Abstract TH926: Association between Frailty and Peripheral Artery Disease among Older Adults: the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Peripheral artery disease (PAD) is a subtype of atherosclerotic cardiovascular disease (CVD) involving the occlusion of arteries in the lower extremities. Frailty has been associated with higher risk for several types of CVDs (i.e., stroke, myocardial infarction, heart failure), but its association with PAD is unclear. Objective: To estimate the association between frailty and risk of PAD hospitalization among older adults. Methods: Data were from 5390 ARIC study participants (mean age: 75.4 ± 5.1 years; 57.1% women; 21.3% Black persons) who attended visit 5 (2011-13). The Fried Frailty Index was used to classify participants as frail (≥3 components), pre-frail (1 to 2 components), or robust (0 components). We excluded prevalent PAD events at visit 5. Incident PAD hospitalizations were identified through ICD codes and participant follow-up for surveillance of events occurring after visit 5 until December 31, 2018. Cox regression was used to estimate the association between frailty status (frail or pre-frail vs. robust) and incident PAD hospitalization, adjusting for socio-demographic characteristics, smoking status (model 1), BMI (model 2), and C-reactive protein and multimorbidity status (model 3; fully adjusted). Results: 2887 participants (53.6%) were classified as either frail or pre-frail. There were 61 incident PAD hospitalization cases over a median follow-up time of 6.3 years. Of the 61 total PAD cases, 42 were from frail or pre-frail participants and 19 were from robust participants, respectively. Relative to robust participants, the PAD hazard ratio (HR) for frail or pre-frail participants was 2.10 (95% CI: 1.20-3.66) when adjusting for demographic factors and smoking; the HR was similar when additionally adjusting for BMI. In the fully adjusted model, the association was attenuated [HR: 1.78 (95% CI: 1.01-3.12)]. Conclusion: Among a sample of surviving older participants in ARIC, participants who were frail or pre-frail had a nearly two-fold higher risk of PAD hospitalization relative to robust participants. Currently, most emphasis is placed on secondary or tertiary prevention of PAD. Frailty becomes more common in later life and could be prevented or delayed through lifestyle (e.g., physical activity). If frailty is an independent risk factor for PAD, it could be targeted for risk stratification and targeted intervention.