Healthy ageing trajectories and incident cardiovascular disease in adults aged 50 years and older: a multi-cohort study

BACKGROUND: The dynamic patterns of healthy ageing may be an important risk factor for chronic diseases including cardiovascular disease (CVD). However, evidence remains limited. OBJECTIVE: To identify associations between healthy ageing trajectories and incident CVD risk. METHODS: This study was based on three large longitudinal ageing cohorts: the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Study of Ageing (ELSA), and the China Health and Retirement Longitudinal Study (CHARLS). Participants aged ≥50 years at baseline and free of CVD during the trajectory period were included. The ATHLOS healthy ageing score was derived using an item response theory model based on 41 indicators of intrinsic capacity and functional ability assessed through questionnaires and performance tests. Group-based trajectory modeling was applied to identify long-term patterns of the healthy ageing. Incident CVD was ascertained from self-reported physician diagnoses of heart disease or stroke. Cox proportional hazards models were applied to examine associations between trajectory groups and incident CVD risk, with adjustment for potential confounders. RESULTS: Participants included 10,847 from SHARE (58.4% women; median age, 59.0 years), 5,611 from ELSA (55.7% women; median age, 57.0 years), and 7,238 from CHARLS (49.9% women; median age, 59.0 years), with median follow-up durations of 8, 7, and 5 years, respectively. Three declining healthy ageing trajectories (low, middle, and high) were identified in each cohort. Compared with the low trajectory group, participants in the middle trajectory group were associated with lower risks of CVD (SHARE, HR = 0.89, 95% CI: 0.77-1.02; ELSA, HR = 0.66, 95% CI: 0.53-0.82; CHARLS, HR = 0.67, 95% CI: 0.58-0.76), whereas the high trajectory group was associated with further reductions in CVD risk (SHARE, HR = 0.61, 95% CI: 0.52-0.71; ELSA, HR = 0.36, 95% CI: 0.28-0.46; CHARLS, HR = 0.39, 95% CI: 0.33-0.45). No consistent significant modifying effects of socioeconomic status (SES) or healthy lifestyle score (HLS) were observed. CONCLUSION: Higher healthy ageing trajectories were significantly associated with lower risks of incident CVD, and this association was generally consistent across populations with different SES and HLS levels.