Abstract
We aimed to investigate the interaction of reduced skeletal muscle mass and abdominal obesity on coronary artery calcification (CAC). A total of 19 728 adults free of cardiovascular disease (CVD) who contemporaneously underwent cardiac tomography and bioelectrical impedance analysis were enrolled in a cross-sectional and longitudinal cohort. Skeletal muscle mass index (SMI) was calculated using the following formula: SMI (%) = total appendicular muscle mass (kg)/body weight (kg) × 100 according to sex. CAC presence or incidence was defined as CAC score > 0, and CAC progression was defined as √CAC score (follow-up) - √CAC score (baseline)>2.5. Pre-sarcopenia was defined as SMI ≤ -1.0 s.d. of the sex-specific mean of a young reference group. Abdominal obesity was defined as waist circumference ≥ 90 cm for men and ≥85 cm for women. All individuals were further classified into four groups: normal, abdominal obesity alone, pre-sarcopenia alone, and pre-sarcopenic obesity. Individuals with pre-sarcopenic obesity showed the highest adjusted odds ratio (AOR) for CAC presence (AOR 2.16, 95% CI : 1.98-2.36, P < 0.001) as well as total CAC incidence and progression (adjusted hazard ratio: 1.54, 95% CI: 1.37-1.75, P < 0.001), compared with normal individuals. Pre-sarcopenic obesity significantly increased CAC incidence and progression compared to either pre-sarcopenia or abdominal obesity alone. Pre-sarcopenia and abdominal obesity together were significantly associated with a higher CAC presence and increased risk of CAC incidence and progression, independent of traditional CVD risk factors.
Highlights
Reduced skeletal muscle mass and obesity worsens cardiometabolic risk factors
The pre-sarcopenic obesity group showed the highest adjusted hazard ratios (AHRs) for CAC presence (AHR 2.16, 95% confident interval [CI]: 1.98-2.36, P
Pre-sarcopenic obesity significantly increased the risk of CAC incidence and progression compared to either pre-sarcopenia or abdominal obesity alone
Summary
Reduced skeletal muscle mass and obesity worsens cardiometabolic risk factors. The combined effect of pre-sarcopenia and obesity on overt and subclinical cardiovascular disease (CVD) has yet to be explored. Reduced skeletal muscle mass and abdominal obesity have a reciprocal influence on each other: low physical activity is associated with sarcopenia, which leads to decreased energy expenditure and increased risk of obesity [3]. The loss of skeletal muscle mass and obesity concomitantly worsens cardiometabolic parameters such as hyperglycemia, hypertension, dyslipidemia, and insulin resistance, compared with sarcopenia or obesity alone [5, 6]. Not muscle mass but strength with obesity was associated with an increased CVD risk [7]. The effect of reduced skeletal muscle mass on CVD in relatively younger population has yet to be explored
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