Vascular Risk Factor Burden, Atherosclerosis, and Functional Dependence in Old Age: A Population-Based Study
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Vascular risk factors such as hypertension and obesity have been associated with physical limitations among older adults.
The purpose of this study is to examine whether individual and aggregated vascular risk factors (VRFs) are associated with functional dependence and to what extent carotid atherosclerosis (CAS) or peripheral artery disease (PAD) may mediate the possible associations of aggregated VRFs with functional dependence.
This cross-sectional study included 1,451 community-living participants aged ≥60 years in the Confucius Hometown Aging Project of China. Data on demographic features, hypertension, high total cholesterol, obesity, smoking, physical inactivity, diabetes, CAS, PAD, and cardiovascular diseases (CVDs) were collected through an interview, a clinical examination, and laboratory tests. Functional dependence was defined as being dependent in at least one activity in the personal or instrumental activities of daily living. Data were analyzed using multiple logistic models controlling for potential confounders. We used the mediation model to explore the potential mediating effect of CAS and PAD on the associations of aggregated VRFs with functional dependence.
Of the 1,451 participants, 222 (15.3 %) had functional dependence. The likelihood of functional dependence increased linearly with increasing number of VRFs (hypertension, high total cholesterol, abdominal obesity, and physical inactivity) (p for trend <0.002). Mediation analysis showed that controlling for demographics and CVDs up to 11 % of the total association of functional dependence with clustering VRFs was mediated by CAS and PAD.
Aggregation of multiple VRFs is associated with an increased likelihood of functional dependence among Chinese older adults; the association is partially mediated by carotid and peripheral artery atherosclerosis independently of CVDs.
KeywordsAging Cardiovascular risk factors Atherosclerosis Functional dependence Population-based study China
The Confucius Hometown Aging Project (CHAP) was supported in part by grants from the Department of Science and Technology (2008GG00221) and the Department of Health (2009-067) in Shandong, China and by the Young Scholar Grant for Strategic Research in Epidemiology at Karolinska Institutet, Stockholm, Sweden. We thank all CHAP participants for their contribution to the project and the CHAP Study Group for their collaboration in data collection and management. Dr. Welmer was supported in part by grants from the Stockholm County Council, and Dr. Qiu was supported by grants from Swedish Research Council and Karolinska Institutet, Stockholm, Sweden.
Conflict of Interest
The authors declare no conflicts of interest. The funding sources had no role in the study design, data collection, analysis, or interpretation of the results.
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