Association between sarcopenia and cardiovascular disease among middle-aged and older adults: Findings from the China health and retirement longitudinal study

Abstract

Background: Little is known about the association between sarcopenia and cardiovascular disease (CVD) among middle-aged and older adults. Using the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS), we conducted cross-sectional and longitudinal analyses to investigate the association between sarcopenia status and CVD in middle-aged and older Chinese population.

Methods: The sample comprised 15,137 participants aged at least 45 years from the CHARLS 2015. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. A total of 11,863 participants without CVD were recruited from the CHARLS 2015 and were followed up in 2018. Cox proportional hazards regression models were conducted to examine the effect of sarcopenia on CVD.

Findings: The pre valence of CVD in total populations, no-sarcopenia, possible sarcopenia and sarcopenia individuals were 12.6% (1905/15,137), 10.0% (1026/10,280), 18.1% (668/3685), 18.0% (211/1172), respectively. Both possible sarcopenia [OR (95% CI): 1.29 (1.13-1.48)] and sarcopenia [1.72 (1.40-2.10)] were associated with CVD in total populations. During the 3.6 years of follow-up, 1,273 cases (10.7%) with incident CVD were identified. In the longitudinal analysis, individuals with the diagnosis of possible sarcopenia (HR:1.22, 95% CI: 1.05-1.43) and sarcopenia participants (HR:1.33, 95% CI: 1.04-1.71) were more likely to have new onset CVD than no-sarcopenia peers.

Interpretation: Both possible sarcopenia and sarcopenia, assessed using the AWGS 2019 criteria, were associated with higher CVD risk among middle-aged and older Chinese adults.

Funding: None.

Keywords: Cardiovascular diseases; Low muscle mass; Possible sarcopenia; Sarcopenia.

Figure 1

Flow diagram for participants included in the study. Abbreviation: BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; CVD, cardiovascular disease.

Figure 2

ORs and 95% CIs of CVD and its components by sarcopenia status in the cross-sectional analysis. Forest plots show odds ratios (ORs) and 95%CIs for A) CVD, B) heart disease, and C) stroke adjusted for age, sex, residence, marital status, educational level, smoking status, drinking status, BMI, SBP, DBP; history of hypertension, dyslipidemia, diabetes, chronic kidney disease; and use hypertension medications, diabetes medications, and lipid-lowering therapy. ORs, odds ratios; CVD, cardiovascular disease; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Figure 3

Longitudinal association of baseline sarcopenia status with incident CVD, 2015–2018. Graph shows hazard ratios (HRs) and 95%CIs for A) CVD, B) heart disease, and C) stroke adjusted for age, sex, residence, marital status, educational level, smoking status, drinking status, BMI, SBP, DBP; history of hypertension, dyslipidemia, diabetes, chronic kidney disease; and use hypertension medications, diabetes medications, and lipid-lowering therapy. CVD, cardiovascular disease; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure.