Impact of Low Cardiovascular Risk Profiles on Geriatric Outcomes: Evidence From 421,000 Participants in Two Cohorts.
Impact of Low Cardiovascular Risk Profiles on Geriatric Outcomes: Evidence From 421,000 Participants in Two Cohorts.
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DOI：
10.1093/gerona/gly083
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发表时间：
2019-02-15
期刊：
影响因子：
--
通讯作者：
Melzer D
中科院分区：
文献类型：
--
作者：
Atkins JL;Delgado J;Pilling LC;Bowman K;Masoli JAH;Kuchel GA;Ferrucci L;Melzer D
心血管危险因素较低的个体患心血管疾病的几率较低，但与老年综合征的关系尚不清楚。我们在两个大型队列中测试了年龄在60-69岁的低心血管疾病风险个体是否不太可能出现与年龄相关的不良健康结果。数据来自人群代表性病历（英国临床实践研究数据链[CPRD]， n = 239,591）和健康志愿者（英国生物银行[UKB]， n = 181,820），随访≤10年。心血管疾病风险评分（CRS）总结了吸烟状况、低密度脂蛋白胆固醇、血压、体重指数、空腹血糖和身体活动，将个体分为低（即所有因素接近理想）、中等或高CRS。Logistic回归、Cox模型以及Fine和Grey风险模型检验了CRS与健康结果之间的关联。低CRS个体的慢性疼痛（UKB：基线优势比= 0.52，可信区间[CI] = 0.50-0.54）、尿失禁（CPRD：亚危险比[sub-HR] = 0.75, 0.63-0.91）、跌倒（亚危险比= 0.82,CI = 0.73-0.91）、脆性骨折（亚危险比= 0.78,CI = 0.65-0.93）和痴呆（相对于高风险；UKB：亚危险比= 0.67,CI = 0.50-0.89； CPRD：亚危险比= 0.79,CI = 0.56-1.12）的发生率较低。CRS低的CPRD中只有5.4%变得虚弱（Rockwood指数），而CRS高的CPRD中只有24.2%。低CRS组的全因死亡率明显低于高CRS组（HR = 0.40, 95% CI = 0.35-0.47）。所有的关联都显示出剂量-反应关系，两个队列的结果相似。年龄在60-69岁之间、心血管危险因素状况接近理想的人，其老年疾病和虚弱的发生率大大降低。优化心血管疾病的危险因素可以大大减少晚年发病的负担。
Individuals with low cardiovascular risk factor profiles experience lower rates of cardiovascular diseases, but associations with geriatric syndromes are unclear. We tested whether individuals with low cardiovascular disease risk, aged 60–69 years old at baseline in two large cohorts, were less likely to develop aging-related adverse health outcomes. Data were from population representative medical records (Clinical Practice Research Datalink [CPRD] England, n = 239,591) and healthy volunteers (UK Biobank [UKB], n = 181,820), followed for ≤10 years. A cardiovascular disease risk score (CRS) summarized smoking status, LDL-cholesterol, blood pressure, body mass index, fasting glucose and physical activity, grouping individuals as low (ie, all factors near ideal), moderate, or high CRS. Logistic regression, Cox models, and Fine and Grey risk models tested the associations between the CRS and health outcomes. Low CRS individuals had less chronic pain (UKB: baseline odds ratio = 0.52, confidence interval [CI] = 0.50–0.54), lower incidence of incontinence (CPRD: subhazard ratio [sub-HR] = 0.75, 0.63–0.91), falls (sub-HR = 0.82, CI = 0.73–0.91), fragility fractures (sub-HR = 0.78, CI = 0.65–0.93), and dementia (vs. high risks; UKB: sub-HR = 0.67, CI = 0.50–0.89; CPRD: sub-HR = 0.79, CI = 0.56–1.12). Only 5.4% in CPRD with low CRS became frail (Rockwood index) versus 24.2% with high CRS. All-cause mortality was markedly lower in the low CRS group (vs. high CRS; HR = 0.40, 95% CI = 0.35–0.47). All associations showed dose–response relationships, and results were similar in both cohorts. Persons aged 60–69 years with near-ideal cardiovascular risk factor profiles have substantially lower incidence of geriatric conditions and frailty. Optimizing cardiovascular disease risk factors may substantially reduce the burden of morbidity in later life.
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影响因子：
6.3
作者：
Jacob ME;Yee LM;Diehr PH;Arnold AM;Thielke SM;Chaves PH;Gobbo LD;Hirsch C;Siscovick D;Newman AB
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