Vascular Risk Factors, Cardiovascular Disease and Functional Impairment in Community-Dwelling Adults

Abstract

Background: Older adults report preservation of functional independence as one of the most important constructs of successful ageing. Vascular risk factors may increase the risk of functional impairment due to clinical and subclinical vascular disease. Objective: To describe the association between vascular risk factors and impaired ability to perform daily living activities, independent of established cardiovascular disease. Methods: We conducted an analysis of the Clarity Cohort, which is a cross-sectional study of 9,816 community-dwelling Irish adults. Of the total cohort, 3,499 completed standardized self-reported health questionnaires, which included questions on activities of daily living. Functional impairment was defined as self-reported impairment in self-care, mobility or household tasks. Using logistic regression analyses, we determined the association between vascular risk factors and functional impairment, independent of demographics, prior coronary artery disease, stroke, congestive heart failure, and peripheral vascular disease. Results: Functional impairment was reported in 40.4% (n = 1,413) of the cohort overall and in 23% of those with established cardiovascular disease. The mean age was 66.2 ± 10.3 years, 52% of the cohort were aged over 65 and 45.6% were male. Some difficulty with instrumental activities of daily living was reported by 35.4% (n = 1,240) while 29.4% (n = 1,029) reported some difficulty with basic activities of daily living. On multivariable analysis, older age [OR 1.03 (1.02, 1.04) per year], current smoking [OR 1.43 (1.08, 1.89)], atrial fibrillation [OR 1.68 (1.07, 2.65)], former alcohol use [OR 1.87 (1.36, 2.57)] and prior stroke [OR 1.91 (1.24, 2.93)] were associated with an increased risk of functional impairment. Older age leaving education [OR 0.96 (0.94, 0.99)], non-use of alcohol [OR 0.76 (0.61, 0.93)] and increased high-density lipoprotein levels [OR 0.70 (0.56, 0.88)] were associated with reduced risk of functional impairment. Conclusions: Independent of established cardiovascular disease, some vascular risk factors are associated with functional impairment. Modification of these risk factors is expected to have a large impact on preservation of functional independence through prevention of overt and covert vascular disease.

The Association Between Lipoproteins, Disability, and Physical Function Among Older Costa Rican Adults

“…After adjusting for all covariates, we found lower HDL-C related to greater ADL disability and lower TC associated with longer times to pick up a pencil and the TUG measure. Our results confirm findings reported by several studies using populations ethnically different from ours (Canavan et al, 2014; Cesari et al, 2010; Landi et al, 2007; Okamura et al, 2008; Schalk et al, 2004; Zuliani et al, 1999).…”

“…Disruption in lipoproteins such as total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) are influential factors for atherosclerosis, subsequent complications such as CVD (Libby, 2012; Libby, Ridker, & Maseri, 2002; Perk et al, 2012) and, in turn, functional decline (van Peet et al, 2013; Welmer et al, 2014). The link between lipoprotein levels and physical function has been established in previous studies (Canavan et al, 2014; Cesari et al, 2010; Formiga et al, 2011; Giampaoli et al, 1999; Giltay et al, 2008; Guo, Matousek, Sundh, & Steen, 2002; Landi et al, 2007; Lawman et al, 2016; Lippi, Sanchis-Gomar, & Montagnana, 2014; Okamura et al, 2008; Reuben, Ix, Greendale, & Seeman, 1999; Sanders et al, 2014; Schalk, Visser, Deeg, & Bouter, 2004; Volpato et al, 2008; Welmer et al, 2014; Zuliani et al, 1999). However, only few have looked at these associations by sex (Guo et al, 2002; Schalk et al, 2004; Volpato et al, 2008), and no study has examined this association within a Hispanic subculture.…”

“…Using a sample of older adults from Ireland, Canavan and colleagues (2014) observed that those older with lower levels of HDL-C had more functional loss even after full adjustment for demographics, CVRFs, and comorbidity (Canavan et al, 2014). Like Canavan and colleagues’, our study adjusted for similar covariates and the associations also remained significant; however, we used a continuous scale for ADLs/IADLs whereas they used a dichotomous variable.…”

“…Physical function reflects the health status and the impact of chronic diseases, and is a crucial determinant of quality of life, affecting strength and mobility, as well as instrumental and basic activities of daily living (IADLs/ADLs) among older adults (den Ouden, Schuurmans, Arts, & van der Schouw, 2011; Idland, Pettersen, Avlund, & Bergland, 2013; Paterson & Warburton, 2010; Seals & Melov, 2014; Tak, Kuiper, Chorus, & Hopman-Rock, 2013). Cardiovascular disease (CVD) is an important contributor to disease burden and decreased quality of life, as it is often accompanied by limitation in functional abilities (Canavan et al, 2014; Giltay, Zitman, & Kromhout, 2008; Scott & Collings, 2012). Disruption in lipoproteins such as total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) are influential factors for atherosclerosis, subsequent complications such as CVD (Libby, 2012; Libby, Ridker, & Maseri, 2002; Perk et al, 2012) and, in turn, functional decline (van Peet et al, 2013; Welmer et al, 2014).…”

Validation of Taiwan Performance-Based Instrumental Activities of Daily Living (TPIADL), a Performance- Based Measurement of Instrumental Activities of Daily Living for Patients with Vascular Cognitive Impairment

“…Vascular diseases are known to be associated with changes in cognition and functional performance [1–4]. Cognitive impairment caused by cerebrovascular disease has been termed “vascular cognitive impairment” (VCI) [5].…”