The association of multi-system health status and its longitudinal changes with cardiovascular disease risk: insights from a secondary analysis of four multinational cohort studies.

Greater baseline multi-system health impairment was associated with higher odds of incident cardiovascular disease across cohorts, particularly among individuals with multiple unhealthy systems.

• The study included 32,661 adults aged ≥45 years from four population-based cohort studies across multiple countries.
• Four health domains were assessed: cognitive function, depressive symptoms, body mass index, and grip strength.
• Data were drawn from the China Health and Retirement Longitudinal Study, the Health and Retirement Study, the English Longitudinal Study of Ageing, and the Survey of Health, Ageing and Retirement in Europe.
• Follow-up occurred between 2006 and 2018 depending on the cohort.
• Multivariable logistic regression was used to evaluate associations with incident CVDs.

Group-based multi-trajectory modelling identified three distinct longitudinal multi-system health trajectory patterns: favourable maintenance, intermediate decline, and accelerated decline.

• Trajectories were identified using group-based multi-trajectory modelling applied across the four health domains simultaneously.
• The three trajectories were labelled as favourable maintenance, intermediate decline, and accelerated decline.
• Participants assigned to the accelerated decline trajectory generally showed higher risk of incident CVDs than those in the other two trajectories.
• The magnitude and statistical significance of associations varied across cohorts.

A higher cumulative burden of unhealthy systems was associated with progressively greater odds of incident cardiovascular disease, indicating a dose-response pattern.

• Cumulative burden was measured as the accumulation of unhealthy systems across the assessed health domains over time.
• The dose-response pattern was observed across the multinational cohorts.
• This finding suggests that the more health domains that are impaired and the longer the duration of impairment, the greater the cardiovascular risk.
• The association was consistent with the cross-sectional baseline findings showing that multiple unhealthy systems conferred greater risk than single system impairment.

The study used a secondary analysis design drawing on four established multinational cohort studies to assess multi-system health and cardiovascular disease risk in middle-aged and older adults.

• The four cohorts were the China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS, USA), the English Longitudinal Study of Ageing (ELSA), and the Survey of Health, Ageing and Retirement in Europe (SHARE).
• Participants were aged ≥45 years at baseline.
• Total sample size was 32,661 adults.
• The study design was a secondary analysis of existing population-based cohort data.

Monitoring multiple health domains simultaneously and longitudinally was identified as potentially valuable for identifying individuals at elevated cardiovascular risk and supporting integrated healthy ageing strategies.

• The findings support an integrated approach to health monitoring rather than single-domain assessment.
• The authors highlight implications for 'integrated healthy ageing strategies.'
• The results were consistent across four geographically and culturally distinct cohorts, suggesting generalizability of the multi-system health framework.
• The study positions multi-system health surveillance as a tool for cardiovascular risk identification in population-based settings.