Silent Myocardial Infarction and Long-Term Risk of Frailty: The Atherosclerosis Risk in Communities Study

Clin Interv Aging. 2021 Jun 18:16:1139-1149. doi: 10.2147/CIA.S315837. eCollection 2021.


Background: Silent myocardial infarction (SMI) accounts for more than half of all MIs, and common risk factors and pathophysiological pathways coexist between SMI and frailty. The risk of frailty among patients with SMI is not well established. This study aimed to examine the association between SMI and frailty.

Methods and results: This analysis included data from the Atherosclerosis Risk in Communities study. Patients without MI at baseline were eligible for inclusion. SMI was defined as electrocardiographic evidence of MI without clinical MI (CMI) after the baseline and until the fourth visit. Frailty was assessed during the fifth visit. A total of 4953 participants were included with an average age of 52.2±5.1 years. Among these participants, 2.7% (n=135) developed SMI, and 2.9% (n=146) developed CMI. After a median follow-up time of 14.7 (14.0-15.3) years, 6.7% (n=336) of the participants developed frailty. Patients with SMI and CMI were significantly more likely to become frail than those without MI (15.6% vs 6.2%, P<0.001 and 16.4% vs 6.2%, P<0.001, respectively). After adjusting for confounders, SMI and CMI were found to be independent predictors of frailty (odds ratio [OR]=2.243, 95% confidence interval [CI]=1.307-3.850, P=0.003 and OR=2.164, 95% CI=1.259-3.721, P=0.005, respectively). The association was consistent among the subgroups of age, sex, race, diabetes, and hypertension.

Conclusion: In conclusion, both SMI and CMI were found to be associated with a higher risk of frailty. Future studies are needed to confirm the beneficial effects of screening for SMI as well as to implement standardized preventive treatment to reduce the risk of frailty.

Clinical trial registration: URL:; Unique identifier: NCT00005131.

Keywords: cardiovascular disease; electrocardiogram; frailty; silent myocardial infarction.

MeSH terms

  • Aged
  • Atherosclerosis / epidemiology*
  • Atherosclerosis / physiopathology
  • Electrocardiography / methods
  • Frailty / epidemiology*
  • Frailty / physiopathology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / physiopathology
  • Prognosis
  • Risk Assessment
  • Risk Factors

Associated data


Grants and funding

This work was supported financially by grants from Sichuan Science and Technology Program (No. 2020YFS0154, 2020YFSY0014), 1•3•5 Project for Disciplines of Excellence-Clinical Research Incubation Project, Sichuan University West China Hospital (No. 2018HXFH001, and 2018HXFH027, 2020HXFH050), Sichuan University West China Hospital (No. CGZH19008), Sichuan University West China Nursing Discipline Development Special Fund Project (No. HXHL20046, HXHL19023), Chengdu Science and Technology Bureau (No. 2019-YF05-00322-SN), National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (No. Z20191009).