The Longitudinal Relationship between Frailty, Loneliness and Cardiovascular Disease: A Prospective Cohort Study

Previous studies had reported that frailty and loneliness were associated with increased risk of cardiovascular disease (CVD). The aim of present study was to evaluate the combined effect of frailty and loneliness on the risk of CVD.A total of 9,674 participants from the China Health and Retirement Longitudinal Study were included. Multivariate Cox proportional hazards regression model was used to explore the associations between frailty, loneliness and new-onset CVD, stroke and cardiac events.During the 7-year follow-up, a total of 1,758 respondents experienced CVD (including 584 stroke and 1,324 cardiac events). Compared to those without loneliness or frailty, individuals with loneliness alone, or with frailty alone, or with both loneliness and frailty were significantly associated with increased risk of CVD, with corresponding HRs (95%CIs) were 1.21(1.07-1.37), 1.57(1.32-1.86) and 1.78(1.52-2.10), respectively. Similarly, participants with loneliness alone, or with frailty alone, or with both loneliness and frailty were associated with higher risk of cardiac events. The significant associations were consistent in age subgroups (participants aged less or more than 60 years).Our study indicated that there was a combined effect of effect of frailty and loneliness on the risk of CVD, stroke and cardiac events. These findings highlighted the importance of identifying loneliness and frailty, and intervening much earlier both in older and younger population.