Multidimensional frailty increases cardiovascular risk in older people: An 8-year longitudinal cohort study in the Osteoarthritis Initiative

Myocardial infarction & C-reactive protein levels among Mexican adults with arthritis: Findings from the Mexican Health and Aging Study

Background

Studies of adult populations in high-income countries have found an association between arthritis and myocardial infarction (MI) due to high levels of systemic inflammation. Our objectives were to examine the association between arthritis and MI among Mexican adults and to assess the mediating effect of C-reactive protein (CRP) on this association.

Methods

Data came from the 2012, 2015, and 2018 observation waves of the Mexican Health and Aging Study. Our sample included 11,707 participants aged 50 and older with no prior MI before 2012. We used self-reported information for arthritis, joint pain, medication use, and limitations to daily activities in 2012. Logistic regression was used to model the association between arthritis and self-reported MI in 2015 or 2018. We used a sub-sample of 1602 participants to assess the mediating effect of CRP.

Results

In the full sample, participants with arthritis that limited their daily activities had higher odds of MI than participants with no arthritis (OR = 1.40; 95 % CI = 1.04-1.88). In the sub-sample, arthritis that limited daily activities was associated with higher mean CRP (5.2 mg/dL; 95 % CI = 4.10-6.21) than arthritis with no limitations (3.5 mg/dL; 95 % CI = 2.93-4.01). However, CRP levels had a small mediating effect, and the relationship between arthritis with physical limitations and MI remained statistically significant.

Conclusion

Mexican adults with arthritis that limits their daily activities are at an increased risk for MI. Continued research is needed to identify factors that contribute to this increased risk.

Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea

Frailty has become increasingly relevant in a rapidly aging society, highlighting the need for its accurate identification and exploring associated clinical outcomes. Using a multidimensional framework to estimate frailty in a sample of community dwelling older adults, its effect on mortality, incurred healthcare costs and utilization were investigated. We obtained data from the 2008-2018 Korean Longitudinal Study of Aging (KLoSA). After excluding individuals aged < 65 years and those with missing data, a total of 3578 participants were included in our study. Cox proportional hazard analysis was conducted to investigate the impact of frailty on all-cause mortality by generating hazard ratios (HRs) and population attributable risks (PARs). Healthcare utilization and out-of-pocket costs incurred by frailty were examined using the Generalized Linear Mixed Model (GLMM). Subgroup analyses were conducted according to frailty components. Among 3578 older adults, 1052 individuals died during a 10-year follow up period. Compared to the low risk frailty group, the moderate risk group (HR: 1.52, 95% CI:1.37-1.69) and severe risk group (HR: 3.10, 95% CI: 2.55-3.77) had higher risks for all-cause mortality. 27.4% (95% CI: 19.0-35.3%) of all-cause mortality was attributable to frailty, and the PARs ranged from 0.5 to 22.6% for individual frailty components. Increasing frailty levels incurred higher total healthcare costs and cost per utilization, including inpatient and outpatient costs. Frailty also increased likelihood of inpatient use, longer length of stay and more frequent outpatient visits. Among the frailty components, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) in particular were linked to elevated mortality, higher incurred healthcare costs and utilization. Frailty-tailored interventions are of utmost relevance to policy makers and primary caregivers as frailty threatens the ability to maintain independent living and increases risk of detrimental outcomes such as mortality and increased utilization and out-of-pocket costs of healthcare in older adults.

The association between frailty and incident cardiovascular disease events in community-dwelling healthy older adults

Study objective

This study examined the association between frailty and incident cardiovascular disease (CVD) events, major adverse cardiovascular events (MACE), and CVD-related mortality.

Design

Longitudinal cohort study.

Setting

The ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial in Australia and the United States.

Participants

19,114 community-dwelling older adults (median age 74.0 years; 56.4 % females).

Interventions

Pre-frailty and frailty were assessed using a modified Fried phenotype and a deficit accumulation Frailty Index (FI) at baseline.

Main outcome measures

CVD was defined as a composite of CVD death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for heart failure; MACE included all except heart failure. Cox proportional hazards regression was used to analyze the association between frailty and CVD outcomes over a median follow-up of 4.7 years.

Results

Baseline pre-frail and frail groups had a higher risk of incident CVD events (Hazard Ratio (HR): 1.31; 95 % Confidence Interval (CI): 1.14-1.50 for pre-frail and HR: 1.63; 95 % CI: 1.15-2.32 for frail) and MACE (pre-frail HR: 1.26; 95 % CI: 1.08-1.47 and frail HR: 1.51; 95 % CI: 1.00-2.29) than non-frail participants according to Fried phenotype after adjusting for traditional CVD risk factors. Effect sizes were similar or larger when frailty was assessed with FI; similar results for men and women.

Conclusion

Frailty increases the likelihood of developing CVD, including MACE, in community-dwelling older men and women without prior CVD events. Screening for frailty using Fried or FI method could help identify community-dwelling older adults without prior CVD events who are more likely to develop CVD, including MACE, and may facilitate targeted preventive measures to reduce their risk.

The role of comprehensive geriatric assessment in older patients affected by knee osteoarthritis: a systematic review

Osteoarthritis (OA) is one of the most common musculoskeletal diseases and highly prevalent in older people. Whilst the management of knee OA is usually multidisciplinary, the use of comprehensive geriatric assessment (CGA) for this condition is still limited. Given this background, with this systematic review, we summarized the current literature regarding the importance of CGA in people affected by knee OA. A systematic search across several databases was run until 10th April 2022 and updated on 21st November 2022 for any study investigating the use of CGA in patients with knee OA. The data were summarized descriptively. Among 295 articles initially included, three studies made in the context of the osteoarthritis initiative (OAI) were included. All the three studies used the OAI multidimensional prognostic index (MPI), a composite score derived from the CGA. Higher MPI values were associated with a higher risk of falls, cardiovascular conditions, and fractures across a follow-up period of 8 years and after adjusting for potential confounders. In conclusion, in this systematic review we summarized the current evidence of CGA in knee OA, finding that the MPI, a CGA derived tool, could be useful to early find people at higher risk of conditions that are associated with knee OA and therefore that can be the target of personalized interventions for preventing these conditions.

Cardiometabolic profile of 15057 elderly Spanish workers: association of sociodemographic variables and tobacco consumption

Background

Aging of the world population is one of the most significant demographic changes of our time. Populations older than 60 years are heterogeneous, and age is an independent cardiovascular risk factor aggravated by frailty, obesity, and diabetes, and influenced by several factors, including sex and socioeconomic status. The objective of this study was to calculate cardiovascular risk in workers of both sexes over 60 years of age and to assess whether there are difference s by sex, social class, smoking, and type of job.

Methods

A cross-sectional study was carried out in 15,057 elderly Spanish workers from different autonomous communities in Spain and with different labor occupations. Anthropometric, sociodemographic, clinical, and laboratory values were determined. People were classified according to age from 60 to 64 years inclusive and from 65 to 69 years, smokers and non-smokers, and both blue-collar and white-collar workers. Subsequently, a multivariate analysis was carried out.

Results

Men, blue-collar workers, smokers, and aging were factors that influenced cardiovascular risk: with an OR of 3.27 (95% CI: 2.64–4.05) in people 65 years of age or older versus the younger group, and an OR of 3.15 (95% CI: 2.69–3.69) in smokers versus non-smokers. A stronger independent association was found between smoking, age, and cardiovascular risk. The risk of developing non-alcoholic fatty liver and liver fibrosis was much higher in men than in women, with an OR of 4.06 (95% CI: 3.66–4.50) for the former and an OR of 2.10 (95% CI: 1.95–2.26) for the BARD index.

Conclusions

The highest risk groups were observed in male subjects with a history of smoking and blue-collar workers and, as such, should be considered for cardiovascular risk screening programs.

Vascular Age, Metabolic Panel, Cardiovascular Risk and Inflammaging in Patients With Rheumatoid Arthritis Compared With Patients With Osteoarthritis

Introduction

The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is 1.5–2 times higher than the general population. The fundamental risk factor for CVD is age, related to alterations at the arterial level. The aim of the study was to compare vascular age (VA) in RA patients under a strict treat-to-target (T2T) strategy with Osteoarthritis (OA) patients without strict follow up and to assess the influence of inflammaging (chronic, sterile, low-grade inflammation related to aging) and metabolic markers on VA.

Materials and Methods

This was an analytical cross-sectional study. Patients with RA (under a strict a T2T strategy) and OA patients without strict clinical follow-up were included. Patients with a history of uncontrolled hypertension, CVD, and/or current smoking were excluded. Sociodemographic, physical activity, and toxic exposure data were obtained. Waist-hip ratio and body mass index (BMI) were measured. DAS-28 (RA) and inflammatory markers, lipid profile, and glycaemia were analyzed. Pulse wave velocity (PWV) was measured (oscillometric method, Arteriograph-TensioMed®). VA was calculated based on PWV. Eleven components of inflammaging [six interleukins, three metalloproteinases (MMP), and two tissue inhibitors of metalloproteinases (TIMP)] were evaluated (Luminex® system). Univariate and bivariate analyzes (Mann Whitney U and chi-square) and correlations (Spearmans Rho) were done to compare the two groups.

Results

A total of 106 patients (74% women) were included, 52/RA and 54/OA. The mean age was 57 (Interquartile range - IQR 9 years). The BMI, waist circumference, and weight were higher in patients with OA (p &lt; 0.001). RA patients had low disease activity (DAS-28-CRP). There were no differences in VA, inflammaging nor in PWV between the two groups. VA had a positive, but weak correlation, with age and LDL. In group of RA, VA was higher in those who did not receive methotrexate (p = 0.013). LDL levels correlated with MMP1, TIMP1, and TIMP2.

Conclusions

When comparing RA patients with low levels of disease activity with OA patients with poor metabolic control, there are no differences in VA. Furthermore, methotrexate also influences VA in RA patients. This shows that implemented therapies may have an impact on not only the inflammatory state of the joint but also CVD risk.

Multidimensional frailty and quality of life: data from the English Longitudinal Study of Ageing

Purpose

Frailty has been found to be associated with poor quality of life (QoL) in older people, but data available are limited to cross-sectional studies. We therefore aimed to assess the association between multidimensional frailty, determined by Multidimensional Prognostic Index (MPI), with mortality and good QoL expectancy (GQoLE) in a large representative sample of older adults, over 10 years of follow-up.

Methods

In the English Longitudinal Study of Ageing, using the data from 2004–2005 and 2014–2015, MPI was calculated using a weighted score of domains of comprehensive geriatric assessment, i.e., number of difficulties in activities of daily living (ADL) and instrumental ADL, depressive symptoms, number of medical conditions, body mass index, physical activity level, and social aspects. Mortality was assessed using administrative data, GQoLE indicators were used for longitudinal changes in QoL.

Results

6244 Participants (mean age 71.8 years, 44.5% males) were followed up for 10 years. After adjusting for potential confounders, compared to people in the MPI low-risk group, people in the moderate (hazard ratio, HR = 4.27; 95% confidence interval, CI 3.55–5.14) and severe-risk group (HR = 10.3; 95% CI 7.88–13.5) experienced a significantly higher mortality rate. During the follow-up period, people in the moderate and severe-risk groups reported lower GQoLE values than their counterparts, independently from age and gender.

Conclusions

Multidimensional frailty was associated with a higher risk of mortality and significantly lower GQoLE, suggesting that the multifactorial nature of frailty is associated not only with mortality, but also poor QoL.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-022-03152-9.

Multidimensional prognostic index and the risk of fractures: an 8-year longitudinal cohort study in the Osteoarthritis Initiative

In this longitudinal study, with a follow-up of 8 years, multidimensional prognostic index (MPI), a product of the comprehensive geriatric assessment, significantly predicted the onset of fractures in older people affected by knee osteoarthritis.

PURPOSE

Frailty may be associated with higher fracture risk, but limited research has been carried out using a multidimensional approach to frailty assessment and diagnosis. The present research aimed to investigate whether the MPI, based on comprehensive geriatric assessment (CGA), is associated with the risk of fractures in the Osteoarthritis Initiative (OAI) study.

METHODS

Community-dwellers affected by knee OA or at high risk for this condition were followed-up for 8 years. A standardized CGA including information on functional, nutritional, mood, comorbidity, medication, quality of life, and co-habitation status was used to calculate the MPI. Fractures were diagnosed using self-reported information. Cox's regression analysis was carried out and results are reported as hazard ratios (HRs), with their 95% confidence intervals (CIs), adjusted for potential confounders.

RESULTS

The sample consisted of 4024 individuals (mean age 61.0 years, females = 59.0%). People with incident fractures had a significant higher MPI baseline value than those without (0.42 ± 0.18 vs. 0.40 ± 0.17). After adjusting for several potential confounders, people with an MPI over 0.66 (HR = 1.49; 95%CI: 1.11-2.00) experienced a higher risk of fractures. An increase in 0.10 point in MPI score corresponded to an increase in fracture risk of 4% (HR = 1.04; 95%CI: 1.008-1.07). Higher MPI values were also associated with a higher risk of non-vertebral clinical fractures.

CONCLUSION

Higher MPI values at baseline were associated with an increased risk of fractures, reinforcing the importance of CGA in predicting fractures in older people affected by knee OA.

Frailty and cardiovascular outcomes in the National Health and Aging Trends Study

AIMS

Physical frailty is a commonly encountered geriatric syndrome among older adults without coronary heart disease (CHD). The impact of frailty on the incidence of long-term cardiovascular outcomes is not known.We aimed to evaluate the long-term association of frailty, measured by the Fried frailty phenotype, with all-cause-mortality and MACE among older adults without a history of CHD at baseline in the National Health and Aging Trends Study.

METHODS AND RESULTS

We used the National Health and Aging Trends Study, a prospective cohort study linked to a Medicare sample. Participants with a prior history of CHD were excluded. Frailty was measured during the baseline visit using the Fried physical frailty phenotype. Cardiovascular outcomes were assessed during a 6-year follow-up.Of the 4656 study participants, 3259 (70%) had no history of CHD 1 year prior to their baseline visit. Compared to those without frailty, subjects with frailty were older (mean age 82.1 vs. 75.1 years, P < 0.001), more likely to be female (68.3% vs. 54.9%, P < 0.001), and belong to an ethnic minority. The prevalence of hypertension, falls, disability, anxiety/depression, and multimorbidity was much higher in the frail and pre-frail than the non-frail participants. In a Cox time-to-event multivariable model and during 6-year follow-up, the incidences of death and of each individual cardiovascular outcomes were all significantly higher in the frail than in the non-frail patients including major adverse cardiovascular event (MACE) [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.53, 2.06], death (HR 2.70, 95% CI 2.16, 3.38), acute myocardial infarction (HR 1.95, 95% CI 1.31, 2.90), stroke (HR 1.71, 95% CI 1.34, 2.17), peripheral vascular disease (HR 1.80, 95% CI 1.44, 2.27), and coronary artery disease (HR 1.35, 95% CI 1.11, 1.65).

CONCLUSION

In patients without CHD, frailty is a risk factor for the development of MACEs. Efforts to identify frailty in patients without CHD and interventions to limit or reverse frailty status are needed and, if successful, may limit subsequent adverse cardiovascular events.

The association between cardiovascular risk factors and major cardiovascular diseases decreases with increasing frailty levels in geriatric outpatients

BACKGROUND

Frailty marks a process of increasing dysregulation of physiological systems which increases the risk of adverse health outcomes. This study examines the hypothesis that the association between multiple cardiovascular risk factors (CVRF) and cardiovascular diseases (CVD) becomes stronger with increasing frailty severity.

METHODS

Cross-sectional analysis of 339 older adults (55.2% women; aged 75.2 ± 9.1 years) from an outpatient geriatric clinic from a middle-income country. The frailty index (FI) was calculated as the proportion of 30 possible health deficits. We assessed hypertension, diabetes, obesity, dyslipidemia, sedentarism and smoking as CVRF (determinants) and myocardial infarction, stroke, heart failure as CVD. Poisson regression models adjusted for age, sex, and education was applied to estimate the association between frailty as well as CVRF (independent variables) with CVD (dependent variable).

RESULTS

Of the 339 patients, 18,3% were frail (FI ≥ 0.25) and 32.7% had at least one CVD. Both frailty and CVRF were significantly associated with CVD (PR = 1.03, 95% CI 1.01 to 1.05; p = 0.001, and PR = 1.46, 95% 1.24 to 1.71; p < 0.001, respectively) adjusted for covariates. The strength of the association between CVRF and CVD decreased with increasing frailty levels, as indicated by a significant interaction term of frailty and CVRF (p < 0.001).

CONCLUSION

Frailty and CVRF are both associated with CVD, but the impact of CVRF decreases in the presence of frailty. When confirmed in longitudinal studies, randomized controlled trials or causal inference methods like Mendelian randomization should be applied to assess whether a shift from traditional CVRF to frailty would improve cardiovascular outcome in the oldest old.