Associations Between Frailty and Risk of All-Cause and Cardiovascular Mortality in Patients with Prediabetes: A Population-Based Study.

Objective: Diabetes is a well-known risk factor for frailty that has been associated with adverse prognosis. However, the association of frailty with all-cause and cardiovascular disease (CVD) mortality in patients with prediabetes has not been thoroughly explored.

Methods: Participants with prediabetes were derived from the 1999-2018 National Health and Nutrition Examination Survey and followed up for all-cause and CVD mortality until December 31, 2019. A frailty index calculated using a 49-item deficit accumulation model > 0.21 was used to indicate the presence of frailty. Kaplan-Meier curves and weighted Cox proportional hazards regression were used to assess the association between frailty and mortality.

Results: The weighted prevalence of frailty was 28.21% in this cohort of 7845 prediabetic participants with a mean age of 62.89 years. During a median follow-up time of 90 months, a total of 1983 all-cause (636 CVD-related) deaths occurred. Each 0.01 score increase in the frailty index was associated with a 5% and 6% increased risk of all-cause and CVD-related mortality, respectively. The hazard ratio and 95% confidence interval for all-cause and CVD mortality in the frailty group were 2.28 (1.89-2.76) and 2.84 (2.01-4.02), respectively, compared with those without frailty. Restricted cubic spline analysis showed a linear association between frailty index and all-cause or CVD mortality. Similar results were observed in the sensitivity analyses.

Conclusion: The frailty index was positively associated with all-cause and CVD mortality in participants with prediabetes, highlighting that appropriate screening and management of frailty may help reduce mortality in patients with prediabetes.