Abstract
Background
Vascular risk factors such as hypertension and obesity have been associated with physical limitations among older adults.
Purpose
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.
Method
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.
Results
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.
Conclusion
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.
Similar content being viewed by others
References
Daviglus ML, Stamler J, Pirzada A, Yan LJL, Garside DB, Liu K, et al. Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. JAMA. 2004;292:1588–92.
Ford ES, Li CY, Zhao GX, Pearson WS, Capewell S. Trends in the prevalence of low risk factor burden for cardiovascular disease among United States adults. Circulation. 2009;120:1181–8.
Sattelmair J, Pertman J, Ding EL, Kohl HW, Haskell W, Lee IM. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation. 2011;124:789–95.
Atkinson HH, Cesari M, Kritchevsky SB, Penninx BW, Fried LP, Guralnik J, et al. Predictors of combined cognitive and physical decline. J Am Geriatr Soc. 2005;53:1197–202.
Dumurgier J, Elbaz A, Dufouil C, Tavernier B, Tzourio C. Hypertension and lower walking speed in the elderly: the Three-City study. J Hypertens. 2010;28:1506–14.
Volpato S, Blaum C, Resnick H, Ferrucci L, Fried LP, Guralnik. Comorbidities and impairments explaining the association between diabetes and lower extremity disability: The Women's Health and Aging Study. Diabetes Care. 2002;25:678–83.
Welmer A, Angleman S, Rydwik E, Fratiglioni L, Qiu C. Association of cardiovascular burden with mobility limitation among elderly people: a population-based study. PLoS One. 2013;31:e65815.
Houston DK, Stevens J, Cai J. Abdominal fat distribution and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study. Int J Obes. 2005;29:1457–63.
O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SKJ. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14–22.
Elbaz A, Ripert M, Tavernier B, Fevrier B, Zureik M, Gariepy J, et al. Common carotid artery intima-media thickness, carotid plaques, and walking speed. Stroke. 2005;36:2198–202.
den Ouden MEM, Schuurmans MJ, Mueller-Schotte S, Brand JS, van der Schouw YT. Domains contributing to disability in activities of daily living. J Am Med Dir Ass. 2013;14:18–24.
Murabito JM, Evans JC, Larson MG, Nieto K, Levy D, Wilson PWF. The ankle-brachial index in the elderly and risk of stroke, coronary disease, and death: the Framingham study. Arch Intern Med. 2003;163:1939–42.
Kuo HK, Yu YH. The relation of peripheral arterial disease to leg force, gait speed, and functional dependence among older adults. J Gerontol A Bio Sci Med Sci. 2008;63:384–90.
Ostchega Y, Paulose-Ram R, Dillon CF, Gu QP, Hughes JP. Prevalence of peripheral arterial disease and risk factors in persons aged 60 and older: data from the National Health and Nutrition Examination Survey 1999–2004. J Am Geriatr Soc. 2007;55:583–9.
Stensland-Bugge E, Bonaa KH, Joakimsen O. Age and sex differences in the relationship between inherited and lifestyle risk factors and subclinical carotid atherosclerosis: the Tromso study. Atherosclerosis. 2001;154:437–48.
Phan HM, Alpert JS, Fain M. Frailty, inflammation, and cardiovascular disease: evidence of a connection. Am J Geriatr Cardiol. 2008;17:101–7.
Kattainen A, Koskinen S, Reunanen A, Martelin T, Knekt P, Aromaa A. Impact of cardiovascular diseases on activity limitations and need for help among older persons. J Clin Epidemiol. 2004;57:82–8.
Pugh KG, Lipsitz LA. The microvascular frontal-subcortical syndrome of aging. Neurobiol Aging. 2002;23:421–31.
Song A, Liang Y, Yan Z, Sun B, Cai C, Jiang H, et al. Highly prevalent and poorly controlled cardiovascular risk factors among Chinese elderly people living in the rural community. Eur J Prev Cardiol. 2013. doi:10.1177/2047487313487621.
Kowal PCS, Naidoo N, Biritwum R, Fan W, Lopez Ridaura R, Maximova T, et al. Data resource profile: The World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol. 2012;41:1639–49.
Spector WD, Fleishman JA. Combining activities of daily living with instrumental activities of daily living to measure functional disability. J Gerontol B Psychol Sci Soc Sci. 1998;53:S46–57.
LaPlante MP. The classic measure of disability in activities of daily living is biased by age but an expanded IADL/ADL measure is not. J Gerontol B Psychol Sci Soc Sci. 2010;65:720–32.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.
Third Report of the National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation. 2002;106:3143–4321.
Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13:275–86.
Dong X, Liu Y, Yang J, Sun Y, Chen L. Efficiency of anthropometric indicators of obesity for identifying cardiovascular risk factors in a Chinese population. Postgrad Med J. 2011;87:251–6.
Rydwik E, Welmer AK, Kåreholt I, Angleman S, Fratiglioni L, Wang HX. Adherence to physical exercise recommendations in people over 65—the SNAC-Kungsholmen study. Eur J Public Health. 2013. doi:10.1093/eurpub/cks150.
Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31:1473–8.
O'Leary DH, Polak JF, Wolfson SKJ, Bond MG, Bommer W, Sheth S, et al. Use of sonography to evaluate carotid atherosclerosis in the elderly: the Cardiovascular Health Study. Stroke. 1991;22:1155–63.
Grenon SM, Gagnon J, Hsiang Y. Video in clinical medicine. Ankle-brachial index for assessment of peripheral arterial disease. N Engl J Med. 2009;36(361):e340.
Hicks R, Tingley D. Causal mediation analysis. Stata J. 2011;11:605–19.
Maher V, O'Dowd M, Carey M, Markham C, Byrne A, Hand E, et al. Association of central obesity with early Carotid intima-media thickening is independent of that from other risk factors. Int J Obes. 2009;33:136–43.
Sacco RL. Achieving ideal cardiovascular and brain health: opportunity amid crisis. Presidential Address at the American Heart Association 2010 Scientific Sessions. Circulation. 2011;123:2653–7.
Thijssen DHJ, Cable NT, Green DJ. Impact of exercise training on arterial wall thickness in humans. Clin Sci (Lond). 2012;122:311–22.
Preacher KJ, Kelley K. Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychol Methods. 2011;16:93–115.
Bots ML, Vanswieten JC, Breteler MMB, Dejong P, Vangijn J, Hofman A, et al. Cerebral white matter lesions and atherosclerosis in the Rotterdam study. Lancet. 1993;341:1232–7.
Zheng JJ, Delbaere K, Close JC, Sachdev PS, Lord SR. Impact of white matter lesions on physical functioning and fall risk in older people: a systematic review. Stroke. 2011;42:2086–90.
Hajjar I, Quach L, Yang F, Chaves PH, Newman AB, Mukamal K, et al. Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the Cardiovascular Health Study. Circulation. 2011;123:858–65.
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Welmer, AK., Liang, Y., Angleman, S. et al. Vascular Risk Factor Burden, Atherosclerosis, and Functional Dependence in Old Age: A Population-Based Study. Int.J. Behav. Med. 21, 597–604 (2014). https://doi.org/10.1007/s12529-013-9352-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12529-013-9352-8