Abstract
BACKGROUND AND AIMS: Despite the frequent co-occurrence of frailty and abdominal aortic aneurysm (AAA), it remains unclear whether frailty is a risk factor for the development of AAA. This study aims to determine the association.
METHODS: The study recruited a large-scale cohort from the UK Biobank. The baseline frailty level was assessed through frailty phenotype and frailty index, categorizing participants as non-frail, pre-frail, or frail. The primary outcome was incidence of AAA during follow-up. Cox proportional hazards model was used to explore the association of frailty with AAA risk. The genetic susceptibility was assessed by polygenic risk score.
RESULTS: A total of 410,606 participants were enrolled in this study. Over a median follow-up of 12.56 years, AAA developed in 692(0.3 %), 931(0.5 %), and 180(1.0 %) participants categorized as non-frail, pre-frail, and frail respectively under the frailty phenotype, while the frailty index revealed 626(0.3 %), 873(0.6 %), and 304(1.1 %) cases across corresponding frailty strata. Compared with the non-frail participants, the risk of AAA was significantly elevated in pre-frail participants (frailty phenotype: HR = 1.28, 95 %CI = 1.16-1.42; frailty index: HR = 1.43, 95 %CI = 1.28-1.59) and frail participants (frailty phenotype: HR = 1.82, 95 % CI = 1.52-2.18; frailty index: HR = 2.03, 95 %CI = 1.74-2.37). The association remained robust in further adjustment of genetic susceptibility and subgroup analysis. Using non-frail participants with low genetic susceptibility as the reference group, those frail participants with high genetic susceptibility demonstrated the greatest hazard for incident AAA, underscoring their synergistic effect on AAA.
CONCLUSIONS: Frailty was longitudinally associated with a high long-term risk of AAA, suggesting frailty as a new independent risk factor for AAA.