Frailty and its components and cardiovascular outcomes in older adults: A nationwide epidemiological study

Although frailty is the result of multifactorial vulnerability, such as physical, cognitive, and socio-psychological factors, the association of multifactor-defined frailty and its components with cardiovascular disease (CVD) has not been investigated. The goal of this paper is to clarify the association between multifactor-defined frailty and its components and CVD in older adults.

Using a nationwide claims database, we included 66 948 participants aged ≥65 years without a history of CVD who were assessed using a simple questionnaire-based approach covering physical, cognitive, oral, nutritional, and social aspects of frailty. The primary outcome was composite CVD events, including ischemic heart disease, heart failure, and stroke.

During a mean follow-up period of 280 ± 153 days, 3721 CVD events were observed. Compared with robust individuals, frailty was associated with an increased risk of developing CVD (adjusted hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.31-1.52). This association was consistent across CVD subtypes. All components of comprehensive measures of frailty, such as physical function (HR 2.32, 95% CI 1.85-2.91), nutritional status (HR 1.46, 95% CI 1.10-1.93), oral function (HR 1.18, 95% CI 1.05-1.32), cognitive function (HR 1.44, 95% CI 1.30-1.60), and social aspects (HR 1.39, 95% CI 1.13-1.72), were also associated with an increased risk of developing CVD.

The multifactorial assessment of frailty significantly stratifies CVD risk in Japanese older adults. Moreover, each component of frailty independently contributes to the likelihood of CVD, underscoring the importance of comprehensive frailty evaluations in preventive care for the aging population. Geriatr Gerontol Int 2025; 25: 1239-1246.