Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis |
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| Institution: | 1. Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy;2. Institute for Clinical Research and Education in Medicine (IREM), Padova, Italy;3. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;4. Physiotherapy Department, South London and Maudsley NHS FoundationTrust, Denmark Hill, London SE5 8AZ, United Kingdom;5. Health Service and Population Research Department, Institute of Psychiatry, King''s College London, De Crespigny Park, London SE5 8AF, United Kingdom;6. Department of Neurosciences, University of Padova, Padova, Italy;7. National Health Care System, Monselice, Padova Local Unit ULSS 17, Italy;8. Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy;9. Surgical Pathology Unit, Santa Chiara Hospital, Trento, Italy;10. National Research Council, Neuroscience Institute—Aging Branch, Padova, Italy;11. South Oaks Hospital, Northwell Health,400 Sunsrise Highway, Amityville, NY 11701, USA;12. Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA;13. Division of Geriatrics and Nutritional Sciences and Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA;14. Department of Clinical and Experimental Sciences, Brescia University, Brescia, Italy;15. CEINGE Biotecnologie Avanzate, Napoli, Italy;p. University of Helsinki and Helsinki University Hospital, Helsinki, Finland;q. University of Oulu,Center for Life Course Health Research, Oulu, Finland;r. Centre de Recherche Inserm, Bordeaux, France;s. University Victor Segalen Bordeaux 2, Bordeaux, France;t. CMRR Paris Nord AP-HP, Groupe Hospitalier Lariboisière Fernand-Widal Saint-Louis, INSERM, U942, Université Paris Diderot, Sorbonne Paris Cité, UMRS 942, Paris, France;u. CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France;v. University of Bordeaux, Neuroepidemiology, UMR897, Bordeaux, France;w. University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Division of Chronic Disease Epidemiology, Hirschengraben 84, CH-8001 Zurich, Switzerland;x. Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy;y. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy;z. Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil;1. Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, (CIBER-CV), Spain;2. Clinical Epidemiology and Biometric Unit, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy;3. The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA;4. Hofstra Northwell School of Medicine, Hempstead, NY, USA;5. The Feinstein Institute for Medical Research, Manhasset, NY, USA;6. Albert Einstein College of Medicine, Bronx, NY, USA;7. Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom;1. Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy;2. Institute for Clinical Research and Education in Medicine (IREM), Padova, Italy;3. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;4. Physiotherapy Department, South London and Maudsley NHS FoundationTrust, Denmark Hill, London SE5 8AZ, United Kingdom;5. Health Service and Population Research Department, Institute of Psychiatry, King''s College London, De Crespigny Park, London SE5 8AF, United Kingdom;6. Department of Neurosciences, University of Padova, Padova, Italy;7. National Health Care System, Monselice, Padova Local Unit ULSS 17, Italy;8. Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy;9. Surgical Pathology Unit, Santa Chiara Hospital, Trento, Italy;10. National Research Council, Neuroscience Institute—Aging Branch, Padova, Italy;11. South Oaks Hospital, Northwell Health,400 Sunsrise Highway, Amityville, NY 11701, USA;12. Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA;13. Division of Geriatrics and Nutritional Sciences and Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA;14. Department of Clinical and Experimental Sciences, Brescia University, Brescia, Italy;15. CEINGE Biotecnologie Avanzate, Napoli, Italy;p. University of Helsinki and Helsinki University Hospital, Helsinki, Finland;q. University of Oulu,Center for Life Course Health Research, Oulu, Finland;r. Centre de Recherche Inserm, Bordeaux, France;s. University Victor Segalen Bordeaux 2, Bordeaux, France;t. CMRR Paris Nord AP-HP, Groupe Hospitalier Lariboisière Fernand-Widal Saint-Louis, INSERM, U942, Université Paris Diderot, Sorbonne Paris Cité, UMRS 942, Paris, France;u. CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France;v. University of Bordeaux, Neuroepidemiology, UMR897, Bordeaux, France;w. University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Division of Chronic Disease Epidemiology, Hirschengraben 84, CH-8001 Zurich, Switzerland;x. Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy;y. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy;z. Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil;1. Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, (CIBER-CV), Spain;2. Clinical Epidemiology and Biometric Unit, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy;3. The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA;4. Hofstra Northwell School of Medicine, Hempstead, NY, USA;5. The Feinstein Institute for Medical Research, Manhasset, NY, USA;6. Albert Einstein College of Medicine, Bronx, NY, USA;7. Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom;1. Faculty of Education and Health, University of Greenwich, London SE9 2UG, UK;2. Acaster Consulting, London SE3 7HU, UK;3. epartment of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, USA;4. Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY 11549, USA;5. Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil;6. Institute for Clinical Research and Education in Medicine, I.R.E.M., Padova, Italy;7. Department of Primary Care and Public Health Sciences, King''s College London, London SE1 3QD, UK;8. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK;9. Health Service and Population Research Department, King''s College London, London SE5 8AF, UK;1. National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy;2. Institute for clinical Research and Education in Medicine, IREM, Padua, Italy;3. Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy;4. South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom;5. Faculty of Health, Social care and Education, Anglia Ruskin University, Chelmsford, United Kingdom;6. Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King''s College London, London, United Kingdom;7. Department of Neurosciences, University of Padova, Padova, Italy;8. Primary Care Department, Azienda ULSS20 Verona, Verona, Italy;9. Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy;1. Cardiogeriatric Unit, Cardiology Division, Federal University of São Paulo, São Paulo, Brazil;2. Cardiology Division, Federal University of São Paulo, São Paulo, Brazil;3. Physical Medicine and Rehabilitation, Federal University of São Paulo, São Paulo, Brazil;4. Statistics Department, Federal University of São Paulo, São Paulo, Brazil;1. Gerontology Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium;2. Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium;3. Geriatrics Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium;4. Rehabilitation Sciences Research Department (RERE), Vrije Universiteit Brussel, Brussels, Belgium;5. Fundamental Rights and Constitutionalism Research Group (FRC), Vrije Universiteit Brussel (VUB), Elsene, Belgium;6. Experimental Anatomy (EXAN), Vrije Universiteit Brussel (VUB), Brussels, Belgium;7. Department of Electronics and Informatics ETRO, Vrije Universiteit Brussel (VUB), Elsene, Belgium;1. Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria;2. Department of Sport Science, University of Vienna, Vienna, Austria |
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| Abstract: | Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any-type CVD in the frail (HR = 1.70 95%CI, 1.18–2.45]; I2 = 66%) and pre-frail (HR = 1.23 95%CI, 1.07–1.36]; I2 = 67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults. |
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| Keywords: | Frailty Cardiovascular disease Meta-analysis |
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