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Venkatesh A, Susheela AT, Kochar B. Frailty: An Underappreciated Risk Factor for IBD Complications. Curr Gastroenterol Rep 2024:10.1007/s11894-024-00945-5. [PMID: 39235680 DOI: 10.1007/s11894-024-00945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE OF REVIEW The prevalence of IBD in older adults is rapidly growing. Older adults with IBD are underrepresented in research and clinical trials and yet at great risk for adverse events. Therefore, understanding advanced aged associated constructs in older adults can be critical to improving the management of older adults with IBD. RECENT FINDINGS In this review, we present recent studies on frailty in IBD. We identify 4 major themes in the literature: studies that describe frailty in patients with IBD, studies that report on consequences of frailty, studies of frailty as a risk stratification modality, and studies of frailty as an exposure and outcome. In reviewing the literature, we discuss the heterogeneity that exists and outline future directions to ensure appropriate applications for frailty in the field of IBD.
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Affiliation(s)
- Ananya Venkatesh
- Department of Medicine, Thomas Jefferson University Hospital, 901 Walnut St, Philadelphia, PA, 19107, USA
| | - Ammu T Susheela
- Chicago Internal Medicine Practice and Research, 101 Madison St Suite 300, Oak Park, IL, 60302, USA
| | - Bharati Kochar
- Division of Gastroenterology, Massachusetts General Hospital, Massachusetts General Hospital Crohn's & Colitis Center, 165 Cambridge Street, 9th Floor, Boston, MA, 02114, USA.
- The Mongan Institute, 100 Cambridge St Suite 1600, Boston, MA, 02114, USA.
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
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2
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Thanapluetiwong S, Chattaris T, Shi SM, Park CM, Sison SDM, Kim DH. Association between Drug Therapy and Risk of Incident Frailty: A Systematic Review. Ann Geriatr Med Res 2024; 28:247-256. [PMID: 38757259 DOI: 10.4235/agmr.24.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
Medication is a potential factor influencing frailty. However, the relationship between pharmaceutical treatments and frailty remains unclear. Therefore, we conducted the present systematic review to summarize the association between drug therapy and the risk of incident frailty in older adults. We systematically searched the MEDLINE electronic database for articles indexed between January 1, 2000, and December 31, 2021, for randomized controlled trials (RCTs) and cohort studies reporting frailty changes associated with drug therapy. A total of six RCTs and 13 cohort studies involving 211,948 participants were identified, and their treatments were categorized into six medication classes: analgesics, cardiometabolic medication, chemotherapy, central nervous system (CNS)-active medication, hormonal therapy, and nutritional supplements. While the analysis revealed that only CNS-active medications were associated with an elevated risk of frailty, other medication classes also affected frailty; however, this is not conclusively attributable to a class-wide effect.
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Affiliation(s)
- Saran Thanapluetiwong
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Tanchanok Chattaris
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Sandra Miao Shi
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chan Mi Park
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephanie Denise M Sison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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3
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James K, Jamil Y, Kumar M, Kwak MJ, Nanna MG, Qazi S, Troy AL, Butt JH, Damluji AA, Forman DE, Orkaby AR. Frailty and Cardiovascular Health. J Am Heart Assoc 2024; 13:e031736. [PMID: 39056350 DOI: 10.1161/jaha.123.031736] [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] [Indexed: 07/28/2024]
Abstract
The incidence of frailty and cardiovascular disease (CVD) increases as the population ages. There is a bidirectional relationship between frailty and CVD, and both conditions share several risk factors and underlying biological mechanisms. Frailty has been established as an independent prognostic marker in patients with CVD. Moreover, its presence significantly influences both primary and secondary prevention strategies for adults with CVD while also posing a barrier to the inclusion of these patients in pivotal clinical trials and advanced cardiac interventions. This review discusses the current knowledge base on the relationship between frailty and CVD, how managing CVD risk factors can modify frailty, the influence of frailty on CVD management, and future directions for frailty detection and modification in patients with CVD.
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Affiliation(s)
- Kirstyn James
- Department of Geriatric Medicine Cork University Hospital Cork Ireland
| | - Yasser Jamil
- Department of Internal Medicine Yale University School of Medicine New Haven CT USA
| | | | - Min J Kwak
- University of Texas Health Science Center at Houston TX USA
| | - Michael G Nanna
- Department of Internal Medicine Yale University School of Medicine New Haven CT USA
| | | | - Aaron L Troy
- Department of Medicine Beth Israel Deaconess Medical Center Boston MA USA
| | - Jawad H Butt
- British Heart Foundation Cardiovascular Research Centre University of Glasgow UK
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Department of Cardiology Zealand University Hospital Roskilde Denmark
| | - Abdulla A Damluji
- Johns Hopkins University School of Medicine Baltimore MD USA
- The Inova Center of Outcomes Research Inova Heart and Vascular Institute Baltimore MD USA
| | - Daniel E Forman
- Department of Medicine (Geriatrics and Cardiology) University of Pittsburgh PA USA
- Pittsburgh GRECC (Geriatrics Research, Education and Clinical Center) VA Pittsburgh Healthcare System Pittsburgh PA USA
| | - Ariela R Orkaby
- VA Boston Healthcare System Boston MA USA
- Division of Aging, Brigham and Women's Hospital Harvard Medical School Boston MA USA
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4
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Bålsrud P, Ulven SM, Ottestad I, Retterstøl K, Schwab U, Holven KB. Association between inflammatory markers, body composition and frailty in home-dwelling elderly: an 8-year follow-up study. GeroScience 2024:10.1007/s11357-024-01279-w. [PMID: 38981983 DOI: 10.1007/s11357-024-01279-w] [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: 05/22/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024] Open
Abstract
Frailty has been linked to inflammation and changes in body composition, but the findings are inconsistent. To explore this, we used the Frailty Index (FI) definition to (1) investigate the association between levels of inflammatory markers (baseline) and change in FI score after 8 years of follow-up and (2) investigate the longitudinal associations between inflammatory markers, body composition, and frailty. Home-dwelling elderly (≥ 70 years) were invited to participate in the study and re-invited to a follow-up visit 8 years later. This study includes a total of 133 participants. The inflammatory markers included were high-sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and glycoprotein acetyls (Gp-acetyls). We used the body composition markers fat mass, fat-free mass, and waist circumference. The FI score consisted of 38 variables. Additional clinical assessments such as blood pressure and body mass index (BMI), as well as information about daily medications, were collected at both visits. Linear regression model and Spearman's rank correlation were used to investigate associations. We showed that the FI score increased after 8 years, and participants with higher hs-CRP levels at baseline had the largest change in the FI score. Changes in fat mass were significantly correlated with changes in hs-CRP and IL-6, and changes in waist circumference were significantly correlated with changes in TNF-α. The use of drugs increased during the 8 years of follow-up, which may have attenuated the associations between inflammation and frailty. However, elevated concentrations of hs-CRP in the elderly may be associated with an increased risk of frailty in subsequent years.
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Affiliation(s)
- Pia Bålsrud
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Clinical Nutrition, Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- The Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
- National Advisory Unit On Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway.
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5
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Orkaby AR, Thomson A, MacFadyen J, Besdine R, Forman DE, Travison TG, Ridker PM. Effect of canakinumab on frailty: A post hoc analysis of the CANTOS trial. Aging Cell 2024; 23:e14029. [PMID: 37927208 PMCID: PMC10776110 DOI: 10.1111/acel.14029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
Although inflammation is strongly associated with frailty, whether medications that lower inflammation decrease frailty is unclear and randomized trial evidence is scant. We sought to test whether canakinumab, a therapeutic monoclonal antibody that inhibits IL-1β and reduces C-reactive protein (CRP), can lower frailty risk. This was a post hoc analysis of the Canakinumab ANti-inflammatory Thrombosis Outcome Study (CANTOS), a randomized double-blind placebo-controlled trial of 10,061 stable postmyocardial infarction patients randomized to subcutaneous canakinumab once every 3 months. Incident frailty was measured using a 34-item cumulative-deficit Frailty Index (FI). Time-to-event analysis using intent to treat. A total of 9942 CANTOS participants had data to calculate a baseline FI. Median age was 61 (IQR 54-68); 74% were male, 12% Asian, 3% Black, 80% White, and 16% Hispanic/Latino. At baseline, mean FI score was 0.12 and 13% were frail using a cutoff of 0.2. Over 5 years, 1080 participants (12.5%) became frail and mean FI scores increased to 0.14. There was no effect on frailty incidence according to randomization to any canakinumab dose versus placebo over time, HR 1.03 (0.91-1.17), p = 0.63. Results were similar using phenotypic frailty. Additionally, the primary findings of CANTOS in terms of canakinumab-associated cardiovascular event reduction were unchanged in analyses stratified by baseline frailty. In conclusion, among stable adult patients with atherosclerosis, random allocation to interleukin-1b inhibition with canakinumab versus placebo did not lower risk of incident frailty over 5 years. More randomized data are needed to understand the role of targeted anti-inflammatory medications for frailty prevention in older adults.
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Affiliation(s)
- Ariela R. Orkaby
- New England GRECC (Geriatric Research, Education, and Clinical Center)VA Boston Healthcare SystemBostonMassachusettsUSA
- Division of Aging, Brigham & Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Aerin Thomson
- Center for Cardiovascular Disease Prevention and Cardiovascular Division, Brigham & Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Jean MacFadyen
- Center for Cardiovascular Disease Prevention and Cardiovascular Division, Brigham & Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Richard Besdine
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Daniel E. Forman
- Section of Geriatric Cardiology, Department of Medicine (Divisions of Geriatrics and Cardiology)University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- Geriatric Research, Education, and Clinical CenterVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Thomas G. Travison
- Marcus Institute for Aging Research, Hebrew SeniorLifeHarvard Medical SchoolBostonMassachusettsUSA
| | - Paul M. Ridker
- Center for Cardiovascular Disease Prevention and Cardiovascular Division, Brigham & Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Marcozzi S, Bigossi G, Giuliani ME, Lai G, Giacconi R, Piacenza F, Malavolta M. Spreading Senescent Cells' Burden and Emerging Therapeutic Targets for Frailty. Cells 2023; 12:2287. [PMID: 37759509 PMCID: PMC10528263 DOI: 10.3390/cells12182287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The spreading of senescent cells' burden holds profound implications for frailty, prompting the exploration of novel therapeutic targets. In this perspective review, we delve into the intricate mechanisms underlying senescent cell spreading, its implications for frailty, and its therapeutic development. We have focused our attention on the emerging age-related biological factors, such as microbiome and virome alterations, elucidating their significant contribution to the loss of control over the accumulation rate of senescent cells, particularly affecting key frailty domains, the musculoskeletal system and cerebral functions. We believe that gaining an understanding of these mechanisms could not only aid in elucidating the involvement of cellular senescence in frailty but also offer diverse therapeutic possibilities, potentially advancing the future development of tailored interventions for these highly diverse patients.
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Affiliation(s)
- Serena Marcozzi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy
| | - Giorgia Bigossi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Maria Elisa Giuliani
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Giovanni Lai
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Robertina Giacconi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Francesco Piacenza
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Marco Malavolta
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
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7
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Mak JKL, Kananen L, Qin C, Kuja‐Halkola R, Tang B, Lin J, Wang Y, Jääskeläinen T, Koskinen S, Lu Y, Magnusson PKE, Hägg S, Jylhävä J. Unraveling the metabolic underpinnings of frailty using multicohort observational and Mendelian randomization analyses. Aging Cell 2023; 22:e13868. [PMID: 37184129 PMCID: PMC10410014 DOI: 10.1111/acel.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023] Open
Abstract
Identifying metabolic biomarkers of frailty, an age-related state of physiological decline, is important for understanding its metabolic underpinnings and developing preventive strategies. Here, we systematically examined 168 nuclear magnetic resonance-based metabolomic biomarkers and 32 clinical biomarkers for their associations with frailty. In up to 90,573 UK Biobank participants, we identified 59 biomarkers robustly and independently associated with the frailty index (FI). Of these, 34 associations were replicated in the Swedish TwinGene study (n = 11,025) and the Finnish Health 2000 Survey (n = 6073). Using two-sample Mendelian randomization, we showed that the genetically predicted level of glycoprotein acetyls, an inflammatory marker, was statistically significantly associated with an increased FI (β per SD increase = 0.37%, 95% confidence interval: 0.12-0.61). Creatinine and several lipoprotein lipids were also associated with increased FI, yet their effects were mostly driven by kidney and cardiometabolic diseases, respectively. Our findings provide new insights into the causal effects of metabolites on frailty and highlight the role of chronic inflammation underlying frailty development.
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Affiliation(s)
- Jonathan K. L. Mak
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Laura Kananen
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC)University of TampereTampereFinland
| | - Chenxi Qin
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Ralf Kuja‐Halkola
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Bowen Tang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Jake Lin
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC)University of TampereTampereFinland
- Institute for Molecular Medicine Finland FIMM, Helsinki Institute of Life Science HiLIFE, University of HelsinkiHelsinkiFinland
| | - Yunzhang Wang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Clinical Sciences, Danderyd HospitalKarolinska InstitutetStockholmSweden
| | | | | | - Yi Lu
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Patrik K. E. Magnusson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Sara Hägg
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC)University of TampereTampereFinland
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Espinoza SE, Woods RL, Ekram ARMS, Ernst ME, Polekhina G, Wolfe R, Shah RC, Ward SA, Storey E, Nelson MR, Reid CM, Lockery JE, Orchard SG, Trevaks R, Fitzgerald SM, Stocks NP, Chan A, McNeil JJ, Murray AM, Newman AB, Ryan J. The Effect of Low-Dose Aspirin on Frailty Phenotype and Frailty Index in Community-Dwelling Older Adults in the ASPirin in Reducing Events in the Elderly Study. J Gerontol A Biol Sci Med Sci 2022; 77:2007-2014. [PMID: 34758073 PMCID: PMC9536436 DOI: 10.1093/gerona/glab340] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Frailty is associated with chronic inflammation, which may be modified by aspirin. The purpose of this study was to determine whether low-dose aspirin reduces incident frailty in healthy older adult participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial. METHODS In the United States and Australia, 19 114 community-dwelling individuals aged ≥70 and older (U.S. minorities ≥65 years) and free of overt cardiovascular disease, persistent physical disability, and dementia were enrolled in ASPREE, a double-blind, placebo-controlled trial of 100-mg daily aspirin versus placebo. Frailty, a prespecified study end point, was defined according to a modified Fried frailty definition (Fried frailty) and the frailty index based on the deficit accumulation model (frailty index). Competing risk Cox proportional hazard models were used to compare time to incident frailty by aspirin versus placebo. Sensitivity analysis was conducted to include frailty data with and without imputation of missing data. RESULTS Over a median 4.7 years, 2 252 participants developed incident Fried frailty, and 4 451 had incident frailty according to the frailty index. Compared with placebo, aspirin treatment did not alter the risk of incident frailty (Fried frailty hazard ratio [HR]: 1.04, 95% confidence interval [CI] 0.96-1.13; frailty index HR: 1.03, 95% CI 0.97-1.09). The proportion of individuals classified as frail, and the trajectory in continuous frailty scores over time, were not different between the aspirin and placebo treatment groups. The results were consistent across a series of subgroups. CONCLUSIONS Low-dose aspirin use in healthy older adults when initiated in older ages does not reduce risk of incident frailty or the trajectory of frailty.
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Affiliation(s)
- Sara E Espinoza
- Division of Geriatrics, Gerontology and Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas, USA.,Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A R M Saifuddin Ekram
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA.,Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Galina Polekhina
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elsdon Storey
- Van Cleef/Roet Centre for Nervous Diseases, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ruth Trevaks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sharyn M Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nigel P Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Andy Chan
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Clinical Outcomes and Research, Hennepin Health Research Institute and Division of Geriatrics, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota, USA
| | - Anne B Newman
- Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joanne Ryan
- Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
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9
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Orkaby AR, Ward R, Chen J, Shanbhag A, Sesso HD, Gaziano JM, Djousse L, Driver JA. Influence of Long-term Nonaspirin NSAID Use on Risk of Frailty in Men ≥60 Years: The Physicians' Health Study. J Gerontol A Biol Sci Med Sci 2022; 77:1048-1054. [PMID: 35018441 PMCID: PMC9071430 DOI: 10.1093/gerona/glac006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Inflammation is a central pathway leading to frailty but whether commonly used nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can prevent frailty is unknown. METHODS Prospective cohort study of male physicians ≥60 who participated in the Physicians' Health Study. Annual questionnaires collected data on NSAID use, lifestyle, and morbidity. Average annual NSAID use was categorized as 0 days/year, 1-12 days/year, 13-60 days/year, and >60 days/year. Frailty was assessed using a validated 33-item frailty index. Propensity score inverse probability of treatment weighting was used to address confounding by indication and logistic regression models estimated odds ratios (ORs) of prevalent frailty according to nonaspirin NSAID use. RESULTS A total of 12 101 male physicians were included (mean age 70 ± 7 years, mean follow-up 11 years). Reported NSAID use was 0 days/year for 2 234, 1-12 days/year for 5 812, 13-60 days/year for 2 833, and >60 days/year for 1 222 participants. A total of 2 413 participants (20%) were frail. Higher self-reported NSAID use was associated with greater alcohol use, smoking, arthritis, hypertension, and heart disease, while less NSAID use was associated with coumadin use and prior bleeding. After propensity score adjustment, all characteristics were balanced. ORs (95% confidence intervals) of prevalent frailty were 0.90 (0.80-1.02), 1.02 (0.89-1.17), and 1.26 (1.07-1.49) for average NSAID use of 1-12 days/year, 13-60 days/year, and >60 days/year, compared to 0 days/year (p-trend < .001). CONCLUSIONS Long-term use of NSAIDs at high frequency is associated with increased risk of frailty among older men. Additional study is needed to understand the role of anti-inflammatory medication in older adults and its implication for overall health.
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Affiliation(s)
- Ariela R Orkaby
- Address correspondence to: Ariela R. Orkaby, MD, MPH, New England GRECC (Geriatric Research, Education, and Clinical Center), VA Boston Healthcare System, 150 South Huntington Street, Boston, MA 02130, USA. E-mail:
| | - Rachel Ward
- New England GRECC (Geriatric Research, Education, and Clinical Center), VA Boston Healthcare System, Boston, Massachusetts, USA,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jiaying Chen
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Akshay Shanbhag
- Department of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Howard D Sesso
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA,Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J Michael Gaziano
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Luc Djousse
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jane A Driver
- New England GRECC (Geriatric Research, Education, and Clinical Center), VA Boston Healthcare System, Boston, Massachusetts, USA,Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Orkaby AR, Dufour AB, Yang L, Sesso HD, Gaziano JM, Djousse L, Driver JA, Travison TG. Long-Term Aspirin Use and Self-Reported Walking Speed in Older Men: The Physicians' Health Study. J Frailty Aging 2022; 11:12-17. [PMID: 35122085 PMCID: PMC8818085 DOI: 10.14283/jfa.2021.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Mobility limitation is a component of frailty that shares a bidirectional relationship with cardiovascular disease (CVD). Data are limited on the role of established CVD prevention therapies, such as aspirin, for prevention of frailty and mobility limitation. OBJECTIVES Examine the association between long-term aspirin use and walking speed. DESIGN, SETTING, PARTICIPANTS Prospective cohort of 14,315 men who participated in the Physicians' Health Study I, a completed randomized controlled trial of aspirin (1982-1988), with extended post-trial follow-up. MEASUREMENTS Annual questionnaires collected data on aspirin use, lifestyle and other factors. Average annual aspirin use was categorized for each participant: ≤60 days/year and >60 days/year. Mobility was defined according to self-reported walking pace, categorized as: don't walk regularly (reference), easy/casual <2mph, normal ≥2-2.9mph, or brisk/very brisk ≥3mph. Propensity scoring balanced covariates between aspirin categories. Multinomial logistic regression models estimated odds of being in each self-reported walking category. RESULTS Mean age was 70±8 years; mean aspirin use 11 years. There were 2,056 (14.3%) participants who reported aspirin use ≤60 days/year. Aspirin use >60 days/year was associated with drinking alcohol, smoking, hypertension, heart disease and stroke, while ≤60 days/year was associated with anticoagulation use and bleeding history. In all, 13% reported not walking regularly, 12% walked <2 mph, 44% walked ≥2-2.9 mph, and 31% walked ≥3 mph. After propensity score adjustment, regular aspirin use was associated with a faster walking speed. Odds ratios (95% confidence intervals) were 1.16 (0.97 to 1.39), 1.24 (1.08 to 1.43), and 1.40 (1.21 to 1.63) for <2 mph, ≥2-2.9 mph and ≥3 mph, respectively, compared to not walking regularly (p-trend<0.001). CONCLUSIONS In this cohort of older men, long-term aspirin use is associated with a greater probability of faster walking speed later in life.
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Affiliation(s)
- Ariela R. Orkaby
- New England GRECC, VA Boston Healthcare System, Boston, MA;,Brigham & Women’s Hospital and Harvard Medical School, Boston, MA
| | - Alyssa B. Dufour
- Marcus Institute for Aging Research, Hebrew Senior Life, and Harvard Medical School, Boston, MA
| | - Laiji Yang
- Marcus Institute for Aging Research, Hebrew Senior Life, and Harvard Medical School, Boston, MA
| | - Howard D. Sesso
- Brigham & Women’s Hospital and Harvard Medical School, Boston, MA
| | - J. Michael Gaziano
- New England GRECC, VA Boston Healthcare System, Boston, MA;,Brigham & Women’s Hospital and Harvard Medical School, Boston, MA
| | - Luc Djousse
- New England GRECC, VA Boston Healthcare System, Boston, MA;,Brigham & Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jane A. Driver
- New England GRECC, VA Boston Healthcare System, Boston, MA;,Brigham & Women’s Hospital and Harvard Medical School, Boston, MA
| | - Thomas G. Travison
- Marcus Institute for Aging Research, Hebrew Senior Life, and Harvard Medical School, Boston, MA
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