Low Physical Function Tied to Cardiac Events in Older Adults

Megan Brooks

September 01, 2022

Reduced physical function is an independent risk factor for composite and individual cardiovascular events, including coronary heart disease (CHD), stroke, and heart failure (HF) in older adults, according to new observational data from the Atherosclerosis Risk in Communities (ARIC) study.

"We found that physical function in older adults predicts future cardiovascular disease (CVD) beyond traditional heart disease risk factors, regardless of whether an individual has a history of cardiovascular disease," senior author Kunihiro Matsushita, MD, PhD, Division of Cardiology, Johns Hopkins School of Medicine in Baltimore, Maryland, said in a news release.

The study was published online August 31 in the Journal of the American Heart Association.

Keeping Fit With Age

The researchers analyzed health data collected between 2011 and 2013 for 5570 ARIC participants (mean age 75 years, 58% women, 22% Black persons). They assessed physical function using the Short Physical Performance Battery (SPPB), which measures walking speed, leg strength, and balance.

On the basis of the results, participants were categorized into three physical function groups: low (score 0-6, 13% of the cohort), intermediate (score 7-9, 30%) and high (score 10-12, 57%).

During a median follow up of 7 years, there were 930 composite CVD events (386 CHD, 251 stroke, and 529 HF).

Adults with lower SPPB scores had a higher cumulative incidence of composite CVD outcomes.

The 5-year cumulative incidence of the composite CVD outcome in the low- and intermediate-SPPB categories was about three times (23.4%) and two times (15.3%) higher than in the high-SPPB category (8.6%), the researchers report.

In addition, continuous SPPB scores showed significant associations with composite and individual CVD outcomes in all models. A 1-point lower SPPB score was associated with 6%-10% higher risk for CVD events after adjusting for potential confounders.

In the fully adjusted model, the risk for composite CVD outcomes was 47% higher (hazard ratio [HR], 1.47; 95% CI, 1.20-1.79) in those with low physical function and 25% higher in those with intermediate physical function (HR, 1.25; 95% CI, 1.07-1.46) compared with peers with high physical function.

For the individual outcomes, low physical function was associated with higher risk for stroke (HR, 1.81; 95% CI, 1.24-2.64) and HF (HR, 1.33; 95% CI, 1.02-1.73), whereas the association for CHD was not significant.

The associations were largely consistent across subgroups, including those with CVD at baseline.

The addition of SPPB scores significantly improved risk prediction of CVD events beyond traditional CVD risk factors in adults regardless of prior CVD history, suggesting that this tool may be useful for classifying CVD risk in older adults, the researchers say.

Meaningful Impact on Care?

"Our findings highlight the value of assessing the physical function level of older adults in clinical practice," lead author Xiao Hu, MHS, with the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health, said in the news release.

"In addition to heart health, older adults are at higher risk for falls and disability," Hu added. "The assessment of physical function may also inform the risk of these concerning conditions in older adults."

Weighing in on the study for theheart.org | Medscape Cardiology, Jonathan Halperin, MD, cardiologist at Mount Sinai Heart, and professor of medicine (cardiology) at the Icahn School of Medicine at Mount Sinai in New York City said that "It's known that cardiorespiratory fitness is an important predictor of cardiovascular risk, but it is one of the few physiological risk factors that are subjectively queried but not objectively assessed in routine clinical practice."

In this study, Halperin noted, the investigators found that a battery of physical performance assessments, including a walk test, chair standing, and balance testing, improved cardiovascular risk prediction.

Halperin cautioned, however, that "since even the short sequence of tests takes time to perform and interpret, and is not currently reimbursed under most health insurance policies, it is not clear whether the report will have a meaningful impact on patient care."

This research was funded by the National Institutes of Health. Matsushita, Hu, and Halperin have no relevant disclosures.

J Am Heart Assoc. Published online August 31, 2022. Abstract

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