Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Cardiovascular risk profile and frailty in Japanese outpatients: the Nambu Cohort Study

Hypertension Research volume 43, pages 817–823 (2020)Cite this article

Abstract

Epidemiologic findings indicate that unfavorable cardiovascular (CV) risk profiles, such as elevated systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and overweight, decelerate with aging. Few studies, however, have evaluated the association between the CV risk profile and frailty. We performed a cross-sectional analysis using the baseline data of a prospective cohort study. A total of 599 subjects (age, 78 [range: 70–83] years; men, 50%) were analyzed in an outpatient setting. Frailty was diagnosed in 37% of the patients according to the Kihon Checklist score. An unfavorable CV risk profile was associated with a lower risk of frailty. The adjusted odds ratios (ORs; 95% confidence interval [CI]) of each CV risk factor for frailty were as follows: SBP (each 10 mmHg increase) 0.83 (0.72–0.95), LDL-C (each 10 mg/dl increase) 0.96 (0.86–1.05), and body mass index (each 1 kg/m2 increase) 1.03 (0.97–1.10). Moreover, the total number of CV risk factors within the optimal range was significantly associated with the risk of frailty with the following ORs (95% CI): 1, 2.30 (0.75–8.69); 2, 3.22 (1.07–11.97); and 3, 4.79 (1.56–18.05) compared with patients having no risk factors within optimal levels (p for trend 0.008). Abnormal homeostasis might lead to lower levels of CV risk factors, which together result in “reverse metabolic syndrome.” Our findings indicate that a favorable CV risk profile is associated with frailty.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Xue Q-L. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27:1–15. https://doi.org/10.1016/j.cger.2010.08.009

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Satake S, Shimokata H, Senda K, Kondo I, Toba K. Validity of total Kihon Checklist Score for predicting the incidence of 3-year dependency and mortality in a community-dwelling older population. J Am Med Dir Assoc. 2017;18:552.e1–e6. https://doi.org/10.1016/j.jamda.2017.03.013

    Article  Google Scholar 

  3. Yamada Y, Nanri H, Watanabe Y, Yoshida T, Yokoyama K, Itoi A, et al. Prevalence of frailty assessed by fried and Kihon Checklist Indexes in a prospective cohort study: design and demographics of the Kyoto-Kameoka Longitudinal Study. J Am Med Dir Assoc. 2017;18:733.e7–e15. https://doi.org/10.1016/j.jamda.2017.02.022

    Article  Google Scholar 

  4. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56. https://doi.org/10.1093/gerona/56.3.M146

    Article  CAS  PubMed  Google Scholar 

  5. Gale CR, Cooper C, Sayer AA. Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing. Age Ageing. 2015;44:162–5. https://doi.org/10.1093/ageing/afu148

    Article  PubMed  Google Scholar 

  6. Afilalo J, Karunananthan S, Eisenberg MJ, Alexander KP, Bergman H. Role of frailty in patients with cardiovascular disease. Am J Cardiol. 2009;103:1616–21. https://doi.org/10.1016/j.amjcard.2009.01.375

    Article  PubMed  Google Scholar 

  7. Ramsay SE, Arianayagam DS, Whincup PH, Lennon LT, Cryer J, Papacosta AO, et al. Cardiovascular risk profile and frailty in a population-based study of older British men. Heart. 2015;101:616–22. https://doi.org/10.1136/heartjnl-2014-306472

    Article  CAS  PubMed  Google Scholar 

  8. Ricci NA, Pessoa GS, Ferriolli E, Dias RC, Perracini MR. Frailty and cardiovascular risk in community-dwelling elderly: a population-based study. Clin Intertv Aging. 2014;9:1677–85. https://doi.org/10.2147/CIA.S68642

    Article  Google Scholar 

  9. Wong TY, Massa MS, O’Halloran AM, Kenny RA, Clarke R. Cardiovascular risk factors and frailty in a cross-sectional study of older people: implications for prevention. Age Ageing. 2018;47:714–20. https://doi.org/10.1093/ageing/afy080

    Article  PubMed  PubMed Central  Google Scholar 

  10. Garre-Olmo J, Calvó-Perxas L, López-Pousa S, de Gracia Blanco M, Vilalta-Franch J. Prevalence of frailty phenotypes and risk of mortality in a community-dwelling elderly cohort. Age Ageing. 2013;42:46–51. https://doi.org/10.1093/ageing/afs047

    Article  PubMed  Google Scholar 

  11. Tavares DM, dos S, Colamego CG, Pegorari MS, Ferreira PC, dos S, et al. Cardiovascular risk factors associated with frailty syndrome among hospitalized elderly people: a cross-sectional study. Sao Paulo Med J. 2016;134:393–9. https://doi.org/10.1590/1516-3180.2016.0028010616

    Article  PubMed  Google Scholar 

  12. Hao Q, Song X, Yang M, Dong B, Rockwood K. Understanding risk in the oldest old: frailty and the metabolic syndrome in a chinese community sample aged 90+ years. J Nutr Health Aging. 2015;20:82–8. https://doi.org/10.1007/s12603-015-0553-5

    Article  Google Scholar 

  13. Testa G, Cacciatore F, Galizia G, Della-Morte D, Mazzella F, Russo S, et al. Charlson Comorbidity Index does not predict long-term mortality in elderly subjects with chronic heart failure. Age Ageing. 2009;38:734–40. https://doi.org/10.1093/ageing/afp165

    Article  PubMed  Google Scholar 

  14. Colucci WS, Chen HH. Natriuretic peptide measurement in heart failure - UpToDate. 2020. https://www.uptodate.com/contents/natriuretic-peptide-measurement-in-heart-failure.

  15. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK. et al. ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guideline. J Am Coll Cardiol. 2011;58:2020–45.

    Article  Google Scholar 

  16. Satake S, Senda K, Hong Y-J, Miura H, Endo H, Sakurai T, et al. Validity of the Kihon Checklist for assessing frailty status. Geriatr Gerontol Int. 2016;16:709–15. https://doi.org/10.1111/ggi.12543

    Article  PubMed  Google Scholar 

  17. Sergi G, Veronese N, Fontana L, De Rui M, Bolzetta F, Zambon S, et al. Pre-frailty and risk of cardiovascular disease in elderly men and women: the Pro.V.A. study. J Am Coll Cardiol. 2015;65:976–83. https://doi.org/10.1016/j.jacc.2014.12.040

    Article  PubMed  Google Scholar 

  18. Vaes B, Depoortere D, Van Pottelbergh G, Matheï C, Neto J, Degryse J. Association between traditional cardiovascular risk factors and mortality in the oldest old: untangling the role of frailty. BMC Geriatr. 2017;17:234. https://doi.org/10.1186/s12877-017-0626-x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Curcio F, Sasso G, Liguori I, Ferro G, Russo G, Cellurale M, et al. The reverse metabolic syndrome in the elderly: Is it a “catabolic” syndrome? Aging Clin Exp Res. 2018;30:547–54. https://doi.org/10.1007/s40520-017-0815-7

    Article  PubMed  Google Scholar 

  20. Taylor JO, Cornoni-Huntley J, Curb JD, Manton KG, Ostfeld AM, Scherr P, et al. Blood pressure and mortality risk in the elderly. Am J Epidemiol. 1991;134:489–501.

    Article  CAS  Google Scholar 

  21. Boshuizen HC, Izaks GJ, van Buuren S, Ligthart GJ. Blood pressure and mortality in elderly people aged 85 and older: community based study. BMJ. 1998;316:1780–4. https://doi.org/10.1136/BMJ.316.7147.1780

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med. 2012;172:1162–8. https://doi.org/10.1001/archinternmed.2012.2555

    Article  PubMed  PubMed Central  Google Scholar 

  23. Benetos A, Labat C, Rossignol P, Fay R, Rolland Y, Valbusa F, et al. Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: the PARTAGE study. JAMA Intern Med. 2015;175:989–95. https://doi.org/10.1001/jamainternmed.2014.8012

    Article  CAS  PubMed  Google Scholar 

  24. Rådholm K, Festin K, Falk M, Midlöv P, Mölstad S, Östgren CJ. Blood pressure and all-cause mortality: a prospective study of nursing home residents. Age Ageing. 2016;45:826–32. https://doi.org/10.1093/ageing/afw122

    Article  PubMed  Google Scholar 

  25. Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD. Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet. 2001;358:351–5. https://doi.org/10.1016/S0140-6736(01)05553-2

    Article  CAS  PubMed  Google Scholar 

  26. Tuikkala P, Hartikainen S, Korhonen MJ, Lavikainen P, Kettunen R, Sulkava R, et al. Serum total cholesterol levels and all-cause mortality in a home-dwelling elderly population: a six-year follow-up. Scand J Prim Health Care. 2010;28:121–7. https://doi.org/10.3109/02813432.2010.487371

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mattila K, Haavisto M, Rajala S. Body mass index and mortality in the elderly. Br Med J (Clin Res Ed). 1986;292:867–8.

    Article  CAS  Google Scholar 

  28. Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL. The effect of age on the association between body-mass index and mortality. N Engl J Med. 1998;338:1–7. https://doi.org/10.1056/NEJM199801013380101

    Article  CAS  PubMed  Google Scholar 

  29. Ding M, Hu Y, Schwartz J, Koh W-P, Yuan J-M, Sesso HD, et al. Delineation of body mass index trajectory predicting lowest risk of mortality in U.S. men using generalized additive mixed model. Ann Epidemiol. 2016;26:698–703.e2. https://doi.org/10.1016/j.annepidem.2016.08.006

    Article  PubMed  Google Scholar 

  30. Charlton J, Ravindrarajah R, Hamada S, Jackson SH, Gulliford MC. Trajectory of total cholesterol in the last years of life over age 80 years: cohort study of 99,758 participants. J Gerontol A Biol Sci Med Sci. 2018;73:1083–9. https://doi.org/10.1093/gerona/glx184

    Article  PubMed  Google Scholar 

  31. Ravindrarajah R, Hazra NC, Hamada S, Charlton J, Jackson SHD, Dregan A, et al. Systolic blood pressure trajectory, frailty, and all-cause mortality >80 years of age: cohort study using electronic health records. Circulation. 2017;135:2357–68. https://doi.org/10.1161/CIRCULATIONAHA.116.026687

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ferrucci L, Cavazzini C, Corsi A, Bartali B, Russo CR, Lauretani F, et al. Biomarkers of frailty in older persons. J Endocrinol Investig. 2002;25:10–5.

    Article  CAS  Google Scholar 

  33. Kalantar-Zadeh K, Horwich TB, Oreopoulos A, Kovesdy CP, Younessi H, Anker SD, et al. Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care. 2007;10:433–42. https://doi.org/10.1097/MCO.0b013e3281a30594

    Article  PubMed  Google Scholar 

  34. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752–62. https://doi.org/10.1016/S0140-6736(12)62167-9

    Article  PubMed  Google Scholar 

  35. Jackson AS, Janssen I, Sui X, Church TS, Blair SN. Longitudinal changes in body composition associated with healthy ageing: men, aged 20-96 years. Br J Nutr. 2012;107:1085–91. https://doi.org/10.1017/S0007114511003886

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Ms. Makiko. Chinen, Ms. Masae Toma, Ms. Mitsue Nakajo, Ms. Asuka Kina, Ms. Minako Kikuyama, Ms. Megumi Ishiki, Ms. Mizuki Ohkata, Ms. Miwa Sunagawa, Ms. Minako Yamaniha, Ms. Masami Fukuyama, Ms. Minatsu Yamashiro, Ms. Megumi Kawabata, Ms. Sawako Sakugawa, Ms. Yuka Shimazaki, Ms. Kaori Unten, Ms. Mitsue Kuwae, Ms. Shoko Nagamine, Ms. Aya Henzan, Ms. Sayuri Matsumura, Ms. Yuko Kohno, Ms. Yoko Karakasa, and Ms. Rie Kubota for their dedicated work and Mr. Makoto Ohmine for retrieving the data. The authors extend their sincere appreciation to Mr. Kazuhide Nizato and Ms. Kuniko Inoue for their dedicated assistance.

Author information

Authors and Affiliations

  1. Matsuoka Clinic, Tomigusuku, Japan

    Mitsuteru Matsuoka

  2. Cardiovascular Medicine, Nambu Hospital, Itoman, Japan

    Taku Inoue, Tetsuji Shinjo & Asuka Miiji

  3. Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan

    Taku Inoue & Hisatomi Arima

  4. Cardiovascular Medicine, Tomishiro Central Hospital, Tomigusuku, Japan

    Masahiro Tamashiro, Kageyuki Oba & Osamu Arasaki

Authors
  1. Mitsuteru Matsuoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Taku Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tetsuji Shinjo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Asuka Miiji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masahiro Tamashiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kageyuki Oba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hisatomi Arima
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Osamu Arasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TI performed the statistical analysis and drafted the manuscript. HA also performed the statistical analysis and participated in drafting the manuscript. TS, MT, and OA participated in the study design. AM and KO participated in study coordination. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Taku Inoue.

Ethics declarations

Conflict of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsuoka, M., Inoue, T., Shinjo, T. et al. Cardiovascular risk profile and frailty in Japanese outpatients: the Nambu Cohort Study. Hypertens Res 43, 817–823 (2020). https://doi.org/10.1038/s41440-020-0427-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-020-0427-z

Keywords

This article is cited by

Search

Advanced search

Quick links