Cardiovascular Risk Profile and Subsequent Disability and Mental Well-being: The Zutphen Elderly Study

From the Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands (EJG, FGZ); and Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (DK).

Address correspondence and reprint requests to: Erik J. Giltay, Ph.D., M.D., E-mail: giltay{at}dds.nl.

	Abstract

Objectives: It is insufficiently known whether "classic" cardiovascular risk factors are associated with subsequent functional disability and mental well-being in elderly men. Design: A population-based cohort study with 15 years of follow-up from 1985 onward. Setting: The Zutphen Study started as the Dutch contribution to the Seven Countries Study. Participants: Five hundred forty-five (59.2%) of 887 men (aged 64–84 years) who were free of preexisting cardiovascular disease and cancer. Measurements: High cardiovascular risk was defined as having 2 "classic" risk factors: body mass index 30.0 kg/m², presently smoking, hypertension (systolic blood pressure 160 mm Hg, diastolic blood pressure 95 mm Hg, or antihypertensive medication), serum cholesterol 6.5 mmol/L, and diabetes mellitus. Self-rated health and dispositional optimism were assessed in 1985, 1990, 1995, and 2000. Disability and depressive symptoms (by the Zung self-rating depression scale) were assessed from 1990 onward. Results: The high-risk (N = 230) versus low-risk group (N = 315) had higher multivariate adjusted risks of all-cause and cardiovascular mortality (hazard ratios: 1.43; confidence interval[CI]: 1.15, 1.76; and 1.61; CI: 1.20, 2.18, respectively). High-risk status was also associated with more functional disability at 5, 10, and 15 years (odds ratios of 2.00, 95% CI: 1.25–3.20; 2.51, 95% CI: 1.36–4.65; and 2.45, 95% CI: 0.91–6.61, respectively), adjusted for baseline age, self-rated health, and dispositional optimism. Risk status was not associated with self-rated health, dispositional optimism, or depressive symptoms at follow-up. Conclusion: Combined "classic" cardiovascular risk factors are not associated with impaired self-rated health or mental well-being in elderly men, but are predictive of functional disability.

Key Words: Cardiovascular diseases, cohort studies, depressive symptoms, disability evaluation, mental health, determinants, mortality