Framingham cardiovascular disease risk scores and incident frailty: the English longitudinal study of ageing.

Catharine R Gale,Cyrus Cooper,Avan Aihie Sayer

doi:10.1007/s11357-014-9692-6

Abstract

Cross-sectional studies show that frailty is common in older people with cardiovascular disease. Whether older people at higher risk of developing cardiovascular disease are more likely to become frail is unclear. We used multinomial logistic regression to examine the prospective relation between Framingham cardiovascular disease risk scores and incidence of physical frailty or pre-frailty, defined according to the Fried criteria, in 1,726 men and women aged 60 to over 90 years from the English Longitudinal Study of Ageing who had no history of cardiovascular disease at baseline. Men and women with higher Framingham cardiovascular risk scores were more likely to become frail over the 4-year follow-up period. For a standard deviation higher score at baseline, the relative risk ratio (95 % confidence interval) for incident frailty, adjusted for sex and baseline frailty status, was 2.76 (2.18, 3.49). There was a significant association between Framingham cardiovascular risk score and risk of pre-frailty: 1.69 (1.46, 1.95). After further adjustment for other potential confounding factors, the relative risk ratios for frailty and pre-frailty were 2.15 (1.68, 2.75) and 1.50 (1.29, 1.74), respectively. The associations were unchanged after excluding incident cases of cardiovascular disease. Separate adjustment for each component of the risk score suggested that no single component was driving the associations between cardiovascular risk score and incident pre-frailty or frailty. Framingham cardiovascular risk scores may be useful for predicting the development of physical frailty in older people. We now need to understand the biological mechanisms whereby cardiovascular risk increases the risk of frailty.

Highlights

Frailty is a clinical syndrome observed in older people whose core feature is an increased vulnerability to stressors due to impairments in multiple, inter-related systems, decreased physiological reserves and a decline in the ability to maintain homeostasis (Bergman et al 2007; Clegg et al 2013)
These findings suggest that cardiovascular disease (CVD) risk may be predictive of future frailty and raise the possibility that multivariable risk factor algorithms for assessing CVD risk in primary care, such as that developed as part of the Framingham Heart Study (D’Agostino et al 2008), might provide a method for identifying individuals currently free of CVD who are at increased risk of becoming frail
In order to investigate whether the associations observed between the Framingham CVD score at baseline and risk of incident frailty or pre-frailty were driven by particular components of the score, we examined the effect on the sex and baseline frailty statusadjusted relative risks of further adjustment for each component in turn

Summary

Introduction

Frailty is a clinical syndrome observed in older people whose core feature is an increased vulnerability to stressors due to impairments in multiple, inter-related systems, decreased physiological reserves and a decline in the ability to maintain homeostasis (Bergman et al 2007; Clegg et al 2013). Longitudinal studies in the Whitehall II cohort have shown that in middleaged people without a history of stroke or heart disease, higher Framingham CVD risk scores are associated with poorer performance on objective tests of physical function (Elbaz et al 2014) and with increased later risk of frailty (Bouillon et al 2013), as defined by the Fried physical frailty phenotype (Fried et al 2001) Whether such scores can predict future risk of frailty defined by the Fried phenotype in older people is unknown

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Results

Conclusion