Functional vulnerability beyond blood pressure: Intrinsic capacity impairment and cardiovascular risk stratification in three prospective aging cohorts.

BACKGROUND: Intrinsic capacity (IC) reflects multidimensional functional reserve, but its joint role with hypertension in cardiovascular risk stratification remains unclear. We examined the independent and combined associations of IC impairment and hypertension with incident cardiovascular disease (CVD), and explored the contribution of specific IC domains. METHODS: We pooled data from three prospective aging cohorts in China, England, and the United States. IC was assessed across cognition, locomotion, vitality, psychological function, and sensory function. Participants were classified according to IC impairment and hypertension status. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD. We also examined risk gradients by the number of impaired IC domains, domain-specific associations, and incremental model discrimination using Harrell's C-index. RESULTS: Among 13,807 participants, 3650 incident CVD events occurred. Compared with participants with intact IC and no hypertension, impaired IC alone (HR 1.53, 95% CI 1.34-1.74) and hypertension alone (HR 1.68, 95% CI 1.46-1.93) were associated with higher CVD risk, while their coexistence conferred the highest risk (HR 2.29, 95% CI 2.02-2.59). CVD risk increased progressively with accumulating impaired IC domains. Impairments in the locomotion, psychological function, and sensory function domains were the main contributors. Adding IC impairment and hypertension modestly improved model discrimination, increasing Harrell's C-index from 0.619 to 0.649. CONCLUSION: IC impairment and hypertension were independently and jointly associated with incident CVD. Integrating multidimensional functional assessment with hypertension status may improve cardiovascular risk stratification in aging populations.