Healthy vascular ageing protects community dwelling elderly from all-cause mortality: 5-year evidence from the North Shanghai Study

Abstract

Abstract Background Healthy vascular ageing (HVA) defined by normal pulse wave velocity (PWV) has been recognized as a valuable indicator of vascular status. And HVA strongly correlates with preclinical targeted organ damage (TOD). While the long-term benefit of HVA remains to be investigated. Aims To investigate the long-term outcome of population with HVA based on large registered North Shanghai Study. Methods Since Jun. 2014, 3363 community-dwelling elderly Chinese (age ≥65 years) were enrolled in the Northern Shanghai Study. HVA was defined as normal carotid femoral PWV that stratified by age and blood pressure. TOD was measured and categorized as vascular TOD indicated by carotid-femoral PWV and ankle-brachial index, cardiac TOD indicated by left ventricular hypertrophy and diastolic dysfunction, and renal TOD indicated by estimated glomerular filtration rate and urinary albumin/creatinine ratio. Follow-up outcome including all-cause mortality, cardiovascular and non-cardiovascular mortalities were evaluated. Results 1016 participants (30.2%) with HVA were identified. Compared with non-HVA group, although no gender difference, HVA group had younger age, lower blood pressure, lower body mass index (BMI), and milder TODs. Through a follow-up period of 5.7±1.8 years, 233 (6.9%) all-cause deaths, including 94 (2.8%) cardiovascular deaths were observed. Participants with HVA showed significantly higher survival from all-cause deaths (Log-rank P=0.002) and cardiovascular deaths (Log-rank P=0.003), but statistically non-significant survival from non-cardiovascular deaths (Log-rank P=0.098).Subgroup analysis showed that HVA was a significant protective factor in female (HR 0.412 (0.245, 0.692), P=0.002), participants aged 65-70 (HR 0.417 (0.194, 0.897), P=0.025), participants with BMI<25 (0.570 (0.386, 0.842) P=0.005), and participants with at least 1 TOD (HR 0.634 (0.444, 0.907), P=0.013). Moreover, the protective value of HVA was only significant in participants without cardiac TOD (0.681, (0.464, 0.998), P=0.049), participants with renal TOD (0.547, (0.354, 0.844), P=0.006), and participants with vascular TOD (0.461 (0.251, 0.848), P=0.013). Conclusion In community-dwelling elderly, HVA could be a significant protective factor for all-cause deaths, especially in subpopulation of female, age 65-70, BMI<25 and with renal and/or vascular TOD.