Effect of Subclinical Cardiovascular Disease
Anne B. Newman, MD, MPH; Alice M. Arnold, PhD; Barbara L. Naydeck, MPH; Linda P. Fried, MD, MPH; Gregory L. Burke, MD; Paul Enright, MD; John Gottdiener, MD; Calvin Hirsch, MD; Daniel O'Leary, MD; Russell Tracy, PhD; for the Cardiovascular Health Study Research Group
Arch Intern Med. 2003;163:2315-2322.
Background Cardiovascular diseases are the primary cause of death in older adults. Among those without clinical disease, high levels of subclinical disease are associated with poor survival. The effect of the extent of subclinical cardiovascular disease on the quality of the remaining years has not been defined.
Methods In a longitudinal cohort study, 2932 men and women aged 65 years and older were followed up for 8 years to determine the likelihood of maintaining intact health and functioning. Successful aging was defined as remaining free of cardiovascular disease, cancer, and chronic obstructive pulmonary disease and with intact physical and cognitive functioning.
Results Younger age at study entry and a lower extent of subclinical cardiovascular disease were independently associated with the likelihood of maintaining successful aging. In age-stratified summaries, those with subclinical disease had a trajectory of decline similar to subjects 5 years older without subclinical vascular disease. Regression analyses showed that the decline associated with subclinical disease was equivalent to 6.5 (95% confidence interval, 6.4-6.6) years of aging for women and 5.6 (95% confidence interval, 5.4-5.8) years of aging for men. Individual measures of the extent of cardiovascular disease, diabetes mellitus, smoking, and higher C-reactive protein level were also independently predictive of fewer years of successful aging, but none of these factors substantially attenuated the effect of age itself.
Conclusions There is a graded relationship between the extent of vascular disease measured noninvasively and the likelihood of maintaining intact health and function. Prevention of subclinical vascular disease may increase the quality and the quantity of years in late life.
From the Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Newman and Ms Naydeck); Department of Biostatistics, University of Washington, Seattle (Dr Arnold); Johns Hopkins University, Baltimore, Md (Dr Fried); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (Dr Burke); Department of Medicine, University of Arizona, Tucson (Dr Enright); Department of Medicine, St Francis Medical Center, Roslyn, NY (Dr Gottdiener); Division of General Medicine, Department of Medicine, University of California Davis Medical Center, Sacramento (Dr Hirsch); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (Dr O'Leary); and Departments of Pathology and Biochemistry, University of Vermont, Colchester (Dr Tracy). The authors have no relevent financial interest in this article. A list of participating institutions and principal investigators in the study was published previously (Arch Intern Med. 1999;159:1339-1347).
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