Operationalizing vascular frailty: structural and functional vascular ageing as determinants of geriatric phenotypes

Frailty is a multidimensional geriatric syndrome, but conventional definitions predominantly focus on physical decline. Vascular aging may contribute to frailty pathogenesis, yet vascular frailty phenotype remains underexplored. This study compared operational definitions of vascular frailty and their associations with key geriatric phenotypes.

Older adults (≥65 years) undergoing annual health examinations in 2023 were prospectively enrolled. Physical frailty and prefrailty were determined by Fried's criteria. Vascular structural abnormality was assessed by aortic arch calcification (AoAC) or abdominal aorta calcification (AbAC) on radiography; vascular functional impairment was defined as brachial-ankle pulse wave velocity ≥1800 cm/s. Seven vascular frailty definitions were tested, combining frailty/prefrailty with structural and/or functional measures. Associations with low hand grip strength and positive multimorbidity index were analyzed using multivariable regression.

Among 258 participants (mean age 74.2 years; 33.7 % male), 5.4 % were frail and 46.5 % prefrail. Vascular frailty prevalence ranged from 11.6 % to 31.4 % across definitions. All definitions were independently associated with low grip strength (odds ratio (OR) range between 2.39 and 4.33). Only the definition combining frailty/prefrailty with both AoAC and vascular stiffness (definition 6) was significantly associated with both low grip strength (OR 4.33, 95 % confidence interval (CI) 2.03-9.22) and positive multimorbidity (OR 2.68, 95 % CI 1.22-5.88).

A vascular frailty definition incorporating both structural and functional vascular impairments alongside physical frailty more effectively identifies older adults with coexisting sarcopenia risk and multimorbidity than physical frailty alone. This construct may improve geriatric risk stratification and guide targeted interventions.