Abstract 47: Mid-Life Vascular Risk and Rate of Physical Function Decline Among Older Adults: The Atherosclerosis Risk in Communities Study

Introduction: Physical function decline is associated with poor outcomes, including disability and death. Late-life vascular risk burden is associated with faster physical decline, but earlier life course influence is still unknown. We hypothesized that higher mid-life vascular risk is associated with faster late-life physical function decline. Methods: We studied 5,481 adults at visit 5 (mean [SD] age=75.8 [5.0], range=67-91 years, 58% women, 21% Black) without stroke or Parkinson disease. Mid-life hypertension (≥140/90 mm Hg or treatment), diabetes (≥126 mg/dL or treatment), high cholesterol (≥240 mg/dL or treatment), and current smoking were assessed at visit 1 (age=45-64 years) and across visits 1-4. Late-life physical function in the Short Physical Performance Battery (SPPB) was assessed at visits 5-7 (median follow-up: 4.8 years). Random-slope, random-intercept linear mixed models tested interactions between rate of SPPB decline and mid-life risk factors, adjusted for visit 5 age, sex, race-site, education, BMI, coronary heart disease, and heart failure. Results: Mid-life hypertension (+57% decline: 0.47 per 5 years, 95% CI: 0.30-0.64, p<0.001) and diabetes (+73% decline: 0.67 per 5 years, 95% CI: 0.24-1.09, p=0.002) were associated with faster SPPB decline compared to midlife low risk (Figure 1), as were higher systolic blood pressure (+17% per SD: 0.16 per 5 years, 95% CI: 0.10-0.23, p<0.001) and fasting blood glucose (+16% per SD: 0.015 per 5 years, 95% CI: 0.06-0.24, p=0.002). Greater cumulative years of exposure to hypertension and diabetes were associated with faster rates of SPPB decline (+32% decline: 0.93 per 5 years, 95% CI: 0.61-1.25, p<0.001) and diabetes (+35% decline: 1.03 per 5 years, 95% CI: 0.38-1.68, p=0.002). Conclusions: Older adults with mid-life hypertension and diabetes had faster rates of late-life physical function decline. Midlife control of blood pressure and diabetes may ameliorate late-life functional decline.