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Coronary Artery Calcium and Physical Function in Older Adults: The Cardiovascular Health Study

¹ Department of Medicine, Division of Geriatric Medicine, and ³ Department of Epidemiology, University of Pittsburgh, Pennsylvania.
² Department of Critical Care Medicine and Surgery, Unit of Geriatrics, University of Florence, Italy.

Address correspondence to Marco Inzitari, MD, Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, 130 N. Bellefield St., Room 518, Pittsburgh, PA. E-mail: inzitarim{at}edc.pitt.edu

Background. In older adults without clinical cardiovascular disease, coronary artery calcium (CAC) is associated with other subclinical vascular diseases, which, in turn, predict physical dysfunction. However, the association between CAC and physical function is unstudied.

Methods. In 387 older community-dwellers from the Cardiovascular Health Study without clinical cardiovascular diseases (mean age ± standard deviation = 78.7 ± 3.7, 35% men, 22% African Americans), CAC was measured using electron beam tomography, and physical performance was assessed by usual pace gait speed, chair stand, and tandem stand. Differences in physical performance across CAC quartiles were investigated in the whole cohort and by gender. Associations with gait speed (m/s) were assessed in multivariable models using both the continuous form of CAC score (log(CAC)) and quartiles of CAC, adjusting for demographics and comorbidities.

Results. No differences in physical performance were observed across CAC quartiles in the whole group. In gender-stratified analyses, a significant association was shown among women, who had progressively lower gait speed across CAC quartiles: Those with CAC > 220 walked more than 0.1 m/s slower than those with CAC < 35 (age-adjusted p_trend =.017). After multivariable adjustment, the association remained statistically significant for women in both linear (log(CAC) and gait speed, p =.025) and logistic models: Each of the top three CAC quartiles (35–220, 221–659, and 660) had a more than twofold odds of walking slower than 1 m/s, compared to the lowest CAC quartile (< 35; p =.021).

Conclusions. In this sample of older community-dwellers without overt cardiovascular disease, CAC was inversely related to gait speed in women, but not in men.

Key Words: Coronary artery calcium • Physical function • Gait • Aging • Elderly