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Subclinical Vascular Disease Burden and Longer Survival
Author(s) -
Odden Michelle C.,
Yee Laura M.,
Arnold Alice M.,
Sanders Jason L.,
Hirsch Calvin,
deFilippi Christopher,
Kizer Jorge R.,
Inzitari Marco,
Newman Anne B.
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13018
Subject(s) - medicine , confounding , confidence interval , kidney disease , subclinical infection , odds ratio , renal function , cardiology , cohort
Objectives To determine the contribution of gradations of subclinical vascular disease ( SVD ) to the likelihood of longer survival and to determine what allows some individuals with SVD to live longer. Design Cohort study. Setting Cardiovascular Health Study. Participants Individuals born between June 30, 1918, and June 30, 1921 (N = 2,082; aged 70–75 at baseline (1992–93)). Measurements A SVD index was scored as 0 for no abnormalities, 1 for mild abnormalities, and 2 for severe abnormalities on ankle–arm index, electrocardiogram, and common carotid intima‐media thickness measured at baseline. Survival groups were categorized as 80 and younger, 81 to 84, 85 to 89, and 90 and older. Results A 1‐point lower SVD score was associated with 1.22 greater odds (95% confidence interval = 1.14–1.31) of longer survival, independent of potential confounders. This association was unchanged after adjustment for intermediate incident cardiovascular events. There was suggestion of an interaction between kidney function, smoking, and C‐reactive protein and SVD ; the association between SVD and longer survival appeared to be modestly greater in persons with poor kidney function, inflammation, or a history of smoking. Conclusion A lower burden of SVD is associated with longer survival, independent of intermediate cardiovascular events. Abstinence from smoking, better kidney function, and lower inflammation may attenuate the effects of higher SVD and promote longer survival.