Impaired Cerebral Hemodynamics and Frailty in Patients with Cardiovascular Disease

J Gerontol A Biol Sci Med Sci. 2018 Nov 10;73(12):1714-1721. doi: 10.1093/gerona/glx253.


Background: Recent studies suggest that impaired cerebrovascular reactivity (CVR), a marker of cerebral microvascular damage, is associated with a higher risk of stroke, cognitive decline, and mortality. We tested whether abnormal cerebrovascular status is associated with late-life frailty among men with pre-existing cardiovascular disease.

Methods: A subset of 327 men (mean age at baseline 56.7 ± 6.5 years) who previously participated in the Bezafibrate Infarction Prevention (BIP) trial (1990-1997) and then in the BIP Neurocognitive Study underwent a neurovascular evaluation 14.6 ± 1.9 years after baseline (T1) and were evaluated for frailty 19.9 ± 1.0 years after baseline (T2). CVR was measured at T1 using the breath-holding index and carotid large-vessel disease using ultrasound. Frailty status was measured at T2 according to the physical phenotype developed by Fried. Patients were categorized into CVR tertiles with cutoff points at ≤0.57, 0.58-0.94, and ≥0.95 and also as normal or impaired (<0.69) CVR. We assessed the change in the odds of being in the advanced rank of frailty status (normal, prefrail, and frail) using ordered logistic regression.

Results: After adjustment, the estimated OR (95% confidence intervals) for increasing frailty in the lower tertile was 1.94 (1.09-3.46) and in the middle tertile 1.24 (0.70-2.19), compared with the higher CVR tertile. The estimated OR for increasing frailty for patients with impaired vs. normal CVR was 1.76 (1.11-2.80).

Conclusions: These findings provide support that cerebral microvascular dysfunction among patients with pre-existing cardiovascular disease is related to prefrailty and frailty and suggest an added value of assessing the cerebral vascular functional status for identifying patients at-risk of developing frailty.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / therapy
  • Cause of Death
  • Cerebrovascular Circulation / physiology*
  • Comorbidity
  • Databases, Factual
  • Disability Evaluation*
  • Frailty / epidemiology*
  • Hemodynamics / physiology*
  • Hospitalization / statistics & numerical data
  • Humans
  • Israel
  • Male
  • Middle Aged
  • Quality of Life*
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Survival Analysis