title: Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study.
abstract: BACKGROUND
  The biological basis of frailty has been difficult to establish owing to the lack of a standard definition, its complexity, and its frequent coexistence with illness.
  
  
  OBJECTIVE
  To establish the biological correlates of frailty in the presence and absence of concurrent cardiovascular disease and diabetes mellitus.
  
  
  METHODS
  Participants were 4735 community-dwelling adults 65 years and older. Frail, intermediate, and nonfrail subjects were identified by a validated screening tool and exclusion criteria. Bivariate relationships between frailty level and physiological measures were evaluated by Pearson chi2 tests for categorical variables and analysis of variance F tests for continuous variables. Multinomial logistic regression was performed to evaluate multivariable relationships between frailty status and physiological measures.
  
  
  RESULTS
  Of 4735 Cardiovascular Health Study participants, 299 (6.3%) were identified as frail, 2147 (45.3%) as intermediate, and 2289 (48.3%) as not frail. Frail vs nonfrail participants had increased mean +/- SD levels of C-reactive protein (5.5 +/- 9.8 vs 2.7 +/- 4.0 mg/L), factor VIII (13 790 +/- 4480 vs 11 860 +/- 3460 mg/dL), and, in a smaller subset, D dimer (647 +/- 1033 vs 224 +/- 258 ng/mL) (P< or =.001 for all, chi2 test for trend). These differences persisted when individuals with cardiovascular disease and diabetes were excluded and after adjustment for age, sex, and race.
  
  
  CONCLUSIONS
  These findings support the hypothesis that there is a specific physiological basis to the geriatric syndrome of frailty that is characterized in part by increased inflammation and elevated markers of blood clotting and that these physiological differences persist when those with diabetes and cardiovascular disease are excluded.
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, Md, USA. jwalston@jhmi.edu
authors.forename: Jeremy
authors.initials: J
authors.lastname: Walston
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: McBurnie
authors.forename: Anne
authors.initials: A
authors.lastname: Newman
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Kop
authors.forename: Calvin H
authors.initials: CH
authors.lastname: Hirsch
authors.forename: John
authors.initials: J
authors.lastname: Gottdiener
authors.forename: Linda P
authors.initials: LP
authors.lastname: Fried
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001778:Blood Coagulation Disorders / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D015331:Cohort Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male