Cardiovascular frailty - an emerging frailty phenotype.

With an ageing population worldwide, there is a corresponding increase in the prevalence of frailty. It is well established that there is a bi-directional relationship between frailty and cardiovascular morbidity and mortality. Different models have been developed to assess frailty in clinical practice exploring the physical phenotypes, cumulative deficits, social, vascular and cognitive aspects of frailty. However, no model as yet integrates the role of cardiovascular frailty in this context. This narrative review presents the concept of cardiovascular frailty, examining existing literature on how components of blood pressure dynamics in older adults, and vascular ageing affects frailty. These are discussed with emphasis on the oxi-inflammaging process that underpins both frailty and changes to blood vessels during the ageing process. Available literature is delineated on how these factors interact in ageing, and their resultant effect on cardiovascular frailty. Evidence is provided on the associations between arterial compliance and blood pressure in older adults with frailty. This is shown to be largely underpinned by oxi-inflammaging occurring at the cellular level, ultimately leading to progression of frailty and increase in cardiovascular-related morbidity and mortality. There is a growing need for a new phenotype- cardiovascular frailty which addresses the bi-directional relationship between frailty and the cardiovascular system and how these can be objectively assessed for clinical management.