Link found between low physical function and cardiovascular disease risk in older adults, AMA study finds

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New research expands on how reduced physical activity is associated with cardiovascular disease (CVD) and more specifically, assesses composite and individual CVD outcomes in older adults and how it can predict future risk of the disease.

The study, published in the Journal of the American Heart Association, was led by study senior author Kunihiro Matsushita, MD, PhD, an associate professor in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health and the Division of Cardiology at the Johns Hopkins School of Medicine in Baltimore. The researchers found that among people older than age 65 who were assessed using a short physical function test, having lower physical function was independently associated with a greater risk of developing heart disease, heart failure, and stroke.

Researchers used The Short Physical Performance Battery (SPPB) to measure physical function, which includes walking speed, leg strength and balance. This study examined physical function, which is different from physical fitness.

“While traditional cardiovascular disease risk factors such as high blood pressure, high cholesterol, smoking, or diabetes are closely linked to cardiovascular disease, particularly in middle-aged people, we also know these factors may not be as predictive in older adults, so we need to identify nontraditional predictors for older adults,” Matsushita said in a statement. “We found that physical function in older adults predicts future cardiovascular disease beyond traditional heart disease risk factors, regardless of whether an individual has a history of cardiovascular disease.”

Researchers analyzed health data for 5,570 adults from The Atherosclerosis Risk in Communities (ARIC) study that included 58 percent women, 78 percent white adults, and 22 percent Black adults. The average age of participants was 75 years, with data taken from 2011 to 2019. Using SPPB scores, the physical function of the participants was categorized into three groups: low, intermediate, and high, based on their test performance.

The association of SPPB scores was examined with categories of future heart attack, stroke, and heart failure, as well as the composite of the three, adjusting for major cardiovascular disease risk factors, such as high blood pressure, smoking, high cholesterol, diabetes, and history of cardiovascular disease.

The study found:

  • Among all participants, 12 percent had low, 30 percent had intermediate and 57 percent had high physical function scores.
  • During the eight years of the study, there were 930 participants with one or more confirmed cardiovascular events: 386 diagnosed with heart attack, 251 who had a stroke and 529 heart failure cases.
  • Compared to adults with high physical function scores, those with low physical function scores were 47 percent more likely to experience at least one cardiovascular disease event, and those with intermediate physical function scores had a 25 percent higher risk of having at least one cardiovascular disease event.
  • The association between physical function and cardiovascular disease remained after controlling for traditional cardiovascular disease risk factors such as age, high blood pressure, high cholesterol, and diabetes.
  • The physical function score improved the risk prediction of cardiovascular disease outcomes beyond traditional cardiovascular risk factors regardless of whether individuals had a history of cardiovascular disease or were healthy.

“Our study adds evidence to past research, which has demonstrated the importance of maintaining physical function at an older age,” Matsushita said. “The next questions are: what is the best way for older adults to maintain physical function, and whether interventions that improve physical function can reduce cardiovascular disease risk?”