Sarcopenia and cardiovascular diseases: A systematic review and meta-analysis

Association of adipose tissue infiltration with cardiac function: scoping review

Evidence suggests that adipose tissue (AT) infiltration in skeletal muscles may negatively influence cardiac function, yet its use as a biomarker remains unclear. This scoping review examined the relationship between AT infiltration and cardiac function in adults. A systematic search of PubMed, CINAHL and SCOPUS identified peer-reviewed studies reporting AT infiltration and cardiac function measures. Excluded were review-type studies, animal studies, abstracts and case series. Study quality was assessed using the Study Quality Assessment Tool (SQAT). Three good-quality studies were included. Findings demonstrated a negative association between AT infiltration and cardiac function parameters, including exercise capacity, left ventricular ejection fraction (LVEF) and heart failure events, in cancer survivors and healthy individuals. There is evidence supporting an association between increased AT infiltration of skeletal muscles and impaired cardiac function, highlighting the need for further research to validate AT infiltration as a potential biomarker. Despite the limited available studies, our findings highlight a distinct association between skeletal muscle AT infiltration and cardiac dysfunction, independent of general obesity.

Association of chair stand performance with all-cause and cardiovascular mortality in older adults with hypertension: A 28-country study

OBJECTIVE

To assess the prospective association of chair stand performance with all-cause and cardiovascular mortality in older adults with hypertension.

METHODS

From the Survey of Health, Ageing and Retirement in Europe (SHARE) study, we included 18,252 adults aged 50 years or more with hypertension from 28 countries (27 European countries and Israel). Chair stand performance was assessed by the time taken to complete five chair stands. We used time-varying Cox regression with restricted cubic splines to determine the prospective association of chair stand time with all-cause and cardiovascular mortality, controlling for various confounders.

KEY RESULTS

Over a mean follow-up of 3.5 years, 648 participants died, with 243 deaths attributed to cardiovascular disease. Using the median chair stand time (11 s) as a reference, both faster and slower times were associated with altered mortality risk in a curvilinear fashion. For all-cause mortality, the 10th percentile of chair stand time (7 s) showed a hazard ratio (HR) of 0.71 (95 % CI 0.60-0.85), while the 90th percentile (19 s) showed a HR of 1.20 (95 % CI 1.10-1.32). For cardiovascular mortality, the 10th percentile showed a subdistribution hazard ratio (SHR) of 0.72 (95 % CI 0.53-0.97), while the 90th percentile showed a SHR of 1.28 (95 % CI 1.10-1.48).

CONCLUSION

Chair stand performance is gradually and inversely associated with risk of all-cause and cardiovascular mortality in older adults with hypertension. These findings highlight the potential of the chair stand test as a prognostic measure.

Combined effect of skeletal muscle mass loss and elevated insulin resistance on heart failure risk in older adults: a community-based longitudinal cohort study

BACKGROUND

Skeletal muscle mass loss and insulin resistance (IR) are associated with cardiovascular diseases risk. However, it remains unclear whether the combination of skeletal muscle mass loss and elevated IR affects heart failure (HF) risk. Here, we investigate the association between a combination of appendicular skeletal muscle mass index (ASMI) with estimated glucose disposal rate (eGDR) and HF risk in older adults.

METHODS

A prospective analysis and a dual-trajectory analysis were carried out to investigate the association of the combined effect of ASMI and eGDR with HF risk. A total of 11,596 adults aged ≥ 60 years were enrolled from the community for prospective analysis. Among them, 10,489 were eligible for the dual-trajectory analysis. The temporal evolution of ASMI and eGDR was determined using a dual-trajectory model.

RESULTS

In the prospective analysis, 1087 individuals developed HF. Restricted cubic splines analysis showed L-shaped associations between ASMI and eGDR and HF risk. HF risk decreased by 32.3% (hazard ratio (HR): 0.677, 95% confidence interval (CI): 0.623-0.734, Padj < 0.001) for female and 9.0% (HR 0.910, 95% CI 0.831-0.996, Padj = 0.003) for male patients per one standard deviation (SD) AMSI increment and 29.4% (HR 0.706, 95% CI 0.647-0.770, Padj < 0.001) for female and 26.8% (HR 0.732, 95% CI 0.668-0.803, Padj < 0.001) for male patients per one SD eGDR increment. There was a synergistic effect on HF risk per one SD ASMI and eGDR increment (Padj < 0.001). Five distinct dual ASMI and eGDR trajectories were identified in the dual-trajectory analysis. A total of 859 (8.85 per 1000 person-years) individuals developed HF. Compared to group 4 with moderate-stable ASMI and eGDR and the lowest incident HF, the HR in group 5 characterized by low-stable ASMI and eGDR was 1.908 (95% CI 1.482-2.457, Padj < 0.001), followed by 1.716 (95% CI 1.296-2.273, Padj < 0.001) in group 3 with low-decrease ASMI and high-decrease eGDR.

CONCLUSIONS

Skeletal muscle mass loss and elevated IR act synergistically to increase the HF risk in older adults. Comprehensive management of muscle mass and IR might be a useful and effective strategy for preventing and controlling HF.

TRIAL REGISTRATION

Retrospectively registered number ChiCTREOC17013598.

Identifying semaphorin 3C as a biomarker for sarcopenia and coronary artery disease via bioinformatics and machine learning

OBJECTIVE

Sarcopenia not only affects patients' quality of life but also may exacerbate the pathological processes of coronary artery disease (CAD). This study aimed to identify potential biomarkers to improve the combined diagnosis and treatment of sarcopenia and CAD.

METHODS

Datasets for sarcopenia and CAD were sourced from the Gene Expression Omnibus (GEO). Weighted gene co-expression network analysis (WGCNA) was used to identify key module genes. Functional enrichment analysis was conducted to explore biological significance. Three machine learning algorithms were applied to further determine candidate hub genes, including SVM-RFE, LASSO regression, and random forest (RF). Then, we generated receiver operating characteristic (ROC) curves to evaluate the diagnostic efficacy of the candidate genes. Moreover, mendelian randomization (MR) analysis was conducted based on GWAS summary data, along with sensitivity analysis to explore causal relationships.

RESULTS

WGCNA analysis identified 278 genes associated with sarcopenia and CAD. The results of the enrichment analysis indicated a complex interplay between RNA metabolism, signaling pathways, and cellular stress responses. Through machine learning methods and ROC curves, we identified the key gene semaphorin 3C (SEMA3C). MR analysis revealed that higher plasma levels of SEMA3C are associated with an increased risk of CAD (OR = 1.068, 95 % CI 1.012-1.128, P = 0.016) and low hand grip strength (HGS) (OR = 1.059, 95 % CI 1.010-1.110, P = 0.018) .

CONCLUSION

SEMA3C has been identified as a key gene for sarcopenia and CAD. This insight suggests that targeting SEMA3C may offer new therapeutic opportunities in related conditions.

Impact of low muscle mass and bone mineral density on long-term outcomes of acute ischemic stroke: A prospective study

BACKGROUND

Premorbid sarcopenia, osteoporosis, and obesity are epiphenomena that affect survival and functional outcomes in patients with acute ischemic stroke. The effects of preexisting sarcopenia and/or osteopenia on long-term outcome after ischemic stroke were herein prospectively studied.

METHODS

Dual-energy x-ray absorptiometry (DeXA), bio-impedance analysis (BIA) and muscle ultrasonography (US) data were prospectively collected within the first 72 h in 297 consecutive acute ischemic stroke patients (45.5 % women, mean age: 67.8 years). Bone mineral density (BMD) and bone mineral content (BMC) were measured by DeXA for the lumbar spine, and hip (femoral neck and total). BIA was used to measure skeletal muscle mass indices (SMMI, normalized to height-squared, weight and body mass index - SMMI-height, SMMI-weight and SMMI-BMI, respectively) and phase angle. Vertical muscle thickness (MT, mm) for biceps brachii (BB), rectus femoris (RF), vastus lateralis (VL) and gastrocnemius medialis (GCM), cross-sectional area (CSA, cm2) for BB and RF, fascicle length (fL) and pennation angle (PeA) for VL and GCM were measured using muscle US. Multiple exploratory logistic regression models were constructed for detect predictors of mortality and unfavorable functional outcome (Modified Rankin score-mRS>1) at the end of the first year. The cut-off value determined by the Younden-J index, and the lower limit of the 95 % confidence interval of the area under the receiver operating characteristic (ROC) curve (AUC) were reported.

RESULTS

Independent predictors for one-year unfavorable prognosis were phase angle (cut-off ≤5°; lower limit of 95%CI of ROC-AUC: 0.704); muscle thickness (AUCs were 0.677 for RF (≤9.29), 0.660 for GCM (≤13.38), 0.655 for R + VIM (vastus intermedius) (≤15.31), 0.605 for BB + brachialis (≤23.98) and 0.592 for VL (≤10.64), 0.619 for VL transverse MT (≤19.95 mm), and cross sectional areas (0.656 for RF (≤4.27 cm2) and 0.609 for BB (≤8.88 cm2). Independent predictors for 1-year mortality were phase angle (95 % lower limit of AUC 0.746 for ≤3.7°), BB + brachialis MT (0.625 for ≤23.98 mm), and BB MT (0.613 for ≤19.27).

CONCLUSIONS

Phase angle and ultrasonographic muscle-size parameters (thickness and cross-sectional area) obtained at admission are significant and independent predictors of long-term functional prognosis and mortality in acute ischemic stroke. Ultrasound parameters of muscle architecture (pennation angle, fiber length), DeXA (BMC and BMD), and BIA-derived SMMI have low independent prediction capability of long-term prognosis.

Causal relationships of circulating amino acids with sarcopenia-related traits: A bidirectional Mendelian randomization study

BACKGROUND AND AIM

Recent studies have indicated a correlation between certain Amino acids (AAs) and sarcopenia. However, the exact causal relationship among these associations is still unclear. This study aims to elucidate the causal relationships between 20 types of AAs and the phenotypic characteristics associated with sarcopenia through Mendelian randomization (MR) analysis.

METHODS AND RESULTS

This MR study employed single nucleotide polymorphisms (SNPs) that were significantly associated with both AAs and the traits of sarcopenia as instrumental variables (IVs). The main method for estimating causal effects was the inverse-variance weighted (IVW) approach. To ensure the robustness of the findings, additional methods such as weighted median, weighted mode, and MR Egger regression were used. Sensitivity analyses included heterogeneity and pleiotropy tests. In this research, we discovered potential causal relationships between AAs and traits associated with sarcopenia. We not only found that AAs previously studied, such as Glutamine, Tyrosine, Glycine, and branched-chain amino acids, play positive roles in muscle metabolism. Additionally, our study identified the role of AAs previously neglected or not considered in earlier research, such as Alanine, Lysine, Cysteine, and Methionine, which exert potential effects on muscle metabolism and offer considerable research potential and value.

CONCLUSIONS

This MR study clarified the reciprocal effects between circulating levels of AAs and sarcopenia-related traits. These results indicate that AAs may be used as biomarkers for diagnosing sarcopenia or as intervention targets for its treatment in clinical practice.

Endoplasmic reticulum stress and unfolded protein response: Roles in skeletal muscle atrophy

Skeletal muscle atrophy is commonly present in various pathological states, posing a huge burden on society and patients. Increased protein hydrolysis, decreased protein synthesis, inflammatory response, oxidative stress, mitochondrial dysfunction, endoplasmic reticulum stress (ERS) and unfolded protein response (UPR) are all important molecular mechanisms involved in the occurrence and development of skeletal muscle atrophy. The potential mechanisms of ERS and UPR in skeletal muscle atrophy are extremely complex and have not yet been fully elucidated. This article elucidates the molecular mechanisms of ERS and UPR, and discusses their effects on different types of muscle atrophy (muscle atrophy caused by disuse, cachexia, chronic kidney disease (CKD), diabetes mellitus (DM), amyotrophic lateral sclerosis (ALS), spinal muscular atrophy (SMA), spinal and bulbar muscular atrophy (SBMA), aging, sarcopenia, obesity, and starvation), and explores the preventive and therapeutic strategies targeting ERS and UPR in skeletal muscle atrophy, including inhibitor therapy and drug therapy. This review aims to emphasize the importance of endoplasmic reticulum (ER) in maintaining skeletal muscle homeostasis, which helps us further understand the molecular mechanisms of skeletal muscle atrophy and provides new ideas and insights for the development of effective therapeutic drugs and preventive measures for skeletal muscle atrophy.

Reliability and Clinical Validity of the SARC-Global Questionnaire for Sarcopenia and Sarcopenic Obesity in Spanish Older Adults

BACKGROUND/OBJECTIVES

Sarcopenia and sarcopenic obesity (SO) are related to an increased risk of adverse outcomes. The objective of this study was to assess the internal and clinical validation of the Spanish version of the SARC-Global questionnaire, a sarcopenia risk screening tool, and its ability to detect sarcopenia, severe sarcopenia, and SO in adults aged ≥ 60 years.

METHODS

A total of 167 participants (73.22 ± 6.70 years, 71.26% women) completed the study. First, reliability was assessed by the inter-rater and the test-retest analyses. For the clinical validation, the risk of sarcopenia (SARC-Global) was compared to sarcopenia diagnosed using three operational definitions. The SARC-Global's ability to detect severe sarcopenia (SS) and sarcopenic obesity assessed with body mass index (SO-BMI) and body fat percentage (SO-BFP), considering nutritional status and physical activity level, was also analyzed.

RESULTS

The Spanish SARC-Global questionnaire showed a substantial to excellent inter-rater and test-retest reliability. Regarding the clinical validation, sensitivity/specificity values to detect cases of sarcopenia were 85.71%/64.38% (EWGSOP2), 83.33%/65.81% (FNIH), and 54.55%/63.46% (AWGS-2019). Diagnostic accuracy ranged from 67.07% (FNIH) to 62.87% (AWGS-2019). The analysis also indicated that SARC-Global cutoff of 13.5 was the optimal score for severe sarcopenia (100.00% sensitivity and 80.49% specificity), SO-BMI (100% sensitivity and 80.49% specificity), and SO-PBF (80.00% sensitivity and 80.86% specificity).

CONCLUSIONS

The Spanish version of the SARC-Global questionnaire is a reliable and clinically valid instrument for identifying people at the risk of sarcopenia, severe sarcopenia, and sarcopenic obesity in Spanish older adults.

More comprehensive relationship between eGDR and sarcopenia in China: a nationwide cohort study with national representation

INTRODUCTION

Although studies had shown that Insulin resistance (IR) was correlated with the occurrence of sarcopenia, there were still many controversial conclusions. Therefore, we conducted a more comprehensive study on the relationship between the estimated glucose disposal rate (eGDR), an alternative indicator of IR, and the risk of sarcopenia, muscle mass, and muscle strength to clarify their interactions.

METHODS

The Study included individuals from The China Health and Retirement Longitudinal Study (CHARLS) who had complete eGDR data at baseline and did not develop low muscle mass and low muscle strength. The individuals were divided into four subgroups based on the quartile (Q) of the eGDR. The lowest quartile (Q1) of the eGDR was used as a reference. Logistic regression and linear regression were used to evaluate the relationship between eGDR and sarcopenia (low muscle mass, low muscle strength, possible sarcopenia, and sarcopenia) and sarcopenia related features (ASM/Ht2, grip, and RMS), respectively. In addition, we further evaluated the nonlinear relationship using smooth curve fitting and threshold effect analysis.

RESULTS

The results showed that after adjusting for confounders, eGDR was negatively associated with the risk of sarcopenia and positively associated with sarcopenia related characteristics. In addition, men showed a more significant reduction in the likelihood of low muscle mass compared to women. But as eGDR levels rise, women gain more ASM/Ht2. Further nonlinear analysis revealed an inverse correlation between eGDR and ASM/Ht2 at the inflection point of 15.3893. Besides that, eGDR was positively correlated with grip (7.1862) and RMS (11.1042) before the inflection point.

CONCLUSIONS

The study found that higher levels of eGDR were associated with a lower risk of developing sarcopenia. However, the effects of eGDR on muscle mass and muscle strength need to be considered comprehensively. For muscle mass, it is recommended to maintain eGDR below 15.3893, and for muscle strength, it is recommended to maintain eGDR below 7.1862, with more potential benefits for early warning of sarcopenia.

Network Pharmacology Combined with Experimental Validation to Investigate the Effects and Mechanisms of Aucubin on Aging-Related Muscle Atrophy

Aucubin (AU) is one of the main components of the traditional Chinese medicine Eucommia ulmoides Oliv (EU). This study investigated the effects of AU on aging-related skeletal muscle atrophy in vitro and in vivo. The results of network pharmacology revealed the potential therapeutic effects of AU on muscle atrophy. In vitro, AU effectively attenuated D-gal-induced cellular damage, reduced the number of senescence-associated β-galactosidase (SA-β-Gal)-positive cells, down-regulated the expression levels of muscle atrophy-related proteins Atrogin-1 and MuRF1, and improved myotube differentiation, thereby mitigating myotube atrophy. Notably, AU was found to attenuate oxidative stress and apoptosis in skeletal muscle cells by reducing ROS production, regulating Cleaved caspase3 and BAX/Bcl-2 expression in apoptotic pathways, and enhancing Sirt1 and PGC-1α signaling pathways. In vivo studies demonstrated that AU treatment extended the average lifespan of Caenorhabditis elegans (C. elegans), increased locomotor activity, improved body wall muscle mitochondrial content, and alleviated oxidative damage in C. elegans. These findings suggested that AU can ameliorate aging-related muscle atrophy and show significant potential in preventing and treating muscle atrophy.

The influence of malnutrition-sarcopenia syndrome on chorioretinal microvasculature using optical coherence tomography angiography

PURPOSE

To probe into the effects of malnutrition-sarcopenia syndrome on the changes of retinal and choroidal microvasculature.

METHODS

To achieve our goals, we employed optical coherence tomography angiography (OCTA), a cutting-edge non-invasive imaging technique, to compare retinal and choroidal parameters in a controlled setting. A total of 22 participants diagnosed with Malnutrition-Sarcopenia Syndrome were enrolled alongside 22 healthy subjects matched for age and gender as controls. Parameters under scrutiny included inner retinal vessel flow density (VFD), total retinal thickness, and choroidal thickness, choroidal vascularity index (CVI). Linear regression analyses were performed to identify any significant variations of systemic profles associated with retinal and choroidal parameters.

RESULTS

Our data unveiled substantial discrepancies in the retinochoroidal microvascular health between the patient cohort and the control group. Specifically, the patients with malnutrition-sarcopenia syndrome showcased notably diminished values in inner retinal VFD, total retinal thickness, choroidal thickness and CVI, all with extreme statistical significance (p < 0.0001). Further, body mass index (BMI) exhibited a noteworthy positive association with retinal thickness (p = 0.026), whereas skeletal muscle index (SMI) showed a similar trend with choroidal thickness and CVI through both univariate and multiple linear regression analyses. Besides, pearson's correlation analysis also indicated that SMI was positively correlated with choroidal thickness and CVI in the sarcopenia patients.

CONCLUSIONS

The collective evidence suggests that malnutrition coupled with sarcopenia exerts deleterious effects on chorioretinal microvasculature, with potential repercussions on visual function. This research underscores the imperative of proactive monitoring and early intervention targeting chorioretinal microvasculature changes in patients battling malnutrition-sarcopenia syndrome.

Dysphagia development in heart failure patients: A scoping review

OBJECTIVE

Dysphagia significantly affects older adults, particularly those with heart failure (HF). This scoping review aimed to delineate the development of dysphagia and its contributing factors in patients with HF.

METHODS

We systematically searched MEDLINE, EMBASE, CINAHL, and CENTRAL databases up to September 2023, focusing on studies involving HF patients aged 60 and above, particularly those assessing post-hospitalization dysphagia.

RESULTS

Of 1,076 identified studies, nine were relevant. The prevalence of dysphagia at admission was 23.6 % (14.1 - 32.9), with 9.4 % (4.5 - 13.8) persisting until discharge. The evaluation of dysphagia primarily relies on oral intake assessments, highlighting several risk factors, including high inflammation, low energy intake, advanced age, low Barthel Index scores, poor oral health, antipsychotic usage, and low maximum tongue pressure. It is important to note potential author bias and overlap among study populations.

CONCLUSIONS

This review highlights the significant development of dysphagia in patients with HF, and the prevalence of newly developed dysphagia was 23.6 % (14.1 - 32.9). Key risk factors include older age, high inflammation, low activities of daily living, and sarcopenia, which is suggested as a pathogenic mechanism in dysphagia. Future research should focus on diverse samples, investigate the impact of sarcopenia and cachexia, and objectively assess swallowing function.

Effects of changes in body composition on cardiometabolic diseases by sex and presence of sarcopenia

BACKGROUND

Muscle mass loss and fat mass increase are risk factors for cardiometabolic disease. We evaluated the effect of changes in body composition on the incidence of cardiometabolic diseases in older adults with or without sarcopenia, over two-year follow-up.

MATERIALS AND METHODS

Changes in body composition and the development of cardiometabolic diseases over 2 years were measured in community-dwelling older adults recruited from the Korean Frailty Aging Cohort Study. Individuals with sarcopenia were 1:1 matched to those without sarcopenia via propensity score matching.

RESULTS

Among a total of 1634 eligible subjects, 353 were identified with sarcopenia. In men without sarcopenia, an increase in waist circumference by 1 cm was associated with a 32 % higher risk of the development of hypertension. Conversely, an increase in appendicular lean mass by 1 kg was associated with lower risks of the development of cardiovascular disease (41 % lower) and hyperlipidemia (28 % lower). However, there were no significant associations between changes in body composition and any incident cardiometabolic diseases in men with sarcopenia. Women without sarcopenia who experienced an increase in weight of 1 kg were 21 % less likely to develop hyperlipidemia. In women with sarcopenia, the risk of diabetes mellitus was reduced by 30 % with an incremental increase in weight by 1 kg, while the risk of hyperlipidemia increased almost threefold with an increase in appendicular lean mass by 1 kg.

CONCLUSIONS

In older adults without sarcopenia, a decrease in obesity-related indices and a gain in muscle gain are beneficial for men, but inverse relationships between weight and cardiometabolic diseases were reported in women. We found no cardiometabolic benefit of increasing lean mass in older adults with sarcopenia regardless of sex.

Multi-omic profiling of sarcopenia identifies disrupted branched-chain amino acid catabolism as a causal mechanism and therapeutic target

Sarcopenia is a geriatric disorder characterized by a gradual loss of muscle mass and function. Despite its prevalence, the underlying mechanisms remain unclear, and there are currently no approved treatments. In this study, we conducted a comprehensive analysis of the molecular and metabolic signatures of skeletal muscle in patients with impaired muscle strength and sarcopenia using multi-omics approaches. Across discovery and replication cohorts, we found that disrupted branched-chain amino acid (BCAA) catabolism is a prominent pathway in sarcopenia, which leads to BCAA accumulation and decreased muscle health. Machine learning analysis further supported the causal role of BCAA catabolic dysfunction in sarcopenia. Using mouse models, we validated that defective BCAA catabolism impairs muscle mass and strength through dysregulated mTOR signaling, and enhancing BCAA catabolism by BT2 protects against sarcopenia in aged mice and in mice lacking Ppm1k, a positive regulator of BCAA catabolism in skeletal muscle. This study highlights improving BCAA catabolism as a potential treatment of sarcopenia.

Association between sarcopenia and cardiovascular disease according to menopausal status: findings from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

Little is known about the association between sarcopenia and cardiovascular disease (CVD) according to menopausal status, and we conducted cross-sectional as well as longitudinal analyses Using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) to investigate the association between sarcopenia and CVD in Chinese women according to menopausal status.

METHOD

The study sample included 5365 (mean age 60.3 ± 9.3 years) female participants from CHARLS 2015 (wave 3). Additionally, 3,882 participants without cardiovascular disease (CVD) were recruited in CHARLS 2015 (Wave 3) and followed up in 2018 (Wave 4). CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. Menopausal status was determined based on self-reported information from questionnaires. Sarcopenia status was assessed using the diagnostic criteria established by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Binary logistic regression analyses were conducted to explore the association between sarcopenia and CVD in both premenopausal and postmenopausal women. Further analyses examined the interaction between sarcopenia and menopausal status to better understand its impact on CVD.

RESULTS

The prevalence of CVD in the total population is 22.5% (1209/5365). Among premenopausal women, the prevalence in no-sarcopenia, possible sarcopenia, and sarcopenia group are 11.3% (86/759), 16.2% (17/105), and 13.9% (5/36), respectively, for postmenopausal women, the prevalence are 19.2% (320/1668), 32.6% (520/1597), and 21.8% (261/1200). Both possible sarcopenia (OR = 1.58; 95% CI: 1.29-1.93) and sarcopenia (OR = 1.34; 95% CI: 1.05,1.72) are associated with CVD in the population of postmenopausal women. There was a significant positive interaction between menopause and sarcopenia on CVD, the RERI = 5.30 (95%CI: 4.63, 5.98), the SI = 2.44 (95%CI: 1.84, 3.63), and the multiplicative effect = 2.18 (95%CI: 1.70, 2.66). In the longitudinal analysis, 514 (13.2%) new cases of CVD were diagnosed. In premenopausal women, sarcopenia was significantly associated with the development of CVD (OR = 2.44, 95% CI: 1.3,4.59). In postmenopausal women, possible sarcopenia (OR = 1.45, 95% CI: 1.28, 1.65) and sarcopenia (OR = 1.42, 95% CI: 1.23, 1.65) were more likely to have new-onset CVD than the postmenopausal no-sarcopenia women.

CONCLUSIONS

Sarcopenia and cardiovascular disease (CVD) risk show significant variations in cross-sectional and longitudinal associations across different menopausal statuses, with higher risks in postmenopausal women. An interaction between menopausal status and sarcopenia on CVD risk was found.

The new definition of metabolic syndrome including hyperuricemia improves its prognostic value: results from NHANES database

BACKGROUND

Metabolic syndrome (MetS) is a significant global health issue that is strongly associated with an increased risk of cardiovascular disease (CVD). While MetS was initially proposed to identify more high-risk individuals and facilitate early management, hyperuricemia has not yet been included in its definition, despite its strong association with MetS. This study aims to explore the prognostic value of incorporating hyperuricemia into the definition of MetS.

METHODS

Data derived from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018 were analyzed. The old version of MetS (MetSold) aligned with NCEP-ATP III criteria, whereas the new version of MetS (MetSnew) included hyperuricemia as a sixth criterion. Baseline characteristics were compared between participants with and without MetS, and outcomes were assessed by multivariate analyses.

RESULTS

Among the 36,363 participants analyzed, 12,594 (34.6%) and 14,137 (38.9%) met MetSold and MetSnew criteriarespectively. Compared to MetSold, MetSnew identified additional 1534(4.24%) participants at metabolic risk. Both MetSold and MetSnew were significantly associated with long-term all-cause and CVD mortality (all P < 0.001). Furthermore, the additional participants identified by MetSnew exhibited a similar risk of all-cause and CVD mortality as those meeting MetSold criteria. MetSnew demonstrated enhanced identification and reclassification abilities compared to MetSold, as evidenced by improvement in C-index, NRI and IDI.

CONCLUSIONS

The inclusion of hyperuricemia in the MetS criteria could identify a larger proportion of individuals at metabolic risk, thereby facilitating early management to prevent long-term adverse events.

Insights into sarcopenia awareness among trainee physicians: a survey-based analysis of a university hospital, Thailand

Background

Sarcopenia is associated with a decline in functionality and disability among older adults. Extensive research has been conducted on the subject matter of sarcopenia; nevertheless, there is a paucity of studies documenting the extent to which practicing physicians are integrating sarcopenia into their clinical practice in the Asian context.

Objectives

To examine trainee physicians' attitude and knowledge in sarcopenia and factors associated with higher scores on knowledge in sarcopenia.

Methods

An electronic survey of trainee physicians of the Faculty of Medicine, Khon Kaen University, Thailand was conducted from November 2022 to December 2023. The survey consisted of questionnaires designed to assess both attitude and knowledge toward sarcopenia. All trainees were invited to participate, and the completed questionnaires were subsequently returned to the researchers for analysis.

Results

A total of 211 trainees enrolled; most of them were familiar with "sarcopenia" (70.1%) but lack of confidence in diagnosis, prevention, and management. The total scores on general knowledge about sarcopenia were 22 out of 30 (73.3%). They scored well in the area of "etiology" (75%) and "terminology and importance" (70%) but fair in "diagnosis" (62.5%) and "management and prevention" (62.5%). The lower age of the trainee physicians, increased years of practice, and "training in internal medicine" were associated with higher scores.

Conclusions

Trainee physicians were aware of the term "sarcopenia" but had limited knowledge in diagnosis, prevention, and management. Certain factors related to better scores on the knowledge evaluation were identified.

Association between appendicular skeletal muscle mass and myocardial glucose uptake measured by 18F-FDG PET

BACKGROUND

Low muscle mass is associated with high insulin resistance and an increased risk of cardiovascular disease. This study aims to determine whether low muscle mass affects the alterations in myocardial substrate metabolism that are associated with the development of cardiovascular disease.

METHOD

The study included 299 individuals (182 men and 117 women) who underwent examination at the Severance Health Check-up Center between January 2018 and February 2019. Myocardial glucose uptake was assessed using [18F]-fluorodeoxyglucose-positron emission tomography (18F-FDG PET/CT) scanning. Direct segmental bioimpedance analysis was used to measure appendicular skeletal muscle mass (ASM).

RESULTS

We analysed men and women separately owing to sex-related body composition differences. ASM/Ht2 was significantly positively correlated with myocardial glucose uptake measured by 18F-FDG PET/CT [ln (SUVheart/liver)] only in men (r = 0.154, P = 0.038 in men; r = -0.042, P = 0.652 in women, respectively). In men, myocardial glucose uptake was significantly associated with ASM/Ht2 even after adjusting for multiple confounders in a multivariable linear regression model (standardized β = 0.397, P = 0.004, in men; β = - 0.051, P = 0.698, in women). In women, age (β = -0.424 P = 0.029) was independent determinants of myocardial glucose uptake.

CONCLUSIONS

In men, ASM was strongly associated with myocardial glucose uptake as measured by 18F-FDG PET/CT. In women, age was significantly correlated with myocardial substrate utilization, but not with ASM.

Hypoalbuminaemia and heart failure: A practical review of current evidence

Hypoalbuminaemia (serum albumin levels ≤3.5 g/dl) is associated with poor outcomes among patients with heart failure (HF). This narrative review includes original articles and reviews published over the past 20 years and retrieved from PubMed using the following search terms (or their combination): 'heart failure', 'hypoalbuminaemia', 'heart failure with reduced ejection fraction', 'heart failure with preserved ejection fraction', 'all-cause mortality', 'in-hospital mortality', 'hospitalization', 'prognosis'. The aims of this review are to provide an overview on the prevalence of hypoalbuminaemia in HF, its impact on clinical outcomes, and potential mechanisms that may suggest future therapeutic strategies. Hypoalbuminaemia is frequent in HF patients, especially among the elderly. However, data about the exact epidemiology of hypoalbuminaemia are scant due to different definitions, and prevalence is estimated between 5% and 70% across the whole spectrum of ejection fraction. Current evidence points to hypoalbuminaemia as a marker of poor outcomes in HF, irrespective of the ejection fraction, and in other cardiovascular diseases. Among patients who suffered from acute coronary syndrome, those with hypoalbuminaemia had an increased risk of new-onset HF and in-hospital mortality. Albumin, however, might also play a role in the natural history of such diseases due to its antioxidant, anti-inflammatory, and antithrombotic properties. Whether albumin supplementation or nutritional support in general would be beneficial in improving clinical outcomes in HF is not completely clear and should be evaluated in adequately designed studies.

Association between sarcopenia and weight-adjusted waist index in male patients with type 2 diabetes

BACKGROUND

The Weight-adjusted-waist index (WWI) has emerged as a predictive factor for a range of metabolic disorders. To date, the predictive value of the WWI in relation to sarcopenia in individuals with diabetics has not been extensively explored. This study aims to investigate the impact of the WWI on the prevalence of sarcopenia among patients with type 2 diabetes mellitus (T2DM).

METHOD

In this study, we enrolled 417 patients with T2DM from the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University between Dec. 2023 and Apr. 2024. The relationship between the WWI and the prevalence of sarcopenia in T2DM patients was evaluated using multivariate logistic regression, subgroup analysis, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curve analysis.

RESULTS

Among the 417 patients with T2DM, 76 (18.22%) were identified as having sarcopenia. The prevalence of sarcopenia across the WWI quartile categories, from the first to the fourth quartile, was 8.65%, 8.57%, 20.19% and 8.65% respectively. Multivariate logistic regression analysis revealed that, after adjusting for covariates, a higher WWI was an independent risk factor for sarcopenia in male T2DM patients (OR = 1.836, 95% CI: 1.216-2.772, P = 0.004). This association was not observed in female patients. Subgroup analysis further revealed a stronger correlation between WWI and sarcopenia among male patients with higher HbA1c levels. In males, RCS regression demonstrated a non-linear positive correlation, with an inflection point at a WWI of 10.42 cm/√kg. Finally, the area under the ROC curve (AUC) for the WWI was 0.612.

CONCLUSIONS

WWI emerges as a robust and independent risk factor for sarcopenia in male patients with T2DM. WWI may serve as an accessible and cost-effective tool for identify sarcopenia in patients with diabetes.

The impact of reduced skeletal muscle mass at stroke onset on 3-month functional outcomes in acute ischemic stroke patients

INTRODUCTION

Sarcopenia, characterized by reduced skeletal muscle mass (RMM), is increasingly recognized as a significant factor influencing outcomes in various health conditions, including stroke. Although most studies focus on sarcopenia developing during stroke rehabilitation, the impact of sarcopenia present at the onset of acute ischemic stroke remains underexplored. This study aims to evaluate the effect of RMM at stroke onset on 3-month functional outcomes in acute ischemic stroke patients.

MATERIALS AND METHODS

We prospectively enrolled acute ischemic stroke patients admitted between May 2019 and December 2019. Muscle mass was accessed early during hospitalization using whole-body dual-energy X-ray absorptiometry (DXA), and patients were categorized into RMM and normal muscle mass (NMM) groups based on the Asian Working Group for Sarcopenia (AWGS) criteria. Functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS), with unfavorable outcomes defined as mRS scores 2-5. Multivariable logistic regression and SHAP (Shapley Additive exPlanations) analyses were used to evaluate the independent impact of RMM on 3-months functional outcomes.

RESULTS

A total of 99 patients were analyzed. The RMM group had a significantly higher prevalence of unfavorable outcomes at 3 months compared to the NMM group (p < 0.001). Patients with RMM were older and presented with more severe strokes. Multivariable analysis confirmed RMM as an independent predictor of unfavorable outcomes (adjusted OR: 8.07, 95% CI: 1.603-40.66, p = 0.011), even after adjusting for age and initial stroke severity. SHAP analysis ranked RMM as the second most influential predictor of unfavorable outcomes, following NIHSS on admission. These findings indicate that RMM not only worsens initial stroke severity but also independently hinders post-stroke recovery.

CONCLUSIONS

Reduced muscle mass at the onset of acute ischemic stroke is a significant, independent predictor of unfavorable outcomes at 3 months. In addition to its impact on recovery, RMM is linked to older age and more severe strokes, worsening prognosis. Maintaining muscle mass is also crucial for stroke prevention, as it supports cardiovascular health and resilience. Early identification and intervention for sarcopenia can improve recovery and reduce future stroke risk.

Sarcopenia and Cardiogeriatrics: The Links Between Skeletal Muscle Decline and Cardiovascular Aging

Sarcopenia, an age-related decline in skeletal muscle mass, strength, and function, is increasingly recognized as a significant condition in the aging population, particularly among those with cardiovascular diseases (CVD). This review provides a comprehensive synthesis of the interplay between sarcopenia and cardiogeriatrics, emphasizing shared mechanisms such as chronic low-grade inflammation (inflammaging), hormonal dysregulation, oxidative stress, and physical inactivity. Despite advancements in diagnostic frameworks, such as the EWGSOP2 and AWGS definitions, variability in criteria and assessment methods continues to challenge standardization. Key diagnostic tools include dual-energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA) for muscle mass, alongside functional measures such as grip strength and gait speed. The review highlights the bidirectional relationship between sarcopenia and cardiovascular conditions such as heart failure, aortic stenosis, and atherosclerotic cardiovascular disease, which exacerbate each other through complex pathophysiological mechanisms. Emerging therapeutic strategies targeting the mTOR pathway, NAD+ metabolism, and senescence-related processes offer promise in mitigating sarcopenia's progression. Additionally, integrated interventions combining resistance training, nutritional optimization, and novel anti-aging therapies hold significant potential for improving outcomes. This paper underscores critical gaps in the evidence, including the need for longitudinal studies to establish causality and the validation of advanced therapeutic approaches in clinical settings. Future research should leverage multi-omics technologies and machine learning to identify biomarkers and personalize interventions. Addressing these challenges is essential to reducing sarcopenia's burden and enhancing the quality of life for elderly individuals with comorbid cardiovascular conditions. This synthesis aims to guide future research and promote effective, individualized management strategies.

Association between body composition indices and vascular health: a systematic review and meta-analysis

OBJECTIVE

This systematic review explores the intricate relationship between body composition, with a specific focus on skeletal muscle mass, and vascular health indices, including measures of arterial stiffness-pulse wave velocity (PWV) and cardio-ankle vascular index (CAVI)-as well as arterial structure, specifically carotid artery intima-media thickness (cIMT).

METHODS

An extensive literature search, encompassing PubMed, Scopus, EMBASE, Web of Science, and Google Scholar, was conducted until January 2024. Inclusion criteria involved original observational studies, with cross-sectional or longitudinal designs, reporting body composition parameters and vascular health measures. The Newcastle-Ottawa Scale (NOS) assessed study quality. Statistical analyses utilized Stata 17.0, employing random-effects meta-analysis, sensitivity analysis, and evaluation of publication bias.

RESULTS

Fifteen observational studies (n = 21,215) met the inclusion criteria. Pooled analyses revealed a positive association between fat-free mass (FFM) and carotid intima-media thickness (IMT) (effect size [ES]: 1.79, 95% CI 1.68-1.91), highlighting a relationship with arterial structure. Similarly, body fat percentage (BFP) was positively associated with PWV (ES: 1.45, 95% CI 1.15-1.82), and FFM showed a positive association with CAVI (ES: 1.46, 95% CI 0.78-2.71), both measures of arterial stiffness. Subgroup analyses revealed a non-significant association between appendicular skeletal muscle (ASM) and IMT (ES: 1.01, 95% CI 0.76-1.35).

CONCLUSION

This meta-analysis highlights the complex relationship between body composition and vascular health. Subgroup analyses suggest the need for further research into specific body composition indices and their clinical implications.

LEVEL OF EVIDENCE

III evidence obtained from well-designed cohort and cross-sectional studies.

Changes in sarcopenia and incident cardiovascular disease in prospective cohorts

BACKGROUND

Previous studies have identified sarcopenia as a significant risk factor for cardiovascular disease (CVD). However, these studies primarily focused on sarcopenia status at baseline, without considering changes in sarcopenia status during follow-up. The aim of this study is to investigate the association between changes in sarcopenia status and the incidence of new-onset cardiovascular disease.

METHODS

This study utilized prospective cohort data from the China Health and Retirement Longitudinal Study (CHARLS). Sarcopenia status was assessed using the 2019 Asian Working Group for Sarcopenia (AWGS) algorithm and categorized as non-sarcopenia, possible sarcopenia, or sarcopenia. Changes in sarcopenia status were evaluated based on assessments at baseline and at the second follow-up survey 2 years later. CVD was identified through self-reported physician diagnoses of heart disease, including angina, myocardial infarction, congestive heart failure, and other heart problems, or stroke. Cox proportional hazards models were employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounding factors.

RESULTS

Based on the inclusion and exclusion criteria, a total of 7499 CHARLS participants were included in the analysis, with 50.8% being female and an average age of 58.5 years. Compared to participants with stable non-sarcopenia status, those who progressed from non-sarcopenia to possible sarcopenia or sarcopenia exhibited a significantly increased risk of new-onset CVD (HR 1.30, 95% CI 1.06-1.59). Conversely, participants who recovered from sarcopenia to non-sarcopenia or possible sarcopenia had a significantly reduced risk of new-onset CVD compared to those with stable sarcopenia status (HR 0.61, 95% CI 0.37-0.99). Among participants with baseline possible sarcopenia, those who recovered to non-sarcopenia had a significantly lower risk of new-onset CVD compared to those with stable possible sarcopenia status (HR 0.67, 95% CI 0.52-0.86).

CONCLUSIONS

Changes in sarcopenia status are associated with varying risks of new-onset CVD. Progression in sarcopenia status increases the risk, while recovery from sarcopenia reduces the risk of developing cardiovascular disease.

Expression and Clinical Implications of pro-BNP and Soluble ST2 in Chronic Heart Failure

Aims/Background Chronic heart failure (CHF) is a complex clinical syndrome resulting from various cardiac diseases, characterized by weakened cardiac pumping capacity and inadequate blood supply to body tissues. This study aims to investigate the expression and clinical implications of pro-B-type natriuretic peptide (pro-BNP) and soluble suppression of tumorigenicity 2 (sST2) in CHF to explore their potential in early diagnosis and severity assessment of the pathological condition. Methods This study included 146 CHF patients treated at our hospital from January 2022 to December 2023, who were classified in the observation group, and 150 concurrent healthy people categorized in the control group. pro-BNP and sST2 levels in the observation and control groups were compared. The diagnostic value of pro-BNP and sST2 in CHF was determined using receiver operating characteristic (ROC) curves. Besides, pro-BNP and sST2 levels in patients with different New York Heart Association (NYHA) grades were compared, and their relationships with left ventricular ejection fraction (LVEF), left atrial diameter (LAD), and left ventricular end-diastolic diameter (LVEDD) were assessed by means of Pearson's correlation. Results CHF cases showed markedly higher pro-BNP and sST2 levels than healthy controls (p < 0.05). The area under the ROC curves for pro-BNP and sST2 in diagnosing CHF was 0.826 (95% CI: 0.778-0.875) and 0.733 (95% CI: 0.674-0.791), respectively. pro-BNP and sST2 levels were similar in grades I and II patients (p > 0.05), but lower when compared with those in grades III and IV patients (p < 0.05). Grade III patients showed lower pro-BNP and sST2 expression than grade Ⅳ patients (p < 0.05). Additionally, pro-BNP and sST2 had an inverse connection with LVEF (r = -0.764 and r = -0.535, respectively) and a positive correlation with LAD (r = 0.752 and r = 0.535, respectively) and LVEDD (r = 0.721 and r = 0.544, respectively). Conclusion pro-BNP and sST2 exhibit good diagnostic value for CHF, owing to their close association with patients' cardiac function. These biomarkers can be used as effective indicators to evaluate the severity of heart failure.

Effects of Blood Flow Restriction Combined with Aerobic Stepping Exercise in Sarcopenia: A Study Protocol for a Randomized Clinical Trial

Background

Blood flow restriction training (BFRT) can produce effects similar to high-intensity exercise at lower intensities, making it a potentially more suitable method for older adults with sarcopenia. This study aims to determine the efficacy of the intervention on improving physical fitness in older adults with sarcopenia when blood flow restriction (BFR) and aerobic exercise (AE) are combined (BFR-AE) and to explore the related metabolic and signaling mechanisms.

Methods

This is a three-arm, parallel, randomized controlled trial. A total of 171 participants, aged 60 to 90 years, with sarcopenia will be randomly assigned (1:1:1) into one of three groups: a control group, an AE group, and a BFR-AE group. The participants in the control group will maintain their usual diet and activity habits. Those in the AE and BFR-AE groups will undergo a 12-week program of AE and BFR-AE respectively. The primary outcomes will include two long-term indicators: the 6-minutes walking test and 30-s chair stand test. Secondary outcomes will include additional long-term measures (eg, appendicular skeletal muscle mass index, handgrip strength, five-time chair stand test, lower extremity knee extensor and flexor muscle strength, sleep quality, emotion status, serum metabonomic and signal proteins), as well as instantaneous indicators (eg, blood pressure, heart rate, saturation of pulse oxygen, rating of perceived exertion, pain score and blood lactate concentration), adherence to exercise, and adverse events. Outcomes will be assessed at one of or all the time points of baseline, 12 and 24 weeks.

Discussion

It is expected that, after 12 weeks of intervention, both exercise groups will show improvements in cardiorespiratory and muscular fitness, with the BFR-AE group demonstrating greater benefits than the AE group alone.

Sarcopenic obesity is significantly associated with poorer overall survival after liver transplantation: a systematic review and meta-analysis

Background

Sarcopenia has been shown to worsen survival after liver transplantation. However, it remains unclear whether coexisting sarcopenia and obesity, so-called sarcopenic obesity (SO), may also synergistically increase their adverse effects. This meta-analysis aimed to evaluate whether pre-transplant SO independently predicts survival in this population.

Methods

We conducted this study according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. The PubMed, Embase, Web of Science, Wanfang, CNKI, and Cochrane databases were searched up to 15 October 2023, for studies with any study design evaluating the relationship between SO and post-transplant survival in patients undergoing liver transplantation. We used ROBINS-E to assess the study quality. The primary outcome was all-cause mortality at any length of follow-up. We calculated pooled odds risks (ORs) or hazard risks (HRs) with 95% confidence intervals (CIs). Heterogeneity was quantified with I 2 statistics. Subgroup analyses and publication bias evaluations were also conducted.

Results

We included nine cohort studies with 2,416 patients. These studies were moderate to high quality. Pre-liver transplant patients commonly experience SO, with a mean prevalence as high as 34%. Overall, patients with SO exhibited a significantly higher overall mortality than patients without SO, as demonstrated by pooled studies using both univariate analysis [HR = 1.76, 95%C 1.33-2.33, p < 0.0001] and multivariate analysis (HR = 2.33, 95%CI 1.34-4.04, p = 0.003). Similar results were also found when comparing patients with or without SO at 1, 3, and 5 years of follow-up (OR = 1.86, 95%CI 1.22-2.83; OR = 1.83, 95%CI: 1.27-2.64; and OR = 1.54, 95% CI 1.02-2.34, respectively). In addition, subgroup analysis based on studies that reported HRs of both sarcopenia and SO indicated both had independent negative effects on post-transplant survival.

Conclusion

Our meta-analysis showed that SO occurs frequently in liver transplant patients. SO is associated with an increased risk of mortality in such patient populations.

Systematic review registration

https://doi.org/10.37766/inplasy2024.2.0069 [inplasy2024.2.0069].

Prognostic Impact of Sarcopenia Assessed Using Modified Asian Working Group for Sarcopenia 2019 Criteria in Heart Failure

BACKGROUND

Sarcopenia is a substantial therapeutic target, yet the validity of risk stratification values per the latest Asian Working Group for Sarcopenia in 2019 (AWGS 2019) remains unconfirmed in patients with heart failure. We hypothesized that using the 6-minute walk test (6MWT) to assess physical performance improves risk stratification.

METHODS

The study included 832 hospitalized patients with heart failure who could walk at discharge. Sarcopenia was diagnosed using both the original AWGS 2019 criteria (AWGS 2019 model) and an alternative method in which physical performance components were replaced with the 6MWT (modified model). An < 300 m 6MWT indicated low physical performance in the modified model. The primary outcome was 2-year mortality.

RESULTS

Sarcopenia and severe sarcopenia were identified in 45 and 150 patients with the AWGS 2019 model and in 75 and 108 patients with the modified model, respectively. Over the 2-year follow-up period, 145 (17.4%) deaths occurred. Adjusted Cox proportional hazard analysis showed both sarcopenia and severe sarcopenia were significantly associated with 2-year mortality in the modified model. In the AWGS 2019 model, only severe sarcopenia was significantly related to 2-year mortality. The modified model demonstrated significant net reclassification improvement (NRI) over the AWGS 2019 model (NRI, 0.396; 95% CI, 0.214-0.578; P < 0.001).

CONCLUSIONS

In patients with heart failure who were ambulatory at discharge, sarcopenia assessment with the modified AWGS 2019 model using the 6MWT as a physical performance component improved risk stratification compared with the original AWGS 2019 model. Reconsidering the current criteria to improve risk stratification is necessary to ensure timely, appropriate treatment.

CLINICAL TRIAL REGISTRATION

UMIN000023929.

Association between cardiovascular disease risk and sarcopenia in community-dwelling Japanese older adults

AIM

Sarcopenia's high prevalence in older adults with cardiovascular disease (CVD) suggests that the risk of comorbidity in sarcopenia might also be increased during the at-risk phase of CVD. However, the relationship between CVD risk and sarcopenia has not been elucidated. Therefore, the purpose of this cross-sectional study was to investigate the association between CVD risk and sarcopenia in community-dwelling Japanese older adults.

METHODS

The participants in this cross-sectional study included 14 923 community-dwelling Japanese older adults (mean age 73.2 ± 5.6 years). The present study estimated the CVD risk using the revised World Health Organization risk chart, and classified CVD risk into "low" (<10%) and "mid-high" (≥10%). Assessments of sarcopenia, muscle mass, muscle strength and gait speed were measured based on the clinical definitions.

RESULTS

Among the participants, 654 people (4.4%) had sarcopenia, and 4857 (32.6%) had CVD mid-high risk. A multiple logistic model showed that the CVD mid-high risk was associated with sarcopenia (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.28-1.89). In addition, CVD mid-high risk was associated with low muscle mass (OR 1.74, 95% CI 1.50-2.01), low muscle strength (OR 1.25, 95% CI 1.14-1.37) and slow gait speed (OR 1.17, 95% CI 1.07-1.27) in the adjusted model.

CONCLUSIONS

Among community-dwelling older adults, high or moderate CVD risk was associated with an increased risk of sarcopenia. Our findings could help identify older adults with a future high risk for sarcopenia. Geriatr Gerontol Int 2024; 24: 1328-1334.

Usefulness of the SARC-F questionnaire and the measurement of the hand grip strength in predicting short-term mortality in older patients hospitalized for acute heart failure

PURPOSE

Sarcopenia is a potentially reversible syndrome that increases the risk of cardiogenic cachexia and adverse outcomes in older patients with heart failure (HF). Despite its clinical significance, sarcopenia remains underdiagnosed due to the complexities of comprehensive assessment in patients with acute HF. This study aimed to evaluate whether the SARC-F questionnaire, its inviduals components, and the handgrip strength test (HGS) can predict short-term prognostic risk in very old patients recently discharged after acute HF.

METHODS

We consecutively enrolled patients aged 75 years or older hospitalized with acute HF in the Geriatrics Unit of a tertiary care hospital. All patients underwent physical examination, complete blood tests, point-of-care ultrasound, and a comprehensive geriatric assessment, including physical performance through SARC-F and HGS. The thirty-day post-discharge mortality rate was assessed by phone interview.

RESULTS

Out of 184 patients hospitalized with acute HF who were enrolled in the study (mean [SD], 86.8 [5.9] years, 60.3% female), 47 died within 30 days after discharge. By multivariate logistic analysis, HGS (β = - 0.73 ± 0.03, p = 0.008) and SARC-F [adjusted OR = 1.18 (CI 95% 1.03-1.33), p = 0.003] resulted independently associated with mortality. Furthermore, two SARC-F sub-items, namely, limitation in rising from a chair and history of falls [aOR: 3.26 (CI95% 1.27-8.34), p = 0.008; aOR: 3.30 (CI 95% 1.28-8.49), p = 0.01; respectively] emerged as determinants of 30-days mortality.

CONCLUSION

SARC-F and HGS test independently predict 30-day post-discharge mortality in oldest-old patients hospitalized for acute HF.

Sarcopenia and frailty among older Chinese adults: Findings from the CHARLS study

BACKGROUND

Sarcopenia and frailty are common among elderly individuals and present substantial health hazards. Exploring their relationship is essential for optimizing geriatric healthcare, particularly within the context of China.

METHODS

A population-based cross-sectional design was employed using data from the China Health and Retirement Longitudinal Study (CHARLS). The study enrolled 5,714 participants aged ≥60 years who underwent assessment for sarcopenia following the criteria established by the Asia Working Group for Sarcopenia (AWGS 2019) in 2019. Frailty status was determined using a frailty index that categorized participants into robustness, pre-frailty, and frailty stages. Multivariable logistic regression models were employed to examine the relationship between sarcopenia and frailty and pre-frailty conditions. Subgroup and interaction analyses were performed to explore the robustness of the associations between sarcopenia and frailty across different subgroups.

RESULTS

Among the participants, 1,028 (18.0%) were identified as frailty, 2,987 (52.3%) as pre-frailty, and 645 (11.3%) had sarcopenia. Sarcopenia demonstrated an independent association with higher risks of frailty (OR = 2.13, 95% CI: 1.52-2.99) and pre-frailty (OR = 1.42, 95% CI: 1.20-1.81) in the multivariable logistic analysis. Subgroup and interaction analyses consistently demonstrated significant associations across nearly all demographic and health-related subgroups.

CONCLUSIONS

This study highlights that sarcopenia is significantly and independently associated with frailty and pre-frailty among older adults in China. Early detection and targeted interventions for sarcopenia are crucial to mitigate frailty and its adverse health outcomes in aging populations, emphasizing the need for tailored healthcare strategies to promote healthy aging.

Sarcopenia in the era of precision health: Toward personalized interventions for healthy longevity

Sarcopenia, characterized by the progressive loss of skeletal muscle mass and function, significantly impacts health outcomes in older adults. This review explores the evolving landscape of sarcopenia research, with a particular focus on its unique characteristics in Asian populations and emerging pharmaceutical interventions. Recent studies have revealed distinct patterns of muscle mass decline in Asian adults, particularly in women, challenging the universal application of global sarcopenia diagnostic criteria. The Asian Working Group for Sarcopenia has proposed region-specific diagnostic criteria, acknowledging these ethnic variations. Prevalence estimates of sarcopenia vary widely, ranging from 10% to 40% in community-dwelling older adults. For specific chronic conditions, the prevalence of sarcopenia is notably higher, reaching 35% for cardiovascular diseases and 24.5% for chronic kidney disease. Sarcopenia is strongly associated with various chronic conditions, increasing the risk of falls by 1.5 to 3 times and significantly increasing mortality risk by 29% to 51%. Current management strategies primarily involve resistance exercise and nutritional interventions, with a recommended daily protein intake of at least 1.2 g/kg to maintain muscle health. Pharmaceutical development has gained significant momentum, with over 20 compounds in various stages of clinical trials. These include myostatin inhibitors, selective androgen receptor modulators, ghrelin receptor agonists, mesenchymal stem cell therapy, and follistatin gene therapy. However, the unique dietary patterns, cultural contexts, and potentially distinct drug responses in Asian populations necessitate tailored interventions and Asia-specific clinical trials. Future directions include refining Asian-specific diagnostic criteria, conducting large-scale epidemiological studies across multiple Asian countries, developing culturally appropriate interventions, integrating sarcopenia management into chronic disease care, and advancing pharmaceutical research with a focus on Asian populations. In conclusion, sarcopenia emerges as a critical nexus in the aging process, intricately linked with multiple organ systems and chronic conditions, underscoring the imperative for its recognition as a cornerstone in person-centered care and the holistic management of age-related health challenges.

Exploring the Relationship Between Gut Microbiota and Sarcopenia Based on Gut-Muscle Axis

Sarcopenia, as a disease characterized by progressive decline of quality, strength, and function of muscles, has posed an increasingly significant threat to the health of middle-aged and elderly individuals in recent years. With the continuous deepening of studies, the concept of gut-muscle axis has attracted widespread attention worldwide, and the occurrence and development of sarcopenia are believed to be closely related to the composition and functional alterations of gut microbiota. In this review, combined with existing literatures and clinical reports, we have summarized the role and impacts of gut microbiota on the muscle, the relevance between gut microbiota and sarcopenia, potential mechanisms of gut microbiota in the modulation of sarcopenia, potential methods to alleviate sarcopenia by modulating gut microbiota, and relevant advances and perspectives, thus contributing to adding more novel knowledge to this research direction and providing certain reference for future related studies.

Impact of Psoas Muscle Area Index on Short- and Mid-Term Mortality in Patients Undergoing Valve Surgery for Infective Endocarditis: A Retrospective Analysis

Background: Sarcopenia, characterized by the loss of skeletal muscle mass, is an emerging comorbidity associated with poor outcomes in cardiovascular surgery. Its impact on mortality in patients undergoing valve surgery for infective endocarditis (IE) remains underexplored. This study investigates the relationship between sarcopenia, measured by the Psoas muscle area index (PMAi), and mortality in patients with IE undergoing valve surgery. Materials and Methods: We retrospectively analyzed 68 patients with IE who underwent valve surgery at a tertiary care center from 2013 to 2021. Sarcopenia was defined as being in the lowest quartile of PMAi, measured via preoperative computed tomography (CT). Baseline characteristics, survival outcomes, and factors influencing mortality were analyzed using Kaplan-Meier survival curves and Cox proportional hazards regression. The predictive value of PMAi for 1-year and 3-year mortality was assessed via receiver operating characteristic (ROC) curves. Results: Sarcopenia was strongly associated with increased mortality at both 1-year (HR: 0.378, p = 0.010) and 3-year follow-ups (HR: 0.457, p = 0.012). Female sex (OR: 275.748, p < 0.001) and older age (OR: 9.995, p = 0.003) were significant predictors of sarcopenia. Chronic kidney insufficiency (CKI) and the use of heart failure medication therapy also significantly impacted survival outcomes. Conclusions: Sarcopenia is a strong independent predictor of short- and mid-term mortality in patients undergoing valve surgery for IE. Routine radiological assessment of sarcopenia using PMAi could improve risk stratification and guide preoperative interventions. Tailored management strategies, especially in older women and patients with CKI, may enhance outcomes in this high-risk population.

Reliability and Validity of the Rate of Force Development for Quadriceps in Older Patients with Cardiovascular Disease

Background/Objectives: The rate of force development (RFD), which is the change in force over a period of time during muscle contraction, quantifies rapid muscle contractions. RFD may serve as a measure of physical rehabilitation in patients with cardiovascular disease (CVD); however, its reliability and validity in older patients remain unclear. This study examined the reliability and validity of quadricep RFD in older patients with CVD. Methods: This prospective study enrolled 30 outpatients undergoing cardiac rehabilitation (median age, 77 years) and 30 inpatients hospitalized for CVD (median age, 76 years). The quadricep RFD values at three time points (RFD50, 0-50 ms; RFD100, 0-100 ms; and RFD200, 0-200 ms) were calculated from the slope of the force-time curve. Physical performance was assessed using the Short Physical Performance Battery (SPPB). Intra- and inter-rater correlation coefficients were assessed for outpatients. The correlation coefficients between RFD values and physical performance indicators were assessed separately for outpatients and inpatients. Results: The intraclass correlation coefficients (1,1) and (2,1) for RFD50, RFD100, and RFD200 were 0.742, 0.893, and 0.873 and 0.810, 0.918, and 0.930, respectively. The correlation coefficients for SPPB with RFD50, RFD100, and RFD200 were 0.553, 0.547, and 0.597 (all p < 0.05), respectively, for inpatients; similar moderate correlations were observed for gait speed and the chair stand test. Conclusions: The test-retest reliability of the RFD was excellent in older patients with CVD. The RFD was positively correlated with physical function indicators, suggesting its validity as a measure of physical rehabilitation.

Effect of low muscle mass on total mortality related to metabolic disease in chronic kidney disease patients

Low muscle mass is a risk factor for mortality in patients with chronic kidney disease (CKD). However, it is not clear to what extent low muscle mass contributes to this risk, either independently or in combination with metabolic abnormalities and frailty. This study used data from the National Health and Nutrition Examination Survey 1999-2006 and 2011-2018. Low muscle mass was defined as Appendicular Skeletal Mass Index < 7 kg/m2 in men or < 5.5 kg/m2 in women. The follow-up duration was from the first anthropometric and clinical measurements to death or the last follow-up. This study enrolled 2072 patients with CKD. Low muscle mass was associated with a lower risk of metabolic abnormalities, but was associated with an elevated mortality risk. Conversely, central obesity was associated with a higher likelihood of metabolic abnormalities and frailty, yet showed no significant association with mortality risk. Subsequently conducted mediation analysis indicated that the effect of low muscle mass on mortality was direct, not mediated by frailty and metabolic abnormalities. In spite of the inverse relationship between low muscle mass and metabolic abnormalities, low muscle mass are directly associated with an increased risk of all-cause mortality. Low muscle mass may directly contribute to mortality in patients with CKD, independent of metabolic abnormalities and frailty in these patients.

Association of estimated cardiorespiratory fitness in middle-aged and elderly people with cardiovascular disease: Evidence from the China health and retirement longitudinal study

BACKGROUND AND AIM

Cardiovascular diseases (CVD) is a major threat to public health, while cardiorespiratory fitness (CRF) is a key predictor of chronic disease. Given this, the purpose of this study was to investigate the relationship between estimated CRF (eCRF) and CVD in middle-aged and elderly Chinese people.

METHODS AND RESULTS

The China Health and Retirement Longitudinal Study (CHARLS) with 4761 individuals were included in analysis. Participants were divided into three groups according to eCRF quantile in sex subgroups. Cox proportional hazards regression models were used to explore the correlation of eCRF with CVD (stroke or cardiac events). In total, 4761 participants were included in this cohort study (2500 [52.51%] women). During a 7-year follow-up from 2011 to 2018, 796 CVDs (268 Strokes and 588 cardiac events) were recorded. In multivariable-adjusted analyses, for per 1 SD increase of eCRF, the age-adjusted risk of CVD was reduced by about 18% (HR = 0.82; 95% CI, 0.72-0.93) in men, and was reduced by about 29% (HR = 0.71; 95% CI, 0.62-0.81) in women. Similar associations were also found between eCRF and stroke and cardiac events. Both subgroup and interaction analyses showed that the interaction of age had a statistically significant effect on CVD risk.

CONCLUSION

ECRF was inversely associated with CVD risk (stroke or cardiac events) in both men and women. Remarkable sex and age differences exist in the effectiveness of increasing eCRF to reduce the risk of CVD. As a potential, efficient and cost-effective risk prediction tool, eCRF deserves further attention and wide application.

Sarcopenia

Sarcopenia is the accelerated loss of skeletal muscle mass and function commonly, but not exclusively, associated with advancing age. It is observed across many species including humans in whom it can lead to decline in physical function and mobility as well as to increased risk of adverse outcomes including falls, fractures and premature mortality. Although prevalence estimates vary because sarcopenia has been defined in different ways, even using a conservative approach, the prevalence is between 5% and 10% in the general population. A life course framework has been proposed for understanding not only the occurrence of sarcopenia in later life but also influences operating at earlier life stages with potentially important implications for preventive strategies. Harnessing progress in understanding the hallmarks of ageing has been key to understanding sarcopenia pathophysiology. Considerable convergence in approaches to diagnosis of sarcopenia has occurred over the last 10 years, with a growing emphasis on the central importance of muscle strength. Resistance exercise is currently the mainstay of treatment; however, it is not suitable for all. Hence, adjunctive and alternative treatments to improve quality of life are needed. An internationally agreed approach to definition and diagnosis will enable a step change in the field and is likely to be available in the near future through the Global Leadership Initiative in Sarcopenia.

Comparison of the correlation of creatinine- and cystatin C-Based estimated GFR and their differences with new-onset heart failure in a community-based population with type 2 diabetes

AIMS

This study aimed to investigate the impact of different estimated glomerular filtration rate (eGFR) values like cystatin C-based eGFR (eGFRcys), creatinine-based eGFR (eGFRcr), and their difference (eGFRdiff; eGFRcys -eGFRcr), on the incidence of heart failure (HF) in patients with type 2 diabetes(T2D).

METHODS

Being a prospective cohort study, it included 7,967 patients with T2D who underwent serum creatinine and cystatin C tests as part of the Kailuan Group's 6th annual health examination (2016). Subsequently, eGFRcys, eGFRcr, and eGFRdiff were calculated. Patients were categorized into three groups: negative (<-15 mL/min/1.73 m2), midrange (-15 to 15 mL/min/1.73 m2), and positive (> 15 mL/min/1.73 m2) eGFRdiff groups, respectively. Furthermore, the relationship between the various eGFR measurements and new-onset HF were studied using Cox proportional hazards regression, and the potential improvement in predictive capability was evaluated by adding these eGFR metrics to established HF risk models.

RESULTS

Among 7967 participants with mean age of 60.51 years, there were 20.92% women and 79.08% men. At baseline, eGFRcys and eGFRcr values differed by more than 15 mL/min/1.73m2 in 41.3% of participants. During a median follow-up period of 3.76 years, there were 172 (2.16%) new HF cases and 517 (6.49%) all-cause deaths. The cumulative incidence of HF in the midrange, negative, and positive eGFRdiff groups was 1.74%, 4.10%, and 0.61%, respectively (p < 0.001). In multivariable adjusted models, participants in the negative eGFRdiff group had higher risk of HF compared with the midrange eGFRdiff group (HR, 2.15; 95% CI, 1.57-2.94). Conversely, participants in the positive eGFRdiff group had lower risk for HF (HR, 0.40; 95% CI, 0.17-0.93). And each 15 mL/min/ 1.73 m2 higher eGFRdiff was associated with 34% (HR, 0.66; 95% CI, 0.58 - 0.47)lower risk of incident HF. The predictive capacity for HF risk in diabetic individuals was enhanced by adding eGFRcys or eGFRdiff to established HF risk models, with eGFRcys showing more significant additional predictive value.

CONCLUSION

These findings suggest that large differences between eGFRcys and eGFRcr were common in community-based population with T2D. Different eGFR metrics can independently predict HF incidence in patients with T2D. Additionally, metrics like eGFRcys and eGFRdiff provide significant predictive value for HF risks beyond traditional risk factors, with eGFRcys showing more pronounced benefits in such cases.

Nurses' Perspectives and Understanding of Sarcopenia in a Tertiary Care Hospital

Background

Sarcopenia is prevalent in older adults. It is essential for nurses to sustain updated information regarding the knowledge of sarcopenia, particularly in relation to approaches to diagnosing and addressing sarcopenia. However, there are limited studies examining the attitudes and awareness of nurses in relation to this condition.

Objective

To assess the attitude and knowledge of nurses regarding sarcopenia and correlation between positive attitude and scores on knowledge.

Materials and Methods

An electronic survey was carried out among the nurses of the Faculty of Medicine, Khon Kaen University, Thailand, during November 2022 and January 2024. This survey encompassed questionnaires aimed at evaluating the nurses' perspectives and understanding of sarcopenia. The participants were invited to complete the survey, and they were returned to the researchers for analysis.

Results

A total of 231 nurses were recruited (response rate 46.2%). Only 58.4% of them were familiar with "sarcopenia," while only 16% had confidence in diagnosing it. For general knowledge, they achieved a total score of 19/30 (63.3%). They demonstrated proficiency in "etiology" (75%), while their performance was fair in "management and prevention" (62.5%) and low in "terminology & importance" (50%) and "diagnosis" (50%). The correlation between positive attitude and knowledge on sarcopenia was 0.22 (p < 0.05).

Conclusion

Nurses exhibited a reduced awareness regarding "sarcopenia." Their comprehension about terminology, diagnosis, prevention, and management of this condition was limited. There was a weak correlation between positive attitude and knowledge. The findings emphasize the essentiality of augmenting the educational programs to enhance the recognition of sarcopenia among nurses.

Screening for sarcopenia with SARC-F in older patients hospitalized with cardiovascular disease

AIMS

SARC-F ≥ 4 points are used for detecting sarcopenia; however, finding a lower SARC-F cut-off value may lead to early detection of sarcopenia. We investigated the SARC-F score with the highest sensitivity and specificity values to identify sarcopenia in older patients with cardiovascular disease (CVD). Motor performances were also examined for each SARC-F score.

METHODS AND RESULTS

This retrospective cross-sectional study examined the sensitivity and specificity of every 1-point increase in the SARC-F score to predict sarcopenia. Eligible participants included patients with CVD (≥65 years old) who were admitted for acute CVD treatment and participated in cardiac rehabilitation. Patients completed the SARC-F questionnaire and the sarcopenia assessment. Area under the curves (AUCs) were investigated for the ability to predict sarcopenia. Multivariable linear regression was used to compare the mean value of physical functions (e.g. walking speed, leg strength, and 6 min walking distance) of each SARC-F score. A total of 1066 participants (63.8% male; median age: 76 years) were included. Sarcopenia was present in 401 patients. A SARC-F cut-off ≥2 presented the optimal balance between sensitivity (68.3%) and specificity (55.6%) to detect sarcopenia (AUCs = 0.658; 95% confidence interval: 0.625-0.691). When the patients had low scores (1-3), every 1 point increase in the SARC-F score was associated with lower physical functions such as lower muscle strength and shorter walking distance (all P < 0.001).

CONCLUSION

A SARC-F cut-off ≥2 was optimal for screening sarcopenia, and even a low SARC-F score is useful in detecting sarcopenia and low physical function at an early stage in patients with CVD.

Relationship Between Sarcopenia and Intensive Blood Pressure Control Efficacy and Safety: A Secondary Analysis of SPRINT

BACKGROUND

Sarcopenia and hypertension are independently associated with worse cardiovascular disease (CVD) risk and survival. While individuals with sarcopenia may benefit from intensive blood pressure (BP) control, the increased vulnerability of this population raises concerns for potential harm. This study aimed to evaluate clinical and safety outcomes with intensive (target <120 mm Hg) versus standard (<140 mm Hg) systolic BP targets in older hypertensive adults with sarcopenia compared with nonsarcopenic counterparts in the SPRINT (Systolic Blood Pressure Intervention Trial).

METHODS

Sarcopenia was defined using surrogates of the lowest sex-stratified median of the sarcopenia index (serum creatinine/cystatin C×100) for muscle wasting and gait speed ≤0.8 m/s for muscle weakness. Outcomes included CVD events, all-cause mortality, and serious adverse events.

RESULTS

Of 2571 SPRINT participants with sarcopenia index and gait speed data available (aged ≥75 years), 502 (19.5%) met the criteria for sarcopenia, which was associated with higher risks of CVD events (adjusted hazard ratio, 1.49 [95% CI, 1.15-1.94]; P=0.003) and all-cause mortality (adjusted hazard ratio, 1.46 [95% CI, 1.09-1.94]; P=0.010). In participants with sarcopenia, intensive (versus standard) BP control nearly halved the risk of CVD events (adjusted hazard ratio, 0.57 [95% CI, 0.36-0.88]; P=0.012) without increasing serious adverse events. Similar risk reduction was seen for all-cause mortality in participants with sarcopenia (adjusted hazard ratio, 0.66 [95% CI, 0.41-1.08]; P=0.102), but the effect was only significant in those without chronic kidney disease.

CONCLUSIONS

Older hypertensive adults with sarcopenia randomized to intensive BP control experienced a lower risk of CVD without increased adverse events compared with standard BP control.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.

Association Between Handgrip Strength and Mortality of Patients With Coronary Artery Disease: A Meta-Analysis

BACKGROUND

Muscular strength has been linked to increased risk of cardiovascular disease in the community population. The aim of this systematic review and meta-analysis is to evaluate the association between weak handgrip strength (HGS) and mortality risk in patients with coronary artery disease (CAD).

METHODS

To carry out the meta-analysis, an extensive search was conducted on databases such as PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI to identify observational studies with longitudinal follow-up. Random-effects models were used to combine the findings, taking into account the potential influence of heterogeneity.

RESULTS

Eight observational studies involving 10 543 patients with CAD were included. During a mean follow-up duration of 20.4 months, 1327 (12.6%) patients died. Pooled results showed that weak HGS at baseline was associated with an increased risk of all-cause mortality during follow-up (risk ratio [RR]: 1.95, 95% confidence interval: 1.50 to 2.55, p < 0.001; I2 = 62%). Subgroup analysis suggested a stronger association between weak HGS and increased mortality in older patients with CAD as compared to that of overall adult patients with CAD (RR: 3.01 vs. 1.60, p for subgroup difference = 0.004). Subgroup analyses according to study location, design, subtype of CAD, follow-up duration, analytical model, and study quality scores showed similar results (p for subgroup difference all > 0.05).

CONCLUSIONS

Weak HGS at baseline is associated with an increased risk of mortality in patients with CAD, particularly in older patients with CAD.

Development and validation of a reliable method for automated measurements of psoas muscle volume in CT scans using deep learning-based segmentation: a cross-sectional study

OBJECTIVES

We aimed to develop an automated method for measuring the volume of the psoas muscle using CT to aid sarcopenia research efficiently.

METHODS

We used a data set comprising the CT scans of 520 participants who underwent health check-ups at a health promotion centre. We developed a psoas muscle segmentation model using deep learning in a three-step process based on the nnU-Net method. The automated segmentation method was evaluated for accuracy, reliability, and time required for the measurement.

RESULTS

The Dice similarity coefficient was used to compare the manual segmentation with automated segmentation; an average Dice score of 0.927 ± 0.019 was obtained, with no critical outliers. Our automated segmentation system had an average measurement time of 2 min 20 s ± 20 s, which was 48 times shorter than that of the manual measurement method (111 min 6 s ± 25 min 25 s).

CONCLUSION

We have successfully developed an automated segmentation method to measure the psoas muscle volume that ensures consistent and unbiased estimates across a wide range of CT images.

Prognostic role of sarcopenia on major adverse cardiac events among patients who underwent successful percutaneous coronary intervention: a retrospective cohort study

AIMS

We investigated the prevalence of sarcopenia and its influence on 1-year major adverse cardiac events (MACEs) in patients after successful percutaneous coronary intervention (PCI).

METHODS AND RESULTS

This retrospective medical record review using purposive sampling was conducted at a tertiary care university hospital in Korea. Medical records of a total of 303 patients (≥40 years) who underwent successful PCI between January 2014 and December 2020 were analysed. We retrospectively assessed sarcopenia at initial admission. Sarcopenia was assessed by a sarcopenia index based on a ratio of serum creatinine to serum cystatin C. MACE rates were evaluated within l year after PCI. A Kaplan-Meier analysis with a log-rank test was performed to compare the time with 1-year MACE event-free survival between groups with and without sarcopenia. Cox proportional hazards regression was conducted to assess sarcopenia's influence on MACE. The prevalence of sarcopenia and 1-year MACE after PCI were 24.8 and 8.6%, respectively. We found that sarcopenia at admission (hazard ratio, 3.01; 95% confidence interval, 1.22-7.38, P = 0.017) was significantly associated with 1-year MACE among patients after PCI.

CONCLUSION

Expanding knowledge of sarcopenia among cardiovascular nurses may aid in early recognition of patients at risk of sarcopenia. Our finding implies that the sarcopenia index based on serum creatinine and cystatin C may be available as a prognostic factor for MACE in patients undergoing PCI. Future studies should be conducted to prospectively validate the sarcopenia index with a multi-centre, large sample.

The Impact of Geriatric Conditions in Elderly Patients with Coronary Heart Disease: A State-of-the-Art Review

The growing geriatric population presenting with coronary artery disease poses a primary challenge for healthcare services. This is a highly heterogeneous population, often underrepresented in studies and clinical trials, with distinctive characteristics that render them particularly vulnerable to standard management/approaches. In this review, we aim to summarize the available evidence on the treatment of acute coronary syndrome in the elderly. Additionally, we contextualize frailty, comorbidity, sarcopenia, and cognitive impairment, common in these patients, within the realm of coronary artery disease, proposing strategies for each case that may assist in therapeutic approaches.

Metabolic-associated fatty liver disease and sarcopenia: A double whammy

The prevalence of metabolic-associated fatty liver disease (MAFLD) has increased substantially in recent years because of the global obesity pandemic. MAFLD, now recognized as the number one cause of chronic liver disease in the world, not only increases liver-related morbidity and mortality among sufferers but also worsens the complications associated with other comorbid conditions such as cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnoea, lipid disorders and sarcopenia. Understanding the interplay between MAFLD and these comorbidities is important to design optimal therapeutic strategies. Sarcopenia can be either part of the disease process that results in MAFLD (e.g., obesity or adiposity) or a consequence of MAFLD, especially in the advanced stages such as fibrosis and cirrhosis. Sarcopenia can also worsen MAFLD by reducing exercise capacity and by the production of various muscle-related chemical factors. Therefore, it is crucial to thoroughly understand how we deal with these diseases, especially when they coexist. We explore the pathobiological interlinks between MAFLD and sarcopenia in this comprehensive clinical update review article and propose evidence-based therapeutic strategies to enhance patient care.