Department of Neurosurgery (D.R., A.B.K., N.S., C.C.M.), Yale School of Medicine, New Haven, CT.
Department of Neurology (D.R., J.N.A., C.R., A.d.H., R.S., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT.
Stroke. 2023 Jun;54(6):1538-1547. doi: 10.1161/STROKEAHA.122.041891. Epub 2023 May 22.
Frailty is a prevalent state associated with several aging-related traits and conditions. The relationship between frailty and stroke remains understudied. Here we aim to investigate whether the hospital frailty risk score (HFRS) is associated with the risk of stroke and determine whether a significant association between genetically determined frailty and stroke exists.
Observational study using data from research program and Mendelian Randomization analyses.
Participants from with available electronic health records were selected for analysis. began national enrollment in 2018 and is expected to continue for at least 10 years. is recruiting members of groups that have traditionally been underrepresented in research. All participants provided informed consent at the time of enrollment, and the date of consent was recorded for each participant. Incident stroke was defined as stroke event happening on or after the date of consent to the study HFRS was measured with a 3-year look-back period before the date of consent for stroke risk. The HFRS was stratified into 4 categories: no-frailty (HFRS=0), low (HFRS ≥1 and <5), intermediate (≥5 and <15), and high (HFRS ≥15). Last, we implemented Mendelian Randomization analyses to evaluate whether genetically determined frailty is associated with stroke risk.
Two hundred fifty-three thousand two hundred twenty-six participants were at risk of stroke. In multivariable analyses, frailty status was significantly associated with risk of any (ischemic or hemorrhagic) stroke following a dose-response way: not-frail versus low HFRS (HR, 4.9 [CI, 3.5-6.8]; <0.001), not-frail versus intermediate HFRS (HR, 11.4 [CI, 8.3-15.7]; <0.001) and not-frail versus high HFRS (HR, 42.8 [CI, 31.2-58.6]; <0.001). We found similar associations when evaluating ischemic and hemorrhagic stroke separately ( value for all comparisons <0.05). Mendelian Randomization confirmed this association by indicating that genetically determined frailty was independently associated with risk of any stroke (OR, 1.45 [95% CI, 1.15-1.84]; =0.002).
Frailty, based on the HFRS was associated with higher risk of any stroke. Mendelian Randomization analyses confirmed this association providing evidence to support a causal relationship.
衰弱是一种与多种与衰老相关的特征和状况相关的普遍状态。衰弱与中风之间的关系仍在研究之中。在这里，我们旨在研究医院衰弱风险评分（HFRS）是否与中风风险相关，并确定是否存在与遗传决定的衰弱和中风之间存在显著关联。
使用研究计划和孟德尔随机化分析的数据进行观察性研究。
从参加研究计划且有可用电子健康记录的参与者中选择进行分析。该研究于 2018 年开始全国招募，预计至少持续 10 年。该研究正在招募在研究中代表性不足的群体的成员。所有参与者在入组时均签署了知情同意书，并为每位参与者记录了同意书的日期。中风事件被定义为同意书日期之后或之后发生的中风事件，HFRS 是在同意书日期之前的 3 年回顾期内测量的，以评估中风风险。HFRS 分为 4 个类别：无衰弱（HFRS=0）、低（HFRS≥1 且 <5）、中（≥5 且 <15）和高（HFRS≥15）。最后，我们实施了孟德尔随机化分析，以评估遗传决定的衰弱是否与中风风险相关。
有 253226 名参与者有中风风险。在多变量分析中，衰弱状况与任何（缺血性或出血性）中风风险呈显著剂量反应关系：无衰弱与低 HFRS（HR，4.9 [CI，3.5-6.8]；<0.001）、无衰弱与中 HFRS（HR，11.4 [CI，8.3-15.7]；<0.001）和无衰弱与高 HFRS（HR，42.8 [CI，31.2-58.6]；<0.001）。当分别评估缺血性和出血性中风时，我们发现了类似的关联（所有比较的 值<0.05）。孟德尔随机化通过表明遗传决定的衰弱与任何中风的风险独立相关（OR，1.45 [95% CI，1.15-1.84]；=0.002）证实了这种关联。
基于 HFRS 的衰弱与任何中风的风险增加相关。孟德尔随机化分析证实了这种关联，提供了支持因果关系的证据。
