Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.
PUCRI Heart and Vascular Health Research Center, Peking University, Shougang Hospital, Beijing, China.
J Cachexia Sarcopenia Muscle. 2023 Feb;14(1):596-605. doi: 10.1002/jcsm.13165. Epub 2022 Dec 26.
Frailty is a dynamic process that increases with ageing, while it remains unclear whether cardiovascular disease (CVD) risk algorithm could predict life course dynamic frailty trajectories, for example, the longitudinal patterns of how frailty evolves with time. We intended to examine the predictive utility of the Systemic Coronary Risk Estimation 2 (SCORE2) algorithm for life course accelerated frailty and physical function decline, in comparison with the precedent SCORE algorithm.
Longitudinal data regarding accumulation of deficits frailty index (FI) and physical function (grip strength, gait speed, peak expiratory flow and timed chair rises) were drawn from the English Longitudinal Study of Ageing (ELSA) and Health and Retirement Study (HRS), two nationally representative cohorts with community-dwelling adults aged ≥50 years. SCORE and SCORE2 were calculated at baselines following European Society of Cardiology guidelines. A group-based trajectory modelling approach was used for identifying potential life course frailty trajectories, based on 14- and 12-year FI data in the ELSA and HRS. Modified Poisson regression and linear mixed model were applied for analysing associations between SCORE2 with accelerated frailty trajectory and physical function decline, respectively. Receiver operating characteristic curve (ROC) analysis was conducted to evaluate predictive utility for accelerated frailty increase trajectory of SCORE and SCORE2, with the area under the curve (AUC) compared using the paired DeLong's test.
A total of 4834 participants from the ELSA and 7815 participants from the HRS were included (mean age: 64.0 ± 9.2 and 65.4 ± 9.9 years; men: 44.3% and 41.4%, respectively). Three frailty trajectories were consistently identified in both cohorts: (1) stable frailty increase (n = 3026 in ELSA and 4004 in HRS); (2) moderate frailty increase (n = 1325 in ELSA and 2955 in HRS); (3) accelerated frailty increase (n = 483 in ELSA and 856 in HRS). Each 10% increment in SCORE2 risk was associated with the higher risk of accelerated frailty increase (risk ratio [RR]: 3.58, 95% confidence interval [CI] [3.22, 3.98], P < 0.001 in ELSA; RR: 1.61, 95% CI [1.56, 1.67], P < 0.001 in HRS) and faster declines in all physical function measurements. SCORE2 algorithm showed good accuracy for predicting accelerated frailty increase (area under the curve [AUC] in ELSA: 0.759; HRS: 0.744), with better performance than the SCORE (AUC in ELSA: 0.729; HRS: 0.700) in both cohorts (P < 0.001 for comparison).
SCORE2 algorithm could serve good utility for predicting life course accelerated frailty increase and physical function decline among community-dwelling non-frail adults aged ≥50 years.
虚弱是一个随着年龄增长而加剧的动态过程，但目前尚不清楚心血管疾病 (CVD) 风险算法是否能够预测生命过程中动态虚弱轨迹，例如虚弱随时间演变的纵向模式。我们旨在研究系统性冠状动脉风险评估 2 型 (SCORE2) 算法对生命过程加速虚弱和身体功能下降的预测作用，与之前的 SCORE 算法相比。
从具有代表性的两个社区居住的成年人年龄≥50 岁的英国老龄化纵向研究 (ELSA) 和健康与退休研究 (HRS) 中提取关于累积缺陷虚弱指数 (FI) 和身体功能（握力、步态速度、呼气峰值流量和定时椅子上升）的纵向数据。按照欧洲心脏病学会指南在基线时计算 SCORE 和 SCORE2。使用基于 14 年和 12 年 FI 数据的基于群组的轨迹建模方法在 ELSA 和 HRS 中识别潜在的生命过程虚弱轨迹。应用修正泊松回归和线性混合模型分别分析 SCORE2 与加速虚弱轨迹和身体功能下降之间的关联。接收者操作特征曲线 (ROC) 分析用于评估 SCORE 和 SCORE2 对加速虚弱增加轨迹的预测效用，并使用配对 DeLong 检验比较曲线下面积 (AUC)。
共纳入来自 ELSA 的 4834 名参与者和来自 HRS 的 7815 名参与者（平均年龄：64.0±9.2 和 65.4±9.9 岁；男性：44.3%和 41.4%）。在两个队列中都一致确定了三种虚弱轨迹：（1）稳定的虚弱增加（ELSA 中有 3026 名，HRS 中有 4004 名）；（2）中度虚弱增加（ELSA 中有 1325 名，HRS 中有 2955 名）；（3）加速的虚弱增加（ELSA 中有 483 名，HRS 中有 856 名）。SCORE2 风险每增加 10%，加速虚弱增加的风险就会增加（风险比 [RR]：3.58，95%置信区间 [CI] [3.22，3.98]，P<0.001 在 ELSA；RR：1.61，95% CI [1.56，1.67]，P<0.001 在 HRS），所有身体功能测量的下降速度也会加快。SCORE2 算法在预测加速虚弱增加方面具有良好的准确性（ELSA 的曲线下面积 [AUC]：0.759；HRS：0.744），在两个队列中的表现均优于 SCORE（ELSA 的 AUC：0.729；HRS：0.700）（比较时 P<0.001）。
SCORE2 算法可用于预测≥50 岁社区居住非虚弱成年人的生命过程中加速虚弱增加和身体功能下降。
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