The age- and gender-related cardio-metabolic changes may limit the applicability of guidelines for the prevention of cardiovascular diseases (CVD) in older people. We investigated the association of cardiovascular risk profile with 20-year all-cause and CVD-mortality in older adults, focusing on age- and gender-specific differences. This prospective study involved 2895 community-dwelling individuals aged ≥65 years who participated in the Pro.V.A study. The sum of achieved target levels (smoking, diet, physical activity, body weight, blood pressure, lipids, and diabetes) recommended by the European Society of Cardiology 2016 guidelines was assessed in each participant. From this sum, cardiovascular risk profile was categorised as very high (0–2), high (3), medium (4), low (5), and very low (6–7 target levels achieved). All-cause and CV mortality data over 20 years were obtained from health registers. At Cox regression, lower cardiovascular risk profile was associated with reduced 20-year all-cause mortality in both genders, with stronger results for women (HR = 0.42 [95%CI:0.25–0.69] and HR = 0.61 [95%CI:0.42–0.89] for very low vs. very high cardiovascular risk profile in women and men, respectively). This trend was more marked for CVD mortality. Lower cardiovascular risk profile was associated with reduced all-cause and CVD mortality only in men < 75 years, while the associations persisted in the oldest old women. A lower cardiovascular risk profile, as defined by current guidelines, may reduce all-cause and CVD mortality in older people, with stronger and longer benefits in women. These findings suggest that personalised and life-course approaches considering gender and age differences may improve the delivery of preventive actions in older people.

与年龄和性别相关的心脏代谢变化可能会限制老年人心血管疾病 (CVD) 预防指南的适用性。我们调查了老年人心血管风险状况与 20 年全因死亡率和 CVD 死亡率之间的关系，重点关注年龄和性别特异性差异。这项前瞻性研究涉及参与 Pro.VA 研究的 2895 名年龄≥65 岁的社区居民。在每位参与者中评估了欧洲心脏病学会 2016 年指南推荐的已达到目标水平（吸烟、饮食、体力活动、体重、血压、血脂和糖尿病）的总和。根据该总和，心血管风险状况分为非常高 (0-2)、高 (3)、中 (4)、低 (5) 和非常低（达到 6-7 个目标水平）。超过 20 年的全因和 CV 死亡率数据来自健康登记册。在 Cox 回归中，较低的心血管风险与降低 20 年全因死亡率相关，女性的结果更强（HR = 0.42 [95%CI:0.25–0.69] 和 HR = 0.61 [95%CI: 0.42–0.89] 分别表示女性和男性的心血管风险非常低和非常高）。这种趋势在 CVD 死亡率方面更为显着。仅在<75岁的男性中，较低的心血管风险与降低的全因死亡率和心血管疾病死亡率相关，而这种关联在最年长的老年女性中仍然存在。根据当前指南的定义，较低的心血管风险特征可能会降低老年人的全因死亡率和心血管疾病死亡率，而对女性的益处更大、时间更长。