Editorial in the Press - Dr. George Heckman
In this issue of the journal, Phyo et al. present a prospective study demonstrating how premorbid
vulnerabilities and incident cardiovascular events can interact in certain older adults to bring
about greater frailty. The ASPREE-XT is an observational extension of the ASPREE clinical
trial of low-dose aspirin for primary prevention of CVD in older adults. The study was conducted
primarily in Australia, with about 10% of participants from the United States. Study participants
were assessed using various measures, including a frailty index and the Fried Frailty Phenotype,
and social determinants of health such as place of residence and socioeconomic status. The
primary outcome was incident frailty, defined as a frailty index greater than 0.21, following a
non-fatal CVD event (myocardial infarction, stroke, coronary heart disease, heart failure
hospitalization). Following such as event, the incidence of frailty exceeded 45%, with risk
factors including older age, women, stroke, prior prefrailty, and living outside urban centres. This
relationship was robust to sensitivity analyses. The authors conclude that a CVD event can
contribute to incident frailty, and recommend screening to identify older adults who would
benefit from interventions to prevent frailty progression, enhance recovery after a CVD event,
and thus maintain their well-being
