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

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.

[1]  Lubomir M. Hadjiiski,et al.  Coronary artery analysis: Computer-assisted selection of best-quality segments in multiple-phase coronary CT angiography. , 2016, Medical physics.

[2]  Yoosoo Chang,et al.  Relationship of sitting time and physical activity with non-alcoholic fatty liver disease. , 2015, Journal of hepatology.

[3]  E. Kang,et al.  Sarcopaenia is associated with NAFLD independently of obesity and insulin resistance: Nationwide surveys (KNHANES 2008-2011). , 2015, Journal of hepatology.

[4]  Kyungdo Han,et al.  Optimal cutoffs for low skeletal muscle mass related to cardiovascular risk in adults: The Korea National Health and Nutrition Examination Survey 2009–2010 , 2015, Endocrine.

[5]  H. Daida,et al.  FGF21 attenuates pathological myocardial remodeling following myocardial infarction through the adiponectin-dependent mechanism. , 2015, Biochemical and biophysical research communications.

[6]  Luigi Ferrucci,et al.  Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases. , 2014, The lancet. Diabetes & endocrinology.

[7]  M. Criqui,et al.  The relationship between insulin resistance and vascular calcification in coronary arteries, and the thoracic and abdominal aorta: the Multi-Ethnic Study of Atherosclerosis. , 2014, Atherosclerosis.

[8]  M. Yamada,et al.  Arterial stiffness is associated with low skeletal muscle mass in Japanese community‐dwelling older adults , 2014, Geriatrics & gerontology international.

[9]  J. J. Rivera,et al.  Dyslipidemia, Coronary Artery Calcium, and Incident Atherosclerotic Cardiovascular Disease: Implications for Statin Therapy From the Multi-Ethnic Study of Atherosclerosis , 2014, Circulation.

[10]  Young Seol Kim,et al.  Sarcopenia Is Independently Associated with Cardiovascular Disease in Older Korean Adults: The Korea National Health and Nutrition Examination Survey (KNHANES) from 2009 , 2013, PloS one.

[11]  M. Narici,et al.  Sarcopenia, Dynapenia, and the Impact of Advancing Age on Human Skeletal Muscle Size and Strength; a Quantitative Review , 2012, Front. Physio..

[12]  B. Oh,et al.  The prevalence and distribution of coronary artery calcium in asymptomatic Korean population , 2012, The International Journal of Cardiovascular Imaging.

[13]  H. Kohl,et al.  Dose Response Between Physical Activity and Risk of Coronary Heart Disease: A Meta-Analysis , 2011, Circulation.

[14]  A. Karlamangla,et al.  Relative muscle mass is inversely associated with insulin resistance and prediabetes. Findings from the third National Health and Nutrition Examination Survey. , 2011, The Journal of clinical endocrinology and metabolism.

[15]  H. J. Yoo,et al.  Prevalence and determinant factors of sarcopenia in patients with type 2 diabetes: The Korean Sarcopenic Obesity Study (KSOS) (Diabetes Care (2010) 33, (1497-1499)) , 2010 .

[16]  K. Park,et al.  Sarcopenic Obesity: Prevalence and Association With Metabolic Syndrome in the Korean Longitudinal Study on Health and Aging (KLoSHA) , 2010, Diabetes Care.

[17]  I. Tabata,et al.  A cross-sectional study of sarcopenia in Japanese men and women: reference values and association with cardiovascular risk factors , 2010, European Journal of Applied Physiology.

[18]  I. D. de Boer,et al.  Urinary Creatinine Excretion Rate and Mortality in Persons With Coronary Artery Disease: The Heart and Soul Study , 2010, Circulation.

[19]  R. Gans,et al.  Urinary creatinine excretion, an indirect measure of muscle mass, is an independent predictor of cardiovascular disease and mortality in the general population. , 2009, Atherosclerosis.

[20]  M. Jaffrin Body composition determination by bioimpedance: an update , 2009, Current opinion in clinical nutrition and metabolic care.

[21]  B. Pedersen,et al.  Fibroblast Growth Factor-21 Is Induced in Human Skeletal Muscles by Hyperinsulinemia , 2009, Diabetes.

[22]  Y. Ahn,et al.  Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study , 2007, European Journal of Clinical Nutrition.

[23]  Jonathan G Goldin,et al.  Assessment of Coronary Artery Disease by Cardiac Computed Tomography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiolog , 2006, Circulation.

[24]  M. Visser,et al.  Inflammatory markers and loss of muscle mass (sarcopenia) and strength. , 2006, The American journal of medicine.

[25]  W. Ambrosius,et al.  Sarcopenia, obesity, and inflammation--results from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors study. , 2005, The American journal of clinical nutrition.

[26]  J. Sundquist,et al.  The long-term effect of physical activity on incidence of coronary heart disease: a 12-year follow-up study. , 2005, Preventive medicine.

[27]  A. Localio,et al.  Coronary artery calcification and cardiovascular risk factors: impact of the analytic approach. , 2004, Atherosclerosis.

[28]  M. Malavolti,et al.  Cross-calibration of eight-polar bioelectrical impedance analysis versus dual-energy X-ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged 21-82 years , 2003, Annals of human biology.

[29]  Robert Ross,et al.  Low Relative Skeletal Muscle Mass (Sarcopenia) in Older Persons Is Associated with Functional Impairment and Physical Disability , 2002, Journal of the American Geriatrics Society.

[30]  J. Rumberger,et al.  Long-Term Prognostic Value of Coronary Calcification Detected by Electron-Beam Computed Tomography in Patients Undergoing Coronary Angiography , 2001, Circulation.

[31]  P. Ridker,et al.  Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. , 1997, The New England journal of medicine.

[32]  R. Detrano,et al.  Quantification of coronary artery calcium using ultrafast computed tomography. , 1990, Journal of the American College of Cardiology.

[33]  J. Baeyens,et al.  European working group on sarcopenia in older people. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people , 2010 .