Hu Tingting, Xu Yiting, Li Xiaoya, Xiao Yunfeng, Wang Yufei, Ma Xiaojing, Bao Yuqian
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 Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China.
Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China.
Eur J Cardiovasc Nurs. 2025 Jun 12. doi: 10.1093/eurjcn/zvaf107.
Although several body sizes have been used in the adjustment of skeletal muscle mass (SMM), their predictive ability for cardiovascular events remained unclear. We aimed to assess and compare the predictive performance of SMM indices for cardiovascular events in middle-aged and older population, and evaluate their association according to different body shape subgroups.
This study included 1374 individuals (43.5% men) aged 50-80 years from four communities. The follow-up was conducted in 2021-2022 with a mean follow-up of 7.5 years. Cardiovascular events were recorded by phone calls and further validated using electronic medical records. Baseline SMM was estimated using a bioelectrical impedance analyzer and adjusted for weight (SMM/Wt), body mass index (SMM/BMI) and visceral fat area (SMM/VFA), respectively. Visceral fat area was measured using magnetic resonance imaging. During a median follow-up of 7.5 years, adjusted hazard ratios for the lowest tertile of SMM/Wt, SMM/BMI, and SMM/VFA were 1.80 (95%CI 1.17-2.77), 1.83 (95%CI 1.15-2.91), and 1.56 (95%CI 0.99-2.46) compared with the highest tertile, respectively. Regarding C-statistics, net reclassification improvement, and integrated discrimination improvement, the greatest improvement was observed when adding SMM/BMI to the model compared with SMM/Wt or SMM/VFA. Moreover, the association between SMM/BMI and cardiovascular events persisted regardless of age, sex, and different body shape subgroups (all P <0.05).
SMM indices were significantly associated with the incidence of cardiovascular events in the middle-aged and older population. SMM/BMI appeared to be a better muscle-relevant risk factor for cardiovascular events.
尽管已有多种身体尺寸指标用于调整骨骼肌质量（SMM），但其对心血管事件的预测能力仍不明确。我们旨在评估和比较SMM指数对中老年人群心血管事件的预测性能，并根据不同体型亚组评估它们之间的关联。
本研究纳入了来自四个社区的1374名年龄在50 - 80岁之间的个体（43.5%为男性）。随访时间为2021 - 2022年，平均随访时间为7.5年。通过电话记录心血管事件，并使用电子病历进一步验证。使用生物电阻抗分析仪估计基线SMM，并分别根据体重（SMM/Wt）、体重指数（SMM/BMI）和内脏脂肪面积（SMM/VFA）进行调整。使用磁共振成像测量内脏脂肪面积。在中位随访7.5年期间，与最高三分位数相比，SMM/Wt、SMM/BMI和SMM/VFA最低三分位数的调整后风险比分别为1.80（95%CI 1.17 - 2.77）、1.83（95%CI 1.15 - 2.91）和1.56（95%CI 0.99 - 2.46）。关于C统计量、净重新分类改善和综合判别改善，与SMM/Wt或SMM/VFA相比，在模型中添加SMM/BMI时观察到最大的改善。此外，无论年龄、性别和不同体型亚组如何，SMM/BMI与心血管事件之间的关联均持续存在（所有P <0.05）。
SMM指数与中老年人群心血管事件的发生率显著相关。SMM/BMI似乎是心血管事件更好的肌肉相关危险因素。
