title: Pre-frailty and risk of cardiovascular disease in elderly men and women: the Pro.V.A. study.
abstract: BACKGROUND
  Frailty is an important risk factor for cardiovascular disease (CVD), but the impact of early, potentially reversible stages of frailty on CVD risk is unknown.
  
  
  OBJECTIVE
  This study sought to ascertain whether pre-frailty can predict the onset of CVD in a cohort of community-dwelling, not disabled, elderly people.
  
  
  METHODS
  A sample of 1,567 participants age 65 to 96 years without frailty or disability at baseline was followed for 4.4 years. Pre-frailty was defined as the presence of 1 or 2 modified Fried criteria (unintentional weight loss, low physical activity level, weakness, exhaustion, and slow gait speed), and incident CVD as onset of coronary artery diseases, heart failure, stroke, peripheral artery disease, or CVD-related mortality.
  
  
  RESULTS
  During follow-up, 551 participants developed CVD. Compared with participants who did not become frail, those with 1 modified Fried criterion (p = 0.03) and those with 2 criteria (p = 0.001) had a significantly higher risk of CVD, even after adjusting for several potential confounders (traditional risk factors for CVD, inflammatory markers, and hemoglobin A1c levels). Low energy expenditure (p = 0.03), exhaustion (p = 0.01), and slow gait speed (p = 0.03) were significantly associated with the onset of CVD, whereas unintentional weight loss and weakness were not.
  
  
  CONCLUSIONS
  Our findings suggest that pre-frailty, which is potentially reversible, is independently associated with a higher risk of older adults developing CVD. Among the physical domains of pre-frailty, low gait speed seems to be the best predictor of future CVD.
authors.affiliation: Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sergi
authors.affiliation: Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy. Electronic address: ilmannato@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Department of Clinical and Experimental Sciences, Brescia University Medical School, Brescia, Italy; Division of Geriatrics and Nutritional Science and Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri; CEINGE Biotecnologie Avanzate, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Fontana
authors.affiliation: Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: De Rui
authors.affiliation: Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bolzetta
authors.affiliation: National Research Council, Aging Branch, Institute of Neuroscience, Padua, Italy; Department of Medical and Surgical Sciences, University of Padua, Padua, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Zambon
authors.affiliation: Azienda Unità Locale Socio Sanitaria 16, Padua, Italy.
authors.forename: Maria-Chiara
authors.initials: MC
authors.lastname: Corti
authors.affiliation: Division of Internal Medicine, Azienda Ospedaliera, Padua, Italy.
authors.forename: Giovannella
authors.initials: G
authors.lastname: Baggio
authors.affiliation: Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy.
authors.forename: Elena Debora
authors.initials: ED
authors.lastname: Toffanello
authors.affiliation: National Research Council, Aging Branch, Institute of Neuroscience, Padua, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Crepaldi
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Padua, Italy.
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.affiliation: Department of Medicine DIMED, Geriatrics Division, University of Padua, Padua, Italy; National Research Council, Aging Branch, Institute of Neuroscience, Padua, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Manzato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D004734:Energy Metabolism; D005260:Female; D016330:Frail Elderly; D005684:Gait; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D015431:Weight Loss
keywords: aging; frailty; risk factor