Muscle mass and grip strength in relation to carotid intima-media thickness and plaque score in patients with type 2 diabetes

Subclinical atherosclerosis and sarcopenia: A prospective study

The relationship between subclinical carotid artery atherosclerosis and sarcopenia has not been clarified in many respects. In this study, the possible relationship between composite clinical sarcopenia indices and various levels of subclinical atherosclerosis parameters was revisited. The Ishii score (Ishii-max and Ishii-average) was used to determine sarcopenia in 257 prospectively recruited healthy controls and patients with neurological diseases (age: 65 ± 10 years, 50% female). Carotid artery distensibility indices (stress, strain, modulus, stiffness, and distensibility), intima-media thickness (IMT-max and IMT-mean), and 10 Kate plaque burden score were obtained for ultrasonographic subclinical atherosclerosis evaluation, together with detailed clinical and anthropometric, quality of life, and nutritional assessments. Sarcopenic subjects (n = 75) were older, slimmer, and at higher risk of malnutrition (Malnutrition Universal Screening Tool score > 0) than nonsarcopenic subjects (n = 182). IMT-mean and IMT-max were significantly higher in sarcopenic cases (mean difference: 45 microns and 60 microns, respectively, P < .05). Carotid plaque burden score was significantly higher in sarcopenic patients (average score: 2.2 vs 0.8 in sarcopenic and nonsarcopenic ones, P < .001). There was no difference in terms of carotid artery distensibility parameters. In various regression models, the Ishii score was always determined as an independent predictor of IMT-max and IMT-mean in the models (standardized beta, from 0.132-0.168; partial-r, from 0.156-0.201; p, from 0.019-0.001). Structural indices of subclinical atherosclerosis (carotid IMT and plaque burden), but not functional ones (carotid artery modulus and distensibility), are significantly abnormal in sarcopenic subjects. If future research validates these findings, employing ultrasonographic atherosclerosis indices as surrogate markers in sarcopenia treatments could address a crucial unmet need.

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.

Correlation of Sarcopenia with Coronary Artery Disease Severity and Pericoronary Adipose Tissue Attenuation: A Coronary CT Study

OBJECTIVE

To investigate the association between sarcopenia, as appraised with CT-derived muscle metrics, and cardiovascular status, as assessed via coronary CT angiography (CCTA) using the Coronary Artery Disease-Reporting and Data System (CAD-RADS) and with pericoronary adipose tissue (pCAT) metrics.

METHODS

A retrospective observational study conducted on patients who underwent CCTA. The cross-sectional area (CSA) and attenuation values of the paravertebral muscles at the T8 level and the pectoralis major muscles at the T6 level were measured. The patient height was employed for the normalization of the skeletal muscle CSA. The pCAT attenuation around the coronary arteries was assessed, and the CAD severity was graded using the CAD-RADS reporting system. Regression analyses were performed to assess the impact of demographics, clinical factors, and CT variables on the CAD-RADS and pCAT.

RESULTS

A total of 220 patients were included (132 males, median age 65 years). Regression analyses showed the associations of CAD with age and sex (p < 0.001). Familiarity with CAD was related to the left anterior descending artery pCAT (p = 0.002) and circumflex artery pCAT (p = 0.018), whereas age was related to the left anterior descending artery pCAT (p = 0.032). Weak positive correlations were found between the lower muscle density and lower pCAT attenuation (ρ = 0.144-0.240, p < 0.039).

CONCLUSIONS

This study demonstrated weak associations between the sarcopenia indicators and the cardiovascular risk, as assessed by the CAD severity and pCAT inflammation. However, these correlations were not strong predictors of CAD severity, as age and traditional cardiovascular risk factors overshadowed the impact of sarcopenia in the cardiovascular risk assessment.

No association between vascular aging and sarcopenia in healthy participants

BACKGROUND & AIMS

Several reports inform an association between vascular aging and sarcopenia. However, both conditions appear along with aging. Therefore, their association may be circumstantial and not casually linked. Our aim was to determine if individuals with higher-than-expected vascular aging have a higher frequency of sarcopenia.

METHODS

In 802 participants we calculated the association between pulse wave pressure and carotid intima media thickness and age and blood pressure, to derive predictive regression equations. In 161 of these participants we measured body composition by double beam X ray absorptiometry (DEXA), hand grip strength, rectus femoris thickness by ultrasound, activity energy expenditure by actigraphy and peak oxygen consumption and workload in an incremental exercise test. We calculated their expected values for pulse wave velocity and carotid intima media thickness and compared muscle mass and function between those with higher or lower than expected parameters. In 60 of these participants, we measured body composition sequentially to assess its change over time.

RESULTS

Age and blood pressure predicted the variance of pulse wave velocity and carotid intima media thickness with R2 values of 0.94-0.97 and 0.54 to 0.66, respectively. No differences in the frequency of sarcopenia and in muscle mass and strength were observed between participants with higher or lower than expected pulse wave velocity and carotid intima media thickness. In the group with sequential assessments, no differences in the change of muscle mass over time were observed in participants with and without accelerated vascular aging.

CONCLUSIONS

We were not able to find an association between vascular aging and sarcopenia.

Effect of Sarcopenia on Coronary Atherosclerotic Burden, Lesion Complexity, and Major Cardiovascular Events in Elderly Patients With Acute Coronary Syndrome: A 1-year Follow-up Study

Sarcopenia is accepted as an indicator of subclinical atherosclerosis. However, its effects on clinical coronary atherosclerotic burden and lesion complexity and major adverse cardiovascular events (MACE) in elderly patients with non-ST elevation myocardial infarction (NSTEMI) are unknown. Therefore, we evaluated these possible effects. Coronary artery disease (CAD) burden and complexity were assessed using the Gensini and TAXus and cardiac surgery (SYNTAX) score, respectively. MACE involving nonfatal myocardial infarction, rehospitalization, ischemic stroke, and total mortality were evaluated after 1 year of the index NSTEMI event. The study included 240 elderly patients; of these, 60 (25%) patients had sarcopenia. The SYNTAX score and Gensini score were similar in both groups (16.8 ± 8.7 vs 17.3 ± 9.2, P = .63 and 67.7 ± 43.9 vs 73.9 ± 45.5, P = .31, respectively). The total MACE rate was significantly higher in patients with sarcopenia than in those without sarcopenia (31.7 vs 14.4%, P = .003). In the multivariate model, age [odds ratio (OR) 1.112, 95% CI: 1.006-1.228, P = .04)], ejection fraction (OR: .923, 95% CI: .897-.951, P < .001), and sarcopenia (OR: 2.262, 95% CI: 1.039-4.924, P = .04) were independently associated with MACE. Sarcopenia was independently associated with MACE but not with CAD burden or complexity in elderly patients with NSTEMI.

Breast arterial calcification is associated with sarcopenia in peri- and post-menopausal women

PURPOSE

Breast arterial calcification (BAC) refers to medial calcium deposition in breast arteries and is detectable via mammography. Sarcopenia, which is characterised by low skeletal muscle mass and quality, is associated with several serious clinical conditions, increased morbidity, and mortality. Both BAC and sarcopenia share common pathologic pathways, including ageing, diabetes, and chronic kidney disease. Therefore, this study evaluated the relationship between BAC and sarcopenia as a potential indicator of sarcopenia.

METHODS

This study involved women aged >40. BAC was evaluated using digital mammography and was defined as vascular calcification. Sarcopenia was assessed using abdominal computed tomography. The cross-sectional skeletal mass area was measured at the third lumbar vertebra level. The skeletal mass index was obtained by dividing the skeletal mass area by height in square meters(m2). Sarcopenia was defined as a skeletal mass index of ≤38.5 cm2/m2. A multivariable model was used to evaluate the relationship between BAC and sarcopenia.

RESULTS

The study involved 240 participants. Of these, 36 (15 %) were patients with BAC and 204 (85 %) were without BAC. Sarcopenia was significantly higher among the patients with BAC than in those without BAC (72.2 % vs 17.2 %, P < 0.001). The multivariable model revealed that BAC and age were independently associated with sarcopenia (odds ratio[OR]: 7.719, 95 % confidence interval[CI]: 3.201-18.614, and P < 0.001 for BAC and OR: 1.039, 95 % CI: 1.007-1.073, P = 0.01 for age).

CONCLUSION

BAC is independently associated with sarcopenia. BAC might be used as an indicator of sarcopenia on screening mammography.

The association of appendicular lean mass and grip strength with low-density lipoprotein, very low-density lipoprotein, and high-density lipoprotein particle diameter: a Mendelian randomization study of the UK Biobank cohort

Aims

Reduced muscle mass and reduced strength are frequently associated with both alterations in blood lipids and poorer cardiometabolic outcomes in epidemiological studies; however, a causal association cannot be determined from such observations. Two-sample Mendelian randomization (MR) was applied to assess the association of genetically determined appendicular lean mass (ALM) and handgrip strength (HGS) with serum lipid particle diameter.

Methods and results

Mendelian randomization was implemented using summary-level data from the largest genome-wide association studies on ALM (n = 450 243), HGS (n = 223 315), and lipoprotein [low-density lipoprotein (LDL), very LDL (VLDL), and high-density lipoprotein (HDL)] particle diameters (n = 115 078). Inverse variance-weighted (IVW) method was used to calculate the causal estimates. Weighted median-based method, MR-Egger, and leave-one-out method were applied as sensitivity analysis. Greater ALM had a statistically significant positive effect on HDL particle diameter (MR-Egger: β = 0.055, SE = 0.031, P = 0.081; IVW: β = 0.068, SE = 0.014, P < 0.001) and a statistically significant negative effect on VLDL particle diameter (MR-Egger: β = -0.114, SE = 0.039, P = 0.003; IVW: β = -0.081, SE = 0.017, P < 0.001). Similarly, greater HGS had a statistically significant positive effect on HDL particle diameter (MR-Egger: β = 0.433, SE = 0.184, P = 0.019; IVW: β = 0.121, SE = 0.052, P = 0.021) and a statistically significant negative effect on VLDL particle diameter (MR-Egger: β = -0.416, SE = 0.163, P = 0.011; IVW: β = -0.122, SE = 0.046, P = 0.009). There was no statistically significant effect of either ALM or HGS on LDL particle diameter.

Conclusion

There were potentially causal associations between both increasing ALM and HGS and increasing HDL particle size and decreasing VLDL particle size. These causal associations may offer possibilities for interventions aimed at improving cardiovascular disease risk profile.

Relationship between neck vessel abnormalities and sarcopenia: results of a study examining trends in health and aging in western China

OBJECTIVE

To elucidate the association between cervical vascular abnormalities (high Crouse score, high carotid intima-media thickness [CIMT], high plaque score [PS]) and sarcopenia and its diagnostic elements.

STUDY DESIGN

This cross-sectional investigation selected patients from the Western China Health and Aging Trends Study (WCHAT) aged 60 years and older. High CIMT and high Crouse score was defined as values ≥ upper quartile cutoff. Moreover, PS ≥ 3 was set as an high PS. Sarcopenia diagnosis and the definition of sarcopenia diagnostic elements were based on the Asian Working Group on Sarcopenia (AWGS) 2019 consensus. Lastly, associations between high Crouse score, high PS, high CIMT, and sarcopenia and its diagnostic elements were assessed using logistic regression.

RESULT

In all, we recruited 932 subjects in this study, among which, 138 people (14.81%) were diagnosed with sarcopenia. The rates of high Crouse score (sarcopenia vs. non-sarcopenia: 37.68% vs. 23.30%, P < 0.001) and high PS (sarcopenia vs. non-sarcopenia: 34.78% vs. 18.39%, P < 0.001) in subjects with sarcopenia were higher than those in subjects without sarcopenia. Logistic regression analysis and the correction of possible confounding factors showed that high Crouse score and high PS were related to sarcopenia (high Crouse score: OR = 1.573; 95%CI: 1.032-2.4; high PS: OR = 1.845; 95%CI: 1.195-2.851). Further analysis indicated that high Crouse score were associated with low muscle mass (OR = 1.403; 95%CI: 1.002-1.966) and low physical function (OR = 1.93; 95%CI: 1.3-2.866). High PS was found to be related to low physical function (OR = 1.83; 95%CI: 1.209-2.771).

CONCLUSION

While both high Crouse score and high PS are related to sarcopenia, further analysis showed that high Crouse score were mainly associated with low muscle mass and low physical function while high PS was associated with low physical function.

The association between grip strength and carotid intima media thickness: A Mendelian randomization analysis of the Canadian Longitudinal Study on Aging

BACKGROUND

Several two-sample Mendelian randomization studies have reported discordant results concerning the association between grip strength and cardiovascular disease, possibly due to the number of instrumental variables used, pleiotropic bias, and/ or effect modification by age and sex.

METHODS

We conducted a sex- and age-stratified one-sample Mendelian randomization study in the Canadian Longitudinal Study on Aging. We investigated whether grip strength is associated with carotid intima media thickness (cIMT), a marker of vascular atherosclerosis event risk, using eighteen single nucleotide polymorphisms (SNP) identified as specifically associated with grip strength.

RESULTS

A total of 20,258 participants of self-reported European ancestry were included in the analytic sample. Our Mendelian randomization findings suggest a statistically significant association between grip strength and cIMT (MR coefficient of 0.02 (95% CI: 0.01, 0.04)). We found no statistically significant differences between sexes (p-value = 0.201), or age groups [(≤ 60 years old versus >60 years old); p-value = 0.421].

CONCLUSION

This study provides evidence that grip strength is inversely associated with cIMT. Our one-sample MR study design allowed us to demonstrate that there is no evidence of heterogeneity of effects according to age group or biological sex.

Relationship between serum creatinine to cystatin C ratio and subclinical atherosclerosis in patients with type 2 diabetes

INTRODUCTION

Sarcopenia index (SI), calculated by (serum creatinine/cystatin C)×100, is reported to be associated with sarcopenia. Few studies reported the association between SI and subclinical atherosclerosis. We evaluated the association between SI and subclinical atherosclerosis, assessed by brachial-ankle pulse wave velocity (baPWV).

RESEARCH DESIGN AND METHODS

One hundred seventy-four patients with type 2 diabetes were included in this cross-sectional study. The relationship between SI and baPWV was assessed by Pearson's correlation coefficient. To calculate area under the receiver operator characteristic (ROC) curve (AUC) of SI for the presence of subclinical atherosclerosis, which was defined as baPWV >1800 cm/s, ROC analysis was performed. Logistic regression analyses were performed to assess the effect of SI on the prevalence of subclinical atherosclerosis adjusting for covariates.

RESULTS

Mean age, duration of diabetes, baPWV, and SI were 66.9 (10.1) years, 17.7 (11.6) years, 1802 (372) cm/s, and 77.6 (15.8), respectively. There was an association between SI and baPWV (men; r=-0.25, p=0.001, and women; r=-0.37, p=0.015). The optimal cut-off point of SI for the presence of subclinical atherosclerosis was 77.4 (sensitivity=0.72, specificity=0.58, p<0.001, AUC 0.66 (95% CI: 0.57 to 0.74)). In addition, SI was associated with the prevalence of subclinical atherosclerosis (adjusted OR 0.95, 95% CI: 0.91 to 0.99, p=0.015).

CONCLUSIONS

SI is associated with the prevalence of subclinical atherosclerosis in patients with type 2 diabetes.

Association of High Muscle Mass with Carotid Atherosclerosis: A Community-Based Population Cohort Study

OBJECTIVES

Although low muscle mass may make an under-appreciated contribution to increasing the risk of cardiovascular diseases, no prospective studies have explored the association between low muscle mass and carotid atherosclerosis. We investigated whether muscle mass was related to a higher carotid intima-media thickness (C-IMT) and carotid artery plaque in a community-based population.

METHODS

The study included 1,253 asymptomatic participants without known cardiovascular disease, who underwent carotid ultrasonography at baseline in 2013-2014 and received a re-examination in 2015-2016. The skeletal muscle mass index was estimated using a bioelectrical impedance analyzer. We assessed the relationship between the skeletal muscle mass index and the development of C-IMT and carotid plaque, both, using multivariate-adjusted logistic regression models.

RESULTS

During the follow up, 400 (51.0%) subjects with normal C-IMT at baseline developed elevated C-IMT and 215 (17.2%) subjects developed carotid plaque. The risk of elevated C-IMT occurrence linearly decreased with an increase in skeletal muscle mass index quintiles or its continuous data, after multivariate-adjustment in men and women, respectively (both P for trend < 0.05; both P < 0.05). Subgroup analyses showed that this association was BMI-dependent. Besides, there was an inverse association between a high skeletal muscle mass index and carotid artery plaque in women, but the association disappeared after multivariate adjustment. In men, the skeletal muscle mass index was not associated with the incidence of carotid plaque.

CONCLUSIONS

Skeletal muscle mass was inversely associated with the incidence of carotid atherosclerosis, suggesting muscle mass maintenance may play a role in modifying atherosclerosis.

Associations between Grip Strength and Glycemic Control in Type 2 Diabetes Mellitus: the 2014-2019 Korea National Health and Nutrition Examination Survey

OBJECTIVES

Glycemic control is essential for preventing severe complications in patients with diabetes mellitus. This study investigated the association between grip strength and glycemic control in Korean adults with type 2 diabetes mellitus.

METHODS

From the Korea National Health and Nutrition Examination Survey, 2,498 participants aged over 19 years that patients with diabetes mellitus who did not have a history of cardiovascular disease or cancer were selected for analysis. Grip strength was assessed using a handheld dynamometer and was represented as age-specific and sex-specific tertiles. Multivariable logistic regression was performed to calculate the odds ratio (OR) and 95% confidence interval (CI) of glycemic control according to the grip strength tertiles.

RESULTS

A significantly lower probability (OR, 0.67; 95% CI, 0.47 to 0.97) for glycemic control was found in the lowest tertile of grip strength compared to the highest tertile. Furthermore, a subgroup analysis by sex only found significant associations between grip strength and glycemic control in males.

CONCLUSIONS

Lower grip strength was associated with poor glycemic control in patients with diabetes mellitus, especially in males. However, further studies are needed to confirm the causal relationship between grip strength and glycemic control.