Deterioration to or persistence of frailty is associated with an elevated risk of CVD in older adults with diabetes, and these associations remained robust after competing-risk validation.
The 'pre-frail→frail' transition group had significantly higher risk of incident CVD compared to the 'robust→robust' group.
The 'frail→frail' (persistent frailty) group had significantly higher risk of incident CVD compared to the 'robust→robust' group.
The 'robust→pre-frail/frail' transition group had significantly elevated risk of incident CVD compared to the 'robust→robust' group.
The study enrolled diabetic older adults from two longitudinal cohorts with substantial numbers of incident CVD cases documented during follow-up.
Competing-risk analysis treating non-CVD death as the competing event confirmed the associations between frailty transitions and CVD incidence remained robust.
This research suggests that how frailty changes over time in older adults with diabetes has a strong relationship with their risk of developing cardiovascular disease (CVD). The study followed nearly 1,800 older diabetic adults across two large longitudinal studies—one in China and one in England—and tracked how their frailty status shifted over time. Participants were grouped into seven patterns based on whether they moved from robust to pre-frail, pre-frail to frail, stayed frail, and so on. The findings show that older diabetic adults who deteriorated from pre-frail to frail had about twice the risk of developing CVD compared to those who remained robust throughout the study period. Similarly, those who remained persistently frail also faced about twice the risk. Even those who went from being robust to becoming pre-frail or frail had a 60% higher risk. Importantly, these elevated risks held up even after accounting for the possibility that some participants might die from non-CVD causes before experiencing a CVD event—a statistical challenge known as 'competing risks.' This research suggests that monitoring changes in frailty status over time—not just measuring frailty at a single point—may be important for identifying older diabetic individuals at higher risk of cardiovascular disease. The consistency of findings across two culturally and geographically distinct cohorts (China and England) adds confidence to these associations. Early identification of those transitioning toward or remaining in frailty could be relevant for clinical monitoring and preventive strategies in elderly diabetic populations.
Li Y, Li S, Jin A. (2026). [A prospective dual-cohort study on the association between frailty index outcomes and cardiovascular disease onset risk in elderly diabetic populations].. Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. https://doi.org/10.3760/cma.j.cn112150-20251016-00994