Cardiovascular Disease and Frailty: What Are the Mechanistic Links?

In aging populations, cardiovascular disease (CVD) and frailty are common and often coexist. It is possible that common risk factors and pathophysiological pathways increase the risk of both CVD and frailty.Frailty is a complex clinical syndrome with multiple causes and contributing factors. It is characterized by multisystem impairment that decreases physiological reserve and increases vulnerability to stress. Diverse methods have been used to evaluate frailty. Most include 1 or several measures related to reduced exercise, physical function, cognition, activities of daily living, comorbidities, deficits and/or markers of physiological dysfunction. CVD and frailty may be linked by several mechanisms. CVD can accelerate frailty, and frailty increases the risk of adverse outcomes in patients with CVD. Common pathophysiological pathways are also important. Low physical activity, poor nutrition, diabetes, hypertension, and smoking may increase the risk of both CVD and frailty. Further research is needed to evaluate whether biomarkers of dysfunction across multiple body systems, which are known to be associated with aging, and with CV and non-CV morbidity and mortality, are also associated with frailty.Multiple pathophysiological pathways are associated with both CVD and frailty, which interact to further increase the risk of adverse outcomes.