First Cardiology Clinic, School of Medicine, University of Athens, Greece; Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
First Cardiology Clinic, School of Medicine, University of Athens, Greece.
Nutr Metab Cardiovasc Dis. 2019 Jul;29(7):718-727. doi: 10.1016/j.numecd.2019.03.011. Epub 2019 Mar 26.
Predictive and prognostic ability of muscle mass in CVD settings is increasingly discussed. The gender-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.
In 2006-2009, n = 1000 consecutive patients (n = 222 women), hospitalized at the First Cardiology Clinic of Athens 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). In the 10-year follow-up (2016), 55% of ACS patients experienced recurrent fatal/non fatal CVD events (53% in women vs.62% in men, p = 0.04). Patients in the 2nd SMI tertile (mostly overweight) had 10% lower risk for CVD recurrence (women:men rate ratio = 0.87) over their counterparts in the 1st (mostly normalweight) and 3rd tertile (mostly obese). Multivariate analysis revealed that ACS patients in the 2nd SMI tertile presented 46% and 85% lower CVD event risk over their counterparts in the 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). Gender-based analysis revealed that this trend remained significant only in women. Inflammatory markers had strong confounding effect.
A U-shape association between SMI and 10-year CVD event especially in women was highlighted. This work reveals gender-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.
肌肉量在心血管疾病（CVD）环境中的预测和预后能力正日益受到关注。本研究评估了骨骼肌指数（SMI）对急性冠状动脉综合征（ACS）患者 10 年复发性致死性/非致死性心血管疾病（CVD）事件的性别特异性影响。
2006-2009 年，连续入选了在雅典第一心脏科诊所因 ACS 住院且存在心力衰竭症状和左心室功能的 1000 例患者（女性 222 例）。通过体质量指数（BMI）除以四肢骨骼肌质量（通过人群公式间接计算）来创建 SMI 以反映骨骼肌量。在 10 年随访（2016 年）中，55%的 ACS 患者发生了复发性致死性/非致死性 CVD 事件（女性为 53%，男性为 62%，p=0.04）。第 2 个 SMI 三分位组（主要为超重）的患者发生 CVD 复发的风险比第 1 个（主要为正常体重）和第 3 个三分位组（主要为肥胖）的患者低 10%（女性：男性率比为 0.87）。多变量分析显示，第 2 个 SMI 三分位组的 ACS 患者发生 CVD 事件的风险比第 1 个三分位组的患者低 46%（危险比（HR）=0.54，95%置信区间（95%CI）为 0.30，0.96，p=0.002）和第 3 个三分位组的患者低 85%（HR=1.85，95%CI 为 1.05，2.94，p=0.03）。基于性别的分析显示，这一趋势仅在女性中仍然显著。炎症标志物具有强烈的混杂作用。
在女性中，SMI 与 10 年 CVD 事件之间呈 U 型关联，这一结果突出了性别特异性的“肥胖-消瘦悖论”。本研究揭示了二级预防中“肥胖-消瘦悖论”的性别特异性特征，这表明高肌肉量伴肥胖和过多脂肪可能并不能保证更好的预后。
