AGE-RELATED TRENDS IN CARDIOVASCULAR MORBIDITY AND PHYSICAL FUNCTIONING IN THE ELDERLY - THE CARDIOVASCULAR HEALTH STUDY

Objective: To describe relationships between age and subclinical cardi ovascular disease, manifest chronic disease, and physical functioning and limitations among persons aged 65 years and older, with emphasis o n the ''oldest old,'' those 85 years and older. Design: Observational population-based study Setting: Four U.S. communities: Forsyth County, North Carolina; Sacramento County, California; Washington County, Mar yland; and Pittsburgh, Pennsylvania. Participants: 5,201 men and women aged 65 years and older. Measurements: Demographic data; histories of cardiovascular disease (CVD), chronic lung disease, arthritis, diabet es, and hypertension; measures of subclinical disease including arm an d ankle blood pressures, internal carotid wall thickness and stenosis, ejection fraction, left ventricular mass, fractional shortening, and diastolic function, electrocardiographic left ventricular hypertrophy and cardiac injury score, forced expiratory flow and volume; functiona l status including self-reported physical functioning, hearing and sig ht limitations and health status, and performance-based measures of fu nction. These variables were examined among men and women in three age groups: 65-74 years, 75-84 years, and 85+ years. Subgroups of partici pants with and without manifest CVD were also examined. Main Results: In women, the prevalence of CVD and other chronic conditions increased with age, and the highest rates occurred among those 85 years and old er. In men, prevalence rateS increased between the two younger groups, but the oldest group had lower than expected rates for coronary heart disease, cerebrovascular disease, hypertension, and chronic lung dise ase. In contrast, there were strong age-related linear trends in most of the subclinical measures of blood pressure atherosclerosis and pulm onary function and in virtually all measures of functional status in b oth gender groups across the age range. There was a particularly marke d decline in functional status between the two older age groups. While subclinical disease was greater and functional status was poorer amon g those with manifest CVD, with few exceptions, age-related trends wer e not significantly different between the two groups. Conclusions: Low er than expected prevalence rates of CVD among those aged 85 years and older, particularly among men, in this study of community-dwelling el derly may represent selection bias or a real plateauing in disease pre valence with age. However, subclinical disease appears to increase and functional status to decline across the age range in both men and wom en regardless of the presence of CVD. The apparent increase in subclin ical disease with age indicates potential for CVD prevention after age 65.