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Frailty Tied to Cardiometabolic Disorders and Death in Large HIV Cohort
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....."Each 0.1 increase in frailty index was an even stronger predictor of shorter survival (HR 3.00, 95% CI 1.82 to 4.96, P < 0.001). After controlling for number of cardiometabolic disorders, each 0.1 higher frailty index independently predicted shorter survival (HR 2.75, 95% CI 1.69 to 4.47).....The Dalhousie-Modena team concluded that "frailty increases risk of mortality even after adjusting for cardiometabolic diagnoses." They suggested that HIV clinicians who see multiple metabolic disorders in a patient "might consider case-finding for frailty.""
from Jules: the point here is that comorbidities & an accumulation of comorbidities CAUSE frailty, this is a well-known & accepted premise. So with HIV+ experiencing more comorbidities & at earlier ages that is one key reason why frailty is increased in HIV and occurring years earlier in HIV+ vs HIV-neg. IF you don't understand what frailty feels like you can't understand why frailty is such an important issue. With frailty comes gait & balance issues which lead to falls & fractures and lack of mobility & ambulatory issues!
Higher Frailty Index Tied to Lower Odds of Successful Cognitive Aging in HIV+ Over 50.....http://www.natap.org/2014/AGE/AGE_07.htm
Biologic aging, frailty, and age-related disease in chronic HIV infection....http://www.natap.org/2014/HIVAGE/Biologic_aging,_frailty,_and_age_related_disease.18.pdf
Frailty in people aging with human immunodeficiency virus (HIV) infection.....http://www.natap.org/2014/HIV/060914_02.htm
6th International Workshop on HIV and Aging
October 5-6, 2015, Washington, DC
Mark Mascolini
Number of cardiometabolic disorders rose in tandem with a 30-item frailty index, and the frailty index predicted survival independently of cardiometabolic conditions in an Italian cohort of 3498 middle-aged people with HIV infection [1].
Inflammation-driven cardiometabolic disorders become more frequent with age, noted researchers at Dalhousie University in Halifax and University of Modena collaborators who conducted this study. Research also links frailty to pro-inflammatory states, they added, and frailty gets worse with age. They conducted this cohort study to explore links between frailty, five cardiometabolic disorders, and mortality.
The study involved 3498 people who entered the Modena [Italy] HIV Metabolic Clinic between January 2005 and December 2014. Health workers measured frailty at the first cohort visit with a 30-item frailty index and recorded diagnoses of five cardiometabolic disorders: cardiovascular disease, hypertension, type 2 diabetes, dyslipidemia, and high waist circumference. None of these cardiovascular disorders were elements in the frailty index, which included an array of conditions (such as chronic kidney disease, cirrhosis, and osteoporosis), lab values (such as AST, GGT, and D-dimer), and behavioral traits (such as sedentary lifestyle and alcohol use). The research team used generalized linear models to assess relationships between frailty and cardiometabolic disorders, and they used Cox regression models to determine the impact of these variables on survival.
Cohort members averaged 45 years in age, 83% had an undetectable viral load, and median CD4 count stood at 543 (interquartile range 385 to 720). Participants averaged 1.1 (+/- 0.9) cardiometabolic disorders, and 27% had two or more disorders. Dyslipidemia was the most prevalent cardiometabolic disorder (66.3%), followed by hypertension (19.7%), high waist circumference (15.2%), diabetes (7.2%), and cardiovascular disease (2.5%).
Frailty index averaged 0.28. (Having 9 of the 30 frailty deficits yields a score of 0.3.) Cohort members with hyperlipidemia had the same average frailty index as people without hyperlipidemia. But for each of the other four cardiometabolic disorders, participants with the disorder had a higher average frailty index than people without the disorder: cardiovascular disease 0.32 versus 0.28, P = 0.002; hypertension 0.31 versus 0.27, P < 0.001; diabetes 0.35 versus 0.27, P < 0.001; high waist circumference 0.30 versus 0.28, P = 0.001.
Number of cardiometabolic disorders rose significantly with the frailty index (r2 = 0.04, P < 0.001) and with age (r2 = 0.1, P < 0.001). The frailty index climbed by 0.02 with each additional cardiometabolic disorder (95% confidence interval [CI] 0.02 to 0.03, P < 0.001). That rate means that for each additional cardiometabolic disorder, cohort members had about one additional deficit out of the 30 deficits that made up the frailty index.
Through an average follow-up of 3.9 years, 64 people (1.8%) died. Every 0.1 increase in the frailty index (equivalent to acquiring 3 frailty deficits) was significantly associated with each of the 5 cardiometabolic disorders (hazard ratios [HR] ranging from 2.72 to 2.85, all P < 0.001). The number of cardiometabolic disorders (0 through 5) was associated with shorter survival (HR 1.30, 95% CI 1.10 to 1.67, P = 0.04). Each 0.1 increase in frailty index was an even stronger predictor of shorter survival (HR 3.00, 95% CI 1.82 to 4.96, P < 0.001). After controlling for number of cardiometabolic disorders, each 0.1 higher frailty index independently predicted shorter survival (HR 2.75, 95% CI 1.69 to 4.47).
The Dalhousie-Modena team concluded that "frailty increases risk of mortality even after adjusting for cardiometabolic diagnoses." They suggested that HIV clinicians who see multiple metabolic disorders in a patient "might consider case-finding for frailty."
Reference
1. Brothers TD, Wallace LMK, Malagoli A, et al. Number of cardiometabolic disorders is associated with degree of frailty among people aging with HIV. 6th International Workshop on HIV and Aging. October 5-6, 2015, Washington, DC. Abstract 1.
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