Frailty index is associated with increased risk of elevated BNP in an elderly population: the Rugao Longevity and Ageing Study

Association of depressive symptoms with cardiovascular events and plasma BNP: A prospective cohort study of the elderly Chinese population

OBJECTIVE

To estimate the prevalence of depressive symptoms and to evaluate the associations of mild and significant depressive symptoms with cardiovascular events and plasma BNP levels (which are surrogate endpoints for cardiovascular events) among older adults in a population-based study.

METHODS

A population-based prospective study of 1,432 elderly people (aged 70-84 years and without cardiovascular disease) was conducted, and the median duration of follow-up for participants with outcomes was 18 weeks. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale (GDS-15). The hazard ratios (HRs) for the time to events and time to death were calculated using the Cox regression analysis. Multiple linear regression models and Spearman rank correlations were used to examine the association of depressive symptoms with Log BNP values.

RESULTS

The prevalence of mild (GDS-15 scores ≥ 6) and significant (GDS-15 scores ≥ 10) depressive symptoms were 7.3% and 2.0% at baseline, respectively. Older adults with significant depressive symptoms exhibited increased risks of time to death (HR: 12.56; 95% CI: 3.58-43.99) and composite cardiovascular endpoints (HR: 3.46; 95% CI: 1.19-3.75). Significant depressive symptoms were associated with Log BNP levels (β=0.56, P = 0.02). Depressive symptom scores were also associated with Log BNP levels (rs=0.21, P = 0.04) in the older adults with depressive symptoms.

CONCLUSIONS

Significant depressive symptoms were associated with a higher risk of cardiovascular events and higher BNP levels in the elderly.

Time Changes of Survival and Cardiovascular Determinants in a Cohort of Middle-Aged Men Followed Up for 61 Years until Extinction

OBJECTIVE

To study possible determinants of longevity in a cohort of middle-aged men followed for 61 years until extinction using measurements taken at baseline and at years 31 or 61 of follow-up.

MATERIAL AND METHODS

In 1960, two rural cohorts including a total of 1712 men aged 40-59 years were enrolled within the Italian section of the Seven Countries Study of Cardiovascular Diseases, and measurements related to mainly cardiovascular risk factors, lifestyle behaviors, and chronic diseases were taken at year 0 and year 31 of follow-up (when only 390 could be examined). Multiple linear regression models were computed to relate personal characteristics with the length of survival in both dead men and survivors.

RESULTS

Baseline cardiovascular risk factors, smoking and dietary habits, and chronic diseases (taken at year 0 with men aged 40-59 years) were significant predictors of the length of survival both from year 0 to year 31 and from year 0 to year 61, but only chronic diseases were independent predictors for the period of 31 to 61 years. Significant predictors of survival using measurements taken at year 31 (age range 71 to 90 years) were only smoking and dietary habits and chronic diseases.

CONCLUSIONS

During a lifetime of follow-up, the personal characteristics with continuous predictive power of survival were only lifestyle behaviors and major chronic diseases.

Longitudinal analysis on inflammatory markers and frailty progression: based on the English longitudinal study of aging

PURPOSE

Frailty is a common health state that is closely linked to adverse health outcomes in aging society. Although many inflammatory biomarkers have been cross-sectionally associated with frailty, knowledge on the longitudinal association is still limited. This study investigated the associations between inflammatory factors in clinical practice and frailty progression over time.

METHODS

To investigate the associations of three common inflammatory markers (hypersensitive C-reactive protein [hsCRP], white blood cell [WBC] and fibrinogen) with the progression of frailty.

METHODS

Data of 2316 participants (age 67.9 ± 6.1 years) were obtained from the English longitudinal study of aging (wave 4, 6 and 8) over an 8-year follow-up. The frailty index (FI) was calculated from 52 items. Mixed-effects models and Cox proportional hazards (Cox-PH) models were used to analyze the associations of hsCRP, WBC and fibrinogen with frailty progression. Values of inflammatory biomarkers were log-transformed. Age, sex and gross wealth were controlled.

RESULTS

Mixed-effects models showed that at a cross-sectional level, higher levels of hsCRP (β: 0.007, 95% CI 0.004-0.010), WBC (β: 0.021, 95% CI 0.010-0.032) and fibrinogen (β: 0.022, 95% CI 0.005-0.038) were associated with greater FI values while no significant time interaction was found. Cox-PH models showed that higher baseline levels of hsCRP (HR: 1.10, 95% CI 1.03-1.17) and WBC (HR: 1.23, 95% CI 1.10-1.37) were linked to a greater risk of developing frailty within 8 years.

CONCLUSIONS

We concluded that hsCRP, WBC and fibrinogen can reflect frailty status at a cross-sectional level while only hsCRP and WBC are associated with frailty progression over an 8-year period.

Development and validation of dynamic nomogram of frailty risk for older patients hospitalized with heart failure

Objective

This study aimed to establish and validate a dynamic online nomograph for predicting the risk of frailty in older patients hospitalized with heart failure in China.

Methods

A total of 451 older adults with heart failure hospitalized were selected between December 2021 and November 2022 at the Department of Cardiovascular Medicine in a Class A tertiary hospital in Shandong, China. The data of patients were obtained by using Barthel Index, instrumental activity of daily living scale, mini nutrition assessment-short form, Pittsburgh sleep quality index scale, Morse fall risk assessment scale and general information scale. The brain natriuretic peptide and echocardiographic indexes of patients were collected by electronic medical records. All participants were randomly divided into the training set (n = 319) and the validation set (n = 132) at the ratio of 7:3. The training set is used for model construction, and the validation set is used for internal validation. Using the Least Absolute Shrinkage and Selection Operator (LASSO) regression method to filter modeling variables, while the multivariable logistic regression was used to establish the nomogram based on the screened optimal variables. The performance of the model was evaluated by the area under the curve (AUC) of the receiver operator characteristic (ROC) curve, Hosmer-Lemeshow test, calibration plot, and decision curve analysis (DCA).

Results

The prevalence of frailty in 451 patients was 50.6%, 51.4%, and 48.5% in the training and validation sets, respectively. Drinking, grip strength, New York Heart Association (NYHA) class, multimorbidity, hospitalization history of heart failure, Barthel Index, the instrumental activities of daily living, nutritional status, sleep, fall, and left atrial end-diastolic diameter were used for LASSO regression analysis as the significant predictors of frailty. According to internal validation, the AUC of the ROC curve for the nomogram was 0.920, with a sensitivity of 86.8% and specificity of 84.4%. Moreover, in the validation set, the P-values of the H-L test were 0.742, and the calibration curve had good concordance between the estimated frailty risk and actual observation, indicating the model was well-calibrated. The DCA results confirmed that the nomogram had a well-performance in clinical suitability.

Conclusions

An online dynamic nomogram predicting frailty for older patients hospitalized for heart failure in China was well-established and identified in this study. This model benefits medical professionals in identifying high-risk frailty in older hospitalized patients with heart failure, which could reduce the medical and disease burden of heart failure to a certain extent. However, further verification is needed in the future.

Is the relationship between erythropoiesis and renal function one of the secrets of extreme longevity?

BACKGROUND AND AIMS

Renal function and erythropoiesis could be impaired with advancing age. Neutrophil gelatinase-associated lipocalin (NGAL) as well as erythropoietin (EPO) levels are two useful biomarkers of the renal status. In advanced age, the relationships between NGAL, EPO and hemoglobin (Hb) levels remains unknown. The aim of the present study is to evaluate the relationship between renal function and erythropoiesis in a small cohort of centenarians.

METHODS AND RESULTS

We observed thirty-one healthy centenarians with normal hemoglobin levels, a mild reduction in eGFR and no need of erythropoiesis support. We found a significant inverse association between NGAL and GFR, hemoglobin levels and EPO, confirming the key role of the renal function on erythropoiesis also in extreme longevity. A gender difference emerged, showing female participants with lower eGFR and Hb values more than males.

CONCLUSIONS

Our findings suggested a new link between renal function, erythropoiesis and longevity in centenarians and these could have relevant implications in clinical practice. These findings could explain why very old subjects presenting a slight GFR reduction seemed not to be exposed to a significant risk of mortality.

Evaluation of the added value of Brain Natriuretic Peptide to a validated mortality risk-prediction model in older people using a standardised international clinical assessment tool

The ability to accurately predict the one-year survival of older adults is challenging for clinicians as they endeavour to provide the most appropriate care. Standardised clinical needs assessments are routine in many countries and some enable application of mortality prediction models. The added value of blood biomarkers to these models is largely unknown. We undertook a proof of concept study to assess if adding biomarkers to needs assessments is of value. Assessment of the incremental value of a blood biomarker, Brain Naturetic Peptide (BNP), to a one year mortality risk prediction model, RiskOP, previously developed from data from the international interRAI-HomeCare (interRAI-HC) needs assessment. Participants were aged ≥65 years and had completed an interRAI-HC assessment between 1 January 2013 and 21 August 2021 in Canterbury, New Zealand. Inclusion criteria was a BNP test within 90 days of the date of interRAI-HC assessment. The primary outcome was one-year mortality. Incremental value was assessed by change in Area Under the Receiver Operating Characteristic Curve (AUC) and Brier Skill, and the calibration of the final model. Of 14,713 individuals with an interRAI-HC assessment 1,537 had a BNP within 90 days preceding the assessment and all data necessary for RiskOP. 553 (36.0%) died within 1-year. The mean age was 82.6 years. Adding BNP improved the overall AUC by 0.015 (95% CI:0.004 to 0.028) and improved predictability by 1.9% (0.26% to 3.4%). In those with no Congestive Heart Failure the improvements were 0.029 (0.004 to 0.057) and 4.0% (0.68% to 7.6%). Adding a biomarker to a risk model based on standardised needs assessment of older people improved prediction of 1-year mortality. BNP added value to a risk prediction model based on the interRAI-HC assessment in those patients without a diagnosis of congestive heart failure.

Aging metrics incorporating cognitive and physical function capture mortality risk: results from two prospective cohort studies

BACKGROUND

Aging metrics incorporating cognitive and physical function are not fully understood, hampering their utility in research and clinical practice. This study aimed to determine the proportions of vulnerable persons identified by three existing aging metrics that incorporate cognitive and physical function and the associations of the three metrics with mortality.

METHODS

We considered three existing aging metrics including the combined presence of cognitive impairment and physical frailty (CI-PF), the frailty index (FI), and the motoric cognitive risk syndrome (MCR). We operationalized them using data from the China Health and Retirement Longitudinal Study (CHARLS) and the US National Health and Nutrition Examination Survey (NHANES). Logistic regression models or Cox proportional hazards regression models, and receiver operating characteristic curves were used to examine the associations of the three metrics with mortality.

RESULTS

In CHARLS, the proportions of vulnerable persons identified by CI-PF, FI, and MCR were 2.2, 16.6, and 19.6%, respectively. Each metric predicted mortality after adjustment for age and sex, with some variations in the strength of the associations (CI-PF, odds ratio (OR) (95% confidence interval (CI)) 2.87 (1.74-4.74); FI, OR (95% CI) 1.94 (1.50-2.50); MCR, OR (95% CI) 1.27 (1.00-1.62)). CI-PF and FI had additional predictive utility beyond age and sex, as demonstrated by integrated discrimination improvement and continuous net reclassification improvement (all P < 0.001). These results were replicated in NHANES.

CONCLUSIONS

Despite the inherent differences in the aging metrics incorporating cognitive and physical function, they consistently capture mortality risk. The findings support the incorporation of cognitive and physical function for risk stratification in both Chinese and US persons, but call for caution when applying them in specific study settings.

Plasma N-Terminal Pro-B-Type Natriuretic Peptide Is Associated with Intrinsic Capacity Decline in an Older Population

OBJECTIVES

To determine the association between plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and intrinsic capacity in an older population.

METHOD

We recruited 283 participants aged 60-97 years (mean 77.42±4.08 years). Intrinsic capacity was assessed with the World Health Organization Integrated Care for Older People (ICOPE) screening tool including six domains: cognition, locomotion, vitality, hearing, vision, and psychology. Multimorbidity, polypharmacy, gait speed, physical activity, lifestyles, and chronic inflammation were assessed. We used multivariate logistic regression and the Spearman's correlation to assess the association between plasma NT-proBNP and intrinsic capacity.

RESULTS

The average intrinsic capacity score was 4.53±1.34. The percentage of decreased intrinsic capacity was 75.3%. Participants with decreased intrinsic capacity were older, with more cardiovascular and cerebrovascular diseases and polypharmacy, and had lower gait speed and higher C-reactive protein. Plasma NT-proBNP was significantly higher in the decreased intrinsic capacity group (128.0[56.8-280.8] pg/mL vs. 72.6[39.7-120.0] pg/mL, p<0.001). Multivariate logistic regression analysis revealed that NT-proBNP was the only independent risk factor for decreased intrinsic capacity among multiple covariates (odds ratio=1.005, p=0.038). Elevated NT-proBNP levels were associated with abnormal locomotion, hearing, vision, and psychology domains. Additionally, NT-proBNP levels were inversely correlated with the intrinsic capacity score adjusted for both age and coronary artery disease (r=-0.371, p< 0.001).

CONCLUSION

Elevated NT-proBNP levels were associated with decreased intrinsic capacity in older persons, independent of age, multimorbidity, polypharmacy, and chronic inflammation. Further longitudinal studies are required to explore the predictive role of NT-proBNP on declines in intrinsic capacity.

Frailty in China: From Research to Practice

Although geriatric research in general has increased in recent years, there is no effective treatment for frailty. Among older adults, those with frailty have an increased risk of falls, disability, and death. The population of older adults has increased rapidly in China, and resulting in an increased demand for medical care services for older adults, including those with frailty. However, much of the research on frailty has been conducted in Europe and the United States, and European and American standards for frailty are not always applicable to Chinese individuals. Clinicians and researchers in China have shown increasing interest in frailty in recent years. Here, we reviewed the current state of frailty research in China.

Impact of Galectin-3 Circulating Levels on Frailty in Elderly Patients with Systolic Heart Failure

Background: Heart Failure (HF), a leading cause of morbidity and mortality, represents a relevant trigger for the development of frailty in the elderly. Inflammation has been reported to play an important role in HF and frailty pathophysiology. Galectin-3 (Gal-3), whose levels increase with aging, exerts a relevant activity in the processes of cardiac inflammation and fibrosis. The aim of the present study was to investigate the potential of Galectin-3 to serve as a biomarker of frailty in HF patients. Methods: 128 consecutive patients aged 65 and older with the diagnosis of systolic HF underwent a frailty assessment and blood sample collection for serum Gal-3 detection. A multivariable regression analysis and decision curve analysis (DCA) were used to identify significant predictors of frailty. Results: Frailty was present in 42.2% of patients. Age: Odds Ratio (OR) = 3.29; 95% Confidence Interval CI (CI) = 1.03-10.55, Cumulative Illness Rating Scale Comorbidity Index (CIRS-CI): OR = 1.85; 95% CI = 1.03-3.32, C-Reactive phase Protein (CRP) OR = 3.73; 95% CI = 1.24-11.22, N-terminal-pro-Brain Natriuretic Peptide (NT-proBNP): OR = 2.39; 95% CI = 1.21-4.72 and Gal-3: OR = 5.64; 95% CI = 1.97-16.22 resulted in being significantly and independently associated with frailty. The DCA demonstrated that the addition of Gal-3 in the prognostic model resulted in an improved clinical 'net' benefit. Conclusions: Circulating levels of Gal-3 are independently associated with frailty in elderly patients with systolic HF.