03882nas a2200481 4500008004100000022001400041245006900055210006800124260001300192300001200205490000700217520256500224653000902789653001002798653000802808653003002816653001902846653001002865653002802875653002802903653002402931653003002955653001902985653002103004653002403025653001803049653001803067653001803085653001103103653003103114653001803145653002203163100001703185700002003202700001903222700001703241700001403258700001303272700001803285700001503303710004703318856003503365 2001 eng d a1079-500600aAssociations of subclinical cardiovascular disease with frailty.0 aAssociations of subclinical cardiovascular disease with frailty c2001 Mar aM158-660 v563 a

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 (1 or 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.

10aAged10aAnkle10aArm10aBlack or African American10aBlood Pressure10aBrain10aCardiovascular Diseases10aCarotid Artery Diseases10aCerebral Infarction10aCerebrovascular Disorders10aCohort Studies10aEchocardiography10aElectrocardiography10aFrail Elderly10aHealth Status10aHeart Failure10aHumans10aMagnetic Resonance Imaging10aUnited States10aVascular Diseases1 aNewman, A, B1 aGottdiener, J S1 aMcBurnie, M, A1 aHirsch, C, H1 aKop, W, J1 aTracy, R1 aWalston, J, D1 aFried, L P1 aCardiovascular Health Study Research Group uhttps://chs-nhlbi.org/node/640