Multidomain vulnerability burden and incident cardiovascular disease among middle-aged and older adults: evidence from three longitudinal ageing cohorts

Functional and psychological vulnerabilities commonly coexist in ageing populations, but their
cumulative association with cardiovascular disease is uncertain. We analysed 31,535 adults aged 50
years or older without baseline heart disease or stroke in the China Health and Retirement Longitudinal
Study, Health and Retirement Study, and English Longitudinal Study of Ageing. Multidomain vulnerability
burden was a non-weighted count of activities of daily living/instrumental activities of daily living
limitation, mobility limitation, and elevated depressive symptoms. During follow-up, 8,950 participants
developed cardiovascular disease. Each additional vulnerability domain was associated with incident
cardiovascular disease in CHARLS (hazard ratio [HR] 1.238, 95% confidence interval [CI] 1.177–1.302),
HRS (HR 1.172, 95% CI 1.133–1.213), and ELSA (HR 1.242, 95% CI 1.166–1.324). The pooled HR was
1.210 (95% CI 1.113–1.316; 95% prediction interval 1.051–1.393). Associations were graded across 0, 1,
and ≥ 2 domains and persisted when each domain was removed in turn. Greater multidomain
vulnerability burden was consistently associated with incident cardiovascular disease, although the
count should be regarded as an analytic measure rather than a validated clinical risk instrument.