肌肉减少症、肌少症型超重/肥胖与心血管疾病和心律失常风险：一项横断面研究。
Sarcopenia, sarcopenic overweight/obesity and risk of cardiovascular disease and cardiac arrhythmia: A cross-sectional study.
机构信息
Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China; Fudan Institute for Metabolic Diseases, Shanghai 200032, China.
Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, China.
出版信息
Clin Nutr. 2021 Feb;40(2):571-580. doi: 10.1016/j.clnu.2020.06.003. Epub 2020 Jun 13.
BACKGROUND
Sarcopenia is an age-dependent skeletal muscle disorder that is common in patients with heart failure. The current study aimed to investigate the associations of sarcopenia with carotid atherosclerosis, cardiovascular disease and cardiac arrhythmia in a middle-aged and elderly population without clinical heart failure.
METHODS
A total of 2432 participants (992 men and 1440 women) from Shanghai Changfeng Study were included for analysis. The degree of sarcopenia was measured using height-adjusted appendicular skeletal muscle mass (ASM/height). Carotid plaques were detected by carotid artery ultrasonography, and myocardial ischemia, infarction and cardiac arrhythmia were diagnosed based on electrocardiogram, past history and clinical manifestations.
RESULTS
Sarcopenia was associated with higher prevalence of carotid atherosclerosis (26.4% vs 20.4%, P = 0.027), myocardial infarction (4.0% vs 1.1%, P = 0.001), and premature ventricular contraction (4.0% vs 2.0%, P = 0.034) in the participants with normal body weight, and higher prevalence of carotid atherosclerosis (45.0% vs 31.2%, P = 0.016), myocardial infarction (10.0% vs 4.3%, P = 0.020) and atrial fibrillation (7.5% vs 1.3%, P < 0.001) in those with overweight/obese status. After adjustment for age, gender, cigarette smoking, alcohol drinking, menopausal status in women and other metabolic and inflammatory confounding factors, sarcopenia was independently associated with the risk of myocardial infarction in the whole population, and the risk of atrial fibrillation in the overweight/obese participants (all P < 0.05). Compared with nonsarcopenic lean participants, the risk of myocardial infarction was gradually increased in sarcopenic lean (OR 3.08 [1.28-7.45], P = 0.012) and sarcopenic overweight/obese participants (OR 4.07 [1.31-12.62], P = 0.015). For the atrial fibrillation, the participants with either sarcopenia or overweight/obesity alone showed no higher risk. However, concomitant sarcopenia and overweight/obesity was associated with approximately 5-fold risk of atrial fibrillation (OR 5.68 [1.34-24.12], P = 0.019) after multiple adjustment.
CONCLUSION
Sarcopenia is associated with myocardial infarction and atrial fibrillation in middle-aged and elderly adults without clinical heart failure.
背景
肌少症是一种与年龄相关的骨骼肌肉疾病，在心力衰竭患者中较为常见。本研究旨在探讨在无临床心力衰竭的中老年人群中，肌少症与颈动脉粥样硬化、心血管疾病和心律失常的关系。
方法
共纳入来自上海长风研究的 2432 名参与者（992 名男性和 1440 名女性）进行分析。使用身高校正的四肢骨骼肌质量（ASM/身高）来衡量肌少症的程度。通过颈动脉超声检测颈动脉斑块，根据心电图、既往病史和临床表现诊断心肌缺血、梗死和心律失常。
结果
在体重正常的参与者中，肌少症与颈动脉粥样硬化（26.4%比 20.4%，P=0.027）、心肌梗死（4.0%比 1.1%，P=0.001）和室性早搏（4.0%比 2.0%，P=0.034）的发生率较高相关，在超重/肥胖人群中，肌少症与颈动脉粥样硬化（45.0%比 31.2%，P=0.016）、心肌梗死（10.0%比 4.3%，P=0.020）和心房颤动（7.5%比 1.3%，P<0.001）的发生率较高相关。在校正年龄、性别、吸烟、饮酒、女性绝经状态和其他代谢和炎症混杂因素后，肌少症与全人群的心肌梗死风险以及超重/肥胖人群的心房颤动风险独立相关（均 P<0.05）。与非肌少症的非肥胖参与者相比，肌少症的非肥胖（OR 3.08[1.28-7.45]，P=0.012）和肌少症的超重/肥胖（OR 4.07[1.31-12.62]，P=0.015）参与者的心肌梗死风险逐渐增加。对于心房颤动，仅存在肌少症或超重/肥胖的参与者并未显示出更高的风险。然而，同时存在肌少症和超重/肥胖与心房颤动的约 5 倍风险相关（OR 5.68[1.34-24.12]，P=0.019），经多次调整后仍如此。
结论
在无临床心力衰竭的中老年人群中，肌少症与心肌梗死和心房颤动有关。
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