Associations Between Sarcopenia, Heart Failure and Myocardial Infarction in Patients With Systemic Lupus Erythematosus and Rheumatoid Arthritis

Abstract

ObjectivesTo evaluate associations between sarcopenia, type of autoimmune disease and risk of heart failure (HF) and myocardial infarction (MI) in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).MethodsIn this population-based, cross-sectional study, discharge data from the 2005–2014 US Nationwide Inpatient Sample (NIS) of hospitalized patients with SLE or RA were extracted and analyzed. Univariate and multivariable regression analyses were conducted to determine associations between sarcopenia, type of autoimmune disease and risk of HF/MI.ResultsAfter exclusions, 781,199 hospitalized patients diagnosed with SLE or RA were included. Among the study cohort, 127,812 (16.4%) were hospitalized with HF, and 12,781 (1.6%) were hospitalized with MI. Sarcopenia was found in only 0.1% of HF/MI patients. Logistic regression analyses revealed that sarcopenia was not significantly associated with presence of either HF or MI. Patients with RA had significantly lower odds of HF than SLE patients (aOR = 0.77, 95%CI: 0.76, 0.79) or MI (aOR = 0.86, 95%CI: 0.82, 0.91).ConclusionIn the US, among hospitalized adults diagnosed with SLE or RA, patients with RA are significantly less likely to have HF or MI than those with SLE. Whether sarcopenia leads to increased HF or MI remains inconclusive. Further studies are warranted to investigate the pathophysiology underlying discrepancies between RA and SLE regarding risk for MI or HF.

A systematic review and meta-analysis of the association between sarcopenia and myocardial infarction

“…After screening full texts of the remaining 9 studies, we further excluded 4 ineligible studies according to the following two reasons: unrelated to the topic ( n = 1) [ 24 ] and lack of grouping myocardial infarction ( n = 3) [ 25 – 27 ] (Supplementary Table 2 ). Finally, five studies [ 28 – 32 ] were included in the final data analysis. Following the PRISMA flowchart [ 18 ], we showed the study screening process in Fig.…”

“…The detailed basic characteristics of these five studies are summarized in Table 1 . Of these five included studies, two [ 28 , 32 ] were from China, one[ 29 ] was from Brazil, and two [ 30 , 31 ] were from Japan. Three studies [ 30 – 32 ] used Asian Working Group for Sarcopenia (AWGS) as a diagnostic criterion for sarcopenia [ 33 ], which was assessed by dual-energy X-ray absorptiometry and appendicular skeletal muscle mass index (ASMI).…”

“…Three studies [ 30 – 32 ] used Asian Working Group for Sarcopenia (AWGS) as a diagnostic criterion for sarcopenia [ 33 ], which was assessed by dual-energy X-ray absorptiometry and appendicular skeletal muscle mass index (ASMI). However, another two studies [ 28 , 29 ] made a diagnosis of sarcopenia based on muscle mass, muscle strength and physical performance. For the diagnosis of heart attack, five studies used a comprehensive clinical diagnosis, including serum, electrocardiogram (ECG), and clinical presentation.…”

“…According to the NOS tool, the total NOS score of 3 studies [ 30 – 32 ] was 7 stars and the total NOS score of two studies [ 28 , 29 ] was 5 stars, indicating that the overall quality of all studies was high in terms of methodological quality. The results of methodological quality assessment based on the NOS tool are shown in Table 2 .…”

“…Sarcopenia, however, is not significantly linked to the occurrence of myocardial infraction, according to the current systematic review and meta-analysis. In fact, among the five studies included in the current systematic review and meta-analysis, only one study [ 32 ] found that sarcopenia increased the risk of myocardial infraction, while the remaining four studies [ 28 – 31 ] did not reveal a significant association between sarcopenia and myocardial infraction. Age, the presence of a disease, dietary status, and lifestyle choices are all thought to have an impact on the development of sarcopenia.…”