Kleipool Emma Ef, Hoogendijk Emiel O, Trappenburg Marijke C, Handoko M Louis, Huisman Martijn, Peters Mike Jl, Muller Majon
1Department of Internal medicine and Geriatrics, VU University Medical Center, 1081 HV Amsterdam, The Netherlands.
2Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
Aging Dis. 2018 Jun 1;9(3):489-497. doi: 10.14336/AD.2017.1125. eCollection 2018 Jun.
Cardiovascular disease (CVD) has been associated with an increased risk of frailty, but the direction of the association remains unclear. This study set out to examine the bidirectional longitudinal association between CVD and frailty over an extended period of time. Data are from 1432 older adults (aged 65-88yrs) of the Longitudinal Aging Study Amsterdam (LASA), who were followed for 17 years. At baseline and follow-up, CVD was assessed through self-report, medication use and medical records, and classified as angina pectoris, myocardial infarction, heart failure (HF), stroke, and peripheral artery disease. Throughout the study, frailty was assessed using Fried's frailty criteria. Cox regression models showed that patients with HF had an increased frailty risk (HR 2.7; 95%CI: 1.5-5.1) after a median follow-up of 8.4 yrs. This finding was independent of potential confounders (age, sex, several comorbidities). Examinations of the reverse association revealed that frail older adults were not at risk of incident CVD. Of all older adults with CVD, those with HF have an increased risk of frailty and frail older adults do not have an increased risk of CVD. Our findings emphasize the need for cardiac rehabilitation programs evaluating the effect of physical exercise programs in order to prevent frailty and therewith improve quality of life and independence of care in CVD patients.
心血管疾病（CVD）与衰弱风险增加有关，但这种关联的方向仍不明确。本研究旨在探讨CVD与衰弱在较长时间内的双向纵向关联。数据来自阿姆斯特丹纵向衰老研究（LASA）的1432名老年人（年龄在65 - 88岁之间），他们被随访了17年。在基线和随访时，通过自我报告、药物使用和医疗记录评估CVD，并将其分类为心绞痛、心肌梗死、心力衰竭（HF）、中风和外周动脉疾病。在整个研究过程中，使用弗里德衰弱标准评估衰弱情况。Cox回归模型显示，在中位随访8.4年后，HF患者的衰弱风险增加（风险比2.7；95%置信区间：1.5 - 5.1）。这一发现独立于潜在的混杂因素（年龄、性别、多种合并症）。对反向关联的检查显示，衰弱的老年人没有发生CVD的风险。在所有患有CVD的老年人中，HF患者的衰弱风险增加，而衰弱的老年人没有CVD风险增加。我们的研究结果强调了心脏康复计划评估体育锻炼计划效果的必要性，以预防衰弱，从而改善CVD患者的生活质量和护理独立性。
