Relationship Between Low Skeletal Muscle Mass and Arteriosclerosis in Western China: A Cross-Sectional Study

Exploring the Association between Elevated Anxiety Symptoms and Low Skeletal Muscle Mass among Asymptomatic Adults: A Population-Based Study in Republic of Korea

Individuals with mental health problems are at higher risk of musculoskeletal diseases. However, the association between low muscle mass (LMM) and anxiety symptoms remains uninvestigated. This cross-sectional study enrolled 174,262 adults (73,833 women, 100,429 men), aged 18 to 89, who completed the anxiety scale and body composition analyses. Using bio-electrical impedance analysis, skeletal muscle mass index (SMI) was calculated based on appendicular skeletal muscle mass (ASM) (kg)/height (m2). LMM was defined as SMI < 7.0 kg/m2 in men and <5.4 kg/m2 in women. Anxiety symptoms were screened using the Clinical Useful Anxiety Outcome Scale (CUXOS) with cut-off scores of 20, 30, and 40. Multivariable logistic regression analyses were performed. LMM prevalence was 20.17% in women, 3.86% in men (p < 0.001). The prevalence of anxiety symptoms in LMM group decreased from mild (CUXOS > 20: women, 32.74%, men, 21.17%) to moderate (CUXOS > 30: 13.34%, 7.32%), to severe anxiety symptoms (CUXOS > 40: 4.00%, 1.73%). In multivariable-adjusted models, LMM was associated with mild (aOR (95% confidence interval)), women, 1.13 (1.08-1.17); men, 1.17 (1.08-1.27)), moderate (1.17 (1.11-1.24); 1.35 (1.19-1.53) and severe anxiety symptoms (1.18 (1.07-1.3), 1.36 (1.06-1.74)), demonstrating an increased risk of ORs with escalating anxiety severity. LMM was independently associated with a higher prevalence of anxiety symptoms.

Association between pulse pressure and low muscle mass in Korean adults: A nationwide cross-sectional study

Sarcopenia is characterized by a loss of muscle mass and strength and is associated with a high risk of cardiovascular events and increased mortality. Pulse pressure (PP) serves as a marker for changes in heart structure and function, as well as arterial stiffness. A high PP also increases the risk of cardiovascular disease and all-cause mortality. However, the relationship between PP and sarcopenia is poorly understood. We used the data of participants of the Korea National Health and Nutrition Examination Survey (KNHANES) of 2008 to 2011. Participants were divided into a control group (PP < 40 mm Hg) and a high-PP group (PP ≥ 40 mm Hg). PP was calculated by subtracting the diastolic blood pressure (DBP) from the systolic blood pressure (SBP), and the low muscle index was assessed using appendicular skeletal muscle mass (ASM) normalized by body mass index (BMI). Multiple logistic regression analyses were performed to examine the association between PP and the prevalence of low muscle mass, adjusting for potential confounders. The high-PP group had a higher age, SBP, DBP, and prevalence of hypertension, diabetes and hyperlipidemia than the control group. The high-PP group had a higher prevalence of low muscle mass than the control group in all models. A high PP is significantly associated with a higher prevalence of low muscle mass. Therefore, PP monitoring may help identify individuals at risk of sarcopenia and guide interventions to improve health outcomes.

The Association of Carbohydrate Antigen (CA) 19-9 Levels and Low Skeletal Muscle Mass in Healthy Adults

Carbohydrate antigen 19-9 (CA 19-9) is a commonly used tumor marker for pancreatic cancer. However, CA 19-9 can be overexpressed in several benign inflammatory diseases. We investigated the relationship between high CA 19-9 level and low muscle mass (LMM) in healthy adults without cancer. Participants who underwent evaluation of muscle mass and CA 19-9 were included. Exclusion criteria were any malignancy, cardiovascular disease, tuberculosis, and chronic lung/liver disease. Participants were classified into "normal", "mild LMM", and "severe LMM" groups based on the skeletal muscle mass index. Multivariable logistic regression analyses were conducted to assess the association of high CA 19-9 with muscle mass status. A total of 263,061 adults were included. The mean age and SMI were 41.03 years and 7.13 kg/m2. After adjustments for various confounders, high CA 19-9 was independently associated with mild LMM (adjusted odds ratio, 1.677 [95% confidence interval, 1.533-1.834]) and severe LMM (2.651 [2.126-3.306]) compared to the normal group. Furthermore, the association between high CA 19-9 and severe LMM was stronger in men than in women. Elevated CA 19-9 levels were independently associated with a higher prevalence of LMM in healthy adults without cancer. Therefore, increased CA 19-9 could be utilized as a novel biomarker for sarcopenia.

Exploring the Diversity of Visceral, Subcutaneous and Perivascular Adipose Tissue in a Vascular Surgery Population

The prevalence of obesity has doubled, with a concomitant increase in cardiovascular disease. This study aimed to compare the characteristics of visceral, subcutaneous and peri-aortic adipose tissue determined with computed tomography (CT) scans and to correlate them with cardiovascular risk factors, anthropometric measures and medication. An observational and prospective study was conducted, and 177 subjects were included. Peri-aortic adipose tissue had the highest density, while the subcutaneous adipose tissue had the lowest. The density of subcutaneous adipose tissue differs from the density of visceral (p = 0.00) and peri-aortic adipose tissue (p = 0.00). Smokers/ex-smokers had a lower area (p = 0.00) and density (p = 0.02) of subcutaneous adipose tissue. Multiple linear regression analysis showed that sex was a predictor of subcutaneous adipose tissue area (β = -0.27, t = -3.12, p = 0.00) but smoking habits were not. After controlling for sex, we found that the association between smokers/ex-smokers and area of subcutaneous adipose tissue was lost, but the association with density persisted. Patients with hypertension had a higher visceral adipose tissue area, and this relationship was maintained even after adjusting for gender. Peri-aortic adipose tissue is similar to visceral and distinct from subcutaneous adipose tissue. Cardiovascular risk factors have different influences in distinct adipose compartments.

Sarcopenia and Cardiovascular Diseases

Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be particularly important among those with chronic disease states. Early recognition of sarcopenia is important because it can provide an opportunity for interventions to reverse or delay the progression of muscle disorder, which may ultimately impact cardiovascular outcomes. Relying on body mass index is not useful for screening because many patients will have sarcopenic obesity, a particularly important phenotype among older cardiac patients. In this review, we aimed to: (1) provide a definition of sarcopenia within the context of muscle wasting disorders; (2) summarize the associations between sarcopenia and different cardiovascular diseases; (3) highlight an approach for a diagnostic evaluation; (4) discuss management strategies for sarcopenia; and (5) outline key gaps in knowledge with implications for the future of the field.

Increased Carcinoembryonic Antigen (CEA) Level Is Highly Associated with Low Skeletal Muscle Mass in Asymptomatic Adults: A Population-Based Study

We investigated the relationship between high carcinoembryonic antigen (CEA) levels and low skeletal muscle mass (LMM) in asymptomatic adults in a population-based study. A total of 202,602 adults (mean age 41.7 years) without malignancy, stroke, cardiovascular disease, or chronic lung/liver disease were included. A high CEA level was defined as ≥5 ng/mL. Skeletal muscle mass index (SMI) was calculated based on appendicular muscle mass (kg)/height (m)2. Participants were classified into three groups based on SMI: “normal”, “mild LMM”, and “severe LMM.” The prevalence of elevated CEA levels was the highest in subjects with severe LMM (4.2%), followed by those with mild LMM (1.6%) and normal muscle mass (1.1%) (p for trend < 0.001). In multivariate logistic regression analysis, high CEA was independently associated with having mild LMM (adjusted odds ratio, 1.139 [95% confidence interval, 1.092−1.188]) and severe LMM (2.611 [2.055−3.319]) compared to normal muscle mass. Furthermore, the association between high CEA and severe LMM was stronger in women than that in men (women, 5.373 [2.705−10.669]; men, 2.273 [1.762−2.933]). Elevated CEA levels were significantly associated with a higher prevalence of LMM. Therefore, increased CEA could be used as a biomarker for detecting LMM in adults without cancer.

SARC-F Is a Predictor of Longer LOS and Hospital Readmission in Hospitalized Patients after a Cardiovascular Event

It is already established that sarcopenia is associated with adverse outcomes; however, few studies have focused on patients who have suffered an acute cardiovascular event. The use of SARC-F, a 5-item sarcopenia screening questionnaire, in these patients remains to be investigated. We aimed to investigate whether SARC-F can predict adverse outcomes in patients admitted to a hospital with a suspected infarction. This is a 1-year prospective cohort study. During hospitalization, patients completed the SARC-F questionnaire (scores ≥ 4 considered positive for the risk of sarcopenia). Length of hospital stay (LOS), new hospital admission, myocardial infarction, and cardiovascular mortality were collected via medical records and phone interviews. In total, 180 patients were evaluated. The median age was 60.6 years; 72.3% of the participants were men, and half of the sample had comorbidities. The median SARC-F score was 1.0 (interquartile range, 0–3.0), and 21.1% of the participants screened positive. Risk of sarcopenia was independently associated with longer LOS (odds ratio, 2.34; 95% CI, 1.09–5.04; p = 0.030) and hospital readmission (odds ratio, 3.73; 95% CI, 1.60–8.69; p = 0.002). One-fifth of post-acute cardiovascular event patients in this cohort screened positive for sarcopenia using the SARC-F screening questionnaire. Positive scores were associated with a longer LOS and hospital readmission.