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Midlife determinants of healthy cardiovascular aging: The Atherosclerosis Risk in Communities (ARIC) study
Xiaoming Jia1, Caroline Sun2, Vijay Nambi3
1Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Insights
Achieving healthier midlife levels for blood pressure, cholesterol, and BMI promotes better cardiovascular health in old age. Stricter risk factor management in middle age is key for long-term heart health.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Current cardiovascular disease (CVD) risk factor cutoffs are based on clinical disease associations.
- Limited research exists on how these risk factors impact preserved cardiovascular health in advanced age.
Purpose of the Study:
- To investigate midlife determinants of healthy versus nonhealthy cardiovascular aging.
- To analyze associations between midlife risk factors and cardiovascular status in older age.
Main Methods:
- Utilized data from the Atherosclerosis Risk in Communities (ARIC) study.
- Categorized participants (mean age 75.8 years) into healthy, subclinical disease, clinical CVD, or death groups.
- Examined associations of midlife (mean age 52.1 years) risk factors (blood pressure, LDL-C, HbA1c, BMI) with older age cardiovascular status using multinomial logistic regression.
Main Results:
- Elevated midlife systolic and diastolic blood pressure were associated with increased odds of subclinical disease, clinical CVD, and death in older age.
- Higher midlife hemoglobin A1c and body mass index were linked to increased odds of subclinical disease, clinical CVD, and death.
- Specific thresholds for midlife risk factors (e.g., SBP 110-119 mmHg, HbA1c ≥ 5.5%) predicted adverse cardiovascular outcomes in older age.
Conclusions:
- More stringent midlife risk factor levels, beyond current guidelines, are associated with preserved cardiovascular health in older age.
- Proactive and stricter management of modifiable risk factors in midlife may be crucial for promoting healthy cardiovascular aging.
Background And Aims:
Risk factor cutoffs are derived from associations with clinical cardiovascular disease (CVD), but how these risk factors associate with preserved cardiovascular health into old age is not well studied. We investigated midlife determinants of healthy versus nonhealthy cardiovascular aging in the Atherosclerosis Risk in Communities (ARIC) study.
Methods:
ARIC participants were categorized by cardiovascular status in older age (mean age 75.8 ± 5.3 years, range 66-90): healthy, subclinical disease (assessed by biomarkers and left ventricular function), clinical CVD (coronary heart disease, stroke, or heart failure), or prior death. We examined associations of midlife (mean age 52.1 ± 5.1 years) systolic and diastolic blood pressure (SBP, DBP), low-density lipoprotein cholesterol (LDL-C), triglycerides, hemoglobin A1c (HbA1c), and body mass index (BMI) with cardiovascular status in older age using multinomial logistic regression analyses.
Results:
Compared with healthy status, odds for subclinical disease (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.09-1.55) and clinical CVD (OR 1.87, 95% CI 1.53-2.29) at older age increased starting with midlife SBP 120-129 mmHg, whereas odds for death increased starting with SBP 110-119 mmHg (OR 1.29, 95% CI 1.10-1.52); findings were similar for DBP. Odds for subclinical disease increased for HbA1c ≥ 6.5% and BMI starting at 30-<35 kg/m2; odds for clinical CVD or death increased starting at HbA1c 5.5-5.9%, LDL-C >160 mg/dL, and BMI 30-<35 kg/m2.
Conclusions:
More-stringent levels of modifiable risk factors in midlife beyond current clinical practice and guidelines were associated with preserved cardiovascular health in older age.
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