Midlife determinants of healthy cardiovascular aging: The Atherosclerosis Risk in Communities (ARIC) study

Background and aims: Risk factor cutoffs are derived from associations with clinical cardiovascular disease (CVD), but how these risk factors associate with preserved cardiovascular health into old age is not well studied. We investigated midlife determinants of healthy versus nonhealthy cardiovascular aging in the Atherosclerosis Risk in Communities (ARIC) study. Methods: ARIC participants were categorized by cardiovascular status in older age (mean age 75.8 ± 5.3 years, range 66–90): healthy, subclinical disease (assessed by biomarkers and left ventricular function), clinical CVD (coronary heart disease, stroke, or heart failure), or prior death. We examined associations of midlife (mean age 52.1 ± 5.1 years) systolic and diastolic blood pressure (SBP, DBP), low-density lipoprotein cholesterol (LDL-C), triglycerides, hemoglobin A1c (HbA1c), and body mass index (BMI) with cardiovascular status in older age using multinomial logistic regression analyses. Results: Compared with healthy status, odds for subclinical disease (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.09–1.55) and clinical CVD (OR 1.87, 95% CI 1.53–2.29) at older age increased starting with midlife SBP 120–129 mmHg, whereas odds for death increased starting with SBP 110–119 mmHg (OR 1.29, 95% CI 1.10–1.52); findings were similar for DBP. Odds for subclinical disease increased for HbA1c ≥ 6.5% and BMI starting at 30–<35 kg/m²; odds for clinical CVD or death increased starting at HbA1c 5.5–5.9%, LDL-C >160 mg/dL, and BMI 30–<35 kg/m². Conclusions: More-stringent levels of modifiable risk factors in midlife beyond current clinical practice and guidelines were associated with preserved cardiovascular health in older age.