Assessing Cardiovascular Risk in Older Adults Integrating Frailty and Competing Risks.

Chronologic age dominates cardiovascular (CV) risk assessment but incompletely reflects risk in older adults. Functional status, frailty, multimorbidity, and competing non-CV risks significantly influence outcomes, therapeutic benefit, and harm. This review proposes a balanced framework integrating traditional risk estimators with measures of frailty, functional capacity, and patient preferences. It highlights limitations of applying standard risk tools to vulnerable older adults and reviews practical frailty assessments relevant to clinical care. Emerging adjuncts such as coronary artery calcium scoring and gait speed are discussed. Preventive and procedural strategies are reframed through time to benefit, competing risks, and shared decision making.