Changes in Intrinsic Capacity and Incident Cardiovascular Diseases in Five Prospective Cohorts

Abstract

Intrinsic capacity (IC), defined by the World Health Organization as the composite of an individual’s physical and mental capacities, has emerged as an important indicator of healthy aging. Although impaired IC has been associated with adverse health outcomes, evidence on whether changes in IC over time are associated with incident cardiovascular disease (CVD) remains limited, particularly across diverse international settings. This study examined the association between changes in IC and incident CVD in five prospective cohorts of older adults.This study used harmonized longitudinal data from five aging cohorts: the Health and Retirement Study (HRS), the Mexican Health and Aging Study (MHAS), the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Study of Ageing (ELSA), and the China Health and Retirement Longitudinal Study (CHARLS). IC was assessed at two time points using a harmonized multidomain framework, and participants were classified into low, medium, and high IC levels within each cohort. IC change groups were constructed according to transitions between the two assessments. A landmark design was applied, and participants with CVD before the second IC assessment were excluded from the analysis of incident CVD. Cox proportional hazards models were fitted separately in each cohort to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), using the stable high IC group (high-to-high) as the reference. Models were adjusted for age, sex, education, smoking, and drinking. Sensitivity analyses additionally examined IC change as a continuous variable using per 1-standard deviation increase in ΔIC. Across the five cohorts, less favorable IC change patterns were generally associated with a higher risk of incident CVD compared with remaining in the high IC group. The most consistent excess risks were observed among participants with low baseline IC, particularly those who remained low over time. Participants whose IC declined from medium to low levels also tended to have elevated CVD risk across cohorts. Although some between-cohort heterogeneity was observed, especially in ELSA, the overall pattern supported an adverse association of persistently low or declining IC with incident CVD. In sensitivity analyses, greater improvement in ΔIC was associated with a lower risk of incident CVD in several cohorts. In conclusion, changes in intrinsic capacity were associated with incident cardiovascular disease across five prospective aging cohorts. Older adults with persistently low IC or declining IC were generally at higher subsequent risk of CVD than those who maintained high IC. These findings support the value of repeated IC assessment for identifying elevated cardiovascular risk and suggest that maintaining or improving IC may be relevant to CVD prevention in later life.