Background--Frailty is associated with greater mortality; however, whether frail patients primarily die of cardiovascular disease (CVD) or non-CVD causes is unknown. Methods and Results--We assessed the cause of death in relation to frailty status, measured at baseline, among 3135 community-dwelling older men in the MrOS Sleep (Outcomes of Sleep Disorders in Older Men) study. Absolute probability and risk of CVD mortality associated with frailty status were estimated with traditional methods that used censoring and newer methods that considered non-CVD mortality as a competing risk. Of the 3135 men (mean age: 76.4±5.6 years), 475 (15.2%) were frail. During an average follow-up of 9.2 years, 1275 (40.7%) men died, including 445 (34.9%) from CVD and 828 (64.9%) from non-CVD causes (2 deaths unadjudicated). Both CVD and non-CVD mortality risk increased with frailty. Cumulative absolute probability of CVD death at 10 years among frail men was 23.8% (20.2-27.6%) using the competing risk method versus 32.5% (27.3-37.8%) using the traditional Kaplan-Meier method (41.5% [95% confidence interval, 36.9-45.9%] and 48.6% [95% confidence interval, 43.6-53.4%], respectively, for non-CVD mortality). The multivariable-adjusted risk of CVD death among frail versus robust men was 1.38 (95% confidence interval, 0.99-1.92) using the competing risk method versus 1.84 (95% confidence interval, 1.35-2.51) using the traditional Cox proportional hazards method. Conclusions--Among community-dwelling older men, ≈35% of the deaths were due to CVD. Frail men were at increased risk of CVD death, but ignoring the competing risk of non-CVD mortality overestimated their long-term probability and relative risk of CVD death.
Bibliographical noteFunding Information:
The MrOS (Osteoporotic Fractures in Men) study is supported by National Institutes of Health funding. The National Institute on Aging, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Center for Advancing Translational Sciences, and NIH Roadmap for Medical Research provide support under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The National Heart, Lung, and Blood Institute provides funding for the MrOS Sleep (Outcomes of Sleep Disorders in Older Men) ancillary study under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL0 70842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. This article is the result of work supported with resources and use of facilities of the Minneapolis VA Health Care System. The contents do not represent the views of the US Department of Veterans Affairs or the US Government.
Tu is supported by a Tier 1 Canada Research Chair in Health Services Research and an Eaton Scholar Award from the Department of Medicine, University of Toronto. Austin and, Alter are supported by Heart and Stroke Foundation Career Investigator Awards; Ko is supported by a Heart and Stroke Foundation Mid-Career Award, and Udell and Bhatia are supported by a Heart and Stroke Foundation National New Investigator and Ontario Clinician Scientist Award, all from the Heart and Stroke Foundation. Alter is also funded by a Chair in Cardiovascular and Metabolic Rehabilitation, University Health Network–Toronto Rehabilitation Institute, University of Toronto.
The study was supported by ICES, an operating grant from the Institute of Circulatory and Respiratory Health, Canadian Institutes of Health Research (ICRH–CIHR) Chronic Diseases Team (grant no. TCA 118349), a CIHR foundation grant (grant no. FDN-143313), a CIHR operating grant (grant no. MOP-111035) and a Canadian Vascular Network (CVN) seed grant. The CVN is supported by grants from the CIHR–ICRH, and the Institute of Aging in partnership with and supported by Hypertension Canada. ICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).
© 2018 The Authors.
- Cardiovascular disease
- Cardiovascular disease risk factors
- Functional capacity impairment