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Cardiovascular Risk Profile and Subsequent Disability and Mental Well-being: The Zutphen Elderly Study

https://doi.org/10.1097/JGP.0b013e3181784122Get rights and content

Objectives

It is insufficiently known whether “classic” cardiovascular risk factors are associated with subsequent functional disability and mental well-being in elderly men.

Design

A population-based cohort study with 15 years of follow-up from 1985 onward.

Setting

The Zutphen Study started as the Dutch contribution to the Seven Countries Study.

Participants

Five hundred forty-five (59.2%) of 887 men (aged 64–84 years) who were free of preexisting cardiovascular disease and cancer.

Measurements

High cardiovascular risk was defined as having ≥2 “classic” risk factors: body mass index ≥30.0 kg/m2, presently smoking, hypertension (systolic blood pressure ≥160 mm Hg, diastolic blood pressure ≥95 mm Hg, or antihypertensive medication), serum cholesterol ≥6.5 mmol/L, and diabetes mellitus. Self-rated health and dispositional optimism were assessed in 1985, 1990, 1995, and 2000. Disability and depressive symptoms (by the Zung self-rating depression scale) were assessed from 1990 onward.

Results

The high-risk (N = 230) versus low-risk group (N = 315) had higher multivariate adjusted risks of all-cause and cardiovascular mortality (hazard ratios: 1.43; confidence interval[CI]: 1.15, 1.76; and 1.61; CI: 1.20, 2.18, respectively). High-risk status was also associated with more functional disability at 5, 10, and 15 years (odds ratios of 2.00, 95% CI: 1.25–3.20; 2.51, 95% CI: 1.36–4.65; and 2.45, 95% CI: 0.91–6.61, respectively), adjusted for baseline age, self-rated health, and dispositional optimism. Risk status was not associated with self-rated health, dispositional optimism, or depressive symptoms at follow-up.

Conclusion

Combined “classic” cardiovascular risk factors are not associated with impaired self-rated health or mental well-being in elderly men, but are predictive of functional disability.

Section snippets

Study Sample

The cohort of the Zutphen Elderly Study consists of men born between 1900 and 1920. The Zutphen Study started in 1960 as the Dutch contribution to the Seven Countries Study on life style, biological risk factors, and CVD in middle-aged men.27 In 1985, 367 of 555 men who were still alive were reexamined. In addition, a new random sample of 711 men of the same age also living in Zutphen but not belonging to the original cohort was invited to participate. The invitation resulted in a total target

Baseline Characteristics

The 342 men who were excluded differed from 545 participating men, as they were older (73.2 ± 5.5 versus 71.7 ± 5.2 years; t (885) = 3.93, p <0.001), were less physically active (geometric mean 210 versus 343 minute per week; t (466) = −3.64, p <0.001), were more often using antihypertensive medication (15.8 versus 9.5%; χ2(1) = 7.80, p = 0.005).

Regarding the risk status, there were 1) 44 (8.1%) men with a BMI ≥30.0 kg/m2, 2) 246 (45.1%) men presently smoking, 3) 210 (38.5%) men with

DISCUSSION

We found that combined “classic” cardiovascular risk factors are predictive of functional disability, but not of mental well-being during follow-up in elderly, community-living men. More specifically, after adjusting for dispositional optimism (and thereby adjusted for a measure of baseline mental well-being), the cardiovascular risk factor status was not associated with an increased risk of depressive symptoms. Our findings are not in line with the hypothesis that “classic” cardiovascular risk

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    The Zutphen Elderly Study was supported by the Netherlands Prevention Foundation (Praeventiefonds).

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