02827nas a2200349 4500008004100000022001400041245009900055210006900154260001600223300001100239490000800250520185800258653000902116653002202125653001102147653001802158653001502176653001102191653001702202653002302219653000902242653002302251653002402274100002402298700002002322700001702342700001802359700002202377700002302399700002002422856003502442 2007 eng d a0003-992600aInsulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study.0 aInsulin resistance and inflammation as precursors of frailty the c2007 Apr 09 a635-410 v1673 a

BACKGROUND: Our research group has previously shown that the geriatric syndrome of frailty is associated with features of the metabolic syndrome (MetS) on cross-sectional analysis.

METHODS: To test whether MetS and its physiologic determinants-insulin resistance as measured by homeostasis model assessment score (IR-HOMA), increased inflammation and coagulation factor levels, and elevated blood pressure-are associated with incident frailty, we studied a subcohort of participants from the Cardiovascular Health Study observed from 1989/1990 through 1998/1999: 3141 community-dwelling adults, aged 69 to 74 years, without frailty and illnesses that increase inflammation markers or mimic frailty. The association of baseline MetS, IR-HOMA, levels of inflammation and coagulation factors, and systolic blood pressure (SBP) with time to onset of frailty was adjusted for demographic and psychosocial factors and incident events. Our main outcome measure was incident frailty.

RESULTS: Metabolic syndrome was not significantly associated with incident frailty (hazard ratio, 1.16 (95% confidence interval [CI], 0.85-1.57). On the other hand, IR-HOMA and C-reactive protein levels were associated with incident frailty: for every standard deviation increment the hazard ratio for frailty was 1.15 (95% CI, 1.02-1.31) and 1.16 (95% CI, 1.02-1.32), respectively. The white blood cell count and factor VIIIc levels had a borderline association. Elevated systolic blood pressure had no association. Similar trends were found for incident prefrailty, a condition that precedes frailty.

CONCLUSIONS: Two physiologic components of MetS- IR-HOMA and inflammation-are associated with incident frailty. Based on these results, IR-HOMA can be considered part of a larger process that leads to generalized decline.

10aAged10aAged, 80 and over10aFemale10aFrail Elderly10aGeriatrics10aHumans10aInflammation10aInsulin Resistance10aMale10aMetabolic Syndrome10aProspective Studies1 aBarzilay, Joshua, I1 aBlaum, Caroline1 aMoore, Tisha1 aXue, Qian, Li1 aHirsch, Calvin, H1 aWalston, Jeremy, D1 aFried, Linda, P uhttps://chs-nhlbi.org/node/955