Subclinical CVD Linked to an Increased Risk of Incident Frailty

Pavankumar Kamat


September 22, 2021


  • Subclinical cardiovascular disease (CVD), measured by carotid intima-media thickness (CIMT), was associated with a greater risk of incident frailty over a 3-year period, independent of incident clinically overt myocardial infarction, stroke, and heart failure.

  • The association was stronger in men aged >80 years.

Why this matters

  • Findings suggest that imaging markers of subclinical CVD, including CIMT, should be evaluated for their ability to predict frailty and risk-stratify those at the highest risk for targeted intervention.

Study design

  • A longitudinal analysis of 865 men (age, 71-92 years) without CVD, identified from the British Regional Heart Study.

  • Subclinical CVD was evaluated using 4 methods:

    • carotid-femoral pulse wave velocity (cfPWV);

    • CIMT;

    • carotid distensibility coefficient (DC); and

    • ankle-brachial pressure index (ABPI).

  • Incident frailty status, based on the Fried phenotype, was obtained from a questionnaire performed 3 years later.

  • Funding: British Heart Foundation.

Key results

  • After adjustment for confounders, higher CIMT was associated with a greater risk of incident frailty:

    • second tertile of CIMT (adjusted OR [aOR], 1.62; 95% CI, 0.78-3.35; P=.20); and

    • third tertile of CIMT (aOR, 2.61; 95% CI, 1.30-5.23; P=.007; Ptrend=.006).

  • Higher cfPWV showed a weaker and non-significant association with incident frailty:

    • second tertile of cfPWV (aOR, 1.79; 95% CI, 0.85-3.78; P=.13); and

    • third tertile of cfPWV (aOR, 1.73; 95% CI, 0.81-3.72; P=.16; Ptrend=.20).

  • DC and ABPI had no significant association with incident frailty.

  • In subgroup analyses, higher CIMT was significantly associated with incident frailty in men aged ≥80 years (third tertile: aOR, 6.99; 95% CI, 1.42-34.5; P=.02), but not in men aged 75-80 years or <75 years.


  • Risk of residual confounding.


McKechnie DGJ, Papacosta AO, Lennon LT, Ellins EA, Halcox JPJ, Ramsay SE, Whincup PH, Wannamethee SG. Subclinical cardiovascular disease and risk of incident frailty: The British Regional Heart Study. Exp Gerontol. 2021 Aug 21 [Epub ahead of print];154:111522. doi: 10.1016/j.exger.2021.111522. PMID: 34428478.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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