Abstract
OBJECTIVES: Cross-sectional evidence has implicated a high prevalence of frailty in patients with aortic valve stenosis (AS); however, the longitudinal association remains unknown. This study aimed to examine the longitudinal association between the physical frailty phenotype and the incidence of AS in middle-aged and older adults.
DESIGN: Prospective cohort and longitudinal study SETTING: A population-based study of middle-aged and older adults.
PARTICIPANTS: This study included participants from the UK biobank study.
MEASUREMENTS: Physical frailty was assessed using the Fried criteria frailty phenotype in the UK biobank in more than half a million participants. The primary outcome was incident degenerative AS, and the secondary outcome was AS-related events, that is, AS-related intervention or death due to AS. Cox proportional hazards models and competing risk models were used to evaluate their associations.
RESULTS: Among 480,967 participants (median age, 58.0 years; 54.6% female), 5,589 AS cases and 2,336 AS-related events were documented during a median follow-up of 14.3 years. Compared with robust participants, the adjusted hazard ratio (HR) in prefrail and frail participants was 1.30 (95% CI, 1.22-1.38) and 1.66 (95% CI, 1.50-1.84) for incident AS and 1.31 (95% CI, 1.19-1.43) and 1.54 (95% CI, 1.30-1.81) for AS-related events, respectively. The results were similar in a series of sensitivity analyses. Compared with robust participants with low genetic risk, frail participants with high genetic risk had the highest risk of AS (HR, 2.56; 95% CI, 2.15-3.06). Progression from robust to frail (HR, 2.41; 95% CI, 1.17-4.98) was associated with increased AS risk, while recovery from prefrail/frail to robust (HR, 0.35; 95% CI, 0.18-0.69) was associated with decreased AS risk.
CONCLUSION: Physical prefrailty and frailty were associated with incident AS and subsequent AS-related events. These findings highlight the importance of integrating frailty assessment into the primary prevention of AS to better identify high-risk individuals.