Relationship Between Low Relative Muscle Mass and Coronary Artery Calcification in Healthy Adults

Abstract

Objective-Sarcopenia or low muscle mass is related to cardiovascular risk factors; however, the association between low muscle mass and subclinical atherosclerosis has been largely unexplored. We investigated whether muscle mass is related to coronary artery calcification (CAC) in a large sample of middle-aged asymptomatic adults. Approach and Results-We performed a cross-sectional study of 31 108 asymptomatic adults without cancer, diabetes mellitus, or known cardiovascular disease who underwent a health checkup examination including cardiac tomography estimation of CAC scores between 2012 and 2013. Skeletal muscle mass index (SMI) [SMI (%)=total skeletal muscle mass (kg)/body weight (kg)×100] was estimated using a bioelectrical impedance analyzer. We assessed the relationship between SMI and CAC scores using both multivariate-adjusted Tobit models and multinomial logistic regression models. Of the 31 108 subjects, 3374 subjects (10.9%) had a CAC score 1 to 100, and 628 subjects (2.0%) had a CAC score >100. SMI was inversely associated with CAC score ratios. Specifically, in a multivariable-adjusted model adjusting for potential confounders, CAC score ratios (95% confidence intervals) of SMI for quartiles 1, 2, and 3 compared with quartile 4 were 2.27 (1.70-3.05), 1.46 (1.15-1.85), and 1.24 (0.98-1.55), respectively (P for trend <0.001). Adjusting for insulin resistance reduced the magnitude of the associations, but they remained statistically significant. Conclusions-Relative muscle mass was negatively associated with the prevalence of coronary calcification, supporting low muscle mass as an independent risk factor of coronary heart disease. Materials and MethodsMaterials and Methods are available in the online-only Data Supplement. ResultsBaseline characteristics of study subjects according to quartiles of skeletal muscle mass index (SMI) are described in subjects were 41.3 years (7.5), 24.2 kg/m 2 (3.1), and 42.2% (3.8), respectively. Of the 31 108 subjects, 4000 (12.9%) had class I sarcopenia and 749 subjects (2.4%) had class II sarcopenia. The prevalence of current smoker status, hypertension, obesity, class I and class II sarcopenic obesity were 27.2%, 14.8%, 37.0%, 10.0%, and 2.3%, respectively. The factors that were negatively associated with SMI were age, body mass index, blood pressure, glucose, uric acid, total cholesterol, low-density lipoprotein cholesterol, triglycerides, alanine aminotransferase, γ-glutamyltransferase, high-sensitivity C-reactive protein (CRP), homeostasis model assessment of insulin resistance (HOMA-IR), CAC score, high alcohol consumption, hypertension, and use of dyslipidemia medication. Conversely, education level, high-density lipoprotein cholesterol, and physical activity level (health-enhancing physically active) were positively associated with SMI. Of the 31 108 subjects, 3374 subjects (10.9%) had a CAC score 1 to 100 and 628 subjects (2.0%) had a CAC score >100. CAC scores increased with increasing sarcopenia class (P value <0.001). The mean CAC scores of subjects with...

Intermuscular Adipose Tissue and Subclinical Coronary Artery Calcification in Midlife

“…A second study in African Americans with diabetes (n=422), found no significant associations of IMAT volume with calcified plaque in the coronary, carotid, or aortic arteries 16 . A number of previous studies should also be discussed in context with the present CARDIA data as those studies suggest that a higher proportion of lean muscle is associated with lower atherosclerosis 12–14,33 . In a study that included 100 participants, higher thigh muscle attenuation (indicative of leaner tissue) was associated with lower carotid intima-media thickness and the association persisted after adjustment for age, diabetes, insulin resistance, and VAT 13 .…”

“…In the study by Ko et al, it is important to note that skeletal muscle mass was inversely associated with BMI; in fact, in the highest quartile of muscle mass only 12% of participants were obese compared to 49% of participants in the lowest quartile of muscle mass 33 . Therefore, the data from Ko and colleagues suggest that it is higher lean muscle mass that is associated with healthier arteries 33 . The present study shows that higher abdominal IMAT, directly quantified using CT, is associated with the prevalence and extent of subclinical atherosclerosis in midlife.…”

“…Higher proportion of lean abdominal muscle was associated with lower likelihood of thoracic aorta calcification in 394 participants, but the authors noted there were no significant associations of muscle composition with carotid, coronary, abdominal aorta, or iliac calcifications, nor was IMAT per se associated with higher calcification in any artery bed 14 . Recently, Ko and colleagues reported that higher total skeletal muscle mass measured using bioelectrical impedance was inversely associated with CAC in more than 31,000 South Korean adults, and these findings remained significant after adjusting for insulin resistance and other potential risk mediators 33 . In the study by Ko et al, it is important to note that skeletal muscle mass was inversely associated with BMI; in fact, in the highest quartile of muscle mass only 12% of participants were obese compared to 49% of participants in the lowest quartile of muscle mass 33 .…”

“…Recently, Ko and colleagues reported that higher total skeletal muscle mass measured using bioelectrical impedance was inversely associated with CAC in more than 31,000 South Korean adults, and these findings remained significant after adjusting for insulin resistance and other potential risk mediators 33 . In the study by Ko et al, it is important to note that skeletal muscle mass was inversely associated with BMI; in fact, in the highest quartile of muscle mass only 12% of participants were obese compared to 49% of participants in the lowest quartile of muscle mass 33 . Therefore, the data from Ko and colleagues suggest that it is higher lean muscle mass that is associated with healthier arteries 33 .…”

Nutrition Status Predicts Severity of Vascular Calcification in Non-Dialyzed Chronic Kidney Disease

“…Ko et al showed that low muscle mass is an independent risk factor of severe coronary artery calcification. 17 Several recent studies have shown that hemodialysis patients with low GNRI have poor cardiovascular outcome, 18 but little is known about nutrition status and its correlation with the severity of arteriosclerosis in non-dialyzed CKD patients. In the present cohort, low GNRI was significantly associated with severe AAC.…”