title: Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis.
abstract: Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any-type CVD in the frail (HR=1.70 [95%CI, 1.18-2.45]; I2=66%) and pre-frail (HR=1.23 [95%CI, 1.07-1.36]; I2=67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults.
authors.affiliation: Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy; Institute for Clinical Research and Education in Medicine (IREM), Padova, Italy; National Research Council, Neuroscience Institute-Aging Branch, Padova, Italy. Electronic address: ilmannato@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cereda
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS FoundationTrust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: Institute for Clinical Research and Education in Medicine (IREM), Padova, Italy; Department of Neurosciences, University of Padova, Padova, Italy; National Health Care System, Monselice, Padova Local Unit ULSS 17, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solmi
authors.affiliation: Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy; Surgical Pathology Unit, Santa Chiara Hospital, Trento, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Luchini
authors.affiliation: Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy; National Research Council, Neuroscience Institute-Aging Branch, Padova, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Manzato
authors.affiliation: Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sergi
authors.affiliation: South Oaks Hospital, Northwell Health,400 Sunsrise Highway, Amityville, NY 11701, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Manu
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Harris
authors.affiliation: Division of Geriatrics and Nutritional Sciences and Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA; Department of Clinical and Experimental Sciences, Brescia University, Brescia, Italy; CEINGE Biotecnologie Avanzate, Napoli, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Fontana
authors.affiliation: University of Helsinki and Helsinki University Hospital, Helsinki, Finland; University of Oulu,Center for Life Course Health Research, Oulu, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Strandberg
authors.affiliation: Centre de Recherche Inserm, Bordeaux, France; University Victor Segalen Bordeaux 2, Bordeaux, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Amieva
authors.affiliation: CMRR Paris Nord AP-HP, Groupe Hospitalier Lariboisière Fernand-Widal Saint-Louis, INSERM, U942, Université Paris Diderot, Sorbonne Paris Cité, UMRS 942, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Dumurgier
authors.affiliation: CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Elbaz
authors.affiliation: University of Bordeaux, Neuroepidemiology, UMR897, Bordeaux, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tzourio
authors.affiliation: University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Division of Chronic Disease Epidemiology, Hirschengraben 84, CH-8001 Zurich, Switzerland.
authors.forename: Monika
authors.initials: M
authors.lastname: Eicholzer
authors.affiliation: University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Division of Chronic Disease Epidemiology, Hirschengraben 84, CH-8001 Zurich, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Quadri
authors.affiliation: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Polidoro
authors.affiliation: Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Roberto Alves
authors.initials: RA
authors.lastname: Lourenço
authors.affiliation: Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Virgilio Garcia
authors.initials: VG
authors.lastname: Moreira
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, (CIBER-CV), Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.affiliation: Clinical Epidemiology and Biometric Unit, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Scotti
authors.affiliation: National Research Council, Neuroscience Institute-Aging Branch, Padova, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Maggi
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA; Hofstra Northwell School of Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality; D016330:Frail Elderly; D006801:Humans; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors
keywords: Cardiovascular disease; Frailty; Meta-analysis