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Frailty, high-sensitivity C-reactive protein and cardiovascular disease: a nationwide prospective cohort study
Lei Zheng1,2, Jianjun Ye2, Xinyang Liao2
1Department of Urology, People's Hospital of Tibet Autonomous Region, Lhasa, 850000, China.
Insights
Frailty and high-sensitivity C-reactive protein (hsCRP) significantly increase cardiovascular disease (CVD) risk. Frailty partially mediates the link between hsCRP and CVD, aiding in risk stratification.
Area of Science:
- Cardiovascular Medicine
- Gerontology
- Biomarkers
Background:
- Cardiovascular disease (CVD) poses a significant health burden.
- Frailty and elevated high-sensitivity C-reactive protein (hsCRP) are independently linked to adverse health outcomes.
- Understanding their combined and mediating effects on CVD is crucial for risk assessment.
Purpose of the Study:
- To investigate the complex associations between frailty, hsCRP, and CVD incidence.
- To explore the mediating role of frailty in the relationship between hsCRP and CVD.
- To assess CVD risk stratification using combined frailty and hsCRP assessment.
Main Methods:
- A nationwide prospective cohort study (China Health and Retirement Longitudinal Study - CHARLS) with 5239 participants.
- Frailty assessed using a 40-item frailty index; CVD defined by physician diagnosis of heart disease and/or stroke.
- Statistical analyses included restricted cubic spline models, ROC curves, Cox regression, interaction, and mediation analyses.
Main Results:
- Over 7 years, 1204 (23.67%) participants developed CVD.
- Both elevated hsCRP and frailty were significantly associated with increased CVD incidence.
- Participants with frailty and elevated hsCRP had the highest risk of CVD (aHR 2.97), heart disease (aHR 2.93), and stroke (aHR 4.26).
- Frailty mediated 19.60% of the association between hsCRP and CVD.
Conclusions:
- Combined assessment of frailty and hsCRP improves CVD risk stratification.
- Frailty partially mediates the relationship between hsCRP and CVD incidence.
- These findings highlight the importance of considering both factors in clinical practice.
Background:
This study aimed to investigate the complex associations of frailty and high-sensitivity C-reactive protein (hsCRP) with cardiovascular disease (CVD) through a nationwide prospective cohort, while also assessing the mediating associations.
Methods:
According to critical criteria, a total of 5239 participants from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 were ultimately enrolled in this study. Frailty was evaluated by the frailty index with 40 items, and CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. A restricted cubic spline model, receiver operating characteristic curves, adjusted Cox proportional hazards regression, interaction analyses and mediation analyses were performed for association exploration.
Results:
During a maximum follow-up of 7.0 years, 1204 (23.67%) people developed CVD. Both elevated hsCRP and frailty were significantly associated with CVD incidence. Compared with participants with a healthy status and low hsCRP (< 1.015 mg/L), those with a frailty status and elevated hsCRP had the highest risk of CVD (adjusted HR, 2.97; 95% CI 2.29-3.84), heart disease (adjusted HR, 2.93; 95% CI 2.16-3.96), and stroke (adjusted HR, 4.26; 95% CI 2.81-6.44), which were still robust in the subgroup analysis. Moreover, frailty significantly mediated 19.60% of the associations between hsCRP and CVD.
Conclusions:
Combined assessment of frailty and hsCRP levels helps to better stratify the individual risk of CVD. Frailty could partly mediate the associations between hsCRP and CVD incidence.
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