Associations between inflammation, cardiovascular biomarkers and incident frailty: the British Regional Heart Study

Abstract

Introduction cardiovascular disease (CVD) and chronic inflammation are implicated in the development of frailty. Longitudinal analyses of inflammatory markers, biomarkers of cardiac dysfunction and incidence of frailty are limited. Methods in the British Regional Heart Study, 1,225 robust or pre-frail men aged 71–92 years underwent a baseline examination, with questionnaire-based frailty assessment after 3 years. Frailty definitions were based on the Fried phenotype. Associations between incident frailty and biomarkers of cardiac dysfunction (high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP)) and inflammation (C-reactive protein (CRP) and interleukin-6 (IL-6)) were examined, by tertile, with the lowest as reference. Results follow-up data were available for 981 men. Ninety one became frail. Adjusted for age, pre-frailty, prevalent and incident CVD, comorbidity, polypharmacy and socioeconomic status, IL-6 (third tertile OR 2.36, 95% CI 1.07–5.17) and hs-cTnT (third tertile OR 2.24, 95% CI 1.03–4.90) were associated with increased odds of frailty. CRP (third tertile OR 1.83, 95% CI 0.97–4.08) and NT-proBNP (second tertile OR 0.48, 95% CI 0.23–1.01) showed no significant association with incident frailty. The top tertiles of CRP, IL-6, hscTnT and NT-proBNP were strongly associated with mortality prior to follow-up. Conclusion IL-6 is associated with incident frailty, supporting the prevailing argument that inflammation is involved in the pathogenesis of frailty. Cardiomyocyte injury may be associated with frailty risk. Associations between elevated CRP and frailty cannot be fully discounted; NT-proBNP may have a non-linear relationship with incident frailty. CRP, IL-6, hs-cTnT and NT-proBNP are vulnerable to survivorship bias.

The impact of cardiovascular health and frailty on mortality for males and females across the life course

“…S5), which is in agreement with previous reports [ 25 , 29 , 31 , 47 , 48 ]. These findings in combination with previous work linking high CVD risk with the onset of frailty (phenotype [ 49 ] and FI [ 50 ]) and subclinical CVD markers [ 51 , 52 ] with frailty further corroborate the intertwined nature of CVD and frailty. Indeed, the relationship between frailty and cardiovascular health may have important clinical implications before a CVD diagnosis.…”

C-reactive protein and white blood cell are associated with frailty progression: a longitudinal study

“…A prospective study showed that the higher CRP on worsening FI, which was confirmed by our findings [ 25 ]. However, another longitudinal study conducted among older male individuals, reported no significant association between CRP and incident frailty based on the Fried phenotype [ 26 ]. Different measurement tools for frailty are possible explanation, as the Fried phenotype is purely physical, whereas the FI contains more dimensions.…”

Admission high-sensitivity cardiac troponin levels as a prognostic indicator for in-hospital mortality rates in the elderly and very elderly COVID-19 patients

“…In this population, HS-cTn value has demonstrated a prognostic capacity in different clinical scenarios and not only in cardiovascular disease. This HS-cTn capacity moved its use from diagnostic to prognostic tool ( Savonitto et al., 2012 ; Chen et al., 2019 ; Ishigami et al., 2019 ; McKechnieT et al., 2021 ).…”