Physical frailty and the risk of degenerative valvular heart disease

The relationship between physical frailty, age-related conditions, and the incidence of degenerative valvular heart disease (VHD) remains unclear. This study aimed to investigate the potential association between physical frailty and the development of degenerative VHD. Participants from the UK Biobank who were initially free of VHD and heart failure were categorized into three groups based on the frailty phenotype: non-frailty, pre-frailty, and frailty. The frailty phenotype was determined by evaluating the following five components: weight loss, exhaustion, reduced physical activity, slow gait speed, and low grip strength. The incidence of degenerative VHD, including mitral valve regurgitation (MR), aortic valve regurgitation (AR), and aortic valve stenosis (AS), was assessed using hospital admission or death registries. Among the 331,642 participants, 11,885 (3.6%) exhibited frailty and 143,379 (43.2%) were categorized as pre-frailty. During a median follow-up of 13.8 years, there were 3,684 MR, 1,205 AR, and 3,166 AS events. Compared to non-frailty participants, those with pre-frailty and frailty showed significantly increased risks for MR (hazard ratio[HR], HR pre-frailty:1.19, 95% confidence interval [CI]: 1.11-1.28; HR frailty: 1.50, 95% CI: 1.30-1.74), AR (HR pre-frailty:1.19, 95% CI: 1.05-1.34; HR frailty: 1.58, 95% CI: 1.22-2.04), and AS (HR pre-frailty:1.19, 95% CI: 1.11-1.29; HR frailty: 1.74, 95% CI: 1.51-2.00). Among the five components, slow gait speed showed the strongest association with the risk of various types of VHD (HR MR: 1.50, 95% CI: 1.34-1.65; HR AR: 1.50, 95% CI: 1.24-1.80; HR AS: 1.46, 95% CI: 1.32-1.62), followed by exhaustion, low grip strength, and weight loss. Pre-frailty and frailty were associated with a higher risk of all three types of degenerative VHD. Early detection and intervention for pre-frailty and frailty in middle-aged and older individuals may assist in preventing or delaying the onset of degenerative VHD.