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Frailty Linked to Subclinical Cardio Risk in Older People With/Without HIV
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AIDS 2022, July 29-August 2, Montreal
Mark Mascolini
Analysis of HIV-positive and negative people older than 50 found independent associations between classically defined frailty and four cardiovascular risk predictors: atherosclerotic cardiovascular disease (ASCVD) risk score of 7.5% or more, coronary artery calcium (CAC) score at or above 100, epicardial fat volume at or above 100 cm(3), and greater carotid intima media thickness (cIMT) [1]. This Bangkok-based study also found that all four CVD metrics occurred more frequently in frail than nonfrail people.
The study by collaborators at Sydney’s University of New South Wales and Bangkok’s HIV-NAT group extends results of a 48-week prospective US study that tied baseline frailty (at least 3 of 5 Fried frailty phenotype components) to newly diagnosed CVD and diabetes, with a trend toward more bone-related problems, in 821 men and 195 women with HIV and a median age of 51 [2]. Increasing frailty over 48 weeks predicted mortality but not other clinical outcomes. A just-published study of 5554 US men and women with or at risk for HIV linked higher Framingham CVD risk score to increased frailty regardless of HIV status [3].
The Australian-Thai team conducted their cross-sectional study in HIV-positive people older than 50 and age- and sex-matched HIV-negative people in Bangkok in 2017 and 2018 [1]. They aimed to explore associations between standard Fried phenotype frailty and ASCVD calculated with pooled cohort equations, CAC and epicardial fat volume were determined by noncontrast cardiac CT scans, and cIMT was measured by ultrasound. Separate multivariable logistic regression models estimated associations between frailty and ASCVD at or above 7.5%, CAC score at or above 100, epicardial fat volume at or above 100 cm(3), and cIMT. The researchers used multinomial logistic regression to determine whether these same CVD precursors predicted frailty.
The study group included 308 people with HIV and 131 without HIV. There were 157 women (36%), and median age stood at 55 (interquartile range 52 to 60). Thirty-tree people (7.5%) were frail (3, 4, or 5 Fried phenotype criteria) and 232 (53%) prefrail (1 or 2 criteria) [4]. A significantly higher proportion of people with than without HIV had frailty (9% vs 3%, P = 0.001). Median ASCVD for the entire group stood at 6.8%, median epicardial fat volume at 93 cm(3), and median cIMT at 0.6 mm. Sixty-five people (15%) had a CAC score at or above 100.
Compared with the nonfrail state, frailty was independently associated with ASCVD risk at or above 7.5% (adjusted odds ratio [aOR] 2.38, 95% confidence interval [CI] 1.06 to 5.33), CAC score at or above 100 (aOR 3.05, 95% CI 1.18 to 7.92), and epicardial fat volume at or above 100 cm(3) (aOR 2.54, 95% CI 1.05 to 6.15).
Running the analysis in the other direction-with CVD signals as predictors and frailty as the outcome-the researchers determined that frailty was more likely in people with ASCVD risk at or above 7.5% (adjusted relative risk ratio [aRRR] 2.05, 95% CI 1.01 to 4.61), CAC score at or above 100 (aRRR 2.93, 95% CI 1.10 to 7.80), and epicardial fat volume at or above 100 cm(3) (aRRR 3.10, 95% CI 1.27 to 7.55). Every 0.1 mm greater cIMT raised the risk of frailty 60% (aRRR 1.60, 95% CI 1.20 to 2.13).
The researchers believe their findings suggest that subclinical atherosclerotic risks are more likely in people with frailty, independently of HIV infection. They stressed “the importance of frailty screening in HIV care,” especially in areas with large aging populations.
References
1. Han WM, Apornpong T, Gatechompol S, Ubolyam S, Kerr SJ, Avihingsanon A. Associations of frailty with cardiovascular disease risks in older people living with HIV. AIDS 2022, July 29-August 2, Montreal. Abstract EPB130.
2. Kelly SG, Wu K, Tassiopoulos K, Erlandson KM, Koletar SL, Palella FJ. Frailty is an independent risk factor for mortality, cardiovascular disease, bone disease, and diabetes among aging adults with human immunodeficiency virus. Clin Infect Dis. 2019;69:1370-1376. doi: 10.1093/cid/ciy1101. https://academic.oup.com/cid/article/69/8/1370/5258114 Among 821 men and 195 women (median age 51 years), 62 (6%) were frail at baseline. Frailty scores increased by ≥1 component among 194 participants (19%) from baseline to 48 weeks. Baseline frailty was associated with an increased risk of incident CVD and DM, with a trend toward a significant association with bone events. Among frailty components, slow gait speed was associated with incident DM and borderline associated with incident CVD. An increase in frailty from baseline to week 48 was associated with mortality but not with the other clinical outcomes.
3. Kuniholm MH, Vasquez E, Appleton AA, et al. Cardiovascular risk score associations with frailty in men and women with or at risk for HIV. AIDS. 2022;36:237-347. doi: 10.1097/QAD.0000000000003107. https://pubmed.ncbi.nlm.nih.gov/34934019/
4. Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27:1-15. doi: 10.1016/j.cger.2010.08.009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028599/
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