Abstract 073: Physical Function And Subsequent Risk Of Cardiovascular Events In Older Adults: The Atherosclerosis Risk In Communities (ARIC) Study

Abstract

Background: Reduced physical function, an exemplary phenotype of aging, has been associated with cardiovascular disease (CVD). However, few studies have comprehensively investigated the association of physical function with risk of incident and recurrent CVD in community-dwelling older adults. Methods: Physical function, evaluated with the Short Performance Physical Battery (SPPB), was assessed in the ARIC study at visit 5 (2011-2013) among 5548 participants (mean age 75±5 years, female 58%, black 22%). The SPPB score was categorized into low (0-6), intermediate (7-9), and high (10-12) physical function. We assessed the associations of SPPB categories with composite and individual outcomes of coronary heart disease (CHD), stroke, or heart failure (HF) using Cox proportional hazards models adjusting for potential confounders. We also evaluated improvement in c-statistics by adding SPPB to covariates. Results: During a median follow-up of 6.2 years, there were 821 composite events (329 CHD, 226 stroke, and 467 HF cases). Compared to high SPPB score, low and intermediate SPPB score were robustly associated with higher risk of the composite CVD outcome (hazard ratio [HR] 1.59 [95% CI 1.29-1.95] and 1.32 [1.12-1.56], respectively) (Table). These associations were largely consistent between participants with and without a history of CVD at baseline. Among individual outcomes, low SPPB score showed the highest HR for stroke, whereas intermediate SPPB score was only significantly associated with HF. The addition of SPPB significantly improved c-statistic for composite outcome (Δc-statistic 0.006 [95% CI 0.002-0.009]), and the improvement was especially evident in participants without history of CVD (Δc-statistic 0.013 [0.003-0.023]). Conclusions: Lower physical function was robustly associated with the risk of CVD and improved its prediction beyond established predictors in older adults. Clinicians should pay attention to physical function when managing CVD risk in older adults.