Zhang ZhengJun, Wu Peng, Yang Shaobin, Zhu Baozhen, Chen Dapeng, Li Xiaocheng, Wang Yarong, Yan Ning
Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China.
The First Clinical College of Ningxia Medical University, Yinchuan, China.
Front Public Health. 2025 May 7;13:1546647. doi: 10.3389/fpubh.2025.1546647. eCollection 2025.
Abdominal aortic calcification (AAC) is one of the earliest observed forms of atherosclerotic calcification and is crucial for early cardiovascular risk prediction. Frailty, a global clinical and public health challenge, is associated with increased risks of mortality, functional decline, and loss of independence. However, the relationship between the Frailty Index (FI) and AAC among middle-aged and older adults has yet to be explored.
This study analyzed data from 2013 to 2014 National Health and Nutrition Examination Survey (NHANES) cohort, focusing on individuals aged ≥ 40 years. The FI was calculated using a 49-item model to assess frailty status and participants were stratified into three groups: non-frail (FI ≤ 0.15), pre-frail (0.15 < FI ≤ 0.25), and frail (FI > 0.25). AAC was measured by dual-energy X-ray absorptiometry and quantified by Kauppila scores. Severe AAC was defined as an AAC score > 6. The relationship between FI and AAC was investigated using multivariable logistic regression, sensitivity analyses, and smoothing curve fitting. Subgroup analyses and interaction tests were conducted to assess the stability of this association across different populations.
A total of 2,572 participants were enrolled in this study. Following adjustment for potential confounders, FI exhibited a statistically significant positive association with both AAC score (β = 2.64, 95%CI = 1.20-4.08) and Severe AAC (OR = 6.36, 95%CI = 1.48-27.41). Similar trends ( for trend < 0.05) were observed when FI was analyzed as a categorical variable. Smooth curve fitting and subgroup analysis were used to investigate the relationship between baseline FI Z-score and AAC score and Severe AAC. Interestingly, we found that the FI Z-score was linearly related to the occurrence of severe AAC, while it was nonlinearly related to the AAC score. The FI-Z score was positively associated with the likelihood of AAC score before the breakpoint ( = 0.78), but not significant after the breakpoint. The association between FI-Z score and Severe AAC was stable in the different subgroups (all for interaction > 0.05).
Our study indicated a stable positive correlation between FI and AAC. FI may serve as a biomarker for early subclinical atherosclerosis detection in middle-aged and older US adults.
腹主动脉钙化（AAC）是最早观察到的动脉粥样硬化钙化形式之一，对早期心血管风险预测至关重要。衰弱是一项全球性的临床和公共卫生挑战，与死亡风险增加、功能衰退和失去独立性相关。然而，中年及老年人中衰弱指数（FI）与AAC之间的关系尚未得到探索。
本研究分析了2013年至2014年美国国家健康与营养检查调查（NHANES）队列的数据，重点关注年龄≥40岁的个体。使用49项模型计算FI以评估衰弱状态，参与者被分为三组：非衰弱（FI≤0.15）、衰弱前期（0.15＜FI≤0.25）和衰弱（FI＞0.25）。通过双能X线吸收法测量AAC，并通过考皮拉评分进行量化。严重AAC定义为AAC评分＞6。使用多变量逻辑回归、敏感性分析和平滑曲线拟合研究FI与AAC之间的关系。进行亚组分析和交互检验以评估这种关联在不同人群中的稳定性。
本研究共纳入2572名参与者。在对潜在混杂因素进行调整后，FI与AAC评分（β = 2.64，95%CI = 1.20 - 4.08）和严重AAC（OR = 6.36，95%CI = 1.48 - 27.41）均呈现出统计学上显著的正相关。将FI作为分类变量进行分析时，观察到类似趋势（趋势P＜0.05）。使用平滑曲线拟合和亚组分析研究基线FI Z评分与AAC评分及严重AAC之间的关系。有趣的是，我们发现FI Z评分与严重AAC的发生呈线性相关，而与AAC评分呈非线性相关。在断点之前，FI - Z评分与AAC评分的可能性呈正相关（P = 0.78），但在断点之后不显著。FI - Z评分与严重AAC之间的关联在不同亚组中是稳定的（所有交互P＞0.05）。
我们的研究表明FI与AAC之间存在稳定的正相关。FI可能作为美国中年及老年人早期亚临床动脉粥样硬化检测的生物标志物。
