The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, 3300 Gallows Road, I-465, Falls Church, VA 22042, USA.
Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
Eur Heart J. 2021 Oct 1;42(37):3856-3865. doi: 10.1093/eurheartj/ehab468.
Physical frailty is a commonly encountered geriatric syndrome among older adults without coronary heart disease (CHD). The impact of frailty on the incidence of long-term cardiovascular outcomes is not known.We aimed to evaluate the long-term association of frailty, measured by the Fried frailty phenotype, with all-cause-mortality and MACE among older adults without a history of CHD at baseline in the National Health and Aging Trends Study.
We used the National Health and Aging Trends Study, a prospective cohort study linked to a Medicare sample. Participants with a prior history of CHD were excluded. Frailty was measured during the baseline visit using the Fried physical frailty phenotype. Cardiovascular outcomes were assessed during a 6-year follow-up.Of the 4656 study participants, 3259 (70%) had no history of CHD 1 year prior to their baseline visit. Compared to those without frailty, subjects with frailty were older (mean age 82.1 vs. 75.1 years, P < 0.001), more likely to be female (68.3% vs. 54.9%, P < 0.001), and belong to an ethnic minority. The prevalence of hypertension, falls, disability, anxiety/depression, and multimorbidity was much higher in the frail and pre-frail than the non-frail participants. In a Cox time-to-event multivariable model and during 6-year follow-up, the incidences of death and of each individual cardiovascular outcomes were all significantly higher in the frail than in the non-frail patients including major adverse cardiovascular event (MACE) [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.53, 2.06], death (HR 2.70, 95% CI 2.16, 3.38), acute myocardial infarction (HR 1.95, 95% CI 1.31, 2.90), stroke (HR 1.71, 95% CI 1.34, 2.17), peripheral vascular disease (HR 1.80, 95% CI 1.44, 2.27), and coronary artery disease (HR 1.35, 95% CI 1.11, 1.65).
In patients without CHD, frailty is a risk factor for the development of MACEs. Efforts to identify frailty in patients without CHD and interventions to limit or reverse frailty status are needed and, if successful, may limit subsequent adverse cardiovascular events.
身体虚弱是无冠心病（CHD）老年人中常见的老年综合征。虚弱对长期心血管结局发生率的影响尚不清楚。我们旨在评估在国家健康与老龄化趋势研究中，无 CHD 病史的老年人在基线时使用 Fried 身体虚弱表型测量的虚弱与全因死亡率和主要不良心血管事件（MACE）之间的长期关联。
我们使用了一项前瞻性队列研究——国家健康与老龄化趋势研究，该研究与医疗保险样本相关联。排除了有 CHD 既往史的参与者。在基线就诊期间使用 Fried 身体虚弱表型测量虚弱。在 6 年的随访期间评估心血管结局。在 4656 名研究参与者中，有 3259 名（70%）在基线就诊前 1 年没有 CHD 病史。与无虚弱的受试者相比，虚弱的受试者年龄更大（平均年龄 82.1 岁比 75.1 岁，P<0.001），女性更多（68.3%比 54.9%，P<0.001），并且属于少数民族。与非虚弱参与者相比，虚弱和衰弱前患者的高血压、跌倒、残疾、焦虑/抑郁和多种合并症的患病率更高。在 Cox 时间事件多变量模型和 6 年随访期间，虚弱患者的死亡和每种心血管结局的发生率均明显高于非虚弱患者，包括主要不良心血管事件（MACE）[风险比（HR）1.77，95%置信区间（CI）1.53，2.06]、死亡（HR 2.70，95% CI 2.16，3.38）、急性心肌梗死（HR 1.95，95% CI 1.31，2.90）、中风（HR 1.71，95% CI 1.34，2.17）、外周血管疾病（HR 1.80，95% CI 1.44，2.27）和冠心病（HR 1.35，95% CI 1.11，1.65）。
在无 CHD 的患者中，虚弱是发生 MACE 的危险因素。需要努力识别无 CHD 患者的虚弱，并采取干预措施限制或逆转虚弱状态，如果成功，可能会限制随后的不良心血管事件。
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