and 80 (8.4%), respectively, experienced an ASCVD event. The cognitive impairment model (baseline Mini\u2010Mental State Examination (MMSE), atrial fibrillation, antidepressant use, mobility impairment, and dependence for grocery shopping) had good discrimination in the internal and external validation cohorts (C index 0.75 and 0.73, respectively). The ASCVD model (employment status, MMSE, aspirin, lipid\u2010lowering medications, blood pressure medications, systolic blood pressure, general health status, high\u2010density lipoprotein cholesterol, triglycerides, creatinine, and mobility impairment) had satisfactory discrimination (C index 0.67) on internal validation and outperformed the pooled cohort equations, but had modest discrimination (C index 0.59) on external validation. Although both models were well calibrated in the internal validation cohorts, they overpredicted risk in the external validation cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"jah310554-sec-0004\" xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Accurate prediction of an older person's risk of developing cognitive impairment is possible, but predicting future ASCVD events remains more challenging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.038949","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T06:41:12Z","timestamp":1747896072000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Development and Validation of Models to Estimate the Incident Risk of Cognitive Impairment and Atherosclerotic Cardiovascular Disease in Older Adults"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5745-1636","authenticated-orcid":false,"given":"Michael G.","family":"Nanna","sequence":"first","affiliation":[{"name":"Section of Cardiovascular Medicine, Yale School of Medicine","place":["New Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Wojdyla","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute","place":["Durham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5415-4721","authenticated-orcid":false,"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"UT Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6197-9860","authenticated-orcid":false,"given":"Ann Marie","family":"Navar","sequence":"additional","affiliation":[{"name":"UT Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff D.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Section on Gerontology and Geriatric Medicine and the Sticht Center for Healthy Aging and Alzheimer\u2019s Prevention at Wake Forest School of Medicine","place":["Winston\u2010Salem, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8742-1788","authenticated-orcid":false,"given":"Lisandro D.","family":"Colantonio","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham","place":["Birmingham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3547-7688","authenticated-orcid":false,"given":"Stephen Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"The CardioVascular Center, Tufts Medical Center","place":["Boston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser","family":"Jamil","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine","place":["Falls Church, USA"]},{"name":"Department of Internal Medicine, Inova Schar Heart and Vascular Institute","place":["Falls Church, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7503-6273","authenticated-orcid":false,"given":"Alain G.","family":"Bertoni","sequence":"additional","affiliation":[{"name":"Section of Epidemiology and Prevention, Wake Forest School of Medicine","place":["Winston\u2010Salem, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musarrat","family":"Nahid","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Weill Cornell Medicine","place":["New York, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8774-6416","authenticated-orcid":false,"given":"Abdulla A.","family":"Damluji","sequence":"additional","affiliation":[{"name":"Inova Center of Outcomes Research","place":["Falls Church, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7474-3737","authenticated-orcid":false,"given":"Parag","family":"Goyal","sequence":"additional","affiliation":[{"name":"Program for the Care and Study of the Aging Heart, Department of Medicine, Weill Cornell Medicine","place":["New York, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5614-8157","authenticated-orcid":false,"given":"Sarwat I.","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale School of Medicine","place":["New Haven, 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