Department of Epidemiology and Population Health, Stanford University, California.
School of Biological and Population Health Sciences, Oregon State University, Corvallis.
J Gerontol A Biol Sci Med Sci. 2020 Oct 15;75(11):2207-2214. doi: 10.1093/gerona/glaa043.
The population age 90 years and older is the fastest growing segment of the U.S. population. Only recently is it possible to study the factors that portend survival to this age.
Among participants of the Cardiovascular Health Study, we studied the association of repeated measures of cardiovascular risk factors measured over 15-23 years of follow-up and not only survival to 90 years of age, but also healthy aging outcomes among the population who reached age 90. We included participants aged 67-75 years at baseline (n = 3,613/5,888) to control for birth cohort effects, and followed participants until death or age 90 (median follow-up = 14.7 years).
Higher systolic blood pressure was associated with a lower likelihood of survival to age 90, although this association was attenuated at older ages (p-value for interaction <.001) and crossed the null for measurements taken in participants' 80's. Higher levels of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and body mass index (BMI) were associated with greater longevity. Among the survivors to age 90, those with worse cardiovascular profile (high blood pressure, LDL cholesterol, glucose, and BMI; low HDL cholesterol) had lower likelihood of remaining free of cardiovascular disease, cognitive impairment, and disability.
In summary, we observed paradoxical associations between some cardiovascular risk factors and survival to old age; whereas, among those who survive to very old age, these risk factors were associated with higher risk of adverse health outcomes.
90 岁及以上的人口是美国人口中增长最快的年龄段。直到最近，人们才有可能研究预示着能活到这个年龄的因素。
在心血管健康研究的参与者中，我们研究了在 15-23 年的随访期间多次测量心血管风险因素与不仅能活到 90 岁，而且能在达到 90 岁的人群中健康衰老的结果之间的关联。我们纳入了基线年龄为 67-75 岁的参与者（n=3613/5888），以控制出生队列效应，并随访参与者直至死亡或 90 岁（中位数随访时间=14.7 年）。
较高的收缩压与活到 90 岁的可能性较低相关，但这种关联在年龄较大时减弱（交互作用的 p 值<0.001），并且在参与者 80 多岁时的测量值穿过了零值。较高的高密度脂蛋白（HDL）胆固醇、低密度脂蛋白（LDL）胆固醇和体重指数（BMI）水平与更长的寿命相关。在活到 90 岁的幸存者中，心血管状况较差（高血压、LDL 胆固醇、血糖和 BMI 高；HDL 胆固醇低）的人，患心血管疾病、认知障碍和残疾的可能性较低。
总之，我们观察到一些心血管风险因素与长寿之间存在矛盾的关联；而在那些活到非常老的年龄的人中，这些风险因素与不良健康结果的风险增加相关。
