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. 2012 Mar 27;59(13):1159-67.
doi: 10.1016/j.jacc.2011.12.019.

Calf muscle characteristics, strength measures, and mortality in peripheral arterial disease: a longitudinal study

Mary M McDermott  1 , Kiang Liu, Lu Tian, Jack M Guralnik, Michael H Criqui, Yihua Liao, Luigi Ferrucci
Affiliations

Calf muscle characteristics, strength measures, and mortality in peripheral arterial disease: a longitudinal study

Mary M McDermott et al. J Am Coll Cardiol. .

Abstract

Objectives: This study analyzed whether lower calf muscle density and poorer upper and lower extremity strength are associated with higher mortality rates in men and women with peripheral arterial disease (PAD).

Background: Men and women with lower extremity PAD have lower calf muscle density and reduced lower extremity strength compared with individuals without PAD.

Methods: At baseline, participants underwent measurement of calf muscle density with computed tomography in addition to knee extension power and isometric knee extension, plantar flexion, and hand grip strength measures. Participants were followed up annually for up to 4 years. Results were adjusted for age, sex, race, body mass index, ankle-brachial index, smoking, physical activity, and comorbidities.

Results: Among 434 PAD participants, 103 (24%) died during a mean follow-up of 47.6 months. Lower calf muscle density was associated with higher all-cause mortality (lowest density tertile hazard ratio [HR]: 1.80 [95% confidence interval (CI): 1.07 to 3.03], second tertile HR: 0.91 (95% CI: 0.51 to 1.62); highest density tertile HR: 1.00; p trend = 0.020) and higher cardiovascular disease mortality (lowest density tertile HR: 2.39 [95% CI: 0.90 to 6.30], second tertile HR: 0.85 [95% CI: 0.27 to 2.71]; highest density tertile HR: 1.00; p trend = 0.047). Poorer plantar flexion strength (p trend = 0.004), lower baseline leg power (p trend = 0.046), and poorer handgrip (p trend = 0.005) were associated with higher all-cause mortality.

Conclusions: These data demonstrate that lower calf muscle density and weaker plantar flexion strength, knee extension power, and hand grip were associated with increased mortality in these participants with PAD, independently of the ankle-brachial index and other confounders.

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Figures

Figure 1
Figure 1. Adjusted Association of baseline calf muscle density with all-cause mortality in participants with peripheral arterial disease (N=434)
Model 1. Adjusted for age, sex, and race. Model 2. Adjusted for covariates in Model 1 and the ankle brachial index, body mass index, comorbidities, physical activity, smoking history and study cohort (WALCS vs. WALCS II). 1P=0.008 for the comparison between the highest and lowest tertiles. 2 P=0.028 for the comparison between the highest and lowest tertiles.
Figure 2
Figure 2. Adjusted Associations of baseline calf muscle density with cardiovascular disease mortality in participants with peripheral arterial disease (N=434)
Model 1. Adjusted for age, sex, and race. Model 2. Adjusted for covariates in Model 1 and the ankle brachial index, body mass index, comorbidities, physical activity, smoking history and study cohort (WALCS vs. WALCS II). 1P=0.020 for the comparison between the highest and lowest tertiles.
Figure 3
Figure 3. Adjusted Associations of baseline knee extension power with all-cause mortality in participants with peripheral arterial disease (N=391)
Model 1. Adjusted for age, sex, and race. Model 2. Adjusted for covariates in Model 1 and the ankle brachial index, body mass index, comorbidities, physical activity, smoking history and study cohort (WALCS vs. WALCS II). 1P=0.006 for the comparison between the highest and lowest tertiles. 2 P=0.038 for the comparison between the highest and lowest tertiles.
Figure 4
Figure 4. Adjusted Associations of baseline plantar flexion strength with all-cause mortality in participants with peripheral arterial disease (N=330)
Model 1. Adjusted for age, sex, and race. Model 2. Adjusted for covariates in Model 1 and the ankle brachial index, body mass index, comorbidities, physical activity, smoking history and study cohort (WALCS vs. WALCS II). 1P=0.0003 for the comparison between the highest and lowest tertiles. 2 P=0.002 for the comparison between the highest and lowest tertiles.
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References

    1. Allison MA, Ho E, Denenberg JO, et al. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007;32:328–333. - PubMed
    1. McDermott MM, Greenland P, Liu K, et al. The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med. 2002;136:873–883. - PubMed
    1. McDermott MM, Liu K, Greenland P, et al. Functional decline in peripheral arterial disease: Associations with the ankle brachial index and leg symptoms. JAMA. 2004;292:453–461. - PubMed
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