Background/objectives

Subclinical cardiovascular disease (CVD) is cross-sectionally associated with frailty, but the relationship between subclinical CVD and incident frailty has not been reported. We aimed to assess this prospective association.

Design

Longitudinal analysis of data from the British Regional Heart Study, a prospective cohort study.

Participants

1057 men, aged 71–92 years, robust or pre-frail at baseline, and without a clinical diagnosis of CVD.

Measurements

Participants underwent baseline measurement of carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (CIMT), carotid distensibility coefficient (DC), and ankle-brachial pressure index (ABPI), and had questionnaire-based frailty assessment after three years. Frailty status was based on the Fried phenotype. Multivariate logistic regressions examined associations between incident frailty and tertile of cfPWV, CIMT, DC, and ABPI group (<0.9, 0.9–1.4, ≥1.4).

Results

865 men were examined and completed the 3 year follow-up questionnaire, of whom 78 became frail. Adjusted for age, prefrailty, body mass index, diabetes, smoking, atrial fibrillation, blood pressure, renal function, and incident CVD, higher CIMT was associated with greater odds of incident frailty (2nd tertile OR 1.62, 95% CI 0.78–3.35, 3rd tertile OR 2.61, 95% CI 1.30–5.23, p = 0.007, trend p = 0.006). cfPWV showed a weaker, non-significant association (2nd tertile OR 1.79, 95% CI 0.85–3.78, 3rd tertile OR 1.73, OR 0.81–3.72, p = 0.16, trend p = 0.20). There was no clear association between incident frailty and DC or ABPI. In subgroup analyses, CIMT was significantly associated with incident frailty in men ≥80 years (3rd tertile OR 6.99, 95%CI 1.42–34.5), but not in men aged 75–80 or < 75 years.

Conclusion

Subclinical CVD, as measured by CIMT, is associated with greater risk of incident frailty in older men over three year follow-up, independent of the development of clinically-apparent stroke, heart failure, or myocardial infarction, and may be a modifiable risk factor for frailty. This association may be stronger in very old age.

中文翻译：

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亚临床心血管疾病和发生衰弱的风险：英国区域心脏研究

背景/目标

亚临床心血管疾病 (CVD) 在横截面上与衰弱相关，但亚临床 CVD 与突发衰弱之间的关系尚未见报道。我们旨在评估这种前瞻性关联。

设计

前瞻性队列研究英国区域心脏研究数据的纵向分析。

参与者

1057 名男性，年龄在 71-92 岁之间，基线时身体强壮或体弱，并且没有临床诊断为 CVD。

测量

参与者接受了颈股动脉脉搏波速度（cfPWV）、颈动脉内膜中层厚度（CIMT）、颈动脉扩张系数（DC）和踝臂压力指数（ABPI）的基线测量，并在三周后进行基于问卷的虚弱评估年。虚弱状态基于 Fried 表型。多变量逻辑回归检查了 cfPWV、CIMT、DC 和 ABPI 组（<0.9, 0.9–1.4, ≥1.4）的衰弱和三分位数之间的关联。

结果

865 名男性接受了检查并完成了 3 年的随访问卷，其中 78 人变得虚弱。调整年龄、体弱前体质指数、糖尿病、吸烟、心房颤动、血压、肾功能和心血管疾病事件后，较高的 CIMT 与较高的体弱事件发生率相关（第二三分位数 OR 1.62，95% CI 0.78-3.35，第三个三分位数 OR 2.61, 95% CI 1.30–5.23, p  = 0.007, 趋势p  = 0.006)。cfPWV 显示出较弱的非显着关联（第二个三分位数 OR 1.79, 95% CI 0.85-3.78, 第三个三分位数 OR 1.73, OR 0.81-3.72, p  = 0.16, 趋势p = 0.20)。事件衰弱与 DC 或 ABPI 之间没有明确的关联。在亚组分析中，CIMT 与 80 岁以上男性的衰弱事件显着相关（第三三分位数 OR 6.99，95% CI 1.42-34.5），但在 75-80 岁或 < 75 岁的男性中不相关。

结论

由 CIMT 测量的亚临床 CVD 与超过 3 年随访的老年男性发生虚弱的风险增加相关，与临床上明显的中风、心力衰竭或心肌梗塞的发展无关，并且可能是一个可改变的风险因素为虚弱。这种关联在非常年老时可能会更强。