In patients without CHD, frailty is a risk factor for the development of MACEs. Efforts to identify frailty in patients without CHD and interventions to limit or reverse frailty status are needed and, if successful, may limit subsequent adverse cardiovascular events.

In the NHATS study, we found that pre-frailty and physical frailty phenotype are associated with a significant risk for mortality and the development of MACE during 6 years of follow-up, even after controlling for traditional cardiovascular risk factors. Efforts to integrate frailty assessment as part of primary cardiovascular prevention programs in older adults at risk for cardiovascular disease are essential in daily clinical cardiovascular practice. Testing the efficacy and safety of physical activity programs, nutritional interventions, and cognitive training to prevent or reverse physical frailty in patients at risk for the development of cardiovascular disease is needed as the US older adult population expands rapidly in the coming decades.