Low physical function in older adults predictive of worse CVD outcomes
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Poor physical function was associated with increased risk for CHD, stroke and HF in adults older than 65 years, according to a new analysis of the Atherosclerosis Risk in Communities study.
When added to traditional CVD risk factors, physical function, as determined by the Short Physical Performance Battery (SPPB), improved the prognostic value of the Pooled Cohort Equation, according to data published in the Journal of the American Heart Association.
“While traditional cardiovascular disease risk factors such as high blood pressure, high cholesterol, smoking or diabetes are closely linked to cardiovascular disease, particularly in middle-aged people, we also know these factors may not be as predictive in older adults, so we need to identify nontraditional predictors for older adults,” Kunihiro Matsushita, MD, PhD, associate professor in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health and the division of cardiology at The Johns Hopkins School of Medicine, said in a press release. “We found that physical function in older adults predicts future cardiovascular disease beyond traditional heart disease risk factors, regardless of whether an individual has a history of cardiovascular disease.”
Using physical function to estimate CVD risk
To better understand how physical function with age impacts CV outcomes, researchers evaluated the SPPB scores of 5,570 participants in the Atherosclerosis Risk in Communities (ARIC) study (mean age, 75 years; 58% women; 22% Black).
SPPB scores were obtained during the fifth visit of the study, and utilized walk tests, chair stands and balance tests to score physical function. The total score ranged from 0 to 12, with higher scores indicating better physical function.
The primary outcome was a composite of CHD, stroke or HF.
Participants with low (0 to 6) and intermediate (7 to 9) scores were more likely to be older, women and Black compared with those with higher scores (10 to 12). In addition, lower scoring participants were more likely to have a lower level of education and worse CVD risk factor profile compared those scoring in the 10-to-12 range, according to the study.
Individuals with low SPPB scores also had the highest prevalence of CVD at baseline (38.9%) compared with the intermediate (25.9%) and high (18.2%) scoring groups.
CVD risk with poor physical function
During a median follow-up of 7 years, researchers reported that the 5-year cumulative incidence of the primary composite outcome among participants with low and intermediate scores were three times (23.4%) and two times (15.3%) higher compared with CVD incidence in the highest scoring category (8.6%).
After adjusting for confounders, Matsushita and colleagues observed increased risk for the composite outcome associated with low and intermediate SPPB scores compared with high scores (HR for low vs. high = 1.47; 95% CI, 1.2-1.79; HR for intermediate vs. high = 1.25; 95% CI, 1.07-1.46).
Moreover, adding SPPB score to the traditional CVD risk factors in the Pooled Cohort Equation improved the C statistic for the composite outcome (change in C statistic, 0.019; 95% CI, 0.011-0.027).
“Our study adds additional evidence to past research, which has demonstrated the importance of maintaining physical function at an older age,” Matsushita said in the release. “The next questions are: What is the best way for older adults to maintain physical function, and whether interventions that improve physical function can reduce cardiovascular disease risk?”
Reference:
- Low physical function after age 65 associated with future cardiovascular disease. newsroom.heart.org/news/low-physical-function-after-age-65-associated-with-future-cardiovascular-disease. Published Aug. 31, 2022. Accessed Aug. 31, 2022.
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