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Associations of Subclinical Cardiovascular Disease With Frailty

^a The University of Pittsburgh, Pennsylvania
^b St. Francis Hospital, Roslyn, New York
^c The University of Washington, Seattle
^d The University of California at Davis, Sacramento
^e Georgetown University Medical Center, Washington, DC, and Uniformed Services University of the Health Sciences, Bethesda, Maryland
^f The University of Vermont, Colchester
^g Johns Hopkins University, Baltimore

Anne B. Newman, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA 15090 E-mail: anewman+{at}pitt.edu.

Decision Editor: John E. Morley, MB, Bch

Background. Frail health in old age has been conceptualized as a loss of physiologic reserve associated with loss of lean mass, neuroendocrine dysregulation, and immune dysfunction. Little work has been done to define frailty and describe the underlying pathophysiology.

Methods. Frailty status was defined in participants of the Cardiovascular Health Study (CHS), a cohort of 5,201 community-dwelling older adults, based on the presence of three out of five clinical criteria. The five criteria included self-reported weight loss, low grip strength, low energy, slow gait speed, and low physical activity. We examined the spectrum of clinical and subclinical cardiovascular disease in those who were frail (3/5 criteria) or of intermediate frailty status (1or 2/5 criteria), compared to those who were not frail (0/5). We hypothesized that the severity of frailty would be related to a higher prevalence of reported cardiovascular disease (CVD), as well as to a greater extent of CVD, measured by noninvasive testing.

Results. Of 4,735 eligible participants, 2,289 (48%) were not frail, 299 (6%) were frail, and 2,147 (45%) were of intermediate frailty status. Those who were frail were older (77.2 yrs) compared to those who were not frail (71.5 yrs) or intermediate (73.4 yrs) (p < .001). Frailty status was associated with clinical CVD and most strongly with congestive heart failure (odds ratio [OR] = 7.51 (95% confidence interval [CI] = 4.66–12.12). In those without a history of a CVD event (n = 1,259), frailty was associated with many noninvasive measures of CVD. Those with carotid stenosis >75% (adjusted OR = 3.41), ankle-arm index <0.8 (adjusted OR = 3.17) or 0.8–0.9 (adjusted OR = 2.01), major electrocardiography (ECG) abnormalities (adjusted OR = 1.58), greater left ventricular (LV) mass by echocardiography (adjusted OR = 1.16), and higher degree of infarct-like lesions in the brain (adjusted OR = 1.71), were more likely to be frail compared to those who were not frail. The overall associations of each of these noninvasive measures of CVD with frailty level were significant (all p < .05).

Conclusions. Cardiovascular disease was associated with an increased likelihood of frail health. In those with no history of CVD, the extent of underlying cardiovascular disease measured by carotid ultrasound and ankle–arm index, LV hypertrophy by ECG and echocardiography, was related to frailty. Infarct-like lesions in the brain on magnet resonance imaging were related to frailty as well.

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