Frailty and transitions across cardiometabolic disease states: evidence from multistate models in a 16-year Chinese cohort
Frailty is a prevalent geriatric syndrome, but its role in cardiometabolic disease (CMD) progression remains unclear. We examined whether frailty predicted CMD transitions. We included 22,754 participants aged 50+ from the Guangzhou Biobank Cohort Study without baseline CMD. Frailty was assessed using a 35-item frailty index (FI). Cardiometabolic multimorbidity (CMM) was defined as ≥2 of type 2 diabetes, ischemic heart disease, and stroke. Cox and multistate models estimated associations of frailty with first CMD (FCMD), CMM, and mortality. During a mean follow-up of 16.4 years, 8710 developed FCMD, 2332 progressed to CMM, and 5411 died. After adjustment, multistate analyses showed that frailty accelerated transitions from health to FCMD, from FCMD to CMM, and from CMM to death (HR per 0.1 increment in FI ranging from 1.14 to 1.48). Frailty was independently associated with CMD progression and mortality. Multistate analyses highlight its dynamic role in multimorbidity, supporting routine frailty assessment in cardiometabolic prevention.
Authors
- Kar Keung Cheng (ORCID: https://orcid.org/0000-0002-1516-1857)
- Lin Yang (ORCID: https://orcid.org/0000-0002-3367-244X)
- Wei Sen Zhang (ORCID: https://orcid.org/0000-0002-6691-4409)
- Ruihang Zhang (ORCID: https://orcid.org/0000-0003-0052-8772)
- Lei Su (ORCID: https://orcid.org/0000-0002-5569-1991)
- TH Lam (ORCID: https://orcid.org/0000-0002-2033-9971)
- Lin Xu (ORCID: https://orcid.org/0000-0002-0537-922X)
- Ying Wang (ORCID: https://orcid.org/0000-0002-1407-2668)
- Jiao Wang (ORCID: https://orcid.org/0000-0002-7883-0341)
- Rui Li (ORCID: https://orcid.org/0000-0002-7210-8358)
- Ting Lu (ORCID: https://orcid.org/0000-0001-5165-3691)
- Bai Jing Zhou
Institutions
- Hong Kong Polytechnic University (HK)
- Sun Yat-sen University (CN)
- Guangzhou University (CN)
- The First Affiliated Hospital, Sun Yat-sen University (CN)
- Twelfth Guangzhou City People's Hospital (CN)
- Department of Health of Guangdong Province (CN)
- University of Birmingham (GB)
- University of Hong Kong (HK)
Publication Details
- Journal
- npj Aging
- Published
- 2025-11-29
- DOI
- https://doi.org/10.1038/s41514-025-00301-5
- Citations
- 1
- Primary Topic
- Frailty in Older Adults
- Type
- article
- Field-Weighted Citation Impact
- 1.22
Funders
- National Natural Science Foundation of China
- Natural Science Foundation of Guangdong Province
- University of Hong Kong
- Health and Medical Research Fund