Abstract：
BACKGROUND: Poor cardiovascular health (CVH) and physical frailty were reported to increase mortality risk, but their joint effects have not been fully elucidated.
OBJECTIVE: We aimed to explore the separate and joint effects of CVH and frailty on mortality based on two perspectives of Life\'s Essential 8 (LE8) and Framingham Risk Score (FRS).
METHODS: 21 062 participants in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 were involved in this study. CVH was evaluated by the LE8 and FRS, and categorized into low, moderate and high CVH groups. Cox proportional hazard models were applied to estimate the separate and joint associations of CVH and frailty index (FI) with all-cause, cardiovascular disease (CVD) and cancer mortality.
RESULTS: Over a median follow-up period of 87 months (95% CI: 86.0-88.0), 2036 deaths occurred. The separate linear dose-response relationships between CVH, frailty and mortality were observed (nonlinear P > .05). The combination of low CVH/frailty was negatively associated with all-cause mortality [hazard ratio (HR) and 95%CI: low LE8*FI, 5.30 (3.74, 7.52); high FRS*FI, 4.34 (3.20, 5.88)], CVD mortality [low LE8*FI, 6.57 (3.54, 12.22); high FRS*FI, 7.29 (3.92, 13.55)] and cancer mortality [low LE8*FI, 1.99 (1.14, 3.25); high FRS*FI, 2.32 (1.30, 4.15)], with high CVH/fit group as reference. Further stratified analyses showed that the combined burden of mortality from frailty and low CVH was greater among the young and females.
CONCLUSIONS: Low CVH and frailty were independently and jointly correlated with greater risk of all-cause, CVD and cancer deaths, especially among the young and females.
OBJECTIVE: We aimed to explore the separate and joint effects of CVH and frailty on mortality based on two perspectives of Life\'s Essential 8 (LE8) and Framingham Risk Score (FRS).
METHODS: 21 062 participants in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 were involved in this study. CVH was evaluated by the LE8 and FRS, and categorized into low, moderate and high CVH groups. Cox proportional hazard models were applied to estimate the separate and joint associations of CVH and frailty index (FI) with all-cause, cardiovascular disease (CVD) and cancer mortality.
RESULTS: Over a median follow-up period of 87 months (95% CI: 86.0-88.0), 2036 deaths occurred. The separate linear dose-response relationships between CVH, frailty and mortality were observed (nonlinear P > .05). The combination of low CVH/frailty was negatively associated with all-cause mortality [hazard ratio (HR) and 95%CI: low LE8*FI, 5.30 (3.74, 7.52); high FRS*FI, 4.34 (3.20, 5.88)], CVD mortality [low LE8*FI, 6.57 (3.54, 12.22); high FRS*FI, 7.29 (3.92, 13.55)] and cancer mortality [low LE8*FI, 1.99 (1.14, 3.25); high FRS*FI, 2.32 (1.30, 4.15)], with high CVH/fit group as reference. Further stratified analyses showed that the combined burden of mortality from frailty and low CVH was greater among the young and females.
CONCLUSIONS: Low CVH and frailty were independently and jointly correlated with greater risk of all-cause, CVD and cancer deaths, especially among the young and females.
摘要：
背景：据报道，不良的心血管健康（CVH）和身体虚弱会增加死亡风险，但是它们的联合作用尚未完全阐明。
目的：我们旨在基于生命基础8（LE8）和弗雷明汉风险评分（FRS）两个视角，探讨CVH和虚弱对死亡率的单独和联合影响。
方法：2007年至2018年国家健康与营养检查调查（NHANES）的21.062名参与者参与了这项研究。通过LE8和FRS评估CVH，并分类为低，中度和高度CVH组。Cox比例风险模型用于估计CVH和虚弱指数（FI）与全因的单独和联合关联，心血管疾病（CVD）和癌症死亡率。
结果：中位随访时间为87个月（95%CI：86.0-88.0），2036人死亡。CVH之间的单独线性剂量反应关系，观察到虚弱和死亡率(非线性P>.05)。低CVH/虚弱的组合与全因死亡率呈负相关[危险比（HR）和95CI：低LE8*FI，5.30（3.74，7.52）；高FRS*FI，4.34(3.20,5.88)],CVD死亡率[低LE8*FI，6.57（3.54，12.22）；高FRS*FI，7.29（3.92，13.55）]和癌症死亡率[低LE8*FI，1.99（1.14，3.25）；高FRS*FI，2.32(1.30,4.15)],以高CVH/拟合组为参考。进一步的分层分析表明，在年轻人和女性中，因虚弱和低CVH而导致的死亡综合负担更大。
结论：低CVH和虚弱与更大的全因风险相关，心血管疾病和癌症死亡，尤其是年轻人和女性。
目的：我们旨在基于生命基础8（LE8）和弗雷明汉风险评分（FRS）两个视角，探讨CVH和虚弱对死亡率的单独和联合影响。
方法：2007年至2018年国家健康与营养检查调查（NHANES）的21.062名参与者参与了这项研究。通过LE8和FRS评估CVH，并分类为低，中度和高度CVH组。Cox比例风险模型用于估计CVH和虚弱指数（FI）与全因的单独和联合关联，心血管疾病（CVD）和癌症死亡率。
结果：中位随访时间为87个月（95%CI：86.0-88.0），2036人死亡。CVH之间的单独线性剂量反应关系，观察到虚弱和死亡率(非线性P>.05)。低CVH/虚弱的组合与全因死亡率呈负相关[危险比（HR）和95CI：低LE8*FI，5.30（3.74，7.52）；高FRS*FI，4.34(3.20,5.88)],CVD死亡率[低LE8*FI，6.57（3.54，12.22）；高FRS*FI，7.29（3.92，13.55）]和癌症死亡率[低LE8*FI，1.99（1.14，3.25）；高FRS*FI，2.32(1.30,4.15)],以高CVH/拟合组为参考。进一步的分层分析表明，在年轻人和女性中，因虚弱和低CVH而导致的死亡综合负担更大。
结论：低CVH和虚弱与更大的全因风险相关，心血管疾病和癌症死亡，尤其是年轻人和女性。
