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Title: Physical functioning and cardiovascular disease risk factors,incidence, and mortality


Decline in cardiovascular disease (CVD) mortality which has beenobserved in Poland since 1992 is not fully explained by theintroduction of new treatment methods and reduction of the exposureto CVD risk factors. Low physical activity is one of the CVD riskfactors but little is known about relationship between CVD and lowphysical functioning. A natural consequence of low physicalfunctioning is low physical activity and on this indirect way, lowphysical functioning may increase the risk of CVD. On the other hand,low physical functioning may be a consequence of CVD or otherchronic conditions that increase the risk of CVD.The objective of this study was to assess the relationship betweenphysical functioning and CVD risk factors, CVD incidenceand mortality.A cohort study with 5-year follow-up was conducted within thePolish component of the HAPIEE (Health, Alcohol and Psychosocialfactors In Eastern Europe) Study. Studied group was a random sampleof 10 728 men and women aged 45-69 years, selected from permanentresidents of Krakow. Physical functioning was assessed using10 questions selected from the SF-36 scale. Information on healthstatus, health behaviours, socioeconomic and psychosocial factors wascollected using standardized questionnaire. Blood pressure andanthropometric measurements were taken according to the standardprotocol. Blood samples were collected to estimate the level of lipidsand glucose using enzymatic and enzymatic-colorimetric methods.Participants were followed to obtain information on deaths andtheir causes and incident CVD. CVD incidence and mortality wereassessed separately in men and women in four subcategoriesof physical functioning, i.e. very good, good, moderate and low,according to quartile values of the distribution of physical functioning.Multivariate logistic regression analysis was used to assess therelationship between physical functioning and CVD risk factors.Relationship between physical functioning and CVD incidence andmortality was assessed using Cox proportional hazards model. Thereference group consisted of participants with very good physicalfunctioning.Compared to men with very good physical functioning, men withlow physical functioning had more frequent low physical activity(OR=2.64; 95%CI: 2.24-3.12), diabetes (OR=2.56; 95%CI: 2.03-3.22), hypertension (OR=1.60; 95%CI: 1.33-1.92), more frequentlywere obese (OR=1.51; 95%CI: 1.25-1.82) and smokers (OR=1.69;95%CI: 1.39-2.00). Compared to women with very good physical ; functioning, women with low physical functioning had more frequentdiabetes (OR=2.63; 95%CI: 2.01-3.44), obesity (OR=2.22;95%CI: 1.86-2.64), hypertension (OR=2.05; 95%CI: 1.73-2.42), lowphysical activity (OR=1.92; 95%CI: 1.65-2.24), more frequent wereoverweight (OR=1.31; 95%CI: 1.12-1.53) and smokers (OR=1.21;95%CI: 1.04-1.41). After adjustment for age, the highest risk of CVDincidence was observed in participants with low physical functioning(HR=1.97; 95%CI: 1.35-2.89 in men and HR=3.02; 95%CI: 1.74-5.24in women). Further adjustment for education, marital status, physicalactivity, history of chronic diseases and CVD risk factors attenuatedrisk partially, but the relationship remained significant (HR=1.57;95%CI: 1.00-2.45 in men and HR=2.07; 95%CI: 1.04-4.10 in women).After adjustment for age, the highest risk of CVD death was observedin participants with low physical functioning (HR=7.43; 95%CI: 3.82-14.46 in men and HR=4.06; 95%CI: 1.79-9.22 in women) in allparticipants, as well as in participants free of CVD at baseline(HR=4.55; 95%CI: 2.15-9.63 in men and HR=3.73; 95%CI: 1.51-9.20in women). Further adjustment for education, marital status, physicalactivity, history of chronic diseases (included CVD) and CVD riskfactors in all participants attenuated risk partially in men (HR=3.86;95%CI: 1.75-8.49) but in women the relationship between physicalfunctioning and CVD mortality became insignificant (HR=2.25;95%CI: 0.78-6.43). Similarly, in participants free of CVD at baseline,adjustment for education, marital status, physical activity, historyof chronic diseases (other than CVD) and CVD risk factors attenuatedrisk partially in men (HR=3.34; 95%CI: 1.37-8.12) but in women therelationship has become insignificant (HR=1.97; 95%CI: 0.65-5.94).In conclusion, both in men and in women, low physical functioningwas related with more frequent prevalence of hypertension, diabetes,smoking, low physical activity and obesity. Men with low physicalfunctioning had higher risk of incident CVD and CVD deathcompared to men with very good physical functioning. Therelationship was independent of classical CVD risk factors. Womenwith low physical functioning had higher risk of incident CVDcompared to women with very good physical functioning.The relationship was independent of classical CVD risk factors. Inwomen, prevalence of CVD risk factors explained the relationshipbetween physical functioning and CVD mortality. Low physicalfunctioning was associated with CVD risk factors as well as CVDincidence and mortality, and method used for assessment of physicalfunctioning may be a simple screening tool for identifying personswith low physical functioning.

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Level of degree:

2 - studia doktoranckie

Degree discipline:

epidemiologia ; choroby układu krążenia

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Nauk o Zdrowiu. Instytut Zdrowia Publicznego.


Andrzej Pająk

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Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

May 24, 2021

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Jun 22, 2015

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Edition name Date
ZB-122886 May 24, 2021


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