Transitions From Frailty States to Cardiovascular Events: An 11-Year Prospective Study of Community-Dwelling Older People

BACKGROUND: This study aims to quantify transition probabilities between frailty states (not-frail, pre-frail, frail) and from different frailty states to the occurrence of a cardiovascular disease (CVD) event; and to examine how age, sex and sociodemographic factors influence these transitions. METHODS: 18,077 initially healthy individuals (91% Caucasians, 56% females) aged ≥65 years enrolled in the ASPREE study who had no prior CVD event and ADL (Activity of Daily Living) disability at recruitment were followed for a median of 7.4 years. Frailty was annually assessed using a 64-item Frailty Index. Continuous-time multi-state Markov modelling was used. RESULTS: The estimated transition probabilities from frail to CVD increased over time (11% at five years, and 18% at ten years) and consistently exceeded the corresponding five- and ten-year transition probabilities from pre-frail to CVD (8% and 14% respectively). Compared to males, females had a 26% higher relative risk of progressing to a pre-frail/frail state; however, they had about 50% lower relative risk of transitioning from pre-frail/frail to CVD. Older age, socioeconomic and geographic disparities were associated with up to 38% higher relative risk of worsening frailty and progression to CVD. Similar findings were observed when using the Fried phenotype. CONCLUSION: The probability of transiting from pre-frail/frail to CVD increased over time, even among initially healthy older people. Targeted prevention strategies may be helpful to delay frailty progression and reduce CVD risk in older age, particularly socioeconomically disadvantaged individuals or those residing outside major cities, and different approaches may be required in females and males.