This study in a representative sample of older British men aged 71–92 years shows that frailty in older age is associated with a range of cardiovascular risk factors (including dyslipidemia, obesity, poor lung function, poor renal function, raised white cells, low albumin, low sodium and altered liver function); several of these cardiovascular factors were also raised or altered in those who were pre-frail. The gene discussed is ALB; the disease is obesity due to melanocortin 4 receptor deficiency.