Epigenetic age acceleration links atherogenic dyslipidaemia, inflammageing and frailty with adverse cardiovascular outcomes in older adults (UFO): a lipid-metabolome and epigenetic clock analysis

Summary Background Frailty and chronic inflammatory diseases are known risk factors for adverse outcomes and have been associated with epigenetic age acceleration (EAA), a quantitative estimation of biological age based on DNA methylation. We investigated the interrelationships between EAA, atherogenic dyslipidaemia and frailty; determined the best performing epigenetic clock for EAA estimation of atherosclerotic cardiovascular disease (ASCVD) risks; and prospectively analysed the capacity of EAA to predict future adverse outcomes. Methods A structured cardiogeriatric evaluation including frailty and physical capacity assessment was performed in community-living older adults aged ≥60 years who met predefined eligibility criteria and had no previous history of heart failure. We prioritised the selection of all available frail older adults from our bioresource and used computerised randomisation to select the more abundant robust and pre-frail individuals for relatively balanced analyses among groups. DNA methylation analysis was performed using the Infinium MethylationEPIC platform. Quantitative proton-nuclear magnetic resonance (NMR) was used for targeted metabolomic analysis of serum. Five common epigenetic clocks were compared for associations with frailty, systemic inflammation, lipid-metabolome and prediction of incident adverse outcomes. Clinical outcomes were queried using electronic medical record systems and by interview. Findings Among 535 older adults, GrimAge 2-estimated EAA (Grim2AA) performed best in classifying and predicting the frailty phenotype. Grim2AA was significantly associated with systemic inflammation indicated by GlycA, increased risk of ASCVD comorbidities, and an atherogenic lipid profile characterised by reduced low-density lipoprotein (LDL) particle size and abnormal triglycerides in lipoproteins. Small LDL particle size but not other lipid/lipoprotein features were also associated with frailty. Of the five epigenetic clocks analysed and benchmarked against the ACC/AHA ASCVD Risk Calculator, Grim2AA was the most strongly associated. For each 10-year increment in Grim2AA, the risk was estimated at 4·92% (p=0·0002). During a median follow-up of 4·68 years, 55 all-cause deaths occurred and 101 individuals experienced cardiovascular hospitalisation. Analysis of cardiovascular hospitalisation revealed marked differences in EAA depending on the cause, and pointed to ASCVD (excluding stroke) as being most common with the highest median Grim2AA at 0·73 years. Kaplan-Meier analysis did not show a difference in the rates of cardiovascular hospitalisation between Grim2AA ≥0 and <0 years (p=0·19). However, the rates of ASCVD hospitalisation (42 of 101) were significantly higher in older adults with the former (p=0·0027). Interpretation As the most comprehensive targeted analysis of blood lipid-metabolome and DNA methylation-based epigenetic clock to date, this study has linked frailty, inflammageing, atherogenic dyslipidaemia and ASCVD risks that can be collectively indicated by Grim2AA in older adults. Grim2AA is an independent predictor of future ASCVD hospitalisation, and may serve as a potential biomarker for monitoring disease trajectory and target for secondary prevention.