P1533The sex-based effect of skeletal muscle mass on 10-year cardiovascular disease prognosis of patients with acute coronary syndrome: the mediating effect of systemic inflammation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kouvari ◽  
C Chrysohoou ◽  
P Dilaveris ◽  
G Georgiopoulos ◽  
N Magkas ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Skeletal Muscle ◽  
Acute Coronary Syndrome ◽  
Confidence Interval ◽  
Muscle Mass ◽  
Inflammatory Markers ◽  
Skeletal Muscle Mass ◽  
Significant Trend ◽  
Mediating Effect ◽  
Coronary Syndrome

Abstract Background/Introduction Predictive and prognostic ability of muscle mass in CVD settings is increasingly discussed. Purpose The sex-specific effect of skeletal muscle mass index (SMI) on 10-year recurrent fatal/non fatal cardiovascular disease (CVD) event of acute coronary syndrome (ACS) patients was evaluated. Methods In 2006–2009, n=1,000 consecutive patients (n=222 females), hospitalized at a cardiology clinic with ACS diagnosis and with symptoms and left ventricular function indicative of heart failure were selected. SMI was created to reflect skeletal muscle mass through appendicular skeletal muscle mass (indirectly calculated through population formulas) divided by body mass index (BMI). Results In 10-year follow-up (2016), 55% of ACS patients exhibited recurrent fatal/non fatal CVD events (53% in females vs. 62% in males, p=0.04). Patients in 2nd SMI tertile (mostly overweight) had 10% lower risk for CVD recurrence (female:male rate ratio=0.87) over their counterparts at 1st (mostly normalweight) and 3rd tertile (mostly obese). Multivariate analysis revealed that ACS patients in 2nd SMI tertile presented 46% and 85% lower CVD event risk over their counterparts in 1st tertile (Hazard Ratio (HR)=0.54, 95% Confidence Interval (95% CI) 0.30, 0.96, p=0.002) and 3rd tertile (HR=1.85, 95% CI 1.05, 2.94, p=0.03). Sex-related sensitivity analyses revealed that even if U-shape association was retained in both males and females in crude and age- adjusted models, further adjustment for clinical, lifestyle and sociodemographic factors resulted in a significant trend only in females (HR=1.85, 95% CI 1.05, 2.94, p=0.03). Mean (95% confidence interval) survival (free-of-CVD) time (years) in females patients at 1st, 2nd and 3rd tertile was 7.4 (6.5, 8.2), 8.2 (7.1, 9.2) and 6.7 (5.5, 7.9), respectively. Inflammatory markers i.e. C-reactive protein (CRP) and white blood cells (WBC) had strong confounding effect on the association between SMI and 10-year recurrent CVD event rate in females. A significant inverse linear association between the examined factors was observed only in females (ρ(CRP)=-0.490, p<0.001 & ρ(WBC)=-0.380, p=0.05). Unadjusted analysis revealed that females of 2nd tertile had significantly lower mean values of inflammatory markers compared with their 1st tertile counterparts (all ps<0.05). Additionally, females of 3rd tertile presented slightly higher inflammation levels compared with females of 2nd tertile yet this difference was not significant. In males no significant trend was observed. Conclusion AU-shape association between SMI and 10-year CVD event especially in females was highlighted. This work reveals sex-specific remarks for “obesity-lean paradox” in secondary prevention, implying that high muscle mass accompanied by obesity and excess adiposity may not guarantee better prognosis. Acknowledgement/Funding None

scholarly journals IMPACT OF SKELETAL MUSCLE MASS ON PROGNOSIS IN PATIENTS WITH ACUTE CORONARY SYNDROME

2020 ◽  
Vol 75 (11) ◽  
pp. 3510
Author(s):  
Yukio Mizuguchi ◽  
Takeshi Yamada ◽  
Norimsa Taniguchi ◽  
Shunsuke Nakajima ◽  
Tetsuya Hata ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Acute Coronary Syndrome ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Coronary Syndrome

scholarly journals Predicted Skeletal Muscle Mass and 4-Year Cardiovascular Disease Incidence in Middle-Aged and Elderly Participants of IKARIA Prospective Epidemiological Study: The Mediating Effect of Sex and Cardiometabolic Factors

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3293
Author(s):  
Christina Chrysohoou ◽  
Matina Kouvari ◽  
George Lazaros ◽  
John Varlas ◽  
Kyriakos Dimitriadis ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Skeletal Muscle ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Disease Incidence ◽  
Specific Effect ◽  
Mediating Effect ◽  
Arterial Distensibility ◽  
Cox Regression Analysis ◽  
Cardiometabolic Factors

The sex-specific effect of skeletal muscle mass (SMM) index (SMI) on 4-year first fatal/non-fatal cardiovascular disease (CVD) event in free-of-disease individuals was examined. In 2009, n = 1411 inhabitants (mean age = 64(12)) from Ikaria were selected. Follow-up was performed in 2013. SMI was created to reflect SMM through appendicular skeletal muscle mass (indirectly calculated through formulas) divided by body mass index (BMI). Fifteen and six tenths percent of participants exhibited CVD (19.8% in men/12% in women, p = 0.002). Significant U-shape trends were observed in participants >65 years old and women irrespective to age confirmed through multi-adjusted Cox regression analysis; in age >65 years, Hazard Ratio (HR)(2nd vs. 1st SMI tertile) = 0.80, 95% Confidence Interval (95%CI) (0.45, 0.96) and in women HR(2nd vs. 1st SMI tertile) = 0.71, 95% CI (0.33, 0.95), while, as for the 3rd SMI tertile, no significant trends were observed. Mediation analysis revealed that mediators of the aforementioned associations in men were the arterial distensibility and total testosterone, while, in women, inflammation, insulin resistance, and arterial distensibility. High SMM accompanied by obesity may not guarantee lower CVD risk. Specific cardiometabolic factors seem to explain this need for balance between lean and fat mass.

scholarly journals Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the ATTICA study

2019 ◽  
Vol 74 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Stefanos Tyrovolas ◽  
Demosthenes Panagiotakos ◽  
Ekavi Georgousopoulou ◽  
Christina Chrysohoou ◽  
Dimitrios Tousoulis ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Skeletal Muscle ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Disease Incidence ◽  
Population Based ◽  
Cardiometabolic Health ◽  
Inverse Association ◽  
Cvd Risk ◽  
Appendicular Skeletal Muscle

BackgroundSkeletal muscle mass (SMM) is inversely associated with cardiometabolic health and the ageing process. The aim of the present work was to evaluate the relation between SMM and 10 year cardiovascular disease (CVD) incidence, among CVD-free adults 45+ years old.MethodsATTICA is a prospective, population-based study that recruited 3042 adults without pre-existing CVD from the Greek general population (Caucasians; age ≥18 years; 1514 men). The 10 year study follow-up (2011–2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). The working sample consisted of 1019 participants, 45+ years old (men: n=534; women: n=485). A skeletal muscle mass index (SMI) was created to reflect SMM, using appendicular skeletal muscle mass (ASM) standardised by body mass index (BMI). ASM and SMI were calculated with specific indirect population formulas.ResultsThe 10 year CVD incidence increased significantly across the baseline SMI tertiles (p<0.001). Baseline SMM showed a significant inverse association with the 10 year CVD incidence (HR 0.06, 95% CI 0.005 to 0.78), even after adjusting for various confounders. Additionally, participants in the highest SMM tertile had 81% (95% CI 0.04 to 0.85) lower risk for a CVD event as compared with those in the lowest SMM tertile.ConclusionsThe presented findings support the importance of SMM evaluation in the prediction of long-term CVD risk among adults 45+ years old without pre-existing CVD. Preservation of SMM may contribute to CVD health.

P4401Depressive symptomatology, sex and 10-year cardiovascular disease; revealing the mediation ranking of lifestyle, sociodemographic and clinical factors in primary and secondary prevention spectrum

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kouvari ◽  
D B Panagiotakos ◽  
C Chrysohoou ◽  
V Notara ◽  
E Georgousopoulou ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Confidence Interval ◽  
Depressive Symptomatology ◽  
Depression Scale ◽  
Specific Effect ◽  
Mediating Effect ◽  
Clinical Factors ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Males And Females

Abstract Background/Introduction Brain and heart interplay is highly discussed in healthy yet even more in cardiac population with inconclusive evidence regarding the sex-related interactions. Purpose The sex-specific effect of depressive symptomatology (DS) on 10-year first and recurrent cardiovascular disease (CVD) events was evaluated. Methods The samples of two cohorts were used; n=845 free of CVD males and females (2002–2012) and n=2,172 males and females with acute coronary syndrome (ACS) (2004–2014) with baseline psychological assessments (Zung Self-Rating Depression Scale and Centre of Epidemiological Studies-Depressive symptoms scale, respectively) were used. The percentage of excess mediated risk (PEMR) and the corresponding 95% Confidence Interval (95% CI) were used to evaluate the mediating effect of various factors on the examined association. Results ACS as well as free-of-CVD females scored significantly higher for DS. Males exceeded females against first (19.7% vs. 11.7%, p<0.001) and subsequent CVD events (38.8% vs. 32.9%, p=0.016) while in participants with DS a male-to-female first and recurrent CVD event rate ratio below -1- was noticed. Multivariate Cox regression analysis revealed that DS remained an independent aggravating factor for first (Hazard Ratio (HR) = 2.72, 95% Confidence Interval (95% CI) 1.50, 9.12, p=0.01) and recurrent (HR=1.31, 95% CI 1.01, 1.69, p<0.001) CVD events only in females. Mediation analysis in females revealed that 35% (23%, 44%) of excess first-CVD-event risk of DS was attributed to lifestyle, sociodemographic, clinical, anthropometric factors as well as lipid and inflammatory markers. The respective number for recurrent events was 46% (23%, 53%). In free-of-CVD females, factors mostly accounted for excess DS risk, close to the overall, were C-reactive protein [38% (31%, 51%)], waist-to-hip ratio [35% (31%, 42%)] and diabetes [32% (27%, 36%)]. Among lipid markers, the biggest mediating effect was observed for high density lipoprotein [28% (25%, 32%)] and triglycerides [26% (22%, 33%)]. As for non-clinical factors, financial status [23% (15%, 31%)] presented the biggest mediating effect followed by educational status, adherence to Mediterranean diet and sleep duration. In ACS females, diabetes [40% (27%, 51%)] and adherence to medication [40% (29%, 53%)] had the biggest mediating effect followed by hypertension [38% (27%, 48%)]. Patients' CVD history and discharge status, presented a very low mediating effect size (∼10%). Among the examined lifestyle factors, current smoking was revealed the strongest mediator, accounting for 33% (19%, 39%) of DS aggravating effect. Anthropometric parameters in terms of body mass index seemed to modestly mediate the examined association (∼29%). Conclusions The present work augments prior evidence that psychological stressors possess important drivers of CVD onset and progression mainly in females while it gives rise to research towards unidentified paths behind this claim. Acknowledgement/Funding The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

scholarly journals Associations of Skeletal Muscle Mass and Fat Mass With Incident Cardiovascular Disease and All‐Cause Mortality: A Prospective Cohort Study of UK Biobank Participants

2021 ◽  
Vol 10 (9) ◽  
Author(s):  
Rebecca Knowles ◽  
Jennifer Carter ◽  
Susan A. Jebb ◽  
Derrick Bennett ◽  
Sarah Lewington ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Skeletal Muscle ◽  
Body Mass Index ◽  
Muscle Mass ◽  
Body Mass ◽  
Fat Mass ◽  
Skeletal Muscle Mass ◽  
Uk Biobank ◽  
Cvd Risk ◽  
All Cause Mortality

Background There is debate whether body mass index is a good predictor of health outcomes because different tissues, namely skeletal muscle mass (SMM) and fat mass (FM), may be differentially associated with risk. We investigated the association of appendicular SMM (aSMM) and FM with fatal and nonfatal cardiovascular disease (CVD) and all‐cause mortality. We compared their prognostic value to that of body mass index. Methods and Results We studied 356 590 UK Biobank participants aged 40 to 69 years with bioimpedance analysis data for whole‐body FM and predicted limb muscle mass (to calculate aSMM). Associations between aSMM and FM with CVD and all‐cause mortality were examined using multivariable Cox proportional hazards models. Over 3 749 501 person‐years of follow‐up, there were 27 784 CVD events and 15 844 all‐cause deaths. In men, aSMM was positively associated with CVD incidence (hazard ratio [HR] per 1 SD 1.07; 95% CI, 1.06–1.09) and there was a curvilinear association in women. There were stronger positive associations between FM and CVD with HRs per SD of 1.20 (95% CI, 1.19–1.22) and 1.25 (95% CI, 1.23–1.27) in men and women respectively. Within FM tertiles, the associations between aSMM and CVD risk largely persisted. There were J‐shaped associations between aSMM and FM with all‐cause mortality in both sexes. Body mass index was modestly better at discriminating CVD risk. Conclusions FM showed a strong positive association with CVD risk. The relationship of aSMM with CVD risk differed between sexes, and potential mechanisms need further investigation. Body fat and SMM bioimpedance measurements were not superior to body mass index in predicting population‐level CVD incidence or all‐cause mortality.

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