Short Physical Performance Battery and Incident Cardiovascular Events Among Older Women

Abstract

Background The Short Physical Performance Battery (SPPB) is an inexpensive, reliable, and easy-to-implement measure of lower-extremity physical function. Strong evidence links SPPB scores with all-cause mortality, but little is known about its relationship with incident cardiovascular disease (CVD). Methods and Results Women (n=5043, mean age=79±7) with no history of myocardial infarction or stroke completed 3 timed assessments-standing balance, strength (5 chair stands), and usual gait speed (4 m walk)-yielding an SPPB score from 0 (worst) to 12 (best). Women were followed for CVD events (myocardial infarction, stroke, or CVD death) up to 6 years. Hazard ratios were estimated for women with Very Low (0-3), Low (4-6), Moderate (7-9), and High (10-12) SPPB scores using Cox proportional hazard models adjusted for demographic, behavioral, and health-related variables including objective measurements of physical activity, blood pressure, lipids, and glucose levels. Restricted cubic splines tested linearity of associations. With 361 CVD cases, crude incidence rates/1000 person-years were 41.0, 24.3, 16.1, and 8.6 for Very Low, Low, Moderate, and High SPPB categories, respectively. Corresponding fully adjusted hazard ratios (95% CIs) were 2.28 (1.50-3.48), 1.70 (1.23-2.36) 1.49 (1.12-1.98), and 1.00 (referent); P-trend <0.001. The dose-response relationship was linear (linear P<0.001; nonlinear P>0.38). Conclusions Results suggest SPPB may provide a measure of cardiovascular health in older adults beyond that captured by traditional risk factors. Because of its high test-retest reliability and low administrative burden, the SPPB should be a routine part of office-based CVD risk assessment.

Keywords: balance; frailty; gait speed; geriatric cardiology; healthy cardiovascular aging; physical functioning.

Figure 1

Baseline SPPB distribution and hazard ratios for incident major CVD, total CVD, and CVD mortality. A, The continuous dose‐response relation of SPPB score with major cardiovascular disease (blue line), total CVD (black line), and CVD mortality (red line) estimated using Cox regression models adjusted for age, race/ethnicity, education, smoking status, alcohol use, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, osteoarthritis, depression, and body mass index. Results are from restricted cubic splines allowing for 3 knots placed at default locations. The reference category was SPPB=12. Results were trimmed at an SPPB score of 2 because of sparse data in the tail. B, A histogram of SPPB score. CVD indicates cardiovascular disease; and SPPB, Short Physical Performance Battery.

Figure 2

Hazard ratios (HRs) and 95% CI for associations of the Short Physical Performance Battery (SPPB) score (comparing the 75th percentile to the 25th percentile [SPPB score interquartile range=3]) and major cardiovascular disease (CVD), total CVD, and CVD mortality by selected participant characteristics; Objective Physical Activity and Cardiovascular Health Study (2012–2018). Associations were adjusted for age, race‐ethnicity, education, smoking status, alcohol use, diabetes mellitus, hypertension, COPD, osteoarthritis, depression, BMI, accelerometer‐measured sedentary time, accelerometer‐measured moderate‐to‐vigorous physical activity, systolic blood pressure, high‐density lipoprotein cholesterol, log(triglycerides), and glucose. Major CVD includes incident myocardial infarction, stroke, and death from CVD. Total CVD includes major CVD+coronary revascularization, hospitalized angina, and heart failure. BMI indicates body mass index; and MVPA, moderate‐to‐vigorous physical activity.