Abstract
Background
Carotid intima-media thickness (cIMT) provides an index of arterial injury. Frailty
is an indicator of vulnerability to adverse health outcomes. It is unclear whether
cIMT is associated with the multi-dimensional frailty index and/or if this relationship
is age- or sex-specific. The aim was to determine the impact of age and sex on the
relationship between cIMT and frailty level in middle-aged and older adults.
Methods
Frailty and cIMT data were extracted from the Canadian Longitudinal Study of Aging
baseline comprehensive cohort of middle-aged (45–64 years) and older adults (>65 years)
(n = 10,209). cIMT was assessed via high-resolution ultrasound. Frailty was determined
using a 52-item index. Covariate-adjusted ordinary least squares regressions were
conducted separately for middle-aged males (n = 3178), middle-aged females (n = 3125), older males (n = 2031), and older females (n = 1875).
Results
Average cIMTs were larger in older versus middle-aged adults and in males versus females
(all, p < 0.001). Average cIMT was positively associated with frailty level in adjusted linear
regression models in middle-aged males [adj. R2 = 0.09; β = 0.015 (95 % CI: 0.005–0.026), p = 0.004], middle-aged females [adj. R2 = 0.11; β = 0.040 (95 % CI: 0.025–0.054), p < 0.001], older males [adj. R2 = 0.12; β = 0.019 (95 % CI: 0.004–0.034), p = 0.01], and older females [adj. R2 = 0.11; β = 0.020 (95 % CI: 0.002–0.039), p = 0.03].
Conclusion
cIMT was an independent contributor to frailty level regardless of age group (middle-aged/older
adults) or sex, with the strongest effect observed in middle-aged females. Our cross-sectional
study documents the independent relationship between a marker of cardiovascular function
and an increased vulnerability to adverse health outcomes in middle-aged and older
males and females.
Graphical abstract

Graphical Abstract
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Frailty among middle-aged and older canadians: population norms for the frailty index using the Canadian longitudinal study on aging.Age Ageing. 2021; 50: 447-456
- Prevalence of frailty in community-dwelling older persons: a systematic review.J Am Geriatr Soc. 2012; 60: 1487-1492
- Frailty in older adults: evidence for a phenotype.J Gerontol - Ser A Biol Sci Med Sci. 2001; 56: M146-M157
- Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care.J Gerontol - Ser A Biol Sci Med Sci. 2004; 59: 255-263
- A comparison of two approaches to measuring frailty in elderly people.J Gerontol - Ser A Biol Sci Med Sci. 2007; 62: 738-743
- Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK biobank participants.Lancet Public Health. 2018; 3: e323-e332
- Carotid intima-media thickness should not be referred to as subclinical atherosclerosis: a recommended update to the editorial policy at atherosclerosis.Atherosclerosis. 2020; 312: 119-120
- Carotid intima-media thickness progression as surrogate marker for cardiovascular risk: meta-analysis of 119 clinical trials involving 100 667 patients.Circulation. 2020; 142: 621-642
- Association between frailty and carotid central structure changes: the three-city study.J Am Geriatr Soc. 2014; 62: 1906-1911
- Association between frailty and carotid intima media thickness and inflammatory marker in an elderly population.Geriatr Gerontol Int. 2017; 17: 2449-2454
- Association between carotid artery intima-media thickness and combinations of mild cognitive impairment and pre-frailty in older adults.Int J Environ Res Public Health. 2019; 16: 2978
- Association of frailty and cardiometabolic risk among community-dwelling middle-aged and older people: results from the I-lan longitudinal aging study.Rejuvenation Res. 2015; 18: 564-572
- Sex differences in frailty: a systematic review and meta-analysis.Exp Gerontol. 2017; 89: 30-40
- Impact of cardiovascular risk factors on carotid intima-media thickness: sex differences.Clin Interv Aging. 2016; 11: 721-731
- Accumulation of deficits as a proxy measure of aging.ScientificWorldJournal. 2001; 1: 323-336
- Comparison and clinical applications of the frailty phenotype and frailty index approaches.in: Interdisciplinary topics in gerontology and geriatrics. Karger, Basel, Switzerland2015: 74-84
- Canadian Institutes of Health Research-Institute of Aging: profile: mining a unique Canadian resource: the Canadian longitudinal study on aging.Can J Aging. 2015; 34: 366-377
- The Canadian longitudinal study on aging (CLSA).Can J Aging / La Rev Can du Vieil. 2009; 28: 221-229
- Cohort profile: the Canadian longitudinal study on aging (CLSA).Int J Epidemiol. 2019; 48: 1752-1753
- A comparison of ultrasound intima-media thickness measurements of the left and right common carotid artery.IEEE J Transl Eng Heal Med. 2015; 3: 1-10
- A standard procedure for creating a frailty index.BMC Geriatr. 2008; 8: 24
- The frailty phenotype and the frailty index: different instruments for different purposes.Age Ageing. 2014; 43: 10-12
- Normative values and correlates of carotid artery intima-media thickness and carotid atherosclerosis in andean-hispanics: the prevencion study.Atherosclerosis. 2010; 211: 499-505
- Carotid intima-media thickness measurements in intervention studies.Stroke. 2003; 34: 2985-2994
- Physical activity and trajectories of frailty among older adults: evidence from the english longitudinal study of ageing.PLoS One. 2017; 12e0170878
- Frailty, hospitalization, and mortality in residential aged care.J Gerontol Ser A. 2018; 73: 1090-1096
- Population projections for Canada, provinces and territories.2010 (Cat. no 91)
Article info
Publication history
Published online: January 27, 2023
Accepted:
December 17,
2022
Received in revised form:
December 2,
2022
Received:
November 2,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.