Liu Weike, Zhang Hua, Wang Xin, Song Huajing, Yao Yanli, Liu Zhendong, Wang Juan, Guo Yuqi
Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China.
Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, No. 16766, Jingshi Road, Jinan, 250014, Shandong, China.
Cardiovasc Diabetol. 2025 Apr 9;24(1):157. doi: 10.1186/s12933-025-02714-8.
Skeletal muscle mass loss and insulin resistance (IR) are associated with cardiovascular diseases risk. However, it remains unclear whether the combination of skeletal muscle mass loss and elevated IR affects heart failure (HF) risk. Here, we investigate the association between a combination of appendicular skeletal muscle mass index (ASMI) with estimated glucose disposal rate (eGDR) and HF risk in older adults.
A prospective analysis and a dual-trajectory analysis were carried out to investigate the association of the combined effect of ASMI and eGDR with HF risk. A total of 11,596 adults aged ≥ 60 years were enrolled from the community for prospective analysis. Among them, 10,489 were eligible for the dual-trajectory analysis. The temporal evolution of ASMI and eGDR was determined using a dual-trajectory model.
In the prospective analysis, 1087 individuals developed HF. Restricted cubic splines analysis showed L-shaped associations between ASMI and eGDR and HF risk. HF risk decreased by 32.3% (hazard ratio (HR): 0.677, 95% confidence interval (CI): 0.623-0.734, P < 0.001) for female and 9.0% (HR 0.910, 95% CI 0.831-0.996, P = 0.003) for male patients per one standard deviation (SD) AMSI increment and 29.4% (HR 0.706, 95% CI 0.647-0.770, P < 0.001) for female and 26.8% (HR 0.732, 95% CI 0.668-0.803, P < 0.001) for male patients per one SD eGDR increment. There was a synergistic effect on HF risk per one SD ASMI and eGDR increment (P < 0.001). Five distinct dual ASMI and eGDR trajectories were identified in the dual-trajectory analysis. A total of 859 (8.85 per 1000 person-years) individuals developed HF. Compared to group 4 with moderate-stable ASMI and eGDR and the lowest incident HF, the HR in group 5 characterized by low-stable ASMI and eGDR was 1.908 (95% CI 1.482-2.457, P < 0.001), followed by 1.716 (95% CI 1.296-2.273, P < 0.001) in group 3 with low-decrease ASMI and high-decrease eGDR.
Skeletal muscle mass loss and elevated IR act synergistically to increase the HF risk in older adults. Comprehensive management of muscle mass and IR might be a useful and effective strategy for preventing and controlling HF.
Retrospectively registered number ChiCTREOC17013598.
骨骼肌质量损失和胰岛素抵抗（IR）与心血管疾病风险相关。然而，骨骼肌质量损失与升高的IR相结合是否会影响心力衰竭（HF）风险仍不清楚。在此，我们研究老年人中四肢骨骼肌质量指数（ASMI）与估计葡萄糖处置率（eGDR）的组合与HF风险之间的关联。
进行前瞻性分析和双轨迹分析，以研究ASMI和eGDR的联合效应与HF风险的关联。共有11596名年龄≥60岁的成年人从社区纳入进行前瞻性分析。其中，10489人符合双轨迹分析条件。使用双轨迹模型确定ASMI和eGDR的时间演变。
在前瞻性分析中，1087人发生HF。受限立方样条分析显示ASMI和eGDR与HF风险之间呈L形关联。每增加一个标准差（SD）的ASMI，女性HF风险降低32.3%（风险比（HR）：0.677，95%置信区间（CI）：0.623 - 0.734，P < 0.001），男性患者降低9.0%（HR 0.910，95% CI 0.831 - 0.996，P = 0.003）；每增加一个SD的eGDR，女性HF风险降低29.4%（HR 0.706，95% CI 0.647 - 0.770，P < 0.001），男性患者降低26.8%（HR 0.732，95% CI 0.668 - 0.803，P < 0.001）。每增加一个SD的ASMI和eGDR对HF风险有协同作用（P < 0.001）。在双轨迹分析中确定了五种不同的ASMI和eGDR双轨迹。共有859人（每1000人年8.85人）发生HF。与ASMI和eGDR中等稳定且HF发生率最低的第4组相比，以低稳定ASMI和eGDR为特征的第5组的HR为1.908（95% CI 1.482 - 2.457，P < 0.001），其次是以ASMI低下降和eGDR高下降为特征的第3组，HR为1.716（95% CI 1.296 - 2.273，P < 0.001）。
骨骼肌质量损失和升高的IR协同作用增加老年人的HF风险。肌肉质量和IR的综合管理可能是预防和控制HF的有用且有效的策略。
回顾性注册编号ChiCTREOC17013598。
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