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Pre-frailty raises risk for CVD in older adults
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Early, potentially reversible stages of frailty are associated with increased risk for CVD in older men and women, according to a study from the Journal of the American College of Cardiology.
Among the indicators of pre-frailty, slow gait speed was identified as the most accurate predictor of future CVD in this population.
For the Pro. V.A. study, researchers analyzed 1,567 participants aged 65 to 96 years who were free from frailty or disability at baseline. They examined the association between pre-frailty, defined as the presence of one or two of the five modified Fried criteria (unintentional weight loss, low physical activity level, weakness, exhaustion and slow gait speed) and incident CVD, defined as onset of CAD, HF, stroke, peripheral artery disease or CV mortality.
Pre-frailty and CVD risk
During a mean follow-up of 4.4 years, Giuseppe Sergi, MD, PhD, and colleagues observed that 551 participants developed CVD.
Compared with those who did not become frail, participants with one modified Fried criterion (HR = 1.25; 95% CI, 1.05-1.64) and two criteria (HR = 1.79; 95% CI, 1.27-2.52) had a higher risk for CVD, even after adjustment for traditional CVD risk factors, inflammatory markers and HbA1c levels.
Low energy expenditure (HR = 1.7; 95% CI, 1.07-3.5), exhaustion (HR = 1.53; 95% CI, 1.09-2.14) and slow gait speed (HR = 1.28; 95% CI, 1.03-1.71) were all independently associated with the onset of CVD, but unintentional weight loss and weakness were not.
The findings regarding slow gait speed are consistent with previous research, according to the researchers.
“In our population, a low gait speed may be better able than a weak handgrip to reflect systemic subclinical CV abnormalities and lesions, such as an abnormal [ankle-brachial index], left ventricular hypertrophy, carotid intima-media thickening and silent carotid plaques. Consistent with this idea, it has been reported that slow gait speed is a powerful predictor of hospitalization and post-operative morbidity and mortality in patients with CVD,” Sergi, from the geriatrics division of the department of medicine at the University of Padua, Padua, Italy, and colleagues wrote.
A vicious cycle
In a related editorial, Kelsey Flint, MD, from the division of cardiology at the University of Colorado School of Medicine, Aurora, Colo., noted that this study “supports the hypothesis that frailty contributes to the subsequent development of CVD by demonstrating that patients are at increased risk for CVD even before the full frailty phenotype manifests.”
Previous research had established that clinical and subclinical CVD is associated with increased risk for frailty, so “the evidence supporting a bidirectional causal relationship between frailty and CVD helps describe these two disease states as a vicious cycle, with the presence of one feeding the development of the other,” Flint wrote. “The results from Sergi et al suggest that any intervention aimed at breaking this vicious cycle may be successful by targeting patients earlier in the disease course (ie, patients with pre-frailty or subclinical CVD).”
Successful interventions may be “those designed to augment overall physiologic reserve and address vulnerabilities specific to CVD risk,” she wrote. – by Erik Swain
Disclosure: The researchers and Flint report no relevant financial disclosures.
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