Skeletal muscle mass in acute coronary syndrome prognosis

Gender-based analysis from Hellenic Heart Failure cohort

M. Kouvari, C. Chrysohoou, P. Dilaveris, G. Georgiopoulos, N. Magkas, P. Aggelopoulos, D. B. Panagiotakos, D. Tousoulis

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Abstract

Background and aims: Predictive and prognostic ability of muscle mass in CVD settings is increasingly discussed. The gender-specific effect of skeletal muscle mass index (SMI) on 10-year recurrent fatal/non fatal cardiovascular disease (CVD) event of acute coronary syndrome (ACS) patients was evaluated. Methods and results: In 2006–2009, n = 1000 consecutive patients (n = 222 women), hospitalized at the First Cardiology Clinic of Athens with ACS diagnosis and with symptoms and left ventricular function indicative of heart failure were selected. SMI was created to reflect skeletal muscle mass through appendicular skeletal muscle mass (indirectly calculated through population formulas) divided by body mass index (BMI). In the 10-year follow-up (2016), 55% of ACS patients experienced recurrent fatal/non fatal CVD events (53% in women vs.62% in men, p = 0.04). Patients in the 2nd SMI tertile (mostly overweight) had 10% lower risk for CVD recurrence (women:men rate ratio = 0.87) over their counterparts in the 1st (mostly normalweight) and 3rd tertile (mostly obese). Multivariate analysis revealed that ACS patients in the 2nd SMI tertile presented 46% and 85% lower CVD event risk over their counterparts in the 1st tertile (Hazard Ratio (HR) = 0.54, 95% Confidence Interval (95% CI) 0.30, 0.96, p = 0.002) and 3rd tertile (HR = 1.85, 95%CI 1.05, 2.94, p = 0.03). Gender-based analysis revealed that this trend remained significant only in women. Inflammatory markers had strong confounding effect. Conclusion: A U-shape association between SMI and 10-year CVD event especially in women was highlighted. This work reveals gender-specific remarks for “obesity-lean paradox” in secondary prevention, implying that high muscle mass accompanied by obesity and excess adiposity may not guarantee better prognosis.

Original languageEnglish
Pages (from-to)718-727
Number of pages10
JournalNutrition, Metabolism and Cardiovascular Diseases
Volume29
Issue number7
DOIs
Publication statusPublished - 1 Jul 2019

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Acute Coronary Syndrome
Skeletal Muscle
Heart Failure
Cardiovascular Diseases
Obesity
Muscles
Adiposity
Secondary Prevention
Cardiology
Left Ventricular Function
Body Mass Index
Multivariate Analysis
Confidence Intervals
Recurrence
Population

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Kouvari, M., Chrysohoou, C., Dilaveris, P., Georgiopoulos, G., Magkas, N., Aggelopoulos, P., ... Tousoulis, D. (2019). Skeletal muscle mass in acute coronary syndrome prognosis: Gender-based analysis from Hellenic Heart Failure cohort. Nutrition, Metabolism and Cardiovascular Diseases, 29(7), 718-727. https://doi.org/10.1016/j.numecd.2019.03.011
Kouvari, M. ; Chrysohoou, C. ; Dilaveris, P. ; Georgiopoulos, G. ; Magkas, N. ; Aggelopoulos, P. ; Panagiotakos, D. B. ; Tousoulis, D. / Skeletal muscle mass in acute coronary syndrome prognosis : Gender-based analysis from Hellenic Heart Failure cohort. In: Nutrition, Metabolism and Cardiovascular Diseases. 2019 ; Vol. 29, No. 7. pp. 718-727.
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Kouvari, M, Chrysohoou, C, Dilaveris, P, Georgiopoulos, G, Magkas, N, Aggelopoulos, P, Panagiotakos, DB & Tousoulis, D 2019, 'Skeletal muscle mass in acute coronary syndrome prognosis: Gender-based analysis from Hellenic Heart Failure cohort', Nutrition, Metabolism and Cardiovascular Diseases, vol. 29, no. 7, pp. 718-727. https://doi.org/10.1016/j.numecd.2019.03.011

Skeletal muscle mass in acute coronary syndrome prognosis : Gender-based analysis from Hellenic Heart Failure cohort. / Kouvari, M.; Chrysohoou, C.; Dilaveris, P.; Georgiopoulos, G.; Magkas, N.; Aggelopoulos, P.; Panagiotakos, D. B.; Tousoulis, D.

In: Nutrition, Metabolism and Cardiovascular Diseases, Vol. 29, No. 7, 01.07.2019, p. 718-727.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Skeletal muscle mass in acute coronary syndrome prognosis

T2 - Gender-based analysis from Hellenic Heart Failure cohort

AU - Kouvari, M.

AU - Chrysohoou, C.

AU - Dilaveris, P.

AU - Georgiopoulos, G.

AU - Magkas, N.

AU - Aggelopoulos, P.

AU - Panagiotakos, D. B.

AU - Tousoulis, D.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background and aims: Predictive and prognostic ability of muscle mass in CVD settings is increasingly discussed. The gender-specific effect of skeletal muscle mass index (SMI) on 10-year recurrent fatal/non fatal cardiovascular disease (CVD) event of acute coronary syndrome (ACS) patients was evaluated. Methods and results: In 2006–2009, n = 1000 consecutive patients (n = 222 women), hospitalized at the First Cardiology Clinic of Athens with ACS diagnosis and with symptoms and left ventricular function indicative of heart failure were selected. SMI was created to reflect skeletal muscle mass through appendicular skeletal muscle mass (indirectly calculated through population formulas) divided by body mass index (BMI). In the 10-year follow-up (2016), 55% of ACS patients experienced recurrent fatal/non fatal CVD events (53% in women vs.62% in men, p = 0.04). Patients in the 2nd SMI tertile (mostly overweight) had 10% lower risk for CVD recurrence (women:men rate ratio = 0.87) over their counterparts in the 1st (mostly normalweight) and 3rd tertile (mostly obese). Multivariate analysis revealed that ACS patients in the 2nd SMI tertile presented 46% and 85% lower CVD event risk over their counterparts in the 1st tertile (Hazard Ratio (HR) = 0.54, 95% Confidence Interval (95% CI) 0.30, 0.96, p = 0.002) and 3rd tertile (HR = 1.85, 95%CI 1.05, 2.94, p = 0.03). Gender-based analysis revealed that this trend remained significant only in women. Inflammatory markers had strong confounding effect. Conclusion: A U-shape association between SMI and 10-year CVD event especially in women was highlighted. This work reveals gender-specific remarks for “obesity-lean paradox” in secondary prevention, implying that high muscle mass accompanied by obesity and excess adiposity may not guarantee better prognosis.

AB - Background and aims: Predictive and prognostic ability of muscle mass in CVD settings is increasingly discussed. The gender-specific effect of skeletal muscle mass index (SMI) on 10-year recurrent fatal/non fatal cardiovascular disease (CVD) event of acute coronary syndrome (ACS) patients was evaluated. Methods and results: In 2006–2009, n = 1000 consecutive patients (n = 222 women), hospitalized at the First Cardiology Clinic of Athens with ACS diagnosis and with symptoms and left ventricular function indicative of heart failure were selected. SMI was created to reflect skeletal muscle mass through appendicular skeletal muscle mass (indirectly calculated through population formulas) divided by body mass index (BMI). In the 10-year follow-up (2016), 55% of ACS patients experienced recurrent fatal/non fatal CVD events (53% in women vs.62% in men, p = 0.04). Patients in the 2nd SMI tertile (mostly overweight) had 10% lower risk for CVD recurrence (women:men rate ratio = 0.87) over their counterparts in the 1st (mostly normalweight) and 3rd tertile (mostly obese). Multivariate analysis revealed that ACS patients in the 2nd SMI tertile presented 46% and 85% lower CVD event risk over their counterparts in the 1st tertile (Hazard Ratio (HR) = 0.54, 95% Confidence Interval (95% CI) 0.30, 0.96, p = 0.002) and 3rd tertile (HR = 1.85, 95%CI 1.05, 2.94, p = 0.03). Gender-based analysis revealed that this trend remained significant only in women. Inflammatory markers had strong confounding effect. Conclusion: A U-shape association between SMI and 10-year CVD event especially in women was highlighted. This work reveals gender-specific remarks for “obesity-lean paradox” in secondary prevention, implying that high muscle mass accompanied by obesity and excess adiposity may not guarantee better prognosis.

KW - Body composition

KW - Heart disease

KW - Lean mass

KW - Obesity

KW - Secondary prevention

KW - Sex

KW - Women

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DO - 10.1016/j.numecd.2019.03.011

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JO - Nutrition, Metabolism and Cardiovascular Diseases

JF - Nutrition, Metabolism and Cardiovascular Diseases

SN - 0939-4753

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