Lower Physical Function Elevates Risk of CVD Outcomes in Older Adults

Kunihiro Matsushita, MD, PhD

New findings suggest physical function was independently associated with composite and individual cardiovascular disease (CVD) outcomes in older adults.

A lower Short Physical Performance Battery (SPPB) score in this population was linked to an elevated risk of composite CVD outcomes, as well as coronary heart disease (CHD), stroke, and heart failure outcomes.

“The inclusion of both older men and women and the extension to 3 major CVD subtypes of CHD, stroke, and heart failure in a single population are important contributions of our study,” wrote study author Kunihiro Matsushita, MD, PhD, Department of Epidemiology Johns Hopkins Bloomberg School of Public Health.

Physical function serves as a representative phenotype of aging and may be a promising predictor of CVD in older adults. Although designed to measure physical function in this population, there have been no formal studies assessing whether SPPB could improve CVD risk prediction beyond traditional risk factors and its predictive value for CVD subtypes in a community-dwelling population.

Using data from the Atherosclerosis Risk in Communities (ARIC) study, investigators studied 5570 participants at visit 5 (2011 - 2013) with a mean age of 75 years and 58% female patients.  The SPPB evaluated physical function incorporating a walk test, chair stands, and balance tests and scored individuals categorically (low [0-6], intermediate [7-9], and high [10-12]) and continuously.

Outcomes of interest consisted of the composite and individual outcomes of CHD, stroke, and heart failure, while multivariable Cox models adjusted for major CVD risk factors and history of CVD.

Data show the most prevalent SPPB category was high (57.3% [n = 3194]), which was followed by intermediate (30.0% [n = 1671]) and low (12.7% [n = 705]) in the patient population.

Over a 7.0 year median follow up, there were 930 composite CVD events (386 coronary heart disease, 251 stroke, and 529 heart failure cases). The findings suggest a higher cumulative incidence of composite CVD was seen among individuals with lower SPPB scores.

In fact, data show the 5-year cumulative incidence of the composite CVD outcome among participants in the low and intermediate SPPB categories was 3 times (23.4%) and 2 times (15.3%) higher than those in the high SPPB category (8.6%).

Moreover, continuous SPPB scores showed important associations with composite and individual CVD outcomes in all models, suggested the findings. Data show the association of categorical SPPB with composite CVD was significant after adjusting for demographic variables, with hazard ratios (HR) of 2.41 (95% confidence interval [CI], 1.99 - 2.91) in the low SPPB and 1.58 (95% CI, 1.36 - 1.84) in the intermediate SPPB categories.

Results remained consistent after accounting for the history of CVD in both the low SPPB group (HR, 1.47; 95% CI, 1.20 - 1.79) and the intermediate SPPB (HR, 1.25; 95% CI, 1.07 - 1.46).

When examining individual SPPB components, investigators noted each was independently associated with composite CVD and heart failure. Adding SPPB to traditional risk factors additionally led to significant improvements in C-statistics of CVD outcomes.

The study, “Physical Function and Subsequent Risk of Cardiovascular Events in Older Adults: The Atherosclerosis Risk in Communities Study,” was published in the Journal of the American Heart Association.