Higher Frailty Index Tied to Increased Risk of Severe Abdominal Aortic Calcification in Adults Aged 40 and Above: Study

The study, published in Frontiers in Public Health, found that individuals with higher Frailty Index (FI) scores had significantly elevated AAC scores (β = 2.64). Notably, frail individuals (FI > 0.25) had a 6.39-fold increased likelihood of severe AAC (defined as a score >6). Additionally, FI Z-scores demonstrated a linear relationship with severe AAC, suggesting that the FI could be a valuable early biomarker for subclinical atherosclerosis and cardiovascular risk in aging populations.

Abdominal aortic calcification is one of the earliest indicators of atherosclerotic calcification and is vital in predicting early cardiovascular risk. Frailty, a significant clinical and public health concern, is linked to increased risks of mortality, functional decline, and loss of independence. Despite its importance, the relationship between frailty and AAC in middle-aged and older adults has not been extensively explored. To address this gap, Zhengjun Zhang, Department of Cardiology, Yinchuan, China, and colleagues analyzed data from the 2013-2014 NHANES, focusing on individuals aged 40 years and older.

For this purpose, the researchers used a 49-item model to calculate the Frailty Index and categorized participants into three groups: non-frail (FI ≤ 0.15), pre-frail (0.15 < FI ≤ 0.25), and frail (FI > 0.25). Abdominal aortic calcification was measured using dual-energy X-ray absorptiometry and quantified using Kauppila scores, with severe AAC defined as a score greater than 6. The relationship between FI and AAC was explored through multivariable logistic regression, sensitivity analyses, and smoothing curve fitting. To ensure the robustness of the findings, subgroup analyses, and interaction tests were conducted across different populations.

The study led to the following findings:

• The study included a total of 2,572 participants.
• After adjusting for potential confounders, the Frailty Index (FI) showed a statistically significant positive association with both the AAC score (β = 2.64) and Severe AAC (OR = 6.36).
• Similar trends were observed when FI was analyzed as a categorical variable.
• Smooth curve fitting and subgroup analysis were used to investigate the relationship between baseline FI Z-score and both AAC score and Severe AAC.
• The FI Z-score showed a linear relationship with the occurrence of severe AAC but a nonlinear relationship with the AAC score.
• The FI-Z score was positively associated with the likelihood of AAC score before the breakpoint (K = 0.78), but the association was not significant after the breakpoint.
• The relationship between the FI-Z score and Severe AAC remained stable across different subgroups.

"Our study demonstrates a consistent positive correlation between the Frailty Index and abdominal aortic calcification," the researchers concluded. They further emphasized, "The findings suggest that FI could serve as a valuable biomarker for the early detection of subclinical atherosclerosis in middle-aged and older adults in the United States."

Reference:

Zhang, Z., Wu, P., Yang, S., Zhu, B., Chen, D., Li, X., Wang, Y., & Yan, N. The association between frailty index and abdominal aortic calcification in the middle-aged and older US adults: NHANES 2013-2014. Frontiers in Public Health, 13, 1546647. https://doi.org/10.3389/fpubh.2025.1546647