Pre-Frailty: A Novel and Potentially Reversible Risk Factor for Cardiovascular Disease

JACC in a Flash | A study published in the March 17 issue of JACC provides a unique look at the impact of pre-frailty on the risk of developing cardiovascular disease (CVD) in a cohort of community-dwelling elderly individuals initially free of cardiovascular disease.

The study, an analysis of the Progetto Veneto Anziani (Pro.V.A.) population-based prospective cohort study conducted in Padua, Italy, used the Fried criteria (unintentional weight loss, low physical activity level, weakness, exhaustion, and slow gait speed) to define pre-frailty and frailty in 1,567 elderly subjects. Weakness and slow gait speed were defined as best handgrip strength value and best timed walked over 4 meters at usual pace, respectively. Participants were classified as frail if they met three or more of the five modified Fried criteria, as pre-frail if they met one or two, or as nonfrail if they met none of the criteria. The primary outcome was incident CVD, defined as onset of coronary artery disease, heart failure, stroke, peripheral artery disease, or CVD-related mortality.

Over a period of 4.4 years, 551 cardiovascular events were recorded with an age-adjusted incidence of cardiovascular disease of 75 events per 1,000 person-years. Overall results showed patients categorized as pre-frail had a higher risk of experiencing a new cardiovascular event (hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.27-2.52), independent of clinical and metabolic risk factors. The following parameters were the most predictive of new cardiovascular events: low energy expenditure, exhaustion, and slow gait. The majority of events were related to heart failure.

“This is an interesting study that establishes a significant association between pre-frailty and the risk of incident CVD, after accounting for traditional risk factors,” said Prashant Vaishnava, MD, in an ACC Journal Scan. “As the authors opine, this observation has significant import, as pre-frailty is potentially reversible. The parameters of low energy expenditure, exhaustion, and slow gait were particularly associated with incident cardiovascular disease and may be useful therapeutic targets. Future studies may help clarify the role of addressing pre-frailty as a means to retard the development or progression of cardiovascular disease.”

Keywords: CardioSource WorldNews, ACC Publications

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