Midlife Determinants of Healthy Cardiovascular Aging: The Atherosclerosis Risk in Communities (ARIC) Study

Authors

Xiaoming Jia
Caroline Sun
Vijay Nambi
Salim S Virani
George Taffet
Eric Boerwinkle
Jan Bressler
Chiadi Ndumele
B Gwen Windham
James A de Lemos
Kunihiro Matsushita
John William McEvoy
Ron C Hoogeveen
Elizabeth Selvin
Christie M Ballantyne

Publication Date

6-1-2022

Journal

Atherosclerosis

DOI

10.1016/j.atherosclerosis.2022.04.028

PMID

35550933

PMCID

PMC9627572

PubMedCentral® Posted Date

6-1-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Aged, Aged, 80 and over, Aging, Atherosclerosis, Blood Pressure, Cardiovascular Diseases, Cholesterol, LDL, Glycated Hemoglobin, Humans, Middle Aged, Risk Factors, Cardiovascular risk factors, healthy aging, cardiovascular disease prevention

Abstract

BACKGROUND AND AIMS: Risk factor cutoffs are derived from associations with clinical cardiovascular disease (CVD), but how these risk factors associate with preserved cardiovascular health into old age is not well studied. We investigated midlife determinants of healthy versus nonhealthy cardiovascular aging in the Atherosclerosis Risk in Communities (ARIC) study.

METHODS: ARIC participants were categorized by cardiovascular status in older age (mean age 75.8 ± 5.3 years, range 66-90): healthy, subclinical disease (assessed by biomarkers and left ventricular function), clinical CVD (coronary heart disease, stroke, or heart failure), or prior death. We examined associations of midlife (mean age 52.1 ± 5.1 years) systolic and diastolic blood pressure (SBP, DBP), low-density lipoprotein cholesterol (LDL-C), triglycerides, hemoglobin A1c (HbA1c), and body mass index (BMI) with cardiovascular status in older age using multinomial logistic regression analyses.

RESULTS: Compared with healthy status, odds for subclinical disease (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.09-1.55) and clinical CVD (OR 1.87, 95% CI 1.53-2.29) at older age increased starting with midlife SBP 120-129 mmHg, whereas odds for death increased starting with SBP 110-119 mmHg (OR 1.29, 95% CI 1.10-1.52); findings were similar for DBP. Odds for subclinical disease increased for HbA1c ≥ 6.5% and BMI starting at 30-/m

CONCLUSIONS: More-stringent levels of modifiable risk factors in midlife beyond current clinical practice and guidelines were associated with preserved cardiovascular health in older age.

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