Vascular frailty, a proposal for new frailty type: A narrative review

Abstract

Frailty is the incremental accumulation of minute defects that progressively impair health and performance. Frailty is commonly observed in older adults; however, secondary frailty may also occur in patients with metabolic disorders or major organ failure. In addition to physical frailty, several distinct types of frailty have been identified, including oral, cognitive, and social frailty, each of which is of practical importance. This nomenclature suggests that detailed descriptions of frailty can potentially advance relevant researches. In this narrative review, we first summarize the clinical value and plausible biological origin of frailty, as well as how to appropriately assess it using physical frailty phenotypes and frailty indexes. In the second part, we discuss the issue of vascular tissue as a relatively underappreciated organ whose pathologies contribute to the development of physical frailty. Moreover, when vascular tissue undergoes degeneration, it exhibits vulnerability to subtle injuries and manifests a unique phenotype amenable to clinical assessment prior to or accompanying physical frailty development. Finally, we propose that vascular frailty, based on an extensive set of experimental and clinical evidence, can be considered a new frailty type that requires our attention. We also outline potential methods for the operationalization of vascular frailty. Further studies are required to validate our claim and sharpen the spectrum of this degenerative phenotype.

Literacy for Frailty among Undergraduate Medical Education: An Under-Recognized Opportunity to Improve Geriatric Care

“…Frailty characterizes an individual’s susceptibility to harsh insults and arises from cumulative subtle deficits over chronologic and/or biologic aging [ 7 ]. The incidence of frailty is estimated at 43.4 cases per 1,000 person-year among older adults, and its prodrome, pre-frailty, occurs at 150.6 per 1,000 person-year [ 8 ].…”

Extracellular MicroRNAs as Potential Biomarkers for Frail Kidney Phenotype: Progresses and Precautions

“…Exosomal miRNAs, such as miR-16-5p, miR-17/92 cluster members, and miR-106-5p also exhibited a close relationship with vascular stiffness severity [ 55 ], a contributor to frailty in those with CKD [ 56 ]. Proatherogenic miRNAs such as miR-223 also exhibit an association with inflammation and vascular dysfunction in ESKD patients [ 57 ], predisposing them to a subtype of frailty termed vascular frailty [ 58 ]. Although none of the existing literature addresses the utility of extracellular microRNA as markers for uremic sarcopenia, there is an anecdotal report suggesting that serum extracellular vesicle miR-203a-3p independently correlated with skeletal muscle mass across different muscular use/disuse conditions [ 59 ].…”

Vascular Calcification Heterogeneity from Bench to Bedside: Implications for Manifestations, Pathogenesis, and Treatment Considerations

“…Finally, VC can directly increase the probability of physical deterioration in older adults [16], which is another important reason that close attention should be paid to this adverse pathology. A newer subtype of frailty, vascular frailty, has been proposed recently to illustrate the accelerated aging process attributable to VC [17].…”