Frailty and Cardiometabolic Outcomes: A Narrative Review

Frailty is a multidimensional state of reduced physiological reserve that is increasingly recognized as a major determinant of outcomes in cardiovascular diseases (CVDs). As populations age and cardiometabolic multimorbidity becomes more prevalent, understanding how frailty interacts with CVD pathology has important implications for risk stratification, clinical decision-making, and patient-centered care. Across diverse cardiovascular conditions and interventions, frailty independently predicts higher risks of mortality, major adverse cardiovascular events (MACE), rehospitalization, procedural complications, functional decline, and reduced quality of life. Shared biological mechanisms-including chronic inflammation, sarcopenia, endothelial dysfunction, and the effects of multimorbidity and polypharmacy-help explain the strong and often bidirectional relationship between frailty and CVD, one that is reported by recent data to be multiplicative as well as additive. Importantly, frailty demonstrates prognostic value beyond traditional risk factors and varies in predictive performance depending on the assessment tool used. Finally, frailty should not be viewed as immutable; evidence shows that appropriate conditioning may slow the decline or even reverse frail or prefrail states. This narrative review aims to synthesize contemporary evidence on frailty definitions and assessment, epidemiology, mechanistic pathways linking frailty with CVD, associated outcomes, prognostic value, and emerging interventions relevant to CVD prevention and management.