The association of multi-system health status and its longitudinal changes with cardiovascular disease risk: insights from a secondary analysis of four multinational cohort studies

Background: Cardiovascular diseases (CVDs) are influenced by multiple interrelated health domains, including cognitive, psychological, anthropometric, and physical functioning. However, little is known about whether overall health status across these domains and their concurrent changes over time are associated with the subsequent development of CVDs. We examined the associations of baseline multi-system health status, its longitudinal trajectories, and cumulative burden with incident CVDs. Methods: We retrieved data on 32,661 adults aged ≥45 years from four population-based studies: the China Health and Retirement Longitudinal Study, the Health and Retirement Study, the English Longitudinal Study of Ageing, and the Survey of Health, Ageing and Retirement in Europe. We followed up the participants between 2006 and 2018, depending on cohort. We assessed multi-system health across four domains (cognitive function, depressive symptoms, body mass index, and grip strength), used group-based multi-trajectory modelling to identify its distinct longitudinal patterns, and applied multivariable logistic regression to evaluate its associations with incident CVDs. Results: Greater baseline multi-system impairment was associated with higher odds of incident CVDs across cohorts, particularly among individuals with multiple unhealthy systems. We identified three distinct multi-system health trajectories: favourable maintenance, intermediate decline, and accelerated decline. Participants assigned to trajectories characterised by accelerated multi-system decline generally showed higher risk of incident CVDs than those in the other two trajectories, although the magnitude and statistical significance of associations varied across cohorts. A higher cumulative burden of unhealthy systems was associated with progressively greater odds of incident CVDs, indicating a dose-response pattern. Conclusions: In our study, poorer baseline multi-system health, unfavourable longitudinal trajectories, and greater cumulative impairment were associated with higher odds of incident CVDs. These findings highlight the potential value of monitoring multiple health domains simultaneously and longitudinally to identify individuals at elevated cardiovascular risk and to support integrated healthy ageing strategies.