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Cardiovascular Dysfunction and Frailty Among Older Adults in the Community: The ARIC Study
Wilson Nadruz1,2, Dalane Kitzman3, Beverly Gwen Windham4
1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Insights
Cardiovascular dysfunction, including left ventricular hypertrophy and impaired heart function, is significantly linked to frailty in older adults. These cardiac issues show the strongest association with frailty compared to other organ system problems.
Area of Science:
- Gerontology
- Cardiology
- Public Health
Background:
- The link between cardiovascular problems and frailty in the elderly is not well understood.
- This research investigates the relationship between frailty and the heart's structure and function.
- It also examines if these links persist independently of other organ system issues.
Purpose of the Study:
- To define the relationship between frailty and cardiovascular structure and function.
- To determine if these associations are independent of abnormalities in other organ systems.
Main Methods:
- The study included 3,991 older adults (mean age 75.6).
- Frailty was defined by low strength, low energy, slowed motor performance, low physical activity, or weight loss (≥3 criteria).
- Cardiac structure and function were assessed using echocardiography, alongside vascular, pulmonary, renal, hematologic, and adipose system evaluations.
Main Results:
- Frailty was present in 5.3% of participants.
- Independent associations were found between frailty and left ventricular hypertrophy (OR=1.72), reduced global longitudinal strain (OR=1.68), and increased left atrial volume index (OR=1.60).
- Combined cardiac abnormalities showed the strongest association with frailty (OR=2.10), exceeding links with vascular, pulmonary, renal, or hematologic issues.
Conclusions:
- Cardiac structure and function abnormalities are independently linked to frailty in older adults.
- These cardiovascular factors demonstrate the most significant association with frailty among all organ systems examined.
- The association between cardiac abnormalities and frailty persists even when individuals with pre-existing cardiovascular disease are excluded.
Background:
The contribution of cardiovascular dysfunction to frailty in older adults is uncertain. This study aimed to define the relationship between frailty and cardiovascular structure and function, and determine whether these associations are independent of coexisting abnormalities in other organ systems.
Methods:
We studied 3,991 older adults (mean age 75.6±5.0 years; 59% female) from the Atherosclerosis Risk in Communities (ARIC) Study in whom the following six organ systems were uniformly assessed: cardiac (by echocardiography), vascular (by ankle-brachial-index and pulse-wave-velocity), pulmonary (by spirometry), renal (by estimated glomerular filtration rate), hematologic (by hemoglobin), and adipose (by body mass index and bioimpedance). Frailty was defined by the presence of ≥3 of the following: low strength, low energy, slowed motor performance, low physical activity, or unintentional weight loss.
Results:
Two hundred eleven (5.3%) participants were frail. In multivariable analyses adjusted for demographics, diabetes, hypertension, and measures of other organ system function, frailty was independently and additively associated with left ventricular hypertrophy (odds ratio [OR] = 1.72; 95% confidence interval [CI] = 1.30-2.40), reduced global longitudinal strain (reflecting systolic function; OR = 1.68; 95% CI = 1.16-2.44), and greater left atrial volume index (reflecting diastolic function; OR = 1.60; 95% CI = 1.13-2.27), which together demonstrated the greatest association with frailty (OR = 2.10; 95% CI = 1.57-2.82) of the systems studied. Lower magnitude associations were observed for vascular and pulmonary abnormalities, anemia, and impaired renal function. Cardiovascular abnormalities remained associated with frailty after excluding participants with prevalent cardiovascular disease.
Conclusions:
Abnormalities of cardiac structure and function are independently associated with frailty, and together show the greatest association with frailty among the organ systems studied.
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