Frailty and prefrailty are associated with increased risk of aortic aneurysm but not aortic dissection: a prospective cohort study of UK biobank participants

Background Frailty is a well-established determinant of adverse outcomes in patients with aortic disease, but its role in incident aortic aneurysm (AA) and aortic dissection (AD) remains unclear. We examined the associations of frailty with long-term risks of AA and AD in a large community-based cohort. Methods We included 474,302 UK Biobank participants free of AA/AD at baseline. Frailty was assessed using physical frailty and the frailty index, categorized as non-frail, prefrail, or frail. The primary outcomes were AA, with secondary outcomes, including abdominal AA (AAA), thoracic AA (TAA) and AD, ascertained through linkage to hospital and death records. Results During a median follow-up of 15.1 years, 3,675 AA, 2,289 AAA, 1,114 TAA, and 310 AD events occurred. After multivariable adjustment, both prefrailty (physical frailty: HR 1.24, 95% CI 1.16–1.33; frailty index: HR 1.67, 95% CI 1.55–1.80) and frailty (physical frailty: HR 1.50, 95% CI 1.28–1.76; frailty index: HR 2.22, 95% CI 1.96–2.51) were associated with higher risk of AA versus non–frailty. Similar results were observed for AAA. For TAA, the frailty index remained significant (prefrailty: HR 1.47, 95% CI 1.29–1.67; frailty: HR 1.61, 95% CI 1.25–2.07), whereas physical frailty was not. Neither frailty measure was associated with AD. Subgroup analyses suggested stronger associations for AAA in younger participants and those without diabetes. Conclusions Frailty was associated with a higher risk of incident AA, particularly AAA, but not AD. Frailty assessment may help improve phenotype-specific risk stratification and inform preventive strategies for aortic disease.