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. 2025 Apr 16:13:1565682.
doi: 10.3389/fpubh.2025.1565682. eCollection 2025.

Cardiometabolic multimorbidity and frailty in middle-aged and older adults: a cross-nationally harmonized study

Kunyan Zhou  1 , Ao Wang  1 , Ke Yi  1
Affiliations

Cardiometabolic multimorbidity and frailty in middle-aged and older adults: a cross-nationally harmonized study

Kunyan Zhou et al. Front Public Health. .

Abstract

Background: Cardiometabolic diseases are prevalent among ageing populations and have a close association with frailty. However, the cumulative impact multiple cardiometabolic diseases have on frailty remains underexplored.

Methods: This study used data from four international cohorts - HRS, CHARLS, ELSA and SHARE - to examine the correlation between frailty and cardiometabolic diseases (CMD). The frailty index was used for assessing frailty and statistical analyses were performed as a means of analysing the correlation between the number of cardiometabolic conditions and frailty severity. Linear regression models were employed to evaluate the associations between CMD and frailty severity.

Results: The study found that as the number of cardiometabolic diseases increased, the frailty index rose significantly [one disease, β = 7.80 (95% CI: 7.70 to 7.90) p < 0.05; two diseases, β = 17.92 (95% CI: 17.76 to 18.08) p < 0.05; three diseases, β = 28.79 (95% CI: 28.41 to 29.17) p < 0.05]. Stroke was found to have the most pronounced impact on frailty (β = 12.34 [95%CI 12.20 to 12.48] p < 0.05) and the coexistence of multiple conditions served to amplify the symptoms of frailty.

Conclusion: This study highlights the compounded impact multiple cardiometabolic diseases have on frailty and also emphasizes the necessity for early intervention.

Keywords: diabetes; frailty index; heart disease; middle-aged and older people; multicohort cardiometabolic diseases; stroke.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The distribution of cardiometabolic diseases across the various databases. CMD, cardiometabolic diseases; HRS, Health and Retirement Study; CHARLS, China Health and Retirement Longitudinal Study; ELSA, English Longitudinal Study of Ageing; SHARE, Survey of Health, Ageing and Retirement in Europe.
Figure 2
Figure 2
Associations between cardiometabolic disease status and frailty index by specific combination of individual cardiometabolic diseases. All models were adjusted for age gender, marital status, educational attainment, obesity, hypertension, cancer, lung disease, current drinking, current smoking, and physical activity.
Figure 3
Figure 3
Associations between cardiometabolic multimorbidity status and frailty index in HRS, CHARLS, ELSA, and SHARE. All models were adjusted for age gender, marital status, educational attainment, obesity, hypertension, cancer, lung disease, current drinking, current smoking, and physical activity. CMD, cardiometabolic diseases; HRS, Health and Retirement Study; CHARLS, China Health and Retirement Longitudinal Study; ELSA, English Longitudinal Study of Ageing; SHARE, Survey of Health, Ageing and Retirement in Europe.
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