Cardiovascular Health, as per Life's Essential 8, and Impaired Lower-Extremity Function in Older Adults

Cardiovascular health (CVH) is a broad construct that encompasses multiple behavioral and biological factors. A decline in CVH has been associated with various adverse health outcomes, but its role in impaired lower-extremity function (ILEF), a major contributor to disability, diminished quality of life and mortality in older adults, is unknown. Therefore, we examined the cross-sectional and prospective association between CVH and lower-extremity function. Using data from 2,487 individuals aged ≥65y from the Seniors-ENRICA-2 cohort, we estimated CVH at baseline using the American Heart Association's Life's Essential 8 (LE8) score (range 0 to 100, with higher values indicating better CVH). We assessed ILEF at baseline and at 2.4-year and 5.2-year follow-ups using the Short Physical Performance Battery (SPPB). Statistical analyses were conducted with logistic regression with adjustment for the main confounders. ILEF was present in 26.8% of participants at baseline (666 events). The cumulative incidence over 2.4 and 5.2 years was 24.8% (278 events) and 22.5% (157 events), respectively. A 10-point higher LE8 score at baseline was associated with lower prevalence of ILEF (SPPB ≤9) at baseline (odds ratio [OR] 0.75, 95% confidence interval [CI]: 0.69-0.80), and lower risk of incident ILEF over 2.4 years (OR 0.77, 95% CI: 0.68-0.87) and 5.2 years (OR 0.76, 95% CI: 0.65-0.89). Physical activity, glucose levels, body mass index and nicotine exposure stood out as major contributors to the lower risk of incident ILEF associated with a higher LE8 score. A higher LE8 score was associated with both a lower prevalence and incidence of ILEF in older adults. Comprehensive evaluation of CVH offers insight into older adults' lower-extremity function and how it may progress over time, identifying opportunities for early intervention.