Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.
J Gerontol A Biol Sci Med Sci. 2018 Nov 10;73(12):1714-1721. doi: 10.1093/gerona/glx253.
Recent studies suggest that impaired cerebrovascular reactivity (CVR), a marker of cerebral microvascular damage, is associated with a higher risk of stroke, cognitive decline, and mortality. We tested whether abnormal cerebrovascular status is associated with late-life frailty among men with pre-existing cardiovascular disease.
A subset of 327 men (mean age at baseline 56.7 ± 6.5 years) who previously participated in the Bezafibrate Infarction Prevention (BIP) trial (1990-1997) and then in the BIP Neurocognitive Study underwent a neurovascular evaluation 14.6 ± 1.9 years after baseline (T1) and were evaluated for frailty 19.9 ± 1.0 years after baseline (T2). CVR was measured at T1 using the breath-holding index and carotid large-vessel disease using ultrasound. Frailty status was measured at T2 according to the physical phenotype developed by Fried. Patients were categorized into CVR tertiles with cutoff points at ≤0.57, 0.58-0.94, and ≥0.95 and also as normal or impaired (<0.69) CVR. We assessed the change in the odds of being in the advanced rank of frailty status (normal, prefrail, and frail) using ordered logistic regression.
After adjustment, the estimated OR (95% confidence intervals) for increasing frailty in the lower tertile was 1.94 (1.09-3.46) and in the middle tertile 1.24 (0.70-2.19), compared with the higher CVR tertile. The estimated OR for increasing frailty for patients with impaired vs. normal CVR was 1.76 (1.11-2.80).
These findings provide support that cerebral microvascular dysfunction among patients with pre-existing cardiovascular disease is related to prefrailty and frailty and suggest an added value of assessing the cerebral vascular functional status for identifying patients at-risk of developing frailty.
最近的研究表明，脑血管反应性（CVR）受损，即脑微血管损伤的标志物，与中风、认知能力下降和死亡率风险增加有关。我们测试了在存在心血管疾病的男性中，异常的脑血管状态是否与晚年虚弱有关。
先前参加过贝扎贝特梗塞预防（BIP）试验（1990-1997 年）的 327 名男性中的一个亚组（基线时的平均年龄为 56.7 ± 6.5 岁），然后参加了 BIP 神经认知研究，在基线后 14.6 ± 1.9 年（T1）进行了神经血管评估，并在基线后 19.9 ± 1.0 年（T2）评估了虚弱状态。在 T1 时使用屏气指数测量 CVR，使用超声测量颈动脉大血管疾病。在 T2 时根据 Fried 开发的物理表型测量虚弱状态。患者根据 CVR 三分位数进行分类，截断值分别为≤0.57、0.58-0.94 和≥0.95，也分为正常或受损（<0.69）CVR。我们使用有序逻辑回归评估处于虚弱状态（正常、虚弱前期和虚弱）高级别几率的变化。
调整后，较低三分位数的虚弱程度增加的估计比值比（95%置信区间）为 1.94（1.09-3.46），中间三分位数为 1.24（0.70-2.19），与较高 CVR 三分位数相比。与正常 CVR 相比，受损 CVR 患者的虚弱程度增加的估计比值比为 1.76（1.11-2.80）。
这些发现为患有先前存在的心血管疾病的患者的脑微血管功能障碍与虚弱前期和虚弱有关提供了支持，并表明评估脑血管功能状态对于识别处于虚弱风险中的患者具有附加价值。
