{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T06:26:59Z","timestamp":1794119219911,"version":"4.8.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T00:00:00Z","timestamp":1705536000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2017YFC0907004"],"award-info":[{"award-number":["2017YFC0907004"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Previous studies found that frailty was an important risk factor for cardiovascular disease (CVD). However, previous studies only focused on baseline frailty status, not taking into consideration the changes in frailty status during follow-up. The aim of this study was to investigate the associations of changes in frailty status with incident CVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study used data of three prospective cohorts: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS). Frailty status was evaluated by the Rockwood frailty index and classified as robust, pre-frail, or frail. Changes in frailty status were assessed by frailty status at baseline and the second survey which was two years after the baseline. Cardiovascular disease was ascertained by self-reported physician-diagnosed heart disease (including angina, heart attack, congestive heart failure, and other heart problems) or stroke. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 7116 participants from CHARLS (female: 48.6%, mean age: 57.4 years), 5303 from ELSA (female: 57.7%, mean age: 63.7 years), and 7266 from HRS (female: 64.9%, mean age: 65.1 years) were included according to inclusion and exclusion criteria. The median follow-up periods were 5.0 years in the CHARLS, 10.7 years in the ELSA, and 9.5 years in the HRS. Compared with stable robust participants, robust participants who progressed to pre-frail or frail status had increased risks of incident CVD (CHARLS, HR = 1.84, 95% CI: 1.54\u20132.21; ELSA, HR = 1.53, 95% CI: 1.25\u20131.86; HRS, HR = 1.59, 95% CI: 1.31\u20131.92). In contrast, frail participants who recovered to robust or pre-frail status presented decreased risks of incident CVD (CHARLS, HR = 0.62, 95% CI: 0.47\u20130.81; ELSA, HR = 0.49, 95% CI: 0.34\u20130.69; HRS, HR = 0.70, 95% CI: 0.55\u20130.89) when compared with stable frail participants. These decreased risks of incident CVD were also observed in pre-frail participants who recovered to robust status (CHARLS, HR = 0.66, 95% CI: 0.52\u20130.83; ELSA, HR = 0.65, 95% CI: 0.49\u20130.85; HRS, HR = 0.71, 95% CI: 0.56\u20130.91) when compared with stable pre-frail participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Different changes in frailty status are associated with different risks of incident CVD. Progression of frailty status increases incident CVD risks, while recovery of frailty status decreases incident CVD risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad885","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T12:59:27Z","timestamp":1703163567000},"page":"1058-1068","source":"Crossref","is-referenced-by-count":427,"title":["Changes in frailty and incident cardiovascular disease in three prospective cohorts"],"prefix":"10.1093","volume":"45","author":[{"given":"Di","family":"He","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoping","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaixin","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusa","family":"He","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyue","family":"He","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanjiao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiyi","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5313-8164","authenticated-orcid":false,"given":"Dan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Big Data in Health Science, School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"},{"name":"Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8409-7636","authenticated-orcid":false,"given":"Yimin","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , China"},{"name":"Cancer Center, Zhejiang University , 866 Yuhangtang Rd, Hangzhou 310058, Zhejiang , 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