Association of clinical biomarker-based biological age and aging trajectory with cardiovascular disease and all-cause mortality in Chinese adults: a population-based cohort study

Abstract

Abstract Background Evidence on the association of clinical biomarker-based biological age (BA) with cardiovascular disease (CVD) and mortality remains insufficient, particularly concerning aging trajectories' relationship with these two outcomes. Methods Seventy-five thousand five hundred thirty-seven Chinese adults from the Kailuan study who participated in the first checkup (2006–2007) were included. BA was predicted by 32 clinical indicators using deep neural networks models. Aging status was divided into decelerated, accelerated, and normal aging based on BA in the first checkup. Six aging trajectories were developed in the initial three checkups. CVD and mortality were followed up till December 31, 2021. Results After adjusting for chronological age, sex, education level, occupation, physical activity, smoking status, alcohol consumption, salt consumption habit, history of hypertension, diabetes, and dyslipidemia, as well as the use of antihypertensive, antidiabetic, and lipid-lowering drugs, Cox proportional hazard models showed that relative to normal aging, accelerated aging was a risk factor for CVD (adjusted hazard ratio [aHR], 1.17 [95% CI 1.11–1.23]) and mortality (aHR, 1.17 [1.12–1.22]), while participants with decelerated aging had a lower risk for CVD (aHR, 0.85 [0.80–0.90]) and mortality (aHR, 0.86 [0.82–0.90]). Relative to low-stable trajectory, other aging trajectories associated with higher risk of CVD and death, and high-stable trajectory associated with the highest risk of CVD (aHR, 1.62 [1.45–1.81]) and mortality (aHR, 1.55 [1.41–1.71]). Relative to high-stable trajectory, high-decreasing trajectory was associated with lower risk of CVD (aHR, 0.76 [0.67–0.86]) and death (aHR, 0.78 [0.70–0.87]), and decreasing-increasing trajectory was associated with lower risk of death (aHR, 0.86 [0.75–0.98]). Conclusions Accelerated BA aging is associated with a higher risk of CVD and mortality, whereas decelerated aging is associated with a lower risk compared to normal aging. Those persistently at high aging levels are at the highest risk for both CVD and death; conversely, it is the act of lowering and continually maintaining a reduced aging state that effectively mitigates these risks.

Keywords

• Biological age
• Aging trajectory
• Cardiovascular disease
• Mortality