Predictors of Cardiovascular Health in Older Adults: a Regression Tree Analysis

Abstract

BackgroundCardiovascular health is central to overall health. Studies on predictors of cardiovascular health in older adults have not fully considered potential interactions among predictor variables.ObjectiveThe purpose of this study was to determine the relationships of lifestyle behaviors and body composition with cardiovascular health in older adults while accounting for potential interactions among lifestyle behaviors, measures of body composition and socio demographic characteristics.MethodsThe Health, Aging and Body Composition (Health ABC)Study is a prospective cohort study of 3,075 adults aged 70 to 79 at baseline. The Generalized, Unbiased, Interaction Detection and Estimation (GUIDE) algorithm for regression tree analysis was used to predict measures of cardiovascular health, including high‐density lipoprotein (HDL) cholesterol, interleukin‐6 (IL‐6), homeostasis model assessment of insulin resistance (HOMA‐IR), and systolic blood pressure (SBP), of Health ABC participants based on their lifestyle behaviors, measures of body composition and socio demographic characteristics.ResultsParticipants with the highest mean HDL cholesterol had trunk lean mass ≤21.6 kg and abdominal visceral fat ≤96.2 cm2, while those with the lowest HDL cholesterol had trunk lean mass >27.8 kg. Persons with the lowest IL‐6 had a sagittal diameter ≤24.7 cm (or had missing values for sagittal diameter) and flossed their teeth at least 3 times per week, while those with the highest IL‐6 had a sagittal diameter >24.7 cm. Persons with the lowest HOMA‐IR had a BMI ≤27.4 kg/m2 (or had missing values for BMI), while those with the highest HOMA‐IR had a BMI >27.4 kg/m2 and a sagittal diameter >27.1 cm. Participants with the lowest SBP were those who were not on (or had missing data on) blood pressure medication, were from the Memphis clinical site and were white, while those with the highest SBP were those on high blood pressure medication from the Pittsburgh site.ConclusionThis study provides further evidence that abdominal adiposity is strongly linked to cardiovascular risk in older adults and supports the use of sagittal diameter as an indicator of cardiovascular health. It also suggests a strong inverse relationship between lean body mass and HDL cholesterol, which warrants further investigation.Support or Funding InformationThis research is supported by USDA‐ARS Specific Cooperative Agreement 8040‐53000‐018‐08. This study is also supported in part by National Institute on Aging (NIA) Contracts N01‐AG‐6‐2101;N01‐AG‐6‐2103; N01‐AG‐6‐2106; NIA grant R01‐AG028050, NINR grant R01‐NR012459, and by the Intramural Research Program of the NIH, NIA.