Xu Zihan, Wang Yingbai, Li Xiaolin, Hou Xuefei, Yue Suru, Wang Jia, Ye Shicai, Wu Jiayuan
Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, China.
Department of Gastroenterology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, China.
BMC Cardiovasc Disord. 2025 Feb 20;25(1):118. doi: 10.1186/s12872-025-04567-1.
Frailty and inflammation may increase the risk of cardiovascular disease (CVD), but their interacting and joint effects on CVDs remain unclear. To explore the interaction effects of frailty and inflammation on CVDs and the role of inflammation in the relationship between frailty and CVDs to provide better understanding of the underlying pathogenesis of CVD.
A total of 220,608 initially CVD-free participants were recruited from the UK Biobank database and were categorized into non-frailty, pre-frailty, and frailty groups based on Fried's criteria. The participants were also grouped according to the low-grade inflammation (INFLA) score and its components: the neutrophil-lymphocyte ratio, C-reactive protein, white blood cell count, and platelet count. Cox proportional hazards models with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to assess the effects of frailty phenotypes and inflammation on CVD risk. Mediation analysis was used to quantify the role of inflammation in the association between frailty and CVDs. The potential interactions between frailty and inflammation in terms of CVD risk were also evaluated using additive and multiplicative scales.
During a median follow-up of 13.3 years, 48,978 participants developed CVDs. After adjusting for various confounders, participants with pre-frailty and frailty had a higher risk of CVDs than those with non-frailty (HRs: 1.20 (95% CI: 1.18-1.23) and 1.80 (95% CI: 1.69-1.91), respectively). A higher risk of CVDs was observed among participants with moderate and high INFLA scores than those with low INFLA scores (HRs: 1.09 (95% CI: 1.07-1.12) and 1.27 (95% CI: 1.24-1.30), respectively). The INFLA score and its components had limited mediating effects in the association between frailty and CVDs. Significant interactions were observed between frailty phenotypes and INFLA scores on CVDs on the multiplicative scale but not on the additive scale.
Inflammation may amplify the harmful effect of frailty on the incidence of CVDs. Improving frailty alone might not substantially reduce the risk of CVDs, but effectively controlling inflammation might help to reduce the negative effects of frailty on cardiovascular health.
衰弱和炎症可能会增加心血管疾病（CVD）的风险，但它们对心血管疾病的相互作用和联合影响仍不清楚。为了探讨衰弱和炎症对心血管疾病的相互作用影响以及炎症在衰弱与心血管疾病关系中的作用，以更好地理解心血管疾病的潜在发病机制。
从英国生物银行数据库中招募了总共220,608名最初无心血管疾病的参与者，并根据弗里德标准将其分为非衰弱、衰弱前期和衰弱组。参与者还根据低度炎症（INFLA）评分及其组成部分进行分组：中性粒细胞与淋巴细胞比率、C反应蛋白、白细胞计数和血小板计数。使用带有风险比（HRs）和95%置信区间（CIs）的Cox比例风险模型来评估衰弱表型对心血管疾病风险的影响。中介分析用于量化炎症在衰弱与心血管疾病关联中的作用。还使用相加和相乘尺度评估了衰弱和炎症在心血管疾病风险方面的潜在相互作用。
在中位随访13.3年期间，48,978名参与者患上了心血管疾病。在调整各种混杂因素后，衰弱前期和衰弱的参与者患心血管疾病的风险高于非衰弱参与者（HRs分别为：1.20（95%CI：1.18 - 1.23）和1.80（95%CI：1.69 - 1.91））。与低INFLA评分的参与者相比，中度和高INFLA评分的参与者患心血管疾病的风险更高（HRs分别为：1.09（95%CI：1.07 - 1.12）和1.27（95%CI：1.24 - 1.30））。INFLA评分及其组成部分在衰弱与心血管疾病的关联中具有有限的中介作用。在相乘尺度上观察到衰弱表型与INFLA评分在心血管疾病方面存在显著相互作用，但在相加尺度上未观察到。
炎症可能会放大衰弱对心血管疾病发病率的有害影响。仅改善衰弱可能不会大幅降低心血管疾病风险，但有效控制炎症可能有助于减少衰弱对心血管健康的负面影响。
