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Aging and disease    2018, Vol. 9 Issue (3) : 489-497     DOI: 10.14336/AD.2017.1125
Orginal Article |
Frailty in Older Adults with Cardiovascular Disease: Cause, Effect or Both?
Kleipool Emma EF.1, Hoogendijk Emiel O.2, Trappenburg Marijke C.1, Handoko M. Louis3, Huisman Martijn2,4, Peters Mike JL.1, Muller Majon1,*
1Department of Internal medicine and Geriatrics, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
2Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
3Department of Cardiology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
4Department of Sociology, VU University, 1081 HV Amsterdam, The Netherlands
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Cardiovascular disease (CVD) has been associated with an increased risk of frailty, but the direction of the association remains unclear. This study set out to examine the bidirectional longitudinal association between CVD and frailty over an extended period of time. Data are from 1432 older adults (aged 65-88yrs) of the Longitudinal Aging Study Amsterdam (LASA), who were followed for 17 years. At baseline and follow-up, CVD was assessed through self-report, medication use and medical records, and classified as angina pectoris, myocardial infarction, heart failure (HF), stroke, and peripheral artery disease. Throughout the study, frailty was assessed using Fried’s frailty criteria. Cox regression models showed that patients with HF had an increased frailty risk (HR 2.7; 95%CI: 1.5-5.1) after a median follow-up of 8.4 yrs. This finding was independent of potential confounders (age, sex, several comorbidities). Examinations of the reverse association revealed that frail older adults were not at risk of incident CVD. Of all older adults with CVD, those with HF have an increased risk of frailty and frail older adults do not have an increased risk of CVD. Our findings emphasize the need for cardiac rehabilitation programs evaluating the effect of physical exercise programs in order to prevent frailty and therewith improve quality of life and independence of care in CVD patients.

Keywords Frailty      older adults      cardiovascular disease      heart failure     
Corresponding Authors: Muller Majon   
About author:

Those authors contributed equally to this work.

Issue Date: 05 June 2018
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Kleipool Emma EF.
Hoogendijk Emiel O.
Trappenburg Marijke C.
Handoko M. Louis
Huisman Martijn
Peters Mike JL.
Muller Majon
Cite this article:   
Kleipool Emma EF.,Hoogendijk Emiel O.,Trappenburg Marijke C., et al. Frailty in Older Adults with Cardiovascular Disease: Cause, Effect or Both?[J]. Aging and disease, 2018, 9(3): 489-497.
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Age (yrs) a78.3 ± 5.975.4 ± 6.60.01
Sex (%female)47%52%0.28

Frailty score
Weight lossb32 (22%)218 (18%)0.14
Weak grip strengthc86 (56%)470 (36%)0.00
Exhaustiond46 (30%)196 (15%)0.00
Slow gait speede50 (35%)231 (18%)0.00
Low physical activityf50 (35%)253 (20%)0.00

Cardiovascular diseaseg
Angina pectoris83 (56%)
Myocardial infarction16 (11%)
Heart failure54 (37%)
Stroke14 (10%)
Peripheral artery disease14 (10%)

Cardiovascular risk factors
Nutritional statusg0.03
Low weight (BMIh <20)2 (1%)54 (4%)
Normal weight (BMI 20-25)35 (24%)396 (31%)
Overweight (BMI >25)111 (75%)834 (65%)
Systolic blood pressure (mmHg)a151 ± 28154 ± 260.18
Diastolic blood pressure (mmHg)a81 ± 1683 ± 130.03
Serum cholesterol (mmol/L)a
Total cholesterol5.6 ± 1.05.7 ± 1.00.50
LDL cholesterol3.6 ± 0.93.7 ± 1.00.43
HDL cholesterol1.2 ± 0.41.4 ± 0.40.00
Triglycerides1.7 ± 0.91.5 ± 0.70.00
Never Former Current

50 (34%) 77 (52%) 20 (14%)

459 (36%) 570 (44%) 254 (20%)
Alcohol useg
No Light Moderate/excessive

45 (31%) 71 (48%) 31 (21%)

311 (24%) 641 (50%) 330 (26%)
Chronic diseasesg
Chronic lung disease36 (24%)188 (15%)0.00
Arthritis57 (39%)602 (47%)0.38
Cancer19 (13%)156 (12%)0.81
Diabetes mellitus20 (14%)95 (7%)0.01
Urine incontinence54 (37%)332 (26%)0.01
No. of drugs taken 0 1 ≥ 2 Antihypertensive drugs Lipid lowering drugs

3 (2%) 5 (3%) 140 (95%) 126 (85%) 14 (10%)

351 (27%) 287 (23%) 646 (50%) 456 (36%) 51 (4%)

0.00 0.00 0.00
Table 1  Baseline characteristics in subjects with and without CVD (n=1432).
Odds ratio95% CIp-value


Chronic diseases
Lung disease1.851.26-2.720.00
Urine incontinence2.481.79-3.440.00

Table 2  Cross-sectional association of CVD, other co-morbidities, polypharmacy with frailty risk (n=1432).
Hazard ratio95% CIp-value


Chronic diseases
Lung disease1.401.01-1.930.04
Urine incontinence1.140.87-1.510.34

Table 3  Longitudinal association between CVD and frailty, excluding subject’s frail at baseline (n=1222).
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