Association of Skeletal Muscle and Cardiovascular Risk Factors in Patients with Lower Extremity Arterial Disease

Abstract

Background: Sarcopenia is defined as low muscle mass, with low muscle strength or low physical performance. The skeletal muscle mass (or density) and strength are inversely associated with cardiovascular risk factors. We aim to determine the relationship between skeletal muscle characteristics (strength, mass, area), and cardiovascular risk factors in a population with lower extremity artery disease (LEAD).

Methods: An observational, prospective study including patients with LEAD was conducted from January 2018 to December 2020. The cardiovascular risk factors and anthropometric measurements were prospectively registered. The skeletal muscle characteristics (area, density/mass and strength) were analysed. The skeletal muscle area and density were quantified with a CT scan. The strength was determined with a Jamar® hydraulic hand dynamometer.

Results: A total of 96 patients with LEAD with 67.70 ± 10.11 years-old were enrolled in the study. The most prevalent cardiovascular risk factor was hypertension, followed by dyslipidemia and diabetes. Patients with diabetes had a lower handgrip strength and skeletal muscle density, when compared with patients without diabetes (strength: 19.67 ± 9.98 kgf vs. 26.79 ± 11.80 kgf, P = 0.002 and skeletal muscle density: 10.58 ± 17.61 HU vs. 18.17 ± 15.33 HU, P = 0.032). There was a trend for the association between the presence of cardiovascular risk factors (hypertension and dyslipidemia) and a decrease in skeletal muscle density and strength (density: hypertension: 13.46 ± 16.74 HU vs. 20.38 ± 11.63 HU P=0.055; dyslipidemia: 13.57 ± 17.16 HU vs. 17.74 ± 13.00 HU P= 0.315; strength- hypertension: 22.55 ± 10.08 kgf vs. 27.58 ± 15.11 P= 0.073; dyslipidemia: 22.80 ± 10.52 kgf vs. 25.28 ± 13.14 kgf P= 0.315). Interestingly, we found that smokers had a favorable skeletal muscle characteristic, which could be explained by the higher prevalence of diabetes in nonsmokers.

Conclusions: The indicators of skeletal muscle dysfunction (strength and density) are associated to the presence of diabetes in patients with LEAD. Therapeutic strategies to improve the skeletal muscle characteristics could have a role in improving LEAD risk factors, particularly diabetes.