Preliminary exploration of comprehensive cardiovascular risk assessment in older adults

Accelerating global population aging is exacerbating the burden of cardiovascular disease (CVD) among older adults. Conventional risk models primarily estimate short-term probabilities of cardiovascular events; however, older adult-specific factors, including frailty, multimorbidity, competing risks of death, and individual preferences, significantly influence predictive outcomes and therapeutic decision-making. Reliance on traditional risk scores alone is therefore insufficient to fully reflect overall risk profiles and potential benefits in this population. CVD risk in older adults involves age-related cardiovascular changes coupled with multiple older adult-specific modifiers, indicating the need for a more comprehensive risk assessment paradigm. This study employs a narrative review methodology with structured literature searches, integrating domestic and international cardiovascular guidelines, risk prediction models, and related research to systematically examine traditional cardiovascular risk factors and older adult-specific modifiers. We analyze the limitations of existing predictive tools among this population characterized by frailty and multimorbidity, and construct a multidimensional clinical decision framework for comprehensive cardiovascular risk assessment. This framework encompasses four key dimensions: baseline cardiovascular risk, frailty and functional status, multimorbidity and target organ damage, and polypharmacy, thereby providing a systematic reference for individualized risk assessment and intervention decision-making.