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Ramonfaur D, Buckley LF, Arthur V, Yang Y, Claggett BL, Ndumele CE, Walker KA, Austin T, Odden MC, Floyd JS, Sanders-van Wijk S, Njoroge J, Kizer JR, Kitzman D, Konety SH, Schrack J, Liu F, Windham BG, Palta P, Coresh J, Yu B, Shah AM. High Throughput Plasma Proteomics and Risk of Heart Failure and Frailty in Late Life. JAMA Cardiol 2024:2819212. [PMID: 38809565 PMCID: PMC11137660 DOI: 10.1001/jamacardio.2024.1178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/05/2024] [Indexed: 05/30/2024]
Abstract
Importance Heart failure (HF) and frailty frequently coexist and may share a common pathobiology, although the underlying mechanisms remain unclear. Understanding these mechanisms may provide guidance for preventing and treating both conditions. Objective To identify shared pathways between incident HF and frailty in late life using large-scale proteomics. Design, Setting, and Participants In this cohort study, 4877 aptamers (Somascan v4) were measured among participants in the community-based longitudinal Atherosclerosis Risk In Communities (ARIC) cohort study at visit 3 (V3; 1993-1995; n = 10 638) and at visit 5 (V5; 2011-2013; n = 3908). Analyses were externally replicated among 3189 participants in the Cardiovascular Health Study (CHS). Data analysis was conducted from February 2022 to June 2023. Exposures Protein aptamers, measured at study V3 and V5. Main Outcomes and Measures Outcomes assessed included incident HF hospitalization after V3 and after V5, prevalent frailty at V5, and incident frailty between V5 and visit 6 (V6; 2016-2017; n = 4131). Frailty was assessed using the Fried criteria. Analyses were adjusted for age, gender, race, field center, hypertension, diabetes, smoking status, body mass index, estimated glomerular filtration rate, prevalent coronary heart disease, prevalent atrial fibrillation, and history of myocardial infarction. Mendelian randomization (MR) analysis was performed to assess potential causal effects of candidate proteins on HF and frailty. Results A total of 4877 protein aptamers were measured among 10 638 participants at V3 (mean [SD] age, 60 [6] years; 4886 [46%] men). Overall, 286 proteins were associated with incident HF after V3 (822 events; P < 1.0 × 10-5), 83 of which were also associated with incident after V5 (336 events; P < 1.7 × 10-4). Among HF-free participants at V5 (n = 3908; mean [SD] age, 75 [5] years; 1861 [42%] men), 48 of 83 HF-associated proteins were associated with prevalent frailty (223 cases; P < 6.0 × 10-4), 18 of which were also associated with incident frailty at V6 (152 cases; P < 1.0 × 10-3). These proteins enriched fibrosis and inflammation pathways and demonstrated stronger associations with incident HF with preserved ejection fraction (HFpEF) than HF with reduced ejection fraction. All 18 proteins were associated with both prevalent frailty and incident HF in CHS. MR identified potential causal effects of several proteins on frailty and HF. Conclusions and Relevance In this study, the proteins associated with risk of HF and frailty enrich for pathways related to inflammation and fibrosis as well as risk of HFpEF. Several of these proteins could potentially contribute to the shared pathophysiology of frailty and HF.
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Affiliation(s)
- Diego Ramonfaur
- University of Texas Southwestern Medical Center, Dallas
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Yimin Yang
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Chiadi E. Ndumele
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland
| | - Thomas Austin
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - Michelle C. Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - James S. Floyd
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - Sandra Sanders-van Wijk
- Division of Cardiology, Department of Medicine, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Joyce Njoroge
- Division of Cardiology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - Jorge R. Kizer
- Division of Cardiology, San Francisco Veterans Affairs Health Care System, and Departments of Medicine, Epidemiology and Biostatistics, San Francisco, California
| | - Dalane Kitzman
- Wake Forest School of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Jennifer Schrack
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fangyu Liu
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Priya Palta
- University of North Carolina School of Medicine, Chapel Hill
| | - Josef Coresh
- Departments of Medicine and Population Health, NYU Langone Health, New York, New York
| | - Bing Yu
- The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Amil M. Shah
- University of Texas Southwestern Medical Center, Dallas
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Xu L, Wang Y, Ji H, Du W, You C, Chen J, Jiang J, Shan Y, Pan Q, Cao R. Frailty and risk of systemic atherosclerosis: A bidirectional Mendelian randomization study. PLoS One 2024; 19:e0304300. [PMID: 38781179 PMCID: PMC11115302 DOI: 10.1371/journal.pone.0304300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Numerous observational studies have reported an association between frailty and atherosclerosis. However, the causal relationship between frailty and the occurrence of atherosclerosis in different anatomical sites remains unclear. we conducted a bidirectional Mendelian randomization (MR) study to evaluate the causal relationship between the frailty index (FI), and both systemic atherosclerosis and lipids. METHODS We obtained summary statistics from large-scale genome-wide association studies (GWAS) of various phenotypes, including frailty (n = 175,226), coronary atherosclerosis (n = 56,685), cerebral atherosclerosis (n = 150,765), peripheral arterial disease (PAD) (n = 361,194), atherosclerosis at other sites (n = 17,832), LDL-C (n = 201,678), HDL-C (n = 77,409), and triglycerides (n = 78,700). The primary MR analysis employed the inverse variance weighted (IVW) method. Furthermore, to assess reverse causality, we employed inverse MR and multivariate MR analysis. RESULTS Genetically predicted FI showed positive associations with the risk of coronary atherosclerosis (OR = 1.47, 95% CI 1.12-1.93) and cerebral atherosclerosis (OR = 1.99, 95% CI 1.05-3.78), with no significant association (p >0.05) applied to peripheral arterial disease and atherosclerosis at other sites. Genetically predicted FI was positively associated with the risk of triglycerides (OR = 1.31, 95% CI 1.08-1.59), negatively associated with the risk of LDL-C (OR = 0.87, 95% CI 0.78-0.97), and showed no significant association with the risk of HDL-C (p >0.05). Furthermore, both reverse MR and multivariate MR analyses demonstrated a correlation between systemic atherosclerosis, lipids, and increased FI. CONCLUSION Our study elucidated that genetically predicted FI is associated with the risk of coronary atherosclerosis and cerebral atherosclerosis by the MR analysis method, and they have a bidirectional causal relationship. Moreover, genetically predicted FI was causally associated with triglyceride and LDL-C levels. Further understanding of this association is crucial for optimizing medical practice and care models specifically tailored to frail populations.
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Affiliation(s)
- Liugang Xu
- Department of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Yajun Wang
- Department of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Hongyun Ji
- Department of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Wei Du
- Department of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Chunhui You
- Department of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Jin Chen
- Department of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Jianyu Jiang
- Department of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Yisi Shan
- Department of Neurology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Qian Pan
- Department of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Ruihong Cao
- Department of Cardiology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Zhangjiagang, Jiangsu, People’s Republic of China
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Calila H, Bălășescu E, Nedelcu RI, Ion DA. Endothelial Dysfunction as a Key Link between Cardiovascular Disease and Frailty: A Systematic Review. J Clin Med 2024; 13:2686. [PMID: 38731215 PMCID: PMC11084631 DOI: 10.3390/jcm13092686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Frailty is increasingly recognized as a significant health concern, particularly due to its association with cardiovascular pathologies. This study aims to examine how vascular endothelial dysfunction, a known premorbid stage in the pathophysiology of cardiovascular diseases, contributes to the link between cardiovascular illness and frailty. Methods: The inclusion criteria allowed us to focus on original clinical research articles published in English between January 2014 and January 2024, which reported quantitative assessments of the relationship between frailty and vascular endothelial dysfunction. Excluded from the study were systematic literature reviews, meta-analyses, editorials, conference articles, theses, methodological articles, and studies using animal or cell culture models. Searches were conducted of electronic databases, including Scopus, ScienceDirect, and Medline, up to 22 January 2024. The risk of bias was assessed using the Joanna Briggs Institute's critical appraisal tools. The methods used to present and synthesize the results involved data extraction and categorization based on biomolecular and clinical findings of endothelial dysfunction. Results: Following the application of the inclusion and exclusion criteria, a total of 29 studies were identified. Vascular endothelial dysfunction was associated with increased frailty phenotypes, and we also identified SGLT-2 inhibitors' potential role as an anti-fragility treatment that affects endothelial dysfunction. This study found that the physical and biomolecular markers of endothelial dysfunction are associated with frailty measures and have predictive value for incident frailty. Furthermore, some studies have shown inflammation to have an impact on endothelial dysfunction and frailty, and an innovative age-related chronic inflammation measure has been proven to predict frailty scores. Conclusions: The current evidence suggests an association between endothelial dysfunction and frailty, highlighting the need for further research to elucidate the underlying mechanisms.
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Affiliation(s)
- Hakan Calila
- Laboratory of Experimental Medicine and Fundamental Research, 2nd Pathophysiology Department, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania; (R.I.N.); (D.A.I.)
| | - Elena Bălășescu
- Laboratory of Experimental Medicine and Fundamental Research, 2nd Pathophysiology Department, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania; (R.I.N.); (D.A.I.)
- SanacareVital Clinic, 010161 Bucharest, Romania
| | - Roxana Ioana Nedelcu
- Laboratory of Experimental Medicine and Fundamental Research, 2nd Pathophysiology Department, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania; (R.I.N.); (D.A.I.)
| | - Daniela Adriana Ion
- Laboratory of Experimental Medicine and Fundamental Research, 2nd Pathophysiology Department, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 2, 020021 Bucharest, Romania; (R.I.N.); (D.A.I.)
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Oba K, Ishikawa J, Tamura Y, Fujita Y, Ito M, Iizuka A, Fujiwara Y, Kodera R, Toyoshima K, Chiba Y, Tanaka M, Araki A. Serum Growth Differentiation Factor 15 Levels Predict the Incidence of Frailty among Patients with Cardiometabolic Diseases. Gerontology 2024; 70:517-525. [PMID: 38286122 DOI: 10.1159/000536150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Frailty is a crucial health issue among older adults. Growth differentiation factor 15 (GDF15) is associated with inflammation, oxidative stress, insulin resistance, and mitochondrial dysfunction, which are possible pathogeneses of frailty. However, few longitudinal studies have investigated the association between GDF15 and the incidence of frailty. Therefore, we investigated whether high serum GDF15 levels are associated with the incidence of frailty. METHODS A total of 175 older adults (mean age: 77 ± 6 years; 63% women) with cardiometabolic diseases and no frailty out of the two criteria at baseline participated. Individuals with severe renal impairment or severe cognitive impairment were excluded. Serum GDF15 levels were measured at baseline. Patients were asked to assess frailty status at baseline and annually during follow-up using the modified version of the Cardiovascular Health Study (mCHS) and the Kihon Checklist (KCL). We examined the association between GDF15 tertiles and each frailty measure during follow-up (median 38-39 months). In the multivariate Cox regression analysis, with the GDF15 tertile groups as the explanatory variables, hazard ratios (HRs) and 95% confidence intervals (CIs) for incident frailty were calculated after adjusting for covariates and using the lowest tertile group as the reference. RESULTS During the follow-up period, 25.6% and 34.0% of patients developed frailty, as defined by the mCHS and KCL, respectively. The highest GDF15 tertile group had a significantly higher incidence of mCHS- or KCL-defined frailty than the lowest GDF15 tertile group. Multivariate Cox regression analysis revealed that the adjusted HRs for incident mCHS- and KCL-defined frailty in the highest GDF15 tertile group were 3.9 (95% CI: 1.3-12.0) and 2.7 (95% CI: 1.1-6.9), respectively. CONCLUSION High serum GDF15 levels predicted the incidence of frailty among older adults with cardiometabolic diseases and could be an effective marker of the risk for frailty in interventions aimed at preventing frailty, such as exercise and nutrition.
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Affiliation(s)
- Kazuhito Oba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yasunori Fujita
- Research Team for Functional Biogerontology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masafumi Ito
- Research Team for Functional Biogerontology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Ai Iizuka
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Research Team for Social Participation and Community, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Remi Kodera
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kenji Toyoshima
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yuko Chiba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masashi Tanaka
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Xu Q, Jia Y, Wang Y, Yang P, Sun L, Liu Y, Chang X, He Y, Guo D, Shi M, Zhang Y, Zhu Z. The bidirectional association between frailty index and cardiovascular disease: A Mendelian randomization study. Nutr Metab Cardiovasc Dis 2024; 34:624-632. [PMID: 38176958 DOI: 10.1016/j.numecd.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/22/2023] [Accepted: 10/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND AND AIM Observational studies have suggested a relationship between frailty and cardiovascular disease (CVD), but the causality is still uncertain. We used bidirectional Mendelian randomization (MR) design to investigate the potential causal associations between frailty and four main CVDs, including hypertension, myocardial infarction (MI), heart failure (HF), and atrial fibrillation (AF). METHODS AND RESULTS Independent single-nucleotide polymorphisms for frailty index (FI) and CVDs (hypertension, MI, HF, and AF) were selected as genetic instruments based on European-descent genome-wide association studies (GWASs). Summary-level data for outcomes on FI (n = 175,226), hypertension (n = 463,010), MI (n = 171,875), HF (n = 977323), and AF (n = 1,030,836) was derived from five large-scale GWASs of European ancestry. We used the inverse-variance weighted (IVW) method to examine the bidirectional associations between FI and CVDs in the main analyses. In the IVW MR analyses, genetically determined high FI was significantly associated with increased risks of hypertension (odds ratio [OR] per 1-SD increase: 1.07 [95 % confidence interval, 1.05-1.08]), MI (OR per 1-SD increase: 1.74 [1.21-2.51]), HF (OR per 1-SD increase: 1.28 [1.10-1.48]), and AF (OR per 1-SD increase: 1.20 [1.08-1.33]). In addition, genetically determined hypertension (beta: 1.406 [1.225-1.587]), MI (beta: 0.045 [0.023-0.067]), HF (beta: 0.105 [0.066-0.143]) and AF (beta: 0.021 [0.012-0.031]) were significantly associated with high FI. These findings were robustly supported by a series of sensitivity analyses with different MR models. CONCLUSIONS We found potential bidirectional causal associations between elevated FI and increased risks of CVD, suggesting mutual risk factors between frailty and CVD.
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Affiliation(s)
- Qingyun Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yiming Jia
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yinan Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Pinni Yang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Lulu Sun
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yi Liu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xinyue Chang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yu He
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Daoxia Guo
- School of Nursing, Medical College of Soochow University, Suzhou, China
| | - Mengyao Shi
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China.
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China.
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Chen A, Lennon L, Papacosta O, Wannamethee SG. Association of night-time sleep duration and daytime napping with all-cause and cause-specific mortality in older British men: Findings from the British Regional HeartStudy. Sleep Med 2023; 109:32-39. [PMID: 37413780 DOI: 10.1016/j.sleep.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
Short and long night-time sleep and daytime napping in young and middle-aged populations were associated with increased mortality, but it is unclear in very older people. The aim of this prospective study was to assess the associations in people aged >70 years. We examined the data of British Regional Heart Study, which included 1722 men aged 71-92 years and had night-time sleep duration and daytime napping measured at baseline and were followed up for nine years. There were 597 deaths. Compared to night-time sleep at 7-<8 h, age-adjusted hazard ratio of all-cause mortality in participants sleeping <6 h was 1.04 (95% CI 0.80-1.35), 1.07 (0.85-1.34) in 6-<7 h, 1.04 (0.83-1.30) in 8-<9 h and 0.93 (0.65-1.33) in ≥9 h. Further adjustments for other co-variables still showed no association, and neither the association with cardiovascular mortality nor non-cardiovascular mortality. Daytime napping, however, was associated with mortality. After adjustment for age, smoking, physical activity, obesity, cardiovascular diseases, diabetes, frailty, general health, anti-hypertensive medication and C-reactive protein level, hazard ratio of all-cause mortality in participants with daytime napping >1-h versus no napping was 1.62 (1.18-2.22) and hazard ratio of non-cardiovascular mortality was 1.77 (1.22-2.57). The fully adjusted hazard ratio of cardiovascular mortality was not significantly increased 1.26 (0.69-2.28), although age-adjusted hazard ratio was significant 1.94 (1.20-3.16). In the elderly men, daytime napping was independently associated with increased all-cause and non-cardiovascular mortality, while its association with cardiovascular mortality could be explained by cardiovascular risk factors and co-morbidities. Night-time sleep duration was not associated with mortality risk.
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Affiliation(s)
- Anthony Chen
- Faculty of Epidemiology and Public Health, University College of London (UCL), UK; Faculty of Medicine & Health Sciences, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Lucy Lennon
- Dept Primary Care and Population Health, University College of London, UK
| | - Olia Papacosta
- Dept Primary Care and Population Health, University College of London, UK
| | - S Goya Wannamethee
- Dept Primary Care and Population Health, University College of London, UK.
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Ramonfaur D, Skali H, Claggett B, Windham BG, Palta P, Kitzman D, Ndumele C, Konety S, Shah AM. Bidirectional Association Between Frailty and Cardiac Structure and Function: The Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2023; 12:e029458. [PMID: 37522168 PMCID: PMC10492980 DOI: 10.1161/jaha.122.029458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/30/2023] [Indexed: 08/01/2023]
Abstract
Background Frailty and heart failure frequently coexist in late life. Limited data exist regarding the longitudinal associations of frailty and subclinical cardiac dysfunction. We aim to quantify the association of frailty with longitudinal changes in cardiac function and of cardiac function with progression in frailty status in older adults. Methods and Results Participants in the Atherosclerosis Risk in Communities cohort underwent frailty assessments at Visit 5 (V5; 2011-2013), V6 (2016-2017), and V7 (2018-2019), and echocardiographic assessments at V5 and V7. We assessed the association between frailty status at V5 and changes in frailty status from V5 to V7 and changes in cardiac function over 6 years. We then evaluated the association of cardiac function measured at Visit 5 with progression in frailty status over 4 years. Multivariable regression models adjusted for demographics and comorbidities. Among 2574 participants free of heart failure at V5 and V7 (age 74±4 years at V5 and 81±4 years at V7), 3% (n=83) were frail. Frailty at V5 was associated with greater left atrial volume index and E/e' ratio at V5 and 7. Participants who transitioned from robust at V5 to frail at V7 demonstrated greater increases in left ventricular mass index, left atrial volume index, and E/e' over the same period. Among 1648 robust participants at Visit 5, greater left ventricular mass index and mean wall thickness, lower tissue Doppler imaging e', and higher E/e' ratio at Visit 5 were associated with progression in frailty status. Conclusions Among robust, older adults free of heart failure, progression in frailty and subclinical left ventricular remodeling and diastolic dysfunction are interrelated.
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Affiliation(s)
- Diego Ramonfaur
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women’s HospitalBostonMA
| | - Hicham Skali
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women’s HospitalBostonMA
| | - Brian Claggett
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women’s HospitalBostonMA
| | - B. Gwen Windham
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMS
| | - Priya Palta
- Division of General Medicine, Departments of Medicine and EpidemiologyColumbia University Irving Medical CenterNew YorkNY
| | - Dalane Kitzman
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Chiadi Ndumele
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseDivision of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | | | - Amil M. Shah
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women’s HospitalBostonMA
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