Department of Geriatrics, Peking University First Hospital, Beijing, People's Republic of China.
Clin Interv Aging. 2023 Apr 13;18:585-595. doi: 10.2147/CIA.S405559. eCollection 2023.
Body mass index (BMI) correlates with aspirin-induced bleeding risk. However, skeletal muscle mass (SMM) loss and fat gain commonly occur with aging, making BMI not a reasonable marker of bleeding risk in older individuals. In the present study, we aimed to investigate the prognostic value of myopenic obesity based on the percent of fat mass (%FM) for aspirin-induced bleeding in Chinese patients over 60 years old.
We prospectively analyzed 185 patients taking aspirin for primary and secondary prevention of cardiovascular diseases. Body composition parameters were estimated using bioelectrical impedance analysis. We defined myopenic obesity (MO) as a height-adjusted appendicular SMM <7.0 kg/m in males and <5.7 kg/m in females with a %FM >29% in males and >41% in females or a BMI ≥25 kg/m. The patients were categorized into four groups by the presence or absence of myopenia and obesity.
Based on the %FM grouping, the bleeding risk was significantly higher in the MO group, followed by the nonmyopenic obesity, myopenic nonobesity, and nonmyopenic nonobesity groups (P = 0.044). No statistically significant differences in the probability of bleeding events were observed among the four BMI-based groups (P = 0.502). Multivariate Cox analysis indicated that MO (hazard ratio [HR] 2.724, 95% confidence interval [CI] 1.073-6.918, P = 0.035), aspirin dose (100 vs 50 mg/day, HR 2.609, 95% CI 1.291-5.273, P = 0.008), concomitant use of histamine-2 receptor antagonists and proton pump inhibitors (HR 1.777, 95% CI 1.007-3.137, P = 0.047), and hemorrhage history (HR 2.576, 95% CI 1.355-4.897, P = 0.004) were associated with bleeding events independently.
%FM-based MO was an independent predictor of aspirin-induced bleeding in older Chinese individuals. Reducing %FM rather than BMI should be an optimal strategy for the management of myopenic obesity.
体重指数（BMI）与阿司匹林相关出血风险相关。然而，骨骼肌量（SMM）减少和脂肪增加在老年人中常同时发生，使得 BMI 不是老年人出血风险的合理标志物。本研究旨在探讨基于体脂肪百分比（%FM）的肌少性肥胖对中国 60 岁以上服用阿司匹林的患者发生阿司匹林相关出血的预后价值。
我们前瞻性分析了 185 名服用阿司匹林进行心脑血管疾病一级和二级预防的患者。使用生物电阻抗分析估计身体成分参数。我们将男性身高调整后的四肢骨骼肌质量 <7.0 kg/m 和女性 <5.7 kg/m 且男性 %FM >29%和女性 >41%或 BMI ≥25 kg/m 的患者定义为肌少性肥胖（MO）。根据是否存在肌少症和肥胖症，将患者分为四组。
基于 %FM 分组，MO 组出血风险显著更高，其次是非肌少性肥胖组、肌少性非肥胖组和非肌少性非肥胖组（P = 0.044）。在基于 BMI 的四组之间，出血事件发生的概率无统计学差异（P = 0.502）。多变量 Cox 分析表明，MO（风险比[HR]2.724，95%置信区间[CI]1.073-6.918，P = 0.035）、阿司匹林剂量（100 与 50 mg/天，HR 2.609，95%CI 1.291-5.273，P = 0.008）、同时使用组胺 2 受体拮抗剂和质子泵抑制剂（HR 1.777，95%CI 1.007-3.137，P = 0.047）和出血史（HR 2.576，95%CI 1.355-4.897，P = 0.004）与出血事件独立相关。
基于 %FM 的 MO 是中国老年人群中阿司匹林相关出血的独立预测因子。减少 %FM 而不是 BMI 应是肌少性肥胖管理的最佳策略。
