Association Between Cardiovascular Risk and Perceived Fatigability in Mid‐to‐Late Life

Abstract

BackgroundCardiovascular disease (CVD) and fatigue commonly co‐occur in older adults, yet the subjective nature of fatigue and its situational dependence leave the true magnitude of this association undefined.Methods and ResultsSix‐hundred and twenty‐five participants with no history of CVD (aged 68.1+12.0 years), from the Baltimore Longitudinal Study of Aging who underwent ≥2 clinic visits between 2007 and 2015 were classified according to sex‐specific predicted 10‐year CVD risk scores using the Framingham CVD risk score (Framingham) and the Pooled Cohort Equation at baseline. Perceived fatigability was assessed using the Borg rating of perceived exertion scale after a 5‐minute treadmill walk (0.67 m/s, 0% grade). Linear models were used to assess the association between baseline CVD risk and perceived fatigability an average of 4.5 years later, adjusted for demographics, behaviors, and medical history. In final models, a 5% higher baseline Pooled Cohort Equation score was associated with greater perceived fatigability at follow‐up (β=0.13 rating of perceived exertion, P=0.008). Stratified analyses suggested this association was stronger among those aged ≤70 years and those with obesity. Of the individual CVD risk score components, older age was most strongly associated with perceived fatigability (β=0.48, P<0.001), followed by women (β=0.11, P=0.002), and treated hypertension (β=0.11, P=0.003). There was no association with the Framingham risk score.ConclusionsPerceived fatigability was higher among participants with greater CVD risk measured using the Pooled Cohort Equation risk score. The strong associations with hypertension and obesity suggest prevention and promotion of cardiovascular health may also lower perceived fatigability, particularly among those aged ≤70 years or living with obesity.

Traits and treadmills: Association between personality and perceived fatigability in well-functioning community-dwelling older adults.

“…In well-functioning older adults, higher perceived fatigability (i.e., feeling more significant levels of exhaustion after completing slow treadmill walk) has been associated with lower objective physical activity (Richardson et al, 2015; Wanigatunga et al, 2018), subjective and performance-based mobility (Simonsick et al, 2016, 2018), and worse inflammatory biomarker levels (Cooper et al, 2019; Wanigatunga et al, 2019). High perceived fatigability is also more prevalent in those with a history of disease including preclinical cardiovascular disease (Qiao et al, 2019), peripheral artery disease (Martinez-Amezcua et al, 2018), cancer (Gresham et al, 2018), cognition (Salerno et al, 2020), and sleep (Alfini et al, 2020). Although several popular adages: It takes as much energy to wish as it does to plan—Eleanor Roosevelt, American Political Figure Our fatigue is often caused not by work, but by worry, frustration and resentment—Dale Carnegie, American Writer Age is not measured by years.…”

Slowing: A Vascular Geriatric Syndrome?

“…Alternatively, higher use of sedatives could represent overall higher incidence of (psychiatric) comorbidities. Because fatigability is increased in individuals at higher risk of cardiovascular disease 44 and other comorbidities, 43 it could be hypothesized that fatigability is a mediating factor in the relationship between CSVD and slowing. Unfortunately, investigating the complex relationship between fatigability and slowing was beyond the scope of our study.…”

Perceived Physical Fatigability Predicts All-Cause Mortality in Older Adults

“…Covariates and potential confounders for model building were chosen based on the fatigability literature in epidemiology and aging. 5 , 8 , 11 The Framingham Physical Activity Index captured rest and activity in 5 domains for a typical day over the past year (MET-h/d); due to skewness (right), we dichotomized at the median for the analyses. We asked self-reported doctor diagnosis of heart disease, stroke, kidney disease, lung disease, peripheral arterial disease, and cancer (excluding skin) at each visit and annually during telephone follow-ups.…”

“…Perceived physical fatigability, whole-body tiredness anchored to quantifiable activities/tasks of fixed intensity and duration, provides a sensitive patient-reported assessment of the degree to which an individual is physically limited by fatigue. 1–6 Perceived physical fatigability is a highly prevalent characteristic reported by older adults, ranging from 22.5% to 89.5%, 5 , 7–9 and is greater with advancing age, 5 higher in women than men, 5 predicts physical and cognitive functional decline, 8 , 10 and associated with cardiovascular risk, 11 and depressive symptomology. 5 In older adults, perceived physical fatigability is clinically useful because it provides a holistic indicator of an individual’s vulnerability to fatigability by capturing what an individual thinks they can do as well as how much effort it takes to perform standard activities.…”