Background We examined the relationship of midlife cardiovascular health (CVH) with late-life robustness among men and women and the impact of survivorship bias on sex-differences in robustness. Methods Prospective analysis of 15,744 participants aged 45-64 (Visit 1 median age: 54 years, 55% female, 27% Black) in 1987-1989 from the population-based ARIC Study. CVH was operationalized according to the Life’s Simple 7 (LS7) metric of health behaviors (smoking, weight, physical activity, diet, cholesterol, blood pressure, and glucose); each behavior was scored as ideal (2 points), intermediate (1 point), or poor (0 points) and summed. Late-life robust/pre-frail/frailty was defined at Visit 5 (2011-2013). Multinomial regression estimated relative prevalence ratios (RPR) of late-life robustness/pre-frailty/frailty/death across overall midlife LS7 score and components, for the full Visit 1 sample. Separate analyses considered Visit 5 survivors only. Results For each one-unit greater midlife LS7 score, participants had a 37% higher relative prevalence of being robust versus frail (overall RPR=1.37, [95% CI: 1.30-1.44]; women=1.45 [1.36-1.54]; men=1.24 [1.13-1.36]). Among the full Visit 1 sample, women had a similar one-level higher robustness category prevalence (RPR=1.35 [95% CI: 1.32-1.39]) than men (RPR=1.31 [95% CI: 1.27-1.35]) for every one-unit higher midlife LS7 score. Among survivors, men were more likely to be robust than women at lower LS7 levels; differences were attenuated and not statistically different at higher midlife LS7 levels. Conclusions Midlife CVH is positively associated with robustness in late-life among men and women. Accounting for mortality in part explains documented sex-differences in robustness across all levels of LS7.

中文翻译：

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中年心血管健康和健壮与虚弱的晚年状态：社区动脉粥样硬化风险 (ARIC) 研究

背景 我们检查了男性和女性中年心血管健康 (CVH) 与晚年稳健性的关系，以及幸存者偏差对稳健性性别差异的影响。方法对 1987-1989 年基于人群的 ARIC 研究中 15,744 名 45-64 岁参与者（访视 1 中位年龄：54 岁，55% 女性，27% 黑人）进行前瞻性分析。CVH 根据 Life's Simple 7 (LS7) 健康行为指标（吸烟、体重、体力活动、饮食、胆固醇、血压和葡萄糖）进行操作；每个行为被评为理想（2 分）、中等（1 分）或差（0 分）并相加。在访问 5 (2011-2013) 中定义了晚年健壮/衰弱前/虚弱。对于完整的就诊 1 样本，多项回归估计了整个中年 LS7 评分和组成部分的晚年稳健性/衰弱前/衰弱/死亡的相对患病率 (RPR)。单独的分析仅考虑访问 5 幸存者。结果 对于中年 LS7 评分每增加一个单位，参与者的健壮与虚弱的相对患病率高 37%（总体 RPR=1.37，[95% CI：1.30-1.44]；女性=1.45 [1.36-1.54]；男性=1.24 [1.13-1.36]）。在完整的就诊 1 样本中，女性的稳健性类别患病率（RPR=1.35 [95% CI: 1.32-1.39]）比男性（RPR=1.31 [95% CI: 1.27-1.35]）相似一个单位更高的中年 LS7 分数。在幸存者中，在 LS7 水平较低的情况下，男性比女性更有可能强壮；在较高的中年 LS7 水平上，差异有所减弱且无统计学差异。结论 中年 CVH 与男性和女性晚年的健壮性呈正相关。对死亡率的解释部分解释了 LS7 所有级别的健壮性的性别差异。