Could Malnutrition Be a Potential Parameter for Cardiac Risk Assessment in Older Adults?

Background: Malnutrition is highly prevalent in older adults and is associated with functional decline, systemic inflammation, and increased mortality. However, its prognostic role in relation to major adverse cardiovascular events (MACE), particularly when considered alongside established cardiovascular risk scores, remains insufficiently defined in geriatric populations. Methods: This retrospective cohort study included 291 adults aged ≥65 years who underwent a comprehensive geriatric assessment at a geriatric outpatient clinic. Nutritional status was evaluated using the Mini Nutritional Assessment-Short Form (MNA-sf). Cardiovascular risk was estimated using the Framingham Risk Score, SCORE2, SCORE2-Older Persons (SCORE2-OP), and LIFE-CVD (version 1). The primary outcome was the occurrence of MACE, and the secondary outcome was all-cause mortality. Multivariable logistic regression and Cox proportional hazards models were used to identify independent predictors of outcomes. Results: During a mean follow-up of 16.9 ± 4.7 months, 43 participants (14.8%) experienced MACE, and 11 (3.8%) died. Malnutrition or risk of malnutrition (MNA-sf < 12), present in 24.1% of participants, was significantly more frequent among those with MACE and those who died. In multivariable analyses, nutritional status remained a consistent independent predictor of both MACE and mortality, whereas commonly used cardiovascular risk scores showed limited or inconsistent associations with outcomes. Conclusions: In older adults, malnutrition assessed by the MNA-sf is a strong and independent predictor of both major adverse cardiovascular events and all-cause mortality, beyond traditional cardiovascular risk scores. These findings underscore the importance of incorporating nutritional status, together with frailty-related parameters, into cardiovascular risk assessment to improve risk stratification in geriatric care.