• CAD Tx Does Little to Stem Frailty But healthy lifestyle linked to much lower risk

    Procedures and medications at best only temporarily halt worsening frailty for older adults with coronary artery disease (CAD), whereas a healthier lifestyle has a big impact, two separate studies suggested.

    In both men and women, frailty tended to improve 6 months after treatment for coronary artery disease (CAD), then worsen at 12 and 30 months (P<0.001), according to Elizabeth Freiheit, PhD, of Canada’s University of Calgary, and colleagues.

    They reported online in Circulation: Cardiovascular Quality and Outcomes that patients older than 75 got more frail within 6 months of coronary artery bypass grafting (CABG) and medical therapy. Those who got percutaneous coronary intervention (PCI) also worsened, but after 6 months.

    On the other hand, their younger peers showed improvements in frailty after both surgery and PCI that lasted throughout follow-up (30 months). Those who just had medical therapy, however, maintained their level of frailty over time.

    “Women, older patients, and those undergoing CABG trended toward higher levels of frailty overall,” the authors noted. “In our sample, frailty followed a U-shaped curve after revascularization. However, relatively older patients (aged ≥75 years) initially assigned to medical therapy or CABG did not experience this temporary decrease (or improvement). They showed continuous increases in their frailty level from baseline during the 30 months.”

    The study included 374 patients who had non-emergent cardiac catheterization followed by CABG, PCI, or medical therapy. A frailty score was designed to incorporate cognitive, emotional, physical, and quality of life domains in their assessment.

    Freiheit’s group acknowledged that the investigation was based in a single tertiary care center, limiting its generalizability. Another caveat was that its frailty score may not be clinically useful, they added.

    Indeed, the “clinical applicability of the 53-item Frailty Index is low because of the time required to measure this sheer volume of items,” wrote Jonathan Afilalo, MD, MSc, of Jewish General Hospital in Montreal, in an accompanying editorial.

    Even so, the authors concluded: “if confirmed by other studies, frailty trajectories could be used to inform individualized decision making about initial treatment choices and allow more tailored subsequent patient care and monitoring once effective therapeutic approaches have been demonstrated.”

    According to another study appearing in the same journal, older patients in good cardiovascular health are less likely to show frailty later on if they meet several criteria.

    Over a mean follow-up of 3.5 years, patients who met two of the seven ideal metrics — never smoking, physically active, healthy diet, body mass index under 25 kg/m2, cholesterol under 200 mg/dL, blood pressure under 140/90 mm Hg, and fasting serum glucose under 100 mg/dL — were associated with about half the risk of frailty as those who met no more than one of those criteria (hazard ratio [HR] 0.51, 95% CI 0.31-0.84). Reaching three or more of the metrics was similarly tied to lower odds of frailty (HR 0.63, 95% CI 0.39-0.99).

    “The cardiovascular metrics associated with the greatest reduction of frailty risk were being physically active and ideal body mass index,” reported Auxiliadora Graciani, MD, of Universidad Autónoma de Madrid, Spain, and colleagues.

    Graciani’s study recruited 1,745 Spanish participants between 2008 and 2010. Enrollees were over the age of 60 and free of cardiovascular disease. The Fried criteria were used to assess frailty.

    “Reaching old age in ideal cardiovascular health is associated with a reduced risk of frailty. This highlights the importance of a life-course approach for frailty prevention,” the investigators emphasized.

    Afilalo agreed, writing that the lesson to be learned from the two studies “is that frailty is not a predetermined trait but rather a dynamic state influenced by everyday choices.” Patients can put themselves at risk by “making poor lifestyle choices,” while physicians contribute to the problem by “prioritizing pharmacotherapy and procedures” over nonpharmacologic approaches.

    “According to our systematic review of randomized trials, prescribed physical activity is the single most robust intervention to mitigate frailty and prevent its undesirable consequences,” the editorialist noted. Those consequences can, after all, include “postprocedural mortality, morbidity, and deconditioning, thus perpetuating the cycle of sedentary behaviors and progressive frailty.”


    Freiheit and Graciani disclosed no relevant conflicts of interest.

    Freiheit’s study was funded by the Canadian Institutes of Health Research Institute of Aging, the MSI Foundation, and the Brenda Strafford Foundation Chair for Geriatric Medicine.

    The investigation by Graciani’s group was supported by Spanish FIS grants, the FRAILOMIC Initiative, and the ATHLOS project.

    Afilalo was supported by the Canadian Institutes of Health Research and the Fond de Recherche du Québec–Santé.


    Circulation: Cardiovascular Quality and Outcomes


    Freiheit EA, et al “Frailty trajectories after treatment for coronary artery disease in older patients” Circ Cardiovasc Qual Outcomes 2016; DOI: 10.1161/CIRCOUTCOMES.115.002204.


    Circulation: Cardiovascular Quality and Outcomes


    Graciani A, et al “Ideal cardiovascular health and risk of frailty in older adults” Circ Cardiovasc Qual Outcomes 2016; DOI: 10.1161/CIRCOUTCOMES.115.002294.


    Circulation: Cardiovascular Quality and Outcomes


    Afilalo J “Road to frailty is paved with good intentions” Circ Cardiovasc Qual Outcomes 2016; DOI: 10.1161/CIRCOUTCOMES.116.002852.

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