Association of frailty with the incidence risk of cardiovascular disease and type 2 diabetes mellitus in long-term cancer survivors: a prospective cohort study

BMC Medicine

Research Article

Yuxian Du¹  Xifeng Wu²  Zuyun Liu²  Xingqi Cao²  Jingyun Zhang²  Xueqin Li²  Zhenqing Yang²  Xuehong Zhang³  Chen Chen⁴  Yong Zhu⁵  Emiel O. Hoogendijk⁶  Lina Ma⁷  Thomas M. Gill⁸  Nengliang Aaron Yao⁹  Yawei Zhang^1,10  Xiaofeng Wang^1,11 

[1] Bayer Healthcare Pharmaceuticals U.S. LLC, 07981, Whippany, NJ, USA;Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 866 Yuhangtang Rd, 310058, Zhejiang, Hangzhou, China;Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 02115, Boston, MA, USA;China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 100000, Beijing, China;Department of Environmental Health Sciences, Yale School of Public Health, Yale University, 06510, New Haven, CT, USA;Department of Epidemiology & Data Science, Amsterdam Public Health research Institute, Amsterdam UMC – location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, the Netherlands;Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, 100053, Beijing, China;Beijing Geriatric Healthcare Center, Xuanwu Hospital Capital Medical University, 100053, Beijing, China;Department of Internal Medicine, Yale School of Medicine, 06511, New Haven, CT, USA;Home Centered Care Institute, Schaumburg, IL, USA;Center For Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, 250012, Jinan, China;Section of Geriatrics, University of Virginia, Charlottesville, VA, USA;National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China;State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Human Phenome Institute, Fudan University, 200433, Shanghai, China;National Clinical Research Center for Ageing and Medicine, Huashan Hospital, Fudan University, 200040, Shanghai, China;

关键词: Cancer survivors;    Frailty;    Aging;    Cardiovascular disease;    Type 2 diabetes mellitus;   

DOI  :  10.1186/s12916-023-02774-1

 received in 2022-04-16, accepted in 2023-02-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundComorbidities among cancer survivors remain a serious healthcare burden and require appropriate management. Using two widely used frailty indicators, this study aimed to evaluate whether frailty was associated with the incidence risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) among long-term cancer survivors.MethodsWe included 13,388 long-term cancer survivors (diagnosed with cancer over 5 years before enrolment) free of CVD and 6101 long-term cancer survivors free of T2DM, at the time of recruitment (aged 40–69 years), from the UK Biobank. Frailty was assessed by the frailty phenotype (FP_Frailty, range: 0–5) and the frailty index (FI_Frailty, range: 0–1) at baseline. The incident CVD and T2DM were ascertained through linked hospital data and primary care data, respectively. The associations were examined using Cox proportional hazards regression models.ResultsCompared with non-frail participants, those with pre-frailty (FP_Frailty [met 1–2 of the components]: hazard ratio [HR]=1.18, 95% confidence interval [CI]: 1.05, 1.32; FI_Frailty [0.10< FI ≤0.21]: HR=1.51, 95% CI: 1.32, 1.74) and frailty (FP_Frailty [met ≥3 of the components]: HR=2.12, 95% CI: 1.73, 2.60; FI_Frailty [FI >0.21]: HR=2.19, 95% CI: 1.85, 2.59) had a significantly higher risk of CVD in the multivariable-adjusted model. A similar association of FI_Frailty with the risk of incident T2DM was observed. We failed to find such an association for FP_Frailty. Notably, the very early stage of frailty (1 for FP_Frailty and 0.1-0.2 for FI_Frailty) was also positively associated with the risk of CVD and T2DM (FI_Frailty only). A series of sensitivity analyses confirmed the robustness of the findings.ConclusionsFrailty, even in the very early stage, was positively associated with the incidence risk of CVD and T2DM among long-term cancer survivors, although discrepancies existed between frailty indicators. While the validation of these findings is required, they suggest that routine monitoring, prevention, and interventive programs of frailty among cancer survivors may help to prevent late comorbidities and, eventually, improve their quality of life. Especially, interventions are recommended to target those at an early stage of frailty when healthcare resources are limited.

【 授权许可】

CC BY   
© The Author(s) 2023

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