Vascular risk factor burden, atherosclerosis, and functional dependence in old age: a population-based study.
BACKGROUND
Vascular risk factors such as hypertension and obesity have been associated with physical limitations among older adults.


OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Gävlegatan 16, SE-113 30, Stockholm, Sweden, anna-karin.welmer@ki.se.
Anna-Karin
AK
Welmer
Yajun
Y
Liang
Sara
S
Angleman
Giola
G
Santoni
Zhongrui
Z
Yan
Chuanzhu
C
Cai
Chengxuan
C
Qiu
D000203:Activities of Daily Living; D000368:Aged; D050197:Atherosclerosis / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D002340:Carotid Artery Diseases / Q000503:physiopathology*; D002681:China; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology; D058729:Peripheral Arterial Disease / Q000503:physiopathology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects