Frailty as a Key Determinant of Cardiovascular Risk and Mortality in Preserved Ratio Impaired Spirometry: A Nationally Representative Study

Q: What are the key findings of this study?

Frailty significantly increased the risk of all-cause mortality in PRISm individuals, with an adjusted HR of 30.66 over 9.9 years.

Q: What does this research mean for the field?

Frailty significantly increases the risk of all-cause mortality in individuals with preserved ratio impaired spirometry (PRISm), with an adjusted hazard ratio of 30.66 over 9.9 years. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yue Ren; Yixing Wu; Weiping Hu; Li Liu; Hui Cai; Jing Zhang

doi:10.1111/crj.70165

January 1, 2026The Clinical Respiratory JournalOpen Access

Frailty as a Key Determinant of Cardiovascular Risk and Mortality in Preserved Ratio Impaired Spirometry: A Nationally Representative Study

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Key result

Frailty linked to ~31-fold higher all-cause mortality risk in PRISm individuals.

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Why the study?

PRISm is associated with elevated CVD risk and progression to COPD, but underlying mechanisms remain unclear, and the role of frailty in PRISm has not been well defined.

Is frailty associated with increased cardiovascular events and all-cause mortality in adults with preserved ratio impaired spirometry (PRISm)?

Key Points

To examine whether frailty correlates with major adverse cardiovascular events and long-term all-cause mortality in individuals with preserved ratio impaired spirometry (PRISm), and to establish risk prediction nomograms.
Analyzed 8882 adults aged 20–79 years from NHANES 2007–2012, identifying 763 (8.6%) individuals with PRISm (FEV1/FVC ≥ 0.70 and FEV1 < 80% predicted).
Assessed frailty with a 23-item laboratory frailty index (FI-LAB; cutoff ≥ 0.23) and evaluated cross-sectional major adverse cardiovascular events (MACEs) alongside linked National Death Index mortality over 9.9 years.
Identified risk factors and developed predictive nomograms using LASSO regression, multivariable logistic regression, and Cox proportional hazards modeling.
PRISm participants demonstrated significantly higher frailty prevalence (53.9% vs. 45.5%, p < 0.0001) and MACE prevalence (16.2% vs. 6.0%, p < 0.0001) than individuals with normal spirometry.
Frailty was independently associated with prevalent MACEs (adjusted OR = 18.87, p < 0.001) with survey-weight-adjusted OR of 2.609 (95% CI, 2.594–2.624), yielding a multivariable model AUC of 0.786.
Over 9.9 years, all-cause mortality was substantially higher in frail compared to non-frail PRISm participants (15.2% vs. 7.0%; adjusted HR = 30.655, 95% CI, 4.161–225.822, p = 0.001; nomogram AUC = 0.81).

Structured PICO

Is frailty associated with increased cardiovascular events and all-cause mortality in adults with preserved ratio impaired spirometry (PRISm)?

P

Population

8,882 adults (aged 20–79 years) from the US NHANES 2007–2012 cohort, including 763 (8.6%) with preserved ratio impaired spirometry (PRISm: FEV1/FVC ≥ 0.70 and FEV1 < 80% predicted).

I

Intervention

Frailty, assessed using the 23-item laboratory frailty index (FI-LAB; cut-off ≥ 0.23)

C

Comparator

Non-frail individuals (FI-LAB < 0.23) and individuals with normal spirometry

O

Outcome

All-cause mortality, obtained from linked National Death Index records over a median 9.9 years follow-uphard clinical

Frailty is highly prevalent in individuals with PRISm and serves as a strong, independent predictor of major adverse cardiovascular events and long-term mortality.

Implication

May support frailty screening for mortality risk stratification in PRISm; leaves open whether modification improves outcomes.

Abstract

Background Preserved ratio impaired spirometry (PRISm) is associated with elevated cardiovascular disease (CVD) risk and progression to COPD, but the underlying mechanisms remain unclear. Frailty is known to worsen outcomes in COPD; however, its role in PRISm has not been well defined. This study examined factors associated with cardiovascular events and mortality in PRISm and developed risk models. Methods We analyzed 8882 adults (aged 20–79 years) from NHANES 2007–2012, identifying 763 (8.6%) with PRISm (FEV 1 /FVC ≥ 0.70 and FEV 1 < 80% predicted). Frailty was assessed using the 23‐item laboratory frailty index (FI‐LAB; cut‐off ≥ 0.23). The primary outcome was all‐cause mortality, obtained from linked National Death Index records; the secondary outcome was major adverse cardiovascular events (MACEs: myocardial infarction, stroke, heart failure, or angina), assessed cross‐sectionally. LASSO regression and multivariable logistic/Cox models were used to identify variables independently associated with the outcomes, and nomograms were constructed. Results PRISm participants had higher frailty prevalence (53.9% vs. 45.5%) and more MACEs (16.2% vs. 6.0%) than those with normal spirometry (both p < 0.0001). Frailty was independently associated with prevalent MACEs (adjusted OR = 18.87, p < 0.001) and was bidirectionally associated with PRISm (OR = 1.40, p < 0.001). Key factors independently associated with MACEs included frailty index, age, sex, anemia, and emphysema (AUC = 0.786). Over 9.9 years, mortality was higher in frail vs. non‐frail PRISm individuals (15.2% vs. 7.0%; adjusted HR = 30.66). Frailty severity demonstrated a clear mortality gradient, and a mortality nomogram integrating age and frailty achieved an AUC of 0.81. Conclusion Frailty is strongly and independently associated with cardiovascular morbidity and mortality. FI‐LAB offers a practical tool for risk stratification and may help guide targeted preventive strategies.

Discussion

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Cite This Study

Ren et al. (2026) studied this question. Frailty significantly increased the risk of all-cause mortality in PRISm individuals, with an adjusted HR of 30.66 over 9.9 years.

synapsesocial.com/papers/6963220791e05aa366cb86df https://doi.org/10.1111/crj.70165

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Frailty as a Key Determinant of Cardiovascular Risk and Mortality in Preserved Ratio Impaired Spirometry: A Nationally Representative Study

Figures

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Frailty as a Key Determinant of Cardiovascular Risk and Mortality in Preserved Ratio Impaired Spirometry: A Nationally Representative Study

Figures

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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