▎ WuXi AppTec content team editor
Multiple studies have shown that the prevalence of sarcopenia in the elderly in Asia is about 6.8% to 25.7%. Sarcopenia is a severe senile syndrome with decreased skeletal muscle mass, low muscle strength, and/or somatic dysfunction. As the global population ages, sarcopenia is also becoming an important public health problem. There is growing evidence that sarcopenia is strongly associated with a variety of adverse outcomes, such as falls, weakness, increased frequency of medical attention, and increased risk of death.
At the same time, aging is also a strong risk factor associated with the development of cardiovascular disease, and cardiovascular disease is the leading cause of death in older patients. So, is sarcopenia in middle-aged and elderly people associated with cardiovascular disease? Large-scale population-based longitudinal studies have been lacking in the past.
Recently, Lancet journal EClinicalMedicine published a large study in Chinese populations, long-term tracking of nearly 15,000 middle-aged and elderly Chinese people showing that sarcopenia is associated with a significantly increased risk of cardiovascular disease, including heart disease and stroke. The research was led by scholars from the Department of Gastroenterology of the First Affiliated Hospital of Xi'an Jiaotong University and the School of Basic Medical Sciences of the Fourth Military Medical University. The paper notes that this study expands our understanding of the cardiometabolic importance of sarcopenia.
Screenshot source: EClinicalMedicine
How to judge sarcopenia?
In this study, sarcopenia was defined using the AWGS 2019 standard.
"Possible sarcopenia" was found in primary care facilities in the community:
Potential cases detected:
Calves circumference male
or SARC-F scale ≥4;
or the SARC-CalF scale ≥11.
risk assessment:
Low muscle strength: male grip
Or low physical function: 5 chair sit-up tests ≥ 12 seconds
On the basis of the judgment of the community primary medical institutions, hospitals and clinical studies can also detect cases through any of the following clinical conditions, including: decreased or restricted function; involuntary weight loss; depressed mood; cognitive impairment; repeated falls; malnutrition; chronic diseases, including heart failure, COPD, diabetes, chronic kidney disease, etc.
Further diagnosis of "sarcopenia" in a hospital setting:
Low physical function:
6 meters walking speed
or 5 chair-up tests ≥ 12 seconds;
Or suggest a Physical Fitness Measure (SPPB) score ≤ 9.
Skeletal muscle content of the extremities:
DAX male 2, female < 5.4 kg / m2;
Or BIA male 2, female < 5.7 kg/m2.
Image credit: 123RF
Sarcopenia and cardiovascular disease
The study was based on nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS).
CHARLS aims to collect a set of high-quality micro-data representing families and individuals aged 45 and over in China to analyze the aging of the Chinese population. The CHARLS National Baseline Survey was conducted in 2011 and covers 150 county-level units, 450 village-level units, and 17,000 people in about 10,000 households. These samples have been followed up every 2-3 years thereafter.
The cross-sectional analysis portion of the study, which included 15,137 participants from CHARLES 2015 ≥ 45 years old, first demonstrated that a group with sarcopenia was more common in people with simultaneous cardiovascular disease.
The prevalence of cardiovascular disease in the general population, the population without sarcopenia, the probable sarcopenia and sartonia population were 12.6% (1905/15137), 10.0% (1026/10280), 18.1% (668/3685), and 18.0% (211/1172), respectively.
After adjusting for sociodemographic characteristics and health-related factors, the risk of cardiovascular disease increased significantly by 29% and 72% in the population with possible sarcopenia and sarcopenia, respectively. The trend is consistent for heart disease (17% and 55% increase, respectively) and stroke (1.18- and 1.7-fold, respectively).
The subsequent longitudinal analysis screened 11,863 participants who did not have cardiovascular disease when they joined the study in 2015 and followed them up to 2018. Longitudinal analysis of the data further shows that with sarcopenia, there is also a higher risk of future cardiovascular disease events.
In an average of 3.6 years of follow-up, a total of 1273 (10.7%) cardiovascular disease events were identified. After adjusting for other potential risk factors, compared to the peers without sarcopenia:
People diagnosed with possible sarcopenia had a 22 percent increased risk of cardiovascular disease; those diagnosed with sarcopenia had a 33 percent increased risk of cardiovascular disease.
This risk is mainly reflected in stroke. Diagnosed as possible with sarcopenia and sarcopenia, the risk of cardiac disease showed a trend of 6% and 21%, respectively, but not significantly, while the risk of stroke was significantly increased by 59% and 67%, respectively.
Regardless of cross-sectional or longitudinal analysis, there was no significant change in the above association after further metabolic biomarkers of nearly 10,000 participants.
In addition, in the absence of low grip and low somatic function (both of which are defined as "possible sarcopenia" in the AWGS 2019 standard), the risk of cardiovascular disease was not significantly increased in people with low muscle mass alone. This also confirms the risk of cardiovascular disease in people who may have sarcopenia.
brief summary
The paper discusses that the association of sarcopenia with cardiovascular disease involves a variety of underlying mechanisms. Patients with sarcopenia may present with several pathophysiological changes, including muscle mitochondrial dysfunction, oxidative stress, excessive inflammatory status, microvascular endothelial dysfunction, and multiple metabolic disorders (insulin resistance and non-alcoholic fatty liver disease); in addition, sarcopenia and cardiovascular disease have similar lifestyle factors, such as malnutrition and physical inactivity.
The paper concludes that these data suggest that assessing underlying sarcopenia on physical examination and routine clinical practice helps identify those at risk for cardiovascular disease who are most likely to benefit from early intervention. Preventing and improving possible sarcopenia and sarcopenia, including maintaining adequate muscle strength and physical function, may help reduce the risk of cardiovascular disease and promote healthy ageing of middle-aged and older populations.