Frailty and Cardiovascular Events as Determined by Body Composition: A Systematic Review

ABSTRACT Introduction Frailty, an increasingly recognized age‐related condition, appears to be associated with an increased risk of cardiovascular events. However, frailty is a heterogeneous condition with a wide metabolic spectrum and variations in body composition. Therefore, not all frail individuals have the same cardiovascular risk. This study aimed to explore the association of frailty with cardiovascular risk according to body composition and metabolic profile of frail individuals. Methods A systematic review of English‐language studies published over the past 20 years was conducted, including studies that examined the association between frailty and cardiovascular events and reported participants' body composition and metabolic profiles. Results A total of 12 studies comprising 864,294 participants, with an average age range of 52–92 years, were included. Frailty was reported as a risk factor for cardiovascular events in 10 studies, but two studies did not show this association. The participants in all the positive studies were either overweight or obese. In addition, they had unfavorable metabolic profiles and increased prevalence of cardiovascular risk factors. Most frailty criteria predicted cardiovascular disease. However, unintentional weight loss was not associated with cardiovascular risk, especially in the very old subjects. This suggests that the sarcopenic obese, rather than the anorexic malnourished, frail individuals are at risk of cardiovascular disease. Conclusion Frailty increases the risk of cardiovascular events only in overweight or obese individuals. Current studies are limited by defining frailty as one category, and future research is required to precisely investigate the metabolic profile of the frailty spectrum and its association with cardiovascular risk. This systematic review was registered in PROSPERO (CRD420251153081).