Journal of Geriatric Cardiology最新文献

Background: Cardiovascular disease (CVD) and frailty are interrelated conditions prevalent in aging populations, yet their dynamic temporal relationship remains underexplored. This study investigates longitudinal changes in frailty trajectories before and after incident CVD across diverse cohorts.

Methods: Utilizing data from four longitudinal, multinational cohorts (ELSA, HRS, CHARLS, SHARE; n = 66,537), we constructed the frailty index (FI) based on age-related health deficits, using 40, 40, 42, and 44 items from ELSA, HRS, CHARLS and SHARE, respectively. Linear mixed models assessed FI changes pre- and post-CVD, adjusting for demographics, lifestyle, and baseline FI. Sensitivity analyses excluded hypertension, diabetes, and arthritis to mitigate confounding.

Results: Frailty increased steadily before CVD onset (pre-CVD slope: ELSA β = 0.005, HRS β = 0.005, CHARLS β = 0.012, SHARE β = 0.007; all P < 0.001), with an acute FI spike at diagnosis (post-CVD acute change: ELSA β = 0.024, HRS β = 0.031, CHARLS β = 0.046, SHARE β = 0.038; all P < 0.001). Post-CVD, frailty progression further accelerated (ELSA β = 0.008, HRS β = 0.005, CHARLS β = 0.017, SHARE β = 0.010; all P < 0.001). Sensitivity analyses confirmed robustness across age strata and FI definitions.

Conclusions: This first multinational study demonstrates bidirectional acceleration of frailty around CVD onset, highlighting their close temporal interplay. These findings suggest that incorporating frailty assessment into CVD management may help identify high-risk individuals and support timely, multidimensional care in aging populations.

Background: Percutaneous coronary intervention (PCI) is a widely utilized revascularization technique for coronary artery disease (CAD). While clinical and biomarker-based prognostic tools are standard for predicting outcomes, there is growing interest in sarcopenia as a marker of frailty and its potential role in long-term prognosis. The prognostic value of the psoas muscle index (PMI), a sarcopenia metric, remains underexplored in PCI populations regarding long term survival.

Methods: This single-center retrospective cohort study evaluated 177 patients undergoing PCI from 2015 to 2019. PMI was calculated from computed tomography (CT) imaging at the L3 vertebral level using the formula: (left psoas area + right psoas area)/height² and expressed in cm²/m². Sarcopenia was defined as the lowest sex-specific PMI quartile. Primary outcomes included 5-year all-cause mortality and 3-point major adverse cardiovascular events (MACE: non-fatal myocardial infarction, ischemic stroke, and cardiac death). Binary linear regression and Cox proportional hazards models were utilized to determine associations between PMI and outcomes.

Results: Sarcopenic patients exhibited significantly higher 5-year all-cause mortality compared to non-sarcopenic counterparts (64.4% vs. 35.6%, P < 0.001), while no significant difference was observed in 3-point MACE incidence (55.6% vs. 51.4%, P = 0.520). Sarcopenia was independently associated with all-cause mortality on binary logistic regression (OR = 3.49; 95% CI: 1.69-7.19; P = 0.0007), but not MACE (OR = 1.00; 95% CI: 0.50-1.98; P = 0.99). In a multivariable Cox regression model, sarcopenia was associated with increased hazard of mortality (HR = 1.60; 95% CI: 0.96-2.66; P = 0.071), though this did not reach statistical significance. Kaplan-Meier analysis demonstrated significantly reduced survival among sarcopenic patients (χ ² = 6.13, P = 0.0133).

Conclusions: PMI is a significant independent predictor of 5-year all-cause mortality in PCI patients, underscoring the prognostic importance of assessing skeletal muscle mass in this population.

Background: Frailty is a major determinant of outcomes in patients with coronary artery disease (CAD) undergoing lower limb amputation. This study evaluates the impact of frailty on in-hospital outcomes in these patients.

Methods: We performed a retrospective analysis of the National Inpatient Sample (2016-2021) to identify adult patients with CAD who underwent lower limb amputation. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator. Multivariable logistic regression was used to assess the independent association of frailty with in-hospital outcomes, and propensity score matching (PSM) was performed to further account for confounding factors.

Results: After PSM, 9,990 patients were included in each cohort. Frail patients experienced higher rates of in-hospital mortality (3.9% vs. 1.5%, P < 0.001), acute limb ischemia (3.8% vs. 3.1%, P = 0.015), fasciotomy (2.1% vs. 1.4%, P < 0.001), stump infection (7.9% vs. 6.6%, P < 0.001), cardiogenic shock (0.9% vs. 0.7%, P = 0.032), sudden cardiac arrest (2.7% vs. 2.1%, P = 0.004), mechanical circulatory support (0.3% vs. 0.2%, P = 0.028), major adverse cardiac and cerebrovascular events (7.7% vs. 5.4%, P < 0.001), and sepsis (18.3% vs. 13.8%, P < 0.001). In multivariable logistic regression analysis, frailty remained an independent predictor of in-hospital mortality and major complications.

Conclusion: Frailty is independently associated with increased in-hospital mortality and adverse events among CAD patients undergoing lower limb amputation. Incorporating frailty assessment into preoperative evaluation may improve risk stratification and guide clinical decision-making in this high-risk population.

Background: Quantitative flow ratio (QFR) based lesion selection for percutaneous coronary intervention (PCI) treatment has shown clinical benefits in terms of reduced risk for myocardial infarction and repeat revascularization. Whether this benefit is consistent across different age groups still needs further investigation.

Methods: In this prespecified subgroup study of FAVOR III China trial, we compared long-term clinical outcomes between QFR-guided and angiography-guided PCI among different age groups among 3825 enrolled subjects. The primary endpoint was major adverse cardiac events (MACEs), a composite of all-cause death, myocardial infarction, and ischemia-driven revascularization.

Results: Of the 3825 patients, 1717 (44.9%) were aged ≥ 65 years. At baseline, patients ≥ 65 had higher rates of hypertension, hyperlipidaemia, stroke history (P < 0.0001), and peripheral vascular disease (P = 0.024) and had higher SYNTAX scores (P = 0.0095). Compared with standard angiography guidance, the QFR-guided strategy consistently reduced the 1-year (≥ 65 years, 6.04% vs. 9.19%, HR = 0.65, 95% CI: 0.46-0.92; < 65 years, 5.53% vs. 8.43%, HR = 0.65, 95% CI: 0.47-0.91) and 3-year MACE rates in both age groups (≥ 65 years, 11.8% vs. 15.2%, HR: 0.75, 95% CI: 0.58-0.98; < 65 years, 9.5% vs. 14.6%, HR = 0.63; 95% CI: 0.49-0.81), without a significant interaction (P _interaction = 0.99). Within the QFR-guided group, the 3-year MACE rate in patients with deferred vessels was numerically greater in patients aged ≥ 65 years than in those aged < 65 years (8.3% vs. 3.0%, P = 0.10).

Conclusions: Although with higher rate of comorbidities and more complex coronary anatomy, the long-term benefit of the QFR-guided PCI strategy remained consistent in patients ≥ 65 years, compared with those < 65 years.

Background: Mild cognitive impairment (MCI) is common in atrial fibrillation (AF) patients and may develop earlier in those with multiple cardiovascular comorbidities, potentially impairing self-management and treatment adherence. This study aimed to characterize the prevalence and profile of MCI in AF patients, examine its associations with cardiovascular comorbidities, and assess how these comorbidities influence specific cognitive domains.

Methods: This cross-sectional study analyzed data from AF patients who underwent cognitive assessment between 2017 and 2021. Cognitive status was categorized as MCI or non-MCI based on the Montreal Cognitive Assessment. Associations between comorbidities and MCI were assessed by logistic regression, and cognitive domains were compared using the Mann-Whitney U test.

Results: Of 4136 AF patients (mean age: 64.7 ± 9.4 years, 64.7% male), 33.5% of patients had MCI. Among the AF patients, 31.2% of patients had coronary artery disease, 20.1% of patients had heart failure, and 18.1% of patients had hypertension. 88.7% of patients had left atrial enlargement, and 11.0% of patients had reduced left ventricular ejection fraction. Independent factors associated with higher MCI prevalence included older age (OR = 1.04, 95% CI: 1.03-1.05, P < 0.001), lower education level (OR = 1.51, 95% CI: 1.31-1.73, P < 0.001), hypertension (OR = 1.28, 95% CI: 1.07-1.52, P = 0.001), heart failure (OR = 1.24, 95% CI: 1.04-1.48, P = 0.020), and lower left ventricular ejection fraction (OR = 1.43, 95% CI: 1.04-1.98, P = 0.028). A higher CHA₂DS₂-VASc score (OR = 1.27, 95% CI: 1.22-1.33, P < 0.001; ≥ 2 points vs. < 2 points), and greater atherosclerotic cardiovascular disease burden (OR = 1.45, 95% CI: 1.02-2.08, P = 0.040; 2 types vs. 0 type) were linked to increased MCI risk. These above factors influenced various cognitive domains.

Conclusions: MCI is common in AF and closely associated with cardiovascular multimorbidity. Patients with multiple comorbidities are at higher risk, highlighting the importance of routine cognitive assessment to support self-management and integrated care.

Background: The beneficial effects of sodium-glucose co-transporter-2 inhibitors (SGLT2i) on adverse cardiac outcomes in diabetic patients are well-established. However, the effects of SGLT2i against cancer therapy-related cardiotoxicity remain understudied. We investigated the association between SGLT2i and cardiac outcomes in cancer patients.

Methods: PubMed, Embase, and the Cochrane Library were searched from their inception until September 30, 2024 for studies evaluating the effects of SGLT2i in patients with cancer. The primary outcomes included incident heart failure (HF), HF exacerbation, HF hospitalization, atrial fibrillation/atrial flutter (AF/AFL), myocardial infarction, and all-cause mortality. The secondary outcomes included acute kidney injury and sepsis. Odds ratio (OR) with 95% CI was pooled.

Results: Thirteen studies with 85,596 patients were included. Compared to non-SGLT2i use, SGLT2i treatment was associated with lower risks of incident HF (OR = 0.51, 95% CI: 0.32-0.79, P = 0.003), HF exacerbation (OR = 0.74, 95% CI: 0.63-0.87, P < 0.001), AF/AFL (OR = 0.67, 95% CI: 0.55-0.82, P < 0.001), myocardial infarction (OR = 0.61, 95% CI: 0.41-0.90, P = 0.01), and all-cause mortality (OR = 0.44, 95% CI: 0.28-0.69, P < 0.001), but not for HF hospitalization (OR = 0.58, 95% CI: 0.22-1.55, P = 0.28). As for safety outcomes, SGLT2i use was associated with lower risks of acute kidney injury (OR = 0.68, 95% CI: 0.57-0.81, P < 0.001) and sepsis (OR = 0.32, 95% CI: 0.23-0.44, P < 0.001).

Conclusions: SGLT2i were associated with lower risks of incident HF, HF exacerbation, AF/AFL, myocardial infarction, all-cause mortality, acute kidney injury, and sepsis in cancer patients.

Background: The atherogenic index of plasma (AIP) has been shown to be positively correlated with cardiovascular disease in previous studies. However, it is unclear whether elderly people with long-term high AIP levels are more likely to develop coronary heart disease (CHD). Therefore, the aim of this study was to investigate the relationship between AIP trajectory and CHD incidence in elderly people.

Methods: 19,194 participants aged ≥ 60 years who had three AIP measurements between 2018 and 2020 were included in this study. AIP was defined as log₁₀ (triglyceride/high-density lipoprotein cholesterol). The group-based trajectory model was used to identify different trajectory patterns of AIP from 2018 to 2020. Cox proportional hazards models were used to estimate the hazard ratio (HR) with 95% CI of CHD events between different trajectory groups from 2020 to 2023.

Results: Three different trajectory patterns were identified through group-based trajectory model: the low-level group (n = 7410, mean AIP: -0.25 to -0.17), the medium-level group (n = 9981, mean AIP: 0.02-0.08), and the high-level group (n = 1803, mean AIP: 0.38-0.42). During a mean follow-up of 2.65 years, a total of 1391 participants developed CHD. After adjusting for potential confounders, compared with the participants in the low-level group, the HR with 95% CI of the medium-level group and the high-level group were estimated to be 1.24 (1.10-1.40) and 1.43 (1.19-1.73), respectively. These findings remained consistent in subgroup analyses and sensitivity analyses.

Conclusions: There was a significant correlation between persistent high AIP level and increased CHD risk in the elderly. This suggests that monitoring the long-term changes in AIP is helpful to identify individuals at high CHD risk in elderly people.