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  • OBJECTIVES: Subclinical vascular disease (SVD) contributes to the aging process and may decrease life expectancy. We aimed to determine the contribution of gradations of SVD to the likelihood of achieving longer survival, and to determine what allows some individuals to achieve longer survival in the presence of high SVD. DESIGN: Cohort Study SETTING: Cardiovascular Health Study PARTICIPANTS: Adults who were born after June 30th, 1918 and before June 30th, 1921 (n=2,082); participants were age 70-75 years at baseline visit (1992-1993). MEASUREMENTS: A SVD index was scored as 0, 1, or 2 for no, mild, or severe abnormalities on ankle-arm index, electrocardiogram, and common carotid intima-media thickness measured at baseline. Survival groups were categorized as <80, 80-84, 85-89, and 90+ years. RESULTS: A one point lower SVD score was associated with a 1.22 (95% confidence interval: 1.14, 1.31) higher odds of achieving longer survival, independent of potential confounders. This association was unchanged after adjustment for intermediate incident cardiovascular events. There was suggestion of an interaction of kidney function, smoking, and CRP with SVD; the association of SVD and longer survival appeared modestly increased in persons with poor kidney function, inflammation, or a history of smoking. CONCLUSION: A lower burden of SVD is associated with longer survival, and this association was independent of intermediate cardiovascular events. Abstinence from smoking, better kidney function, and lower inflammation may attenuate the effects of higher SVD and further promote longer survival.
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