The impact of cardiovascular health and frailty on mortality for males and females across the life course

Jack Quach; Olga Theou; Judith Godin; Kenneth Rockwood; Dustin Scott Kehler

doi:10.1186/s12916-022-02593-w

The impact of cardiovascular health and frailty on mortality for males and females across the life course

Jack Quach, Olga Theou, Judith Godin, Kenneth Rockwood, Dustin Scott Kehler

Résultat de recherche: Article › examen par les pairs

8 Citations (Scopus)

Résumé

Background: The effect of frailty and poor cardiovascular health on mortality for males and females is not fully elucidated. We investigated whether the combined burden of frailty and poor cardiovascular health is associated with all-cause and cardiovascular disease (CVD) mortality by sex and age. Methods: We analyzed data of 35,207 non-institutionalized US residents aged 20–85 years old (mean age [standard deviation]: 46.6 [16.7 years], 51.4% female, 70.8% White, 10.3% Black, 13.2% Hispanic) from the National Health and Nutrition Examination Survey (1999–2015). Cardiovascular health was measured with the American Heart Association’s Life’s Simple 7 score (LS7). A 33-item frailty index (FI) was constructed to exclude cardiovascular health deficits. We grouped the FI into 0.1 increments (non-frail: FI < 0.10, very mildly frail: 0.1 ≤ FI < 0.20, mildly frail: 0.20 ≤ FI < 0.30, and moderately/severely frail: FI ≥ 0.30) and LS7 into tertiles (T1[poor] = 0–7, T2[intermediate] = 8-9, T3[ideal] = 10–14). All-cause and CVD mortality data were analyzed up to 16 years. All regression models were stratified by sex. Results: The average FI was 0.09 (SD 0.10); 29.6% were at least very mildly frail, and the average LS7 was 7.9 (2.3). Mortality from all-causes and CVD were 8.5% (4228/35,207) and 6.1% (2917/35,207), respectively. The median length of follow-up was 8.1 years. The combined burden of frailty and poor cardiovascular health on mortality risk varied according to age in males (FI*age interaction p = 0.01; LS7*age interaction p < 0.001) but not in females. In females, poor FI and LS7 combined to predict all-cause and CVD mortality in a dose-response manner. All-cause and CVD mortality risk was greater for older males (60 and 70 years old) who were at least mildly frail and had intermediate cardiovascular health or worse (hazard ratio [lower/higher confidence interval ranges] range: all-cause mortality = 2.02–5.30 [1.20–4.04, 3.15–6.94]; CVD-related mortality = 2.22–7.16 [1.03–4.46, 4.49–11.50]) but not for younger males (30, 40, and 50 years old). Conclusions: The combined burden of frailty and LS7 on mortality is similar across all ages in females. In males, this burden is greater among older people. Adding frailty to assessments of overall cardiovascular health may identify more individuals at risk for mortality and better inform decisions to implement preventative or treatment approaches.

Langue d'origine	English
Numéro d'article	394
Journal	BMC Medicine
Volume	20
Numéro de publication	1
DOI	https://doi.org/10.1186/s12916-022-02593-w
Statut de publication	Published - déc. 2022

Note bibliographique

Funding Information:
This study was supported by establishment grant funding through the Faculty of Health, Dalhousie University. JQ was supported by the Canadian Institutes of Health Research—Canada Graduate Scholarships, the Nova Scotia Graduate Scholarship, and the Heart and Stroke BrightRed Student Research Award.

Funding Information:
KR: KR has asserted copyright of the Clinical Frailty Scale through Dalhousie University’s Industry, Liaison, and Innovation Office. Use is free for education, research, and not-for-profit health care. Users agree not to change or commercialize the scale. In addition to academic and hospital appointments, KR is cofounder of Ardea Outcomes, which (as DGI Clinical) in the last 3 years has contracts with pharma and device manufacturers (Biogen, Hollister, InMune, Novartis, Nutricia, and Takeda) on individualized outcome measurement. In 2019, KR was paid an honorarium for an interview with Biogen. In 2020, he attended an advisory board meeting with Nutricia on dementia and chaired a scientific workshop and technical review panel on frailty for the Singapore National Research Foundation. Otherwise, any personal fees were for invited guest lectures, rounds and academic symposia, received directly from event organizers for presentations on frailty. KR is associate director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes for Health Research, the Alzheimer Society of Canada, and several other charities.

Publisher Copyright:
© 2022, The Author(s).

ASJC Scopus Subject Areas

General Medicine

PubMed: MeSH publication types

Journal Article
Research Support, Non-U.S. Gov't

ODD de l’ONU

Cette action contribue à la réalisation des objectifs de développement durable suivants

Accès au document

10.1186/s12916-022-02593-w

Autres fichiers et liens

Citer

@article{03dba5ddfb8746c5ae8c0986a359d65a,

title = "The impact of cardiovascular health and frailty on mortality for males and females across the life course",

abstract = "Background: The effect of frailty and poor cardiovascular health on mortality for males and females is not fully elucidated. We investigated whether the combined burden of frailty and poor cardiovascular health is associated with all-cause and cardiovascular disease (CVD) mortality by sex and age. Methods: We analyzed data of 35,207 non-institutionalized US residents aged 20–85 years old (mean age [standard deviation]: 46.6 [16.7 years], 51.4% female, 70.8% White, 10.3% Black, 13.2% Hispanic) from the National Health and Nutrition Examination Survey (1999–2015). Cardiovascular health was measured with the American Heart Association{\textquoteright}s Life{\textquoteright}s Simple 7 score (LS7). A 33-item frailty index (FI) was constructed to exclude cardiovascular health deficits. We grouped the FI into 0.1 increments (non-frail: FI < 0.10, very mildly frail: 0.1 ≤ FI < 0.20, mildly frail: 0.20 ≤ FI < 0.30, and moderately/severely frail: FI ≥ 0.30) and LS7 into tertiles (T1[poor] = 0–7, T2[intermediate] = 8-9, T3[ideal] = 10–14). All-cause and CVD mortality data were analyzed up to 16 years. All regression models were stratified by sex. Results: The average FI was 0.09 (SD 0.10); 29.6% were at least very mildly frail, and the average LS7 was 7.9 (2.3). Mortality from all-causes and CVD were 8.5% (4228/35,207) and 6.1% (2917/35,207), respectively. The median length of follow-up was 8.1 years. The combined burden of frailty and poor cardiovascular health on mortality risk varied according to age in males (FI*age interaction p = 0.01; LS7*age interaction p < 0.001) but not in females. In females, poor FI and LS7 combined to predict all-cause and CVD mortality in a dose-response manner. All-cause and CVD mortality risk was greater for older males (60 and 70 years old) who were at least mildly frail and had intermediate cardiovascular health or worse (hazard ratio [lower/higher confidence interval ranges] range: all-cause mortality = 2.02–5.30 [1.20–4.04, 3.15–6.94]; CVD-related mortality = 2.22–7.16 [1.03–4.46, 4.49–11.50]) but not for younger males (30, 40, and 50 years old). Conclusions: The combined burden of frailty and LS7 on mortality is similar across all ages in females. In males, this burden is greater among older people. Adding frailty to assessments of overall cardiovascular health may identify more individuals at risk for mortality and better inform decisions to implement preventative or treatment approaches.",

author = "Jack Quach and Olga Theou and Judith Godin and Kenneth Rockwood and Kehler, {Dustin Scott}",

note = "Funding Information: This study was supported by establishment grant funding through the Faculty of Health, Dalhousie University. JQ was supported by the Canadian Institutes of Health Research—Canada Graduate Scholarships, the Nova Scotia Graduate Scholarship, and the Heart and Stroke BrightRed Student Research Award. Funding Information: KR: KR has asserted copyright of the Clinical Frailty Scale through Dalhousie University{\textquoteright}s Industry, Liaison, and Innovation Office. Use is free for education, research, and not-for-profit health care. Users agree not to change or commercialize the scale. In addition to academic and hospital appointments, KR is cofounder of Ardea Outcomes, which (as DGI Clinical) in the last 3 years has contracts with pharma and device manufacturers (Biogen, Hollister, InMune, Novartis, Nutricia, and Takeda) on individualized outcome measurement. In 2019, KR was paid an honorarium for an interview with Biogen. In 2020, he attended an advisory board meeting with Nutricia on dementia and chaired a scientific workshop and technical review panel on frailty for the Singapore National Research Foundation. Otherwise, any personal fees were for invited guest lectures, rounds and academic symposia, received directly from event organizers for presentations on frailty. KR is associate director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes for Health Research, the Alzheimer Society of Canada, and several other charities. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = dec,

doi = "10.1186/s12916-022-02593-w",

language = "English",

volume = "20",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

T1 - The impact of cardiovascular health and frailty on mortality for males and females across the life course

AU - Quach, Jack

AU - Theou, Olga

AU - Godin, Judith

AU - Rockwood, Kenneth

AU - Kehler, Dustin Scott

N1 - Funding Information: This study was supported by establishment grant funding through the Faculty of Health, Dalhousie University. JQ was supported by the Canadian Institutes of Health Research—Canada Graduate Scholarships, the Nova Scotia Graduate Scholarship, and the Heart and Stroke BrightRed Student Research Award. Funding Information: KR: KR has asserted copyright of the Clinical Frailty Scale through Dalhousie University’s Industry, Liaison, and Innovation Office. Use is free for education, research, and not-for-profit health care. Users agree not to change or commercialize the scale. In addition to academic and hospital appointments, KR is cofounder of Ardea Outcomes, which (as DGI Clinical) in the last 3 years has contracts with pharma and device manufacturers (Biogen, Hollister, InMune, Novartis, Nutricia, and Takeda) on individualized outcome measurement. In 2019, KR was paid an honorarium for an interview with Biogen. In 2020, he attended an advisory board meeting with Nutricia on dementia and chaired a scientific workshop and technical review panel on frailty for the Singapore National Research Foundation. Otherwise, any personal fees were for invited guest lectures, rounds and academic symposia, received directly from event organizers for presentations on frailty. KR is associate director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes for Health Research, the Alzheimer Society of Canada, and several other charities. Publisher Copyright: © 2022, The Author(s).

PY - 2022/12

Y1 - 2022/12

N2 - Background: The effect of frailty and poor cardiovascular health on mortality for males and females is not fully elucidated. We investigated whether the combined burden of frailty and poor cardiovascular health is associated with all-cause and cardiovascular disease (CVD) mortality by sex and age. Methods: We analyzed data of 35,207 non-institutionalized US residents aged 20–85 years old (mean age [standard deviation]: 46.6 [16.7 years], 51.4% female, 70.8% White, 10.3% Black, 13.2% Hispanic) from the National Health and Nutrition Examination Survey (1999–2015). Cardiovascular health was measured with the American Heart Association’s Life’s Simple 7 score (LS7). A 33-item frailty index (FI) was constructed to exclude cardiovascular health deficits. We grouped the FI into 0.1 increments (non-frail: FI < 0.10, very mildly frail: 0.1 ≤ FI < 0.20, mildly frail: 0.20 ≤ FI < 0.30, and moderately/severely frail: FI ≥ 0.30) and LS7 into tertiles (T1[poor] = 0–7, T2[intermediate] = 8-9, T3[ideal] = 10–14). All-cause and CVD mortality data were analyzed up to 16 years. All regression models were stratified by sex. Results: The average FI was 0.09 (SD 0.10); 29.6% were at least very mildly frail, and the average LS7 was 7.9 (2.3). Mortality from all-causes and CVD were 8.5% (4228/35,207) and 6.1% (2917/35,207), respectively. The median length of follow-up was 8.1 years. The combined burden of frailty and poor cardiovascular health on mortality risk varied according to age in males (FI*age interaction p = 0.01; LS7*age interaction p < 0.001) but not in females. In females, poor FI and LS7 combined to predict all-cause and CVD mortality in a dose-response manner. All-cause and CVD mortality risk was greater for older males (60 and 70 years old) who were at least mildly frail and had intermediate cardiovascular health or worse (hazard ratio [lower/higher confidence interval ranges] range: all-cause mortality = 2.02–5.30 [1.20–4.04, 3.15–6.94]; CVD-related mortality = 2.22–7.16 [1.03–4.46, 4.49–11.50]) but not for younger males (30, 40, and 50 years old). Conclusions: The combined burden of frailty and LS7 on mortality is similar across all ages in females. In males, this burden is greater among older people. Adding frailty to assessments of overall cardiovascular health may identify more individuals at risk for mortality and better inform decisions to implement preventative or treatment approaches.

AB - Background: The effect of frailty and poor cardiovascular health on mortality for males and females is not fully elucidated. We investigated whether the combined burden of frailty and poor cardiovascular health is associated with all-cause and cardiovascular disease (CVD) mortality by sex and age. Methods: We analyzed data of 35,207 non-institutionalized US residents aged 20–85 years old (mean age [standard deviation]: 46.6 [16.7 years], 51.4% female, 70.8% White, 10.3% Black, 13.2% Hispanic) from the National Health and Nutrition Examination Survey (1999–2015). Cardiovascular health was measured with the American Heart Association’s Life’s Simple 7 score (LS7). A 33-item frailty index (FI) was constructed to exclude cardiovascular health deficits. We grouped the FI into 0.1 increments (non-frail: FI < 0.10, very mildly frail: 0.1 ≤ FI < 0.20, mildly frail: 0.20 ≤ FI < 0.30, and moderately/severely frail: FI ≥ 0.30) and LS7 into tertiles (T1[poor] = 0–7, T2[intermediate] = 8-9, T3[ideal] = 10–14). All-cause and CVD mortality data were analyzed up to 16 years. All regression models were stratified by sex. Results: The average FI was 0.09 (SD 0.10); 29.6% were at least very mildly frail, and the average LS7 was 7.9 (2.3). Mortality from all-causes and CVD were 8.5% (4228/35,207) and 6.1% (2917/35,207), respectively. The median length of follow-up was 8.1 years. The combined burden of frailty and poor cardiovascular health on mortality risk varied according to age in males (FI*age interaction p = 0.01; LS7*age interaction p < 0.001) but not in females. In females, poor FI and LS7 combined to predict all-cause and CVD mortality in a dose-response manner. All-cause and CVD mortality risk was greater for older males (60 and 70 years old) who were at least mildly frail and had intermediate cardiovascular health or worse (hazard ratio [lower/higher confidence interval ranges] range: all-cause mortality = 2.02–5.30 [1.20–4.04, 3.15–6.94]; CVD-related mortality = 2.22–7.16 [1.03–4.46, 4.49–11.50]) but not for younger males (30, 40, and 50 years old). Conclusions: The combined burden of frailty and LS7 on mortality is similar across all ages in females. In males, this burden is greater among older people. Adding frailty to assessments of overall cardiovascular health may identify more individuals at risk for mortality and better inform decisions to implement preventative or treatment approaches.

UR - http://www.scopus.com/inward/record.url?scp=85141586953&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85141586953&partnerID=8YFLogxK

U2 - 10.1186/s12916-022-02593-w

DO - 10.1186/s12916-022-02593-w

M3 - Article

C2 - 36357932

AN - SCOPUS:85141586953

SN - 1741-7015

VL - 20

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 394

ER -

The impact of cardiovascular health and frailty on mortality for males and females across the life course

Résumé

Note bibliographique

ASJC Scopus Subject Areas

PubMed: MeSH publication types

ODD de l’ONU

Accès au document

Autres fichiers et liens

Empreinte numérique

Citer