With advancing age traditional cardiovascular risk factors follow a U-shaped relationship with survival outcomes. This relationship has been described as reverse metabolism. The mechanism of such relationship is unclear. However, it appears that malnutrition, inflammation and functional decline are characteristics shared by populations exhibiting the U-shaped risk. Thus, frailty or decline in functional reserve may be the main confounding factor of the relationship between cardiovascular risk factors and adverse outcomes in older patients. Clinical implication of this is not yet clear but more attention should be focused on optimal management of undernutrition and weight loss by improving feeding and maintaining physical activity.
Keywords: Frailty; cardiovascular risk; malnutrition.