Relationship Between Ideal Cardiovascular Health and Disability in Older Adults: The Chilean National Health Survey (2009-10)

Association between ideal cardiovascular health and multiple disabilities among US adults, BRFSS 2017-2019

OBJECTIVES

Cardiovascular health is the leading cause of death and disability in the United States. Our objective was to estimate the association between ideal cardiovascular health (ICVH) and multiple disabilities among US adults stratified into the three age groups of young (18-44 years), midlife (45-64 years), and older adults (≥65 years).

STUDY DESIGN

We conducted a cross-sectional analysis using data pooled from the 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

Using American Heart Association's seven-component (four ideal behaviors and three ideal health factors) scoring tool, we identified ICVH as a composite score ≥5 and also computed the ideal behavioral (score ≥3) and ideal health factors (score = 3) submetrics. The outcome, single vs multiple disabilities indicator, was defined using US Census's disability domains and analyzed using multinomial regression.

RESULTS

For all three groups, the prevalence of multiple disabilities was significantly lower among those meeting ICVH, ideal behavioral, and ideal health factors compared with those that did not. After controlling for covariates, ICVH score ≥5 was associated with lower relative risk of multiple disabilities in all groups. Although both ideal health and ideal behavioral factors were associated with lower relative risk of multiple disabilities among all groups, the reduction in risk was the highest for multiple disabilities and ideal behavioral factors among midlife (relative risk ratio: 0.30, 95% confidence interval: 0.25, 0.36) and older adults (relative risk ratio: 0.40, 95% confidence interval: 0.33, 0.48).

CONCLUSION

Adults with less-than-ideal cardiovascular health had a higher relative risk of multiple disabilities. Addressing the risk of multiple disabilities of US adults will require effective promotion of ICVH.

Effects of a Physical Exercise Intervention on Pain in Workplaces: A Case Study

Interventions that promote physical activity and healthy habits in workplaces have proven to be effective in reducing risk factors associated with numerous pathologies. This study examines the effects of an individualized physical exercise program that lasts five minutes for 30 working days on the perceived pain of workers, as well as analyzing adherence to it within workplaces. Data were collected through a visual analog scale of 1–10 of the perception of pain by anatomical areas, and, thus, we could observe variations in the perceived pain of workers through a program of five individualized exercises for one minute each based on the analysis of the worker and the job position. Significant differences were observed in three of the four centers analyzed (1: p = 0.006; 2: p = 0.009; 3: p = 0.000; 4: p = 0.791). A five-minute exercise program in the work environment appears to be an effective tool in terms of time and an improvement in workers’ perception of pain.

Metabolic syndrome predicts incident disability and functional decline among Chinese older adults: results from the China Health and Retirement Longitudinal Study

AIMS

To investigate the longitudinal association of metabolic syndrome (MetS) and its components with disability outcomes.

METHODS

A total of 5875 participants aged 60 and above completed the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). MetS at baseline was measured by the National Cholesterol Education Program Adult Treatment Panel III criteria. Logistic regressions were conducted to analyze the associations between baseline MetS and incident disability, measured as the onset of limitations regarding instrumental activities of daily living (IADL) and activities of daily living (ADL) 4 years later. Linear regression was adopted to analyze the longitudinal impact of baseline MetS on the number of IADL and ADL limitations in 2015. A comprehensive list of baseline covariates was adjusted in all regression analyses.

RESULTS

Baseline MetS was related to increased odds of incident IADL disability (OR = 1.28, 95% CI 1.05-1.55) and incident ADL disability (OR = 1.27, 95% CI 1.05-1.53) among disability-free participants at baseline. Baseline MetS was also associated with an increase in the number of IADL (beta = 0.15, 95% CI 0.07-0.23) and ADL limitations (beta = 0.10, 95% CI 0.01-0.18), while adjusting for baseline functional performance. Significant MetS component predictors of disability outcomes include abdominal obesity, high blood pressure, and a low level of high-density lipoprotein cholesterol.

CONCLUSIONS

Our findings suggest an increased risk of incident disability and deteriorated functional performance over 4 years, associated with the presence of MetS and its components.

Ideal Cardiovascular Health in the Oldest-Old and Centenarians and Its Association With Disability and Health-Related Quality of Life

Objective: This study aimed to investigate the distribution of ideal cardiovascular health (ICH) indicators among the oldest-old and centenarians and explore their relationships with disability and health-related quality of life of this population.

Methods: One thousand two centenarians from China Hainan Centenarian Cohort Study and 798 oldest-old from the China Hainan Oldest-old Cohort study were the target subjects in this analysis. ICH status, disability, and health-related quality of life of study subjects were assessed.

Findings: The median value of ICH indicators among centenarians and the oldest-old is 4 (4–5) and 3 (3–5), respectively. The ICH indicators with the highest percentage of ideal level/status are fasting plasm glucose (FPG) (90.2% of study subjects are at the ideal level), BMI (89.8% of study subjects are at the ideal level), and smoking (89.4% of study subjects are at the ideal status). The disability rates of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) decrease with the increasing number of ICH indicators. The EQ VAS and EQ-5D score show an increasing trend along with the increasing number of ICH indicators (p < 0.05). After adjusting related covariates, the risk of disability and lower health-related quality of life decreased gradually as the number of ICH metrics increased (p < 0.05).

Interpretation: The ICH metrics of centenarians and oldest-old were at a relatively good level, and there was a strong and independent relationship between the number of ICH indicators and disability as well as the lower health-related quality of life.

Association of Life's Simple 7 with incident dementia and its modification by the apolipoprotein E genotype

INTRODUCTION

There is limited and inconsistent reporting on the association between Life's Simple 7 (LS7) and dementia in the elderly population.

METHODS

Based on the Washington Heights-Inwood Columbia Aging Project (WHICAP), LS7 scores were estimated to assess cardiovascular health status. Associations between LS7 scores and incident dementia were investigated by Cox proportional hazards models.

RESULTS

Among 1987 subjects, 291 incident cases of dementia were identified over a median follow-up of 5.84 years. Compared with subjects in the poor cardiovascular health group (scores 0 to 5), those in intermediate (6 to 9) and optimal (10 to 14) groups had lower dementia risk, with the hazard ratio (HR; 95% confidence interval) being 0.74 (0.54 to 1.00) and 0.59 (0.38 to 0.91), respectively. These results were significant in apolipoprotein E genotype ε4 (APOE ε4) allele non-carriers but not in carriers.

DISCUSSION

Higher LS7 scores are protective for dementia, especially among the APOE ε4 noncarriers.

Changes in anthropometric parameters and physical fitness in older adults after participating in a 16-week physical activity program

Introduction: Physical activity is important for achieving healthy aging. Objective: To analyze changes in anthropometric parameters and physical fitness among Chilean older adults after participating in a 16-week physical activity program and to evaluate whether there were differences in relation to their baseline nutritional status or not. Materials and methods: Pre-experimental quantitative study. The study population consisted of 176 older adults (155 women and 21 men) distributed in three groups: normal weight (n=56), overweight (n=67) and obese (n=53). The following variables were evaluated: body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR) and physical fitness. Results: Significant decreases between pre- and post-measurements were found for WC (p<0.001), BMI (p=0.015), and WHR (p<0.001). Improvements were observed in the following tests: chair stand (p<0.001), arm curl (p<0.001), 2-min step (p<0.001), chair sit-&-reach (p=0.018) and back scratch (p=0.014). Regarding BMI, significant changes were observed between normal weight vs. overweight participants (p=0.001) and between normal weight vs. obese participants (p=0.001). Conclusion: Older adult participants that regularly attended the physical activity program were able to reduce their WC, BMI and WHR, and also improved their physical-functional performance on the chair stand, arm curl, 2-min step, chair sit-&-reach and back scratch tests. In addition, anthropometric parameters and physical fitness also improved regardless of their baseline nutritional status.  

Are Health Behaviors and Self-Rated Health Related to Cardiovascular Health and Functional Performance? Results from the Lookup 7+ Cross-Sectional Survey among Persons Aged 65+

OBJECTIVES

Cardiovascular health (CVH) and physical performance (PP) are key factors of successful ageing. This study investigated whether self-reported CVH behaviours and self-rated health (SRH) are related to ideal CVH and PP.

DESIGN

Cross-sectional survey.

SETTING

Public places in Italy (e.g. exhibitions, malls, health promotion campaigns), outside of conventional healthcare settings.

PARTICIPANTS

1415 community-living persons aged 65+ years (mean age 72.2 ± 5.4; 58.4% female).

MEASUREMENTS

Three ideal CVH behaviors [regular physical activity (PA), healthy diet, no smoking] and SRH (1 excellent - 4 poor) were assessed through a brief questionnaire. Four ideal CVH factors [iBMI ≤ 25 kg/m2, untreated random total blood cholesterol ≤200 mg/dl, absence of diabetes (untreated random blood glucose ≤200 mg/dl), untreated blood pressure (iBP) <140/90mmHg] and two ideal PP factors [grip strength (iGrip), 5-repetition chair-stand test <10 seconds (iStand)] were measured.

RESULTS

Adjusted for age and gender, regular PA was positively related to CVH factor score (β = 0.1; p = < .001), iBMI (OR = 1.8; 95% CI = 1.5-2.3), iBP (OR = 1.3; 95% CI = 1.1-1.6) and iStand (OR = 1.6; 95% CI = 1.3-2.1). Healthy diet was positively related to CVH factor score (β = 0.1; p = < .05) and iGrip (OR = 1.4; 95% CI = 1.1-1.8). Participants rating SRH as "good" (OR = 2.0; 95% CI = 1.1-3.9) and "not so good" (OR = 2.3; 95% CI = 1.2-4.5) met iDiabetes more often than those with poor SRH. Moreover, iStand (OR = 3.2; 95% CI = 1.6-6.6) and iGrip (OR = 4.2; 95% = CI 2.0-8.8) were more prevalent among participants with excellent SRH compared with those with poor SRH.

CONCLUSIONS

Physical activity, diet and self-rated health may provide quick and easy-to-assess metrics to identify persons aged 65+ years at risk of cardiovascular events and functional impairment, who could particularly benefit from engaging in health promotion programs.

Cardiovascular Health Is Associated With Disability Among Older Community Dwelling Men and Women

Objective: The aim of this study was to investigate whether an index of overall cardiovascular health (CVH) is associated with disability in older individuals. Method: Data on 925 participants of the InCHIANTI study (Invecchiare in Chianti, aging in the Chianti area, ≥65 years, 55% women) with median follow-up of 9 years were used. CVH score was assessed by smoking status, physical activity, body mass index, diet quality, blood pressure, plasma cholesterol, and fasting blood glucose. Disability was examined using instrumental activities of daily living (IADL disabilities >0 vs. 0) and activities of daily living (ADL disabilities >0 vs. 0). Generalized estimating equations and Cox models assessed relationships between baseline CVH with disability and worsening over 9 years. Results: A 1-point increase in the CVH score was associated with 23% and 17% of lower odds of ADL (p < .001) and IADL (p < .001) disability and was protective of worsening of disability over 9 years. Cox models demonstrated that a 1-point increase in CVH score was associated with lower hazards of both ADL (hazard ratio [HR] = 0.86, p = .005) and IADL (HR = 0.91, p = .007) disability. Discussion: Among older individuals, better CVH was associated with lower risk of disability and worsening over 9 years.

Differences in Cardiovascular Health Metrics in Emergency Medical Technicians Compared to Paramedics: A Cross-Sectional Study of Emergency Medical Services Professionals

Background:

Emergency Medical Services (EMS) professionals face high physical demands in high-stress settings; however, the prevalence of cardiovascular health (CVH) risk factors in this health care workforce has not been explored. The primary objective of this study was to compare the distribution of CVH and its individual components between a sample of emergency medical technicians (EMTs) and paramedics. The secondary objective was to identify associations between demographic and employment characteristics with ideal CVH in EMS professionals.

Methods:

A cross-sectional survey based on the American Heart Association’s (AHA; Dallas, Texas USA) Life’s Simple 7 (LS7) was administered to nationally-certified EMTs and paramedics. The LS7 components were scored according to previously described cut points (ideal = 2; intermediate = 1; poor = 0). A composite CVH score (0-10) was calculated from the component scores, excluding cholesterol and blood glucose due to missing data. Multivariable logistic regression was used to estimate odds ratios (OR; 95% CI) for demographic and employment characteristics associated with optimal CVH (≥7 points).

Results:

There were 24,708 respondents that were currently practicing and included. More EMTs achieved optimal CVH (n = 4,889; 48.8%) compared to paramedics (n = 4,338; 40.6%). Factors associated with higher odds of optimal CVH included: higher education level (eg, college graduate or more: OR = 2.26; 95% CI, 1.97-2.59); higher personal income (OR = 1.26; 95% CI, 1.17-1.37); and working in an urban versus rural area (OR = 1.31; 95% CI, 1.23-1.40). Paramedic certification level (OR = 0.84; 95% CI, 0.78-0.91), older age (eg, 50 years or older: OR = 0.65; 95% CI, 0.58-0.73), male sex (OR = 0.54; 95% CI, 0.50-0.56), working for a non-fire-based agency (eg, private service: OR = 0.68; 95% CI, 0.62-0.74), and providing medical transport service (OR = 0.81; 95% CI, 0.69-0.94) were associated with lower odds of optimal CVH.

Conclusions:

Several EMS-related characteristics were associated with lower odds of optimal CVH. Future studies should focus on better understanding the CVH and metabolic risk profiles for EMS professionals and their association with incident cardiovascular disease (CVD), major cardiac events, and occupational mortality.

Cash RE, Crowe RP, Bower JK, Foraker RE, Panchal AR. Differences in cardiovascular health metrics in emergency medical technicians compared to paramedics: a crosssectional study of Emergency Medical Services professionals.Prehosp Disaster Med.2019;34(3):288–296.

Relationship between cardiovascular health metrics and physical performance in community-living people: Results from the Longevity check-up (Lookup) 7+ project

Cardiovascular health metrics (CHMs) may predict disability independent of vascular events. Though, the link between CHMs and physical performance is unclear. This relationship was explored using data from the Longevity check-up (Lookup) 7+ project. Lookup 7+ is an ongoing cross-sectional survey conducted in unconventional settings across Italy. People who are at least 18-year-old and provide written informed consent are eligible. CHMs [i.e., smoking status, healthy diet, body mass index (BMI), blood pressure, blood cholesterol, and diabetes status] are assessed through closed questions and objective measurements. Physical performance is measured via the 5-repetition chair-stand test. Analyses included 7446 participants (55.5 ± 14.9 years; 56% women). Physical performance positively correlated with CHMs scores, such that participants who scored higher (6-7 points) completed the chair-stand test about 2 s faster than those scoring lower (1-2 points). In fully adjusted analysis, better physical performance was more frequently observed in younger, non-smoking, physically active men, with ideal BMI, and no diabetes. Our findings indicate a gradient of better physical function with increasing CHMs scores. Future investigations should establish the longitudinal effect of unhealthy behaviours and cardiovascular risk factors on physical performance and verify whether implementation of large-scale primordial cardiovascular prevention may positively impact physical fitness.