Cardiovascular disease risk scores in identifying future frailty: the Whitehall II prospective cohort study

OBJECTIVES To examine the capacity of existing cardiovascular disease (CVD) risk algorithms widely used in primary care, to predict frailty. DESIGN Prospective cohort study. Risk algorithms at baseline (1997-1999) were the Framingham CVD, coronary heart disease and stroke risk scores, and the Systematic Coronary Risk Evaluation. SETTING Civil Service departments in London, UK. PARTICIPANTS 3895 participants (73% men) aged 45-69 years and free of CVD at baseline. MAIN OUTCOME MEASURE Status of frailty at the end of follow-up (2007-2009), based on the following indicators: self-reported exhaustion, low physical activity, slow walking speed, low grip strength and weight loss. RESULTS At the end of the follow-up, 2.8% (n=108) of the sample was classified as frail. All four CVD risk scores were associated with future risk of developing frailty, with ORs per one SD increment in the score ranging from 1.35 (95% CI 1.21 to 1.51) for the Framingham stroke score to 1.42 (1.23 to 1.62) for the Framingham CVD score. These associations remained after excluding incident CVD cases. For comparison, the corresponding ORs for the risk scores and incident cardiovascular events varied between 1.36 (1.15 to 1.61) and 1.64 (1.50 to 1.80) depending on the risk algorithm. CONCLUSIONS The use of CVD risk scores in clinical practice may also have utility for frailty prediction.