Prognostic Value of Arm Circumference for Cardiac Damage and Major Adverse Cardiovascular Events: A Friend or a Foe? A 2-Year Follow-Up in the Northern Shanghai Study

Abstract

Background: The high prevalence of cardiovascular diseases globally causes a great social burden and much individual suffering. The effective recognition of high-risk subjects is critical for primary prevention in the general population. In the elderly cohort, anthropometric measurements may have different prognostic values. Our study aimed to find convincing anthropometric measures to supplement conventional risk factors for major adverse cardiovascular events (MACEs) in the elderly cohort.

Materials and methods: A total of 1,576 elderly participants (44.5% male, aged 72.0 ± 6.0 years) recruited into the Northern Shanghai Study (2014-2015) were followed up between 2016 and 2017. Following the standard guideline for cardiovascular risk evaluation, all conventional cardiovascular risk factors were assessed. The body measures were made up of body weight, body height, hip circumference, waist circumference, and middle-upper arm circumference (MUAC). Organ damage (OD) markers for cardiac, vascular, and renal diseases will be evaluated by the standardized methods.

Results: After the average 571 (±135) days of follow-up, a total of 90 MACEs (5.7%) occurred, i.e., 13 non-fatal myocardial infarction, 68 non-fatal stroke, and 9 cardiovascular deaths. Univariable COX survival analysis revealed that only MUAC could validly predict MACEs among anthropometric characters [adjusted hazard ratio (HR) 0.89; 95% confidence interval (CI) 0.82-0.96]. In Kaplan-Meier analysis, the group of high MUAC showed the lowest MACE risk (log-rank p = 0.01). Based on OD analysis, MUAC was independently linked to higher risk of left ventricular hypertrophy (LVH) in women and left ventricular diastolic dysfunction (LVDD) in both men and women. In adjusted COX analysis, only MUAC indicated statistical significance, but all other anthropometric parameters such as BMI, waist circumference, and waist-to-hip ratio (WHR) did not indicate significance. The higher level of MUAC remained a protective factor in fully adjusted models (HR: 0.73; 95% CI: 0.59-0.91), with p-values markedly significant in men (HR: 0.69; 95% CI: 0.49-0.97) and marginally significant in women (HR: 0.0.77; 95% CI: 0.59-1.01). After considering all factors (i.e., cardiovascular risk factors, MUAC, BMI, and WHR), the fully adjusted COX regression analysis demonstrated that the increased MUAC level was linked to decreased MACE risk in both men (HR: 0.57; 95% CI: 0.37-0.88) and women (aHR: 0.64; 95% CI: 0.46-0.93).

Conclusion: Despite being associated with a higher rate of cardiac damage, higher MUAC independently and significantly conferred protection against the MACE, in the elderly cohort.

Keywords: Chinese; anthropometric measurement; cardiovascular; elderly; health care; target organ damage.

FIGURE 1

Kaplan-Meier plots of anthropometry factors for MACE. (A) Male and female participants were, respectively, divided into three groups according to the tertiles of MUAC level (low group: male MUAC ≤ 26.3 cm, female MUAC ≤ 25.9 cm; mid group: male < 26.3 ≤ MUAC ≤ 28.5 cm, female 25.0 < MUAC ≤ 28.0 cm; and high group: male MUAC > 28.5 cm, female > 28.0 cm). (B) Participants were divided into obesity (BM ≥ 28 kg/m²) and non-obesity. (C) Participants were divided into central obesity (WC ≥ 85 cm for male and ≥ 80 cm for female) and non-central obesity. MUAD, middle-up arm circumference.

FIGURE 2

Multivariate Cox regression of risk factors for MACE. MUAC, middle-upper arm circumference; BMI, body mass index; eGFR, estimated glomerular filtration rate; DM, diabetes mellitus; CHD, coronary heart disease. *P-value < 0.05 were considered significant.

FIGURE 3

Association of LVH, LVDD with MUAC analyzed by univariate regression in male, female, and overall. aHR of MUAC for MACE analysis by multivariate Cox regression adjusted by age, BMI < WHR, hypertension, diabetes mellitus, hyperlipidemia, estimated glomerular filtration rate, stroke history, coronary heart disease history, and smoking (only in the model of male and overall). MUAC, middle-up arm circumference; LVH, left ventricular hypertrophy; LVDD, left ventricular diastolic dysfunction; MACE, major adverse cardiovascular event.