Cognitive Impairment and Frailty in Older Adults With Cardiovascular Disease: 2026 ACC Scientific Statement

In older adults, cardiovascular disease (CVD) rarely occurs in isolation; cognitive impairment, frailty, and physical disability frequently coexist and together shape trajectories of health and function in later life. This American College of Cardiology Scientific Statement reviews the intersections among CVD, cognitive impairment, and frailty; highlights the role of biological aging and its contribution to vascular dysfunction, chronic inflammation, and sarcopenia; and summarizes practical, consensus-based approaches for prevention, assessment, and management. Key recommendations include viewing CVD, cognitive impairment, and frailty as manifestations of shared biological aging processes; targeting common, modifiable risk factors; ensuring appropriate diagnostic evaluation and referral; and promoting resilience through medication, structured exercise, nutrition, and limiting polypharmacy. These recommendations for cardiovascular care in older adults are common sense but rest on a limited and fragmented evidence base. As CVD, cognitive impairment, and frailty are outcomes most central to older patients, there is a need for increased consideration in clinical care and inclusion in research.