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

Study Questions:

What is the impact of pre-frailty on the risk of developing cardiovascular disease (CVD) in a cohort of community-dwelling elderly individuals initially free of CVD?


This was an analysis of the Progetto Veneto Anziani (Pro.V.A.) population-based prospective cohort study conducted in Padua, Italy. The Fried criteria were used to define pre-frailty and frailty. Fried defined frailty using the following five measurable items: unintentional weight loss, low physical activity level, weakness, exhaustion, and slow gait speed. 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.


The analytic sample consisted of 1,567 elderly subjects. Over a period of 4.4 years, 551 CV events were recorded with an age-adjusted incidence of CVD of 75 events per 1,000 person-years. Compared with those who were nonfrail, those meeting two criteria had a higher risk of experiencing a new CV 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 CVD events: low energy expenditure, exhaustion, and slow gait. The majority of CVD events were related to heart failure.


Among a cohort of Italian community-dwelling elderly men and women free of disability, pre-frailty was a significant predictor of incident CVD.


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. 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 CVD and may be useful therapeutic targets. Future studies may help clarify the role of explicating addressing pre-frailty as a means to retard the development or progression of CVD.

Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure

Keywords: Primary Prevention, Geriatrics, Aged, Cardiovascular Diseases, Heart Failure, Coronary Artery Disease, Energy Metabolism, Gait, Hand Strength, Motor Activity, Weight Loss, Peripheral Arterial Disease, Stroke, Risk, Risk Factors, Prospective Studies, Cohort Studies, Mortality

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