Associations of Modified Healthy Aging Index With Major Adverse Cardiac Events, Major Coronary Events, and Ischemic Heart Disease

Abstract

BACKGROUND: The Healthy Aging Index (HAI) has been regarded as useful in capturing the health status of multiple organ sys-tems. However, to what extent the HAI is associated with major cardiovascular events remains largely unknown. The authors constructed a modified HAI (mHAI) to quantify the association of physiological aging with major vascular events and explored how the effects of a healthy lifestyle can modify this association. METHODS AND RESULTS: The participants with either missing values of any individual mHAI component or major illnesses such as heart attack, angina and stroke, and self-reported cancer at baseline were excluded. The mHAI components include systolic blood pres-sure, reaction time, forced vital capacity, serum cystatin c, and serum glucose. The authors used Cox proportional hazard models to quantify the association of mHAI with major adverse cardiac events, major coronary events, and ischemic heart disease. Cumulative incidence at 5 and 10 years was estimated, and joint analyses were stratified by age group and 4 mHAI categories. The mHAI was significantly correlated with major cardiovascular events, which is a better reflection of the aging level of the body than chronological age. An mHAI was calculated in 338044 participants aged 38 to 73years in the UK Biobank. Each point increase in the mHAI was associated with a 44% higher risk of major adverse cardiac events (adjusted hazard ratio [aHR], 1.44 [95% CI, 1.40–1.49]), 44% higher risk of major coronary events (aHR, 1.44 [95% CI, 1.40–1.48]), and 36% higher risk of ischemic heart disease (aHR, 1.36 [95% CI, 1.33–1.39]). The percentage of population-attribution risk was 51% (95% CI, 47–55) for major adverse cardiac events, 49% (95% CI, 45–53) for major coronary events, and 47% (95% CI, 44–50) for ischemic heart disease, which means that a substantial portion of these events could be prevented. Systolic blood pressure was the factor most significantly associated with major adverse cardiac events (aHR, 1.94 [95% CI, 1.82–2.08]; percentage of population-attribution risk, 36%), major coronary events (aHR, 2.01 [95% CI, 1.85–2.17]; percentage of population-attribution risk, 38%), and ischemic heart disease (aHR, 1.80 [95% CI, 1.71–1.89]; percentage of population-attribution risk, 32%). A healthy lifestyle significantly attenuated mHAI associations with incidence of vascular events. CONCLUSIONS: Our findings indicate that higher mHAI is associated with increased major vascular events. A healthy lifestyle may attenuate these associations.