Limitations to functioning and independent living after the onset of coronary heart disease: what is the role of lifestyle factors and obesity?

Background: People with coronary disease have a higher risk of functional limitations than their same-age counterparts without disease. This study examined prospectively the extent to which functioning and independent living among individuals with coronary disease in early old age are associated with lifestyle factors before and after disease onset. Methods: Participants were 986 British civil servants (657 men and 329 women aged 35–55 years), who were free of coronary disease at study entry in 1985–88 but developed disease during 21 years follow-up (the Whitehall II study). Lifestyle factors (obesity, smoking, alcohol, diet and physical activity) were measured at baseline and follow-up in 2007–09. Post-disease limitations to functioning were measured in 2006–09 at mean age is 68 years using activities of daily living scales. Results: Low physical activity and being overweight [body mass index (BMI) ≥25] before and after disease onset were associated with having one or more limitations in activities of daily living among coronary patients [age-, sex- and socio-economic position adjusted odds ratios for pre-disease inactivity and obesity 1.53 [95% confidence interval (95% CI) 0.99–2.35] and 2.53 (95% CI 1.53–4.18), respectively]. A decrease in physical activity [odds ratio (OR): 2.42, 95% CI 1.59–3.68] and an increase of >5 U in BMI (OR: 2.05, 95% CI 1.34–3.13) were also related to limitations in activities of daily living after disease onset. These relationships were not accounted for by measured co-morbidities. No robust associations were observed for smoking, alcohol use and diet. Conclusion: Physical activity and weight control across the adult life course are associated with fewer limitations to functioning and independent living after the onset of coronary disease.