Frailty and risk of cardiovascular disease and mortality.
Prospective cohort studies suggest that frailty is associated with an increased risk of incident
cardiovascular disease (CVD) morbidity and mortality, but their mechanistic and developmental
relations are not fully understood. We investigated whether frailty predicted an
increased risk of incident nonfatal and fatal CVD among community-dwelling older adults.
Methods
A population cohort of 5015 participants aged 55 years and above free of CVD at baseline
was followed for up to 10 years. Pre-frailty and frailty were defined as the presence of 1–2
and 3–5 modified Fried criteria (unintentional weight loss, weakness, slow gait speed,
exhaustion, and low physical activity), incident CVD events as newly diagnosed registered
cases of myocardial infarction (MI), stroke, and CVD-related mortality (ICD 9: 390 to 459 or
ICD-10: I00 to I99). Covariate measures included traditional cardio-metabolic and vascular
risk factors, medication therapies, Geriatric Depression Scale (GDS), Mini-Mental State
Exam (MMSE), and blood biomarkers (haemoglobin, albumin, white blood cell counts and
creatinine).
Results
Pre-frailty and frailty were significantly associated with elevated HR = 1.26 (95%CI: 1.02–
1.56) and HR = 1.54 (95%CI:1.00–2.35) of overall CVD, adjusted for cardio-metabolic and
vascular risk factors and medication therapies, but not after adjustment for GDS depression
and MMSE cognitive impairment. The HR of association between frailty status and both
CVD mortality and overall mortality, however, remained significantly elevated after full
adjustment for depression, cognitive and blood biomarkers.
Conclusion
Frailty was associated with increased risk of CVD morbidity and especially mortality, mediated in parts by traditional cardio-metabolic and vascular risk factors, and co-morbid depression and associated cognitive impairment and chronic inflammation. Given that prefrailty and frailty are reversible by multi-domain lifestyle and health interventions, there is potential benefits in reducing cardiovascular diseases burden and mortality from interventions targeting pre-frailty and early frailty population.
History
Journal/Conference/Book title
PLOS OnePublication date
2023-01-01Version
- Published