Background Individuals with low cardiovascular risk factor profiles experience lower rates of cardiovascular diseases (CVD) and mortality. However, little is known about how older persons with near ideal cardiovascular risk factors age, especially for non-cardiovascular outcomes. We tested whether older individuals with near ideal CVD risks were less likely to develop ageing-related adverse health outcomes in two large cohorts.

Methods Data were from population representative primary care medical records (Clinical Practice Research Datalink, CPRD, England, n=239,591) and also healthy volunteers (UK Biobank, UKB, n=181,820), aged 60 to 69 years at baseline followed for up to 10 years. A cardiovascular risk score (CRS) summarized smoking status, low density lipoprotein cholesterol (LDL), blood pressure, body mass index (BMI), fasting glucose and physical activity, grouping individuals as low (all factors near ideal), moderate or high CRS, following the American Heart Association ‘Life’s Simple 7’ approach. Data were available on a range of prevalent and incident ageing-related adverse health outcomes from CPRD and UK Biobank. Logistic regression and Cox proportional hazards regression models (Fine and Grey models including death as a competing risk) were used to test associations between the CRS and prevalent or incidence health outcomes respectively.

Results Older subjects with near ideal CVD risks had less chronic pain (UKB baseline odds ratios (OR), 0.52, 95% CI 0.50 to 0.54), lower incidence of incontinence (CPRD sub-hazard ratio (sub-HR), 0.75, 95% CI 0.63 to 0.91), falls (sub-HR, 0.82, 95% CI 0.73 to 0.91) and fragility fractures (sub-HR, 0.78, 95% CI 0.65 to 0.93). Only 5.4% in our primary care sample with near ideal CVD risks became frail (Rockwood index) versus 24.2% with high risks. All-cause mortality was markedly lower in the low CRS group (vs. high CRS, HR, 0.40: 95% CI 0.35 to 0.47). All associations showed dose-response relationships. Estimates of associations were remarkably similar in both cohorts despite differences in the cohort profiles and risk factor ascertainment, suggesting robustness of results.

Conclusion Persons aged 60 to 69 years with near ideal cardiovascular risk factor profiles have substantially lower incidence of common conditions of ageing, including frailty. Optimizing CVD risk factors may substantially reduce the burden of morbidity in later life: we thus likely already have the tools for radical improvement in ageing health outcomes. However, further work is needed to provide evidence of whether this association is causal. Using largescale data from UK Biobank, we aim to expand the existing study and tease apart the roles of component risk factors using genetic evidence.