Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China.
Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China.
Eur J Intern Med. 2023 Aug;114:113-119. doi: 10.1016/j.ejim.2023.05.007. Epub 2023 May 8.
We aimed to explore the association between skeletal muscle mass and cardiovascular events, and its additional value on the assessment of cardiovascular diseases (CVD) over traditional risk scores.
The study included 1365 community-based participants aged over 50 years and free of CVDs at baseline. Participants completed detailed assessments at baseline and received a follow-up assessment in 2021-2022 via phone calls or electronic medical records. Skeletal muscle mass was measured using an automatic bioelectric analyzer. Predicted probabilities of 10-year atherosclerotic cardiovascular disease (ASCVD) risk were estimated individually with the China-PAR equation.
After a mean follow-up of 7.6 years, 144 cardiovascular events were identified. The fully-adjusted hazard ratios (HRs) of cardiovascular events were 0.93 (0.88-0.98) and 1.08 (1.04-1.12) for skeletal muscle mass and predicted 10-year risk, respectively. Among participants over 60 years and with two or more risk factors, cardiovascular events risk increased progressively with each decreasing skeletal muscle tertile. Receiver operating characteristic curves showed that the C-statistic of predicting cardiovascular events for a 10-year risk assessment was slightly increased after adding skeletal muscle mass. The categorical net reclassification improvement (NRI) showed a 56.7% increase in the reclassification. The continuous NRI and integrated discrimination improvement increased as well.
Participants with low skeletal muscle mass were more likely to have cardiovascular events. Low muscle mass improved the predictive power of CVD incidence over the original risk score, indicating that muscle mass could be a valuable parameter and a declining value needed early detection in the population.
本研究旨在探讨骨骼肌质量与心血管事件之间的关联，以及其在评估心血管疾病（CVD）方面相对于传统风险评分的额外价值。
本研究纳入了 1365 名年龄在 50 岁以上且基线时无 CVD 的社区居民。参与者在基线时完成了详细的评估，并在 2021-2022 年通过电话或电子病历接受了随访评估。骨骼肌质量使用自动生物电阻抗分析仪进行测量。采用中国 PAR 方程分别估计每位参与者的 10 年动脉粥样硬化性心血管疾病（ASCVD）风险的预测概率。
平均随访 7.6 年后，共发生 144 例心血管事件。经过多因素调整后，骨骼肌质量和预测 10 年风险的 HRs 分别为 0.93（0.88-0.98）和 1.08（1.04-1.12）。在 60 岁以上且有两个或更多危险因素的参与者中，随着骨骼肌质量每降低一个三分位，心血管事件风险逐渐增加。ROC 曲线显示，在加入骨骼肌质量后，预测心血管事件的 10 年风险评估的 C 统计量略有增加。分类净重新分类改善（NRI）显示重新分类的增加了 56.7%。连续 NRI 和综合鉴别改善也有所增加。
骨骼肌质量低的参与者发生心血管事件的风险更高。低肌肉质量提高了 CVD 发生率的预测能力，表明肌肉质量可能是一个有价值的参数，在人群中需要早期检测其下降值。
