Table 5.
Association of Change in the Individual Cardiovascular Health Metrics With the Risk of Subsequent Incident Cardiovascular Disease Events and All‐Cause Mortality
| Pattern of Change | Low‐Low | Low‐Moderate | Low‐High | Moderate‐Low | Moderate‐Moderate | Moderate‐High | High‐Low | High‐Moderate | High‐High |
|---|---|---|---|---|---|---|---|---|---|
| Incident cardiovascular disease, adjusted sHR (95% CI)* | |||||||||
| Elderly 60–74, y | |||||||||
| Smoking | 1 [Reference] | 0.84 (0.69–1.02) | 0.84 (0.74–0.96) | 0.87 (0.70–1.09) | 0.77 (0.65–0.91)† | 0.74 (0.64–0.85)† | 0.81 (0.71–0.93)† | 0.76 (0.67–0.87)† | 0.68 (0.63–0.74)† |
| Body mass index | 1 [Reference] | 0.80 (0.58–1.09) | 1.67 (0.78–3.57) | 0.82 (0.60–1.12) | 0.82 (0.69–0.98) | 0.80 (0.66–0.97) | 1.66 (0.87–3.15) | 0.74 (0.61–0.91)† | 0.74 (0.63–0.88)† |
| Physical activity | 1 [Reference] | 0.87 (0.80–0.94)† | 0.87 (0.79–0.95)† | 0.91 (0.82–1.01) | 0.68 (0.62–0.76)† | 0.78 (0.70–0.87)† | 0.87 (0.76–1.00) | 0.84 (0.74–0.96)† | 0.75 (0.68–0.83)† |
| Blood pressure | 1 [Reference] | 0.89 (0.82–0.96)† | 0.70 (0.58–0.86)† | 0.87 (0.80–0.95)† | 0.79 (0.73–0.85)† | 0.55 (0.48–0.63)† | 0.81 (0.66–0.99) | 0.58 (0.51–0.66)† | 0.44 (0.37–0.51)† |
| Total cholesterol | 1 [Reference] | 0.73 (0.64–0.84)† | 0.81 (0.67–0.98)† | 0.70 (0.61–0.80)† | 0.66 (0.59–0.74)† | 0.65 (0.58–0.73)† | 0.88 (0.72–1.08) | 0.67 (0.59–0.75)† | 0.56 (0.51–0.62)† ‡ |
| Fasting glucose | 1 [Reference] | 0.84 (0.74–0.97) | 0.63 (0.50–0.79)† | 0.84 (0.73–0.97) | 0.66 (0.59–0.73)† | 0.52 (0.46–0.59)† | 0.76 (0.61–0.94)† | 0.54 (0.48–0.60)† | 0.50 (0.45–0.55)† |
| Very elderly, ≥75 y | |||||||||
| Smoking | 1 [Reference] | 0.97 (0.67–1.41) | 0.80 (0.62–1.03) | 0.67 (0.39–1.15) | 0.67 (0.46–0.96) | 0.76 (0.58–0.99) | 0.66 (0.50–0.89)† | 0.69 (0.53–0.90)† | 0.67 (0.57–0.80)† |
| Body mass index | 1 [Reference] | 0.79 (0.42–1.49) | 1.30 (0.40–4.25) | 1.06 (0.59–1.93) | 0.67 (0.46–0.98) | 0.91 (0.62–1.36) | 1.05 (0.37–2.98) | 0.85 (0.57–1.28) | 0.78 (0.54–1.12) |
| Physical activity | 1 [Reference] | 0.92 (0.80–1.06) | 0.81 (0.69–0.95) | 0.86 (0.69–1.06) | 0.80 (0.66–0.98) | 0.76 (0.61–0.95) | 1.09 (0.87–1.38) | 0.80 (0.62–1.03) | 0.75 (0.62–0.92)† |
| Blood pressure | 1 [Reference] | 0.98 (0.85–1.13) | 0.69 (0.48–1.01) | 0.97 (0.83–1.13) | 0.82 (0.71–0.93)† | 0.71 (0.54–0.92) | 0.95 (0.67–1.35) | 0.61 (0.46–0.82)† | 0.51 (0.37–0.72)† |
| Total cholesterol | 1 [Reference] | 1.01 (0.77–1.32) | 0.94 (0.66–1.35) | 1.03 (0.79–1.35) | 0.90 (0.73–1.12) | 0.80 (0.63–1.02) | 1.06 (0.68–1.64) | 0.92 (0.72–1.18) | 0.81 (0.66–1.01)† |
| Fasting glucose | 1 [Reference] | 0.75 (0.57–0.99) | 0.83 (0.59–1.17) | 0.82 (0.63–1.08) | 0.65 (0.52–0.81)† | 0.56 (0.45–0.71)† | 0.65 (0.44–0.95) | 0.60 (0.48–0.75)† | 0.56 (0.46–0.69)† |
| All‐cause mortality, adjusted HR (95% CI)§ | |||||||||
| Elderly, 60–74 y | |||||||||
| Smoking | 1 [Reference] | 0.86 (0.73–1.02) | 0.89 (0.80–1.00) | 0.70 (0.57–0.87)† | 0.60 (0.50–0.71)† | 0.58 (0.50–0.66)† | 0.78 (0.69–0.89)† | 0.61 (0.53–0.69)† | 0.59 (0.55–0.64)† |
| Body mass index | 1 [Reference] | 0.89 (0.63–1.26) | 1.16 (0.43–3.14) | 1.11 (0.80–1.54) | 0.77 (0.63–0.95) | 1.01 (0.81–1.25) | 0.55 (0.18–1.74) | 0.82 (0.66–1.03) | 1.03 (0.84–1.25) |
| Physical activity | 1 [Reference] | 0.92 (0.85–1.00) | 0.87 (0.80–0.96)† | 0.86 (0.77–0.95)† | 0.67 (0.60–0.74)† | 0.75 (0.67–0.84)† | 0.84 (0.74–0.96) | 0.79 (0.70–0.90) | 0.75 (0.68–0.83)† |
| Blood pressure | 1 [Reference] | 1.00 (0.92–1.09) | 0.99 (0.83–1.19) | 0.97 (0.89–1.07) | 0.98 (0.88–1.02) | 0.86 (0.76–0.97) | 0.98 (0.80–1.19) | 0.86 (0.76–0.97) | 0.91 (0.80–1.03) |
| Total cholesterol | 1 [Reference] | 0.92 (0.78–1.07) | 0.99 (0.81–1.22) | 0.91 (0.77–1.06) | 0.79 (0.69–0.90)† | 0.95 (0.83–1.09) | 1.28 (1.04–1.59) | 0.88 (0.76–1.01) | 1.00 (0.89–1.13) |
| Fasting glucose | 1 [Reference] | 0.86 (0.75–1.00) | 0.88 (0.71–1.08) | 0.79 (0.69–0.92)† | 0.68 (0.61–0.76)† | 0.62 (0.55–0.70)† | 0.85 (0.70–1.05) | 0.59 (0.52–0.66)† | 0.56 (0.51–0.62)† |
| Very elderly, ≥75 y | |||||||||
| Smoking | 1 [Reference] | 0.83 (0.62–1.12) | 0.85 (0.70–1.01) | 1.04 (0.75–1.44) | 0.70 (0.53–0.93) | 0.65 (0.53–0.80)† | 0.75 (0.61–0.93)† | 0.73 (0.60–0.89)† | 0.65 (0.58–0.74)† |
| Body mass index | 1 [Reference] | 1.22 (0.63–2.38) | 2.40 (0.82–7.00) | 1.51 (0.81–2.84) | 1.16 (0.75–1.80) | 1.91 (1.22–3.00)† | 1.91 (0.72–4.40) | 1.56 (0.99–2.46) | 1.68 (1.09–2.59) |
| Physical activity | 1 [Reference] | 0.94 (0.84–1.05) | 0.80 (0.70–0.91)† | 0.83 (0.70–0.97) | 0.83 (0.71–0.96) | 0.75 (0.62–0.90)† | 0.93 (0.77–1.13) | 0.78 (0.63–0.95) | 0.67 (0.57–0.79)† |
| Blood pressure | 1 [Reference] | 1.10 (0.97–1.24) | 1.23 (0.96–1.58) | 1.06 (0.93–1.20) | 1.00 (0.89–1.11) | 1.04 (0.86–1.26) | 1.06 (0.80–1.40) | 1.03 (0.84–1.25) | 0.94 (0.75–1.16) |
| Total cholesterol | 1 [Reference] | 0.92 (0.73–1.17) | 1.05 (0.79–1.41) | 1.00 (0.79–1.26) | 0.80 (0.66–0.97) | 0.94 (0.77–1.15) | 1.49 (1.07–2.07) | 0.98 (0.80–1.20) | 1.04 (0.87–1.24) |
| Fasting glucose | 1 [Reference] | 0.72 (0.58–0.89)† | 0.66 (0.49–0.88)† | 0.84 (0.68–1.04) | 0.63 (0.53–0.75)† | 0.58 (0.49–0.70)† | 0.74 (0.56–0.99) | 0.58 (0.49–0.70)† | 0.57 (0.48–0.66)† |
HR indicates hazard ratio; and sHR, subhazard ratio.
*
Cardiovascular disease was adjusted for sex, age, economic status, Hospital Frailty Score, living in metropolitan cities, and competing risk of death.
†
P<0.0083 for differences reported.
‡
Compared with low‐low group, high‐high group of total cholesterol level was associated lower risk of CVD event in elderly but not in the very elderly population (p interaction=0.005).
§
All‐cause mortality was adjusted for sex, age, economic status, Hospital Frailty Score, and living in metropolitan cities.