Skeletal Muscle Mass May Be Predictive of Long-Term CVD Risk

Skeletal muscle fibers
Skeletal muscle fibers
Evaluation of skeletal muscle mass may help predict long-term cardiovascular disease (CVD) risk in adults without preexisting CVD.

Evaluation of skeletal muscle mass may help predict long-term cardiovascular disease (CVD) risk in adults without preexisting CVD, according to research published in the Journal of Epidemiology and Community Health.

Using data from the prospective, population-based ATTICA study, researchers evaluated the relationship between skeletal muscle mass and the 10-year incidence of CVD in adults without preexisting CVD who were recruited between 2001 and 2002 (n=3042; ≥18 years; 49.8% men). A 10-year follow up was conducted from 2011 to 2012, and the median follow-up was 8.41 years. A total of 2583 of the initial participants were assessed at follow-up.

In this cohort, the 10-year incidence of fatal or nonfatal 10-year CVD was 26.7%. Participants with the lowest 10-year CVD incidence were in the highest tertile of baseline skeletal muscle mass index. These patients had a lower prevalence of obesity, hypertension, and diabetes, and they tended to be younger men, smokers, more physically active, and to observe a Mediterranean diet.

Three survival models accounting for various sociodemographic, lifestyle, and clinical variables were created. Baseline skeletal muscle mass index were found to consistently and independently be inversely associated with 10-year CVD incidence (hazard ratio [HR], 0.06; 95% CI, 0.005-0.78) in patients ≥45 years. Education level and Mediterranean diet adherence were also associated with a lower 10-year CVD risk (HR, 0.91 and 0.95, respectively; 95% CI, 0.84-0.99 and 0.91-0.99, respectively). The presence of hypertension and being a man were associated with a higher CVD risk in this population subset (HR, 1.64 and 3.7, respectively; 95% CI, 1.05-2.57 and 1.32-10.5, respectively).

Men were found to have a 6.1 times higher risk for incident CVD compared with women (95% CI, 2.45-15.18). Increased body mass index, but not waist circumference or waist-to-hip ratio, was also associated with a higher CVD risk. Additionally, skeletal muscle mass index values were found to be inversely associated with levels of interleukin-6, C-reactive protein, and fibrinogen. Further analysis indicated a lack of influence of these inflammatory markers on the relationship between skeletal muscle mass index and CVD.

Study limitations include the potential for measurement error in the baseline/study entry examination, as well as the lack of generalizability to populations outside of Greece.

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“It is of major interest…to study the [skeletal muscle mass] transition in order to better understand its role on CVD outcomes,” the researchers concluded. “The prevention of [skeletal muscle mass] decline, which is becoming increasingly prevalent among middle aged and older populations, may constitute an effective means of promoting CVD health.”


Tyrovolas S, Panagiotakos D, Georgousopoulou E, et al. Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the ATTICA study [published online November 11, 2019]. J Epidemiol Community Health. doi: 10.1136/jech-2019-212268