Cardiovascular frailty: a new concept

Introduction: Frailty is a reversible syndrome increasing with age. In France, cardiovascular diseases are the second cause of death after 65. Few data are available on specific factors modifying cardiovascular diseases prognosis coupled with frailty in elderly. Our objective is to define cardiovascular frailty. Materials and methods: PubMed® search (publications between 2018-2021) with MeSH terms: “Cardiovascular Physiological Phenomena” OR “Cardiovascular diseases” AND “Aged, 80 and over” AND (“Frailty” OR “Frail Elderly”). Selection by title and abstract, then systematically collecting data from the articles selected, using the PRISMA method. Results: A total of 481 articles were reviewed and 39 were selected. We identified three clusters in the elderly: 1) frailty, 2) inflammation, 3) other factors. Frailty is significantly associated with morbi-mortality in heart failure (HF), coronary syndrome (CS), aortic stenosis, rhythm disorders, all-cause CV diseases. Increase in inflammatory markers were significantly associated with CV morbi-mortality: high sensitivity C-reactive protein (CV diseases); neutrophil/lymphocyte ratio (CS); Interleukine-6 (IL-6), serum level of Suppressor of Tumorigenicity 2, adipokines (HF). Other markers were significantly associated with frailty: decrease in hemoglobin; increase in neutrophil/lymphocyte ratio, Trimethylamine N-oxide, 8-oxo-7,8- dihydroguanosine (CV diseases); increased aspartate aminotransferase/alanine aminotransferase ratio, depression, occupational status, sarcopenia, hypoalbuminemia (HF); anxiety, low education, atrial fibrillation symptoms (rhythm disorders); diastolic dysfunction, arterial stiffness, elevated Growth Differentiation Factor 15 (CS); fewer teeth (CS, HF, rhythm disorders). Conclusion: Three clusters of cardiovascular frailty are defined: some are eligible to specific treatment, other can be easily detected by care-givers in general population in order to prevent cardiovascular diseases in general population. Studies are needed to propose management of these factors and improve cardiovascular morbi-mortality.