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Do subclinical vascular abnormalities precede impaired physical ability and ADL disability?
Marjolein E M den Ouden1, Marieke J Schuurmans2, Sigrid Mueller-Schotte3
1Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
Insights
Subclinical vascular abnormalities, like pulse wave velocity and carotid intima media thickness, are linked to declining physical ability in older adults. Changes in these markers also predict worsening physical function, but not necessarily daily living disability.
Area of Science:
- Gerontology and Cardiovascular Health
- Vascular Biology and Aging
- Physical Function and Disability Studies
Background:
- Cardiovascular disease significantly impacts daily activities and physical functioning.
- The role of subclinical vascular abnormalities and their progression in physical ability decline remains unclear.
- Understanding these links is crucial for developing targeted interventions in aging populations.
Purpose of the Study:
- To investigate the association between subclinical vascular abnormalities and physical ability.
- To determine if the rate of change in vascular markers predicts changes in physical ability and ADL disability.
- To explore these relationships in a longitudinal cohort of middle-aged and older adults.
Main Methods:
- Longitudinal study including 490 middle-aged and older individuals.
- Physical ability assessed using the Short Physical Performance Battery.
- Subclinical vascular abnormalities measured by pulse wave velocity (PWV) and carotid intima media thickness (CIMT); ADL disability assessed via self-report questionnaires.
- Generalized estimation equation models used to analyze longitudinal associations.
Main Results:
- Higher baseline PWV, PWV change, baseline CIMT (in men), and CIMT change (in men) were associated with a greater decline in physical ability.
- No significant association was found between vascular abnormalities and overall change in ADL disability.
- In individuals with incident cardiovascular disease, increased PWV change correlated with a higher rate of ADL disability decline.
Conclusions:
- Subclinical vascular abnormalities and their progression are associated with reduced physical ability over time.
- The link between vascular changes and ADL disability is more pronounced in individuals with existing or newly diagnosed cardiovascular disease.
- ADL decline may be more directly caused by clinical cardiovascular events than by the progression of subclinical vascular disease.
Abstract:
Cardiovascular disease is an important cause of disability in activities of daily living (ADL) through its effect on physical functioning. However, it is unclear whether subclinical vascular abnormalities and rate of change in subclinical vascular abnormalities is also associated with an impaired physical ability and with ADL disability. In a longitudinal study, 490 middle-aged and older persons were included. Physical ability was measured using the Short Physical Performance Battery and ADL disability using a questionnaire on self-reported basic and instrumental ADL. Subclinical vascular abnormalities were measured by pulse wave velocity (PWV) and carotid intima media thickness (CIMT, in men only). Longitudinal associations between baseline markers of subclinical vascular abnormalities, their rate of change, and change in physical ability or ADL disability were assessed using generalized estimation equation models. After adjustment for confounders, higher baseline PWV, change in PWV, baseline CIMT (in men) and change in CIMT (in men) were associated with a higher rate of change in physical ability (regression coefficients 0.035, 95% CI [0.018; 0.052]; 0.047, 95% CI [0.024; 0.069]; 0.214, 95% CI [0.070; 0.358] and 0.148, 95% CI [0.019; 0.277], respectively). No relations were found for change in ADL disability. In subjects with incident cardiovascular disease, higher change in PWV was associated with a higher rate of change in ADL disability (regression coefficient 0.054, 95% CI [0.001; 0.106]). The present study showed that subclinical vascular abnormalities and rate of change were associated with higher rate of change in physical ability. The association between (change in) subclinical vascular abnormalities and ADL disability tended to be stronger in persons with incident and prevalent cardiovascular disease. These data may suggest that ADL decline is more a direct effect of experienced clinically manifest vascular events rather than the effect of progression of subclinical vascular abnormalities.
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