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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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de Sousa MKF, Silva RDM, Freire YA, Souto GC, Câmara M, Cabral LLP, Macêdo GAD, Costa EC, Oliveira RS. Associations between physical activity and cardiorespiratory fitness with vascular health phenotypes in older adults: a cross-sectional study. Front Physiol 2023; 14:1096139. [PMID: 37256064 PMCID: PMC10225566 DOI: 10.3389/fphys.2023.1096139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
Objective: We investigated the associations between physical activity (PA) and cardiorespiratory fitness (CRF) with vascular health phenotypes in community-dwelling older adults. Methods: This cross-sectional study included 82 participants (66.8 ± 5.2 years; 81% females). Moderate-to-vigorous physical activity (MVPA) was assessed using accelerometers, and CRF was measured using the distance covered in the 6-min walk test (6MWT). The vascular health markers were as follows: i) arterial function measured as aortic pulse wave velocity (aPWV) estimated using an automatic blood pressure device; and ii) arterial structure measured as the common carotid intima-media thickness (cIMT). Using a combination of normal cIMT and aPWV values, four groups of vascular health phenotypes were created: normal aPWV and cIMT, abnormal aPWV only, abnormal cIMT only, and abnormal aPWV and cIMT. Multiple linear regression was used to estimate the beta coefficients (β) and their respective 95% confidence intervals (95% CI) adjusting for BMI, and medication for diabetes, lipid, and hypertension, sex, age, and blood pressure. Results: Participants with abnormal aPWV and normal cIMT (β = -53.76; 95% CI = -97.73--9.78 m; p = 0.017), and participants with both abnormal aPWV and cIMT (β = -71.89; 95% CI = -125.46--18.31 m; p = 0.009) covered less distance in the 6MWT, although adjusting for age, sex and blood pressure decreased the strength of the association with only groups of abnormal aPWV and cIMT covering a lower 6MWT distance compared to participants with both normal aPWV and cIMT (β = -55.68 95% CI = -111.95-0.59; p = 0.052). No associations were observed between MVPA and the vascular health phenotypes. Conslusion: In summary, poor CRF, but not MVPA, is associated with the unhealthiest vascular health phenotype (abnormal aPWV/cIMT) in older adults.
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Affiliation(s)
| | - Raíssa de Melo Silva
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Department of Physical Education, ExCE Research Group, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Yuri Alberto Freire
- Department of Physical Education, ExCE Research Group, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Gabriel Costa Souto
- Department of Physical Education, ExCE Research Group, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Marcyo Câmara
- Department of Physical Education, ExCE Research Group, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ludmila Lucena Pereira Cabral
- Department of Physical Education, ExCE Research Group, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Geovani Araújo Dantas Macêdo
- Department of Physical Education, ExCE Research Group, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Eduardo Caldas Costa
- Department of Physical Education, ExCE Research Group, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ricardo Santos Oliveira
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- INTEGRA—Integrative Physiology, Health, and Performance Research Group, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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