Frailty and Cardiovascular Health

Abstract

The incidence of frailty and cardiovascular disease (CVD) increases as the population ages. There is a bidirectional relationship between frailty and CVD, and both conditions share several risk factors and underlying biological mechanisms. Frailty has been established as an independent prognostic marker in patients with CVD. Moreover, its presence significantly influences both primary and secondary prevention strategies for adults with CVD while also posing a barrier to the inclusion of these patients in pivotal clinical trials and advanced cardiac interventions. This review discusses the current knowledge base on the relationship between frailty and CVD, how managing CVD risk factors can modify frailty, the influence of frailty on CVD management, and future directions for frailty detection and modification in patients with CVD.

Keywords: aging; cardiovascular diseases; cardiovascular interventions; frailty; geriatric syndromes; primary prevention; secondary prevention.

Figure 1. Biological mechanisms common to frailty and cardiovascular disease.

CCR indicates CC chemokine receptor; CD, clusters of differentiation; CRP, C‐reactive protein; CXCL, chemokine (C‐X‐C motif) ligand; IGF‐1, insulin‐like growth factor 1; IL, interleukin; NADPH, nicotinamide adenine dinucleotide phosphate; ROS, reactive oxygen species; TNF‐α, tumor necrosis factor α; and TCA cycle, tricarboxylic acid cycle.

Figure 2. Interplay between cardiovascular risk factor management and frailty: mutual influences on health outcomes.

ACS indicates acute coronary syndrome; AF, atrial fibrillation; CABG, coronary artery bypass graft; DAPT, dual antiplatelet therapy; GDMT, guideline‐directed medical therapy; HF, heart failure; HbA1c, glycated hemoglobin; MACE, major adverse cardiovascular events; NOAC, non–vitamin K oral anticoagulant; PCI, percutaneous coronary intervention; SAE, serious adverse event; and VHD, valvular heart disease.

Figure 3

Unanswered questions in managing frailty and cardiovascular disease.