Cardiovascular Health and Long-Term Physical Function | Journal Scan

Study Questions:

Do the characteristics of the American Heart Association’s (AHA’s) definition of ideal cardiovascular health predict long-term functional status?

Methods:

Data from the Northern Manhattan Study, a prospective community-based study of adults 40 years of age or older and free of stroke at baseline, were used for the present analysis. Participants lived in northern Manhattan and were recruited between 1993 and 2001. Mean follow-up was 13 years. Seven cardiovascular (CV) factors (current smoking, body mass index, physical activity, total cholesterol, fasting glucose, blood pressure, and healthy diet) identified by the AHA were classified as ideal, intermediate, or poor. Participants were grouped by number of ideal CV factors (0-1, 2, 3, 4, and 5-7). A score was calculated by summing the values of each of the seven CV factors (range 0-14). The primary outcome of interest was functional status, which was assessed each year using the Barthel index. The Barthel index assesses core activities of daily living (scale from 0-100), with 100 being considered normal.

Results:

A total of 3,219 participants (mean age 69 years, 63% female) were included, and a mean of 13 assessments were made for each participant during the follow-up period. In this cohort, 21% were white, 25% were non-Hispanic black, and 54% were Hispanic. Distribution of CV factors noted 10% of participants had 0 or 1 ideal factor, approximately 30% had two, and 30% had three ideal factors, whereas only 4% had five or more ideal factors. Mean baseline Barthel index score was 97.1, and a higher score was associated with greater number of ideal CV factors. At both 5 and 10 years, higher functional activity (Barthel index score) was associated with an increased number of CV ideal factors. This association persisted after adjustment for incident stroke and myocardial infarction.

Conclusions:

The authors concluded that ideal CV health as defined by the AHA (after accounting for vascular events) is associated with long-term function.

Perspective:

Not surprisingly, functional status is associated with ideal CV metrics. It is likely that interventions which improved function will improve CV factors; however, clinical trials to assess such relationships are needed.

Clinical Topics: Dyslipidemia, Prevention, Vascular Medicine, Lipid Metabolism, Nonstatins, Diet, Smoking

Keywords: Cerebrovascular Disorders, Motor Activity, Activities of Daily Living, Stroke, Myocardial Infarction, Blood Pressure, Cholesterol, Body Mass Index, Fasting, Glucose, Smoking, Primary Prevention, Prospective Studies, Hispanic Americans, African Americans


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