title: Cardiovascular Dysfunction and Frailty Among Older Adults in the Community: The ARIC Study.
abstract: BACKGROUND
  The contribution of cardiovascular dysfunction to frailty in older adults is uncertain. This study aimed to define the relationship between frailty and cardiovascular structure and function, and determine whether these associations are independent of coexisting abnormalities in other organ systems.
  
  
  METHODS
  We studied 3,991 older adults (mean age 75.6±5.0 years; 59% female) from the Atherosclerosis Risk in Communities (ARIC) Study in whom the following six organ systems were uniformly assessed: cardiac (by echocardiography), vascular (by ankle-brachial-index and pulse-wave-velocity), pulmonary (by spirometry), renal (by estimated glomerular filtration rate), hematologic (by hemoglobin), and adipose (by body mass index and bioimpedance). Frailty was defined by the presence of ≥3 of the following: low strength, low energy, slowed motor performance, low physical activity, or unintentional weight loss.
  
  
  RESULTS
  Two hundred eleven (5.3%) participants were frail. In multivariable analyses adjusted for demographics, diabetes, hypertension, and measures of other organ system function, frailty was independently and additively associated with left ventricular hypertrophy (odds ratio [OR] = 1.72; 95% confidence interval [CI] = 1.30-2.40), reduced global longitudinal strain (reflecting systolic function; OR = 1.68; 95% CI = 1.16-2.44), and greater left atrial volume index (reflecting diastolic function; OR = 1.60; 95% CI = 1.13-2.27), which together demonstrated the greatest association with frailty (OR = 2.10; 95% CI = 1.57-2.82) of the systems studied. Lower magnitude associations were observed for vascular and pulmonary abnormalities, anemia, and impaired renal function. Cardiovascular abnormalities remained associated with frailty after excluding participants with prevalent cardiovascular disease.
  
  
  CONCLUSIONS
  Abnormalities of cardiac structure and function are independently associated with frailty, and together show the greatest association with frailty among the organ systems studied.
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.|Department of Internal Medicine, University of Campinas, Campinas, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Nadruz
authors.affiliation: Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Dalane
authors.initials: D
authors.lastname: Kitzman
authors.affiliation: Department of Medicine, Geriatrics University of Mississippi Medical Center, Jackson.
authors.forename: Beverly Gwen
authors.initials: BG
authors.lastname: Windham
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill.
authors.forename: Anna
authors.initials: A
authors.lastname: Kucharska-Newton
authors.affiliation: Department of Medicine, Geriatrics University of Mississippi Medical Center, Jackson.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Butler
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill.
authors.forename: Priya
authors.initials: P
authors.lastname: Palta
authors.affiliation: Department of Medicine, Geriatrics University of Mississippi Medical Center, Jackson.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Griswold
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Wagenknecht
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Hicham
authors.initials: H
authors.lastname: Skali
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D002319:Cardiovascular System / Q000473:pathology / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Echocardiography; Elderly; Frailty; Systolic function