UCL MRC Unit for Lifelong Health and Ageing, University College London, Fitzrovia, London, WC1E 7HB, UK.
UCL Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK.
Sci Rep. 2021 Mar 18;11(1):6272. doi: 10.1038/s41598-021-85435-8.
A frailty index (FI) counts health deficit accumulation. Besides traditional risk factors, it is unknown whether the health deficit burden is related to the appearance of cardiovascular disease. In order to answer this question, the same multidimensional FI looking at 45-health deficits was serially calculated per participant at 4 time periods (0-16, 19-44, 45-54 and 60-64 years) using data from the 1946 Medical Research Council (MRC) British National Survey of Health and Development (NSHD)-the world's longest running longitudinal birth cohort with continuous follow-up. From these the mean and total FI for the life-course, and the step change in deficit accumulation from one time period to another was derived. Echocardiographic data at 60-64 years provided: ejection fraction (EF), left ventricular mass indexed to body surface area (LVmassi, BSA), myocardial contraction fraction indexed to BSA (MCF) and E/e'. Generalized linear models assessed the association between FIs and echocardiographic parameters after adjustment for relevant covariates. 1375 participants were included. For each single new deficit accumulated at any one of the 4 time periods, LVmass increased by 0.91-1.44% (p < 0.013), while MCF decreased by 0.6-1.02% (p < 0.05). A unit increase in FI at age 45-54 and 60-64, decreased EF by 11-12% (p < 0.013). A single health deficit step change occurring between 60 and 64 years and one of the earlier time periods, translated into higher odds (2.1-78.5, p < 0.020) of elevated LV filling pressure. Thus, the accumulation of health deficits at any time period of the life-course associates with a maladaptive cardiac phenotype in older age, dominated by myocardial hypertrophy and poorer function.
衰弱指数（FI）计算健康缺陷的积累。除了传统的风险因素外，尚不清楚健康缺陷负担与心血管疾病的出现是否有关。为了回答这个问题，使用来自 1946 年医学研究委员会（MRC）英国国家卫生与发展调查（NSHD）的数据，对每个参与者在 4 个时期（0-16 岁、19-44 岁、45-54 岁和 60-64 岁）进行了相同的多维 FI 计算，这是世界上最长的连续纵向出生队列，具有连续随访。由此得出了一生中的平均和总 FI，以及从一个时期到另一个时期的缺陷积累的阶跃变化。60-64 岁时的超声心动图数据提供了射血分数（EF）、左心室质量与体表面积指数（LVmassi，BSA）、心肌收缩分数与 BSA 指数（MCF）和 E/e'。广义线性模型评估了 FI 与超声心动图参数之间的关联，调整了相关协变量。共纳入 1375 名参与者。在 4 个时期中的任何一个时期新累积的每个单一缺陷，LVmass 增加 0.91-1.44%（p<0.013），而 MCF 降低 0.6-1.02%（p<0.05）。45-54 岁和 60-64 岁时 FI 的单位增加会使 EF 降低 11-12%（p<0.013）。60-64 岁和较早时期之间发生的单一健康缺陷阶跃变化会导致更高的左室充盈压升高的几率（2.1-78.5，p<0.020）。因此，一生中任何时期的健康缺陷积累都与老年时适应性较差的心脏表型相关，主要表现为心肌肥厚和功能较差。
