Is dynapenic abdominal obesity a risk factor for cardiovascular mortality? A competing risk analysis

Abstract

Background: Dynapenic abdominal obesity has been shown as a risk factor for all-cause mortality in older adults. However, there is no evidence on the association between this condition and cardiovascular mortality.

Objective: We aimed to investigate whether dynapenic abdominal obesity is associated with cardiovascular mortality in individuals aged 50 and older.

Methods: A longitudinal study with an 8-year follow-up was conducted involving 7,030 participants of the English Longitudinal Study of Ageing study. Abdominal obesity and dynapenia were respectively defined based on waist circumference (> 102 cm for men and > 88 cm for women) and grip strength (< 26 kg for men and < 16 kg for women). The sample was divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO). The outcome was cardiovascular mortality. The Fine-Grey regression model was used to estimate the risk of cardiovascular mortality as a function of abdominal obesity and dynapenia status in the presence of competing events controlled by socio-demographic, behavioural and clinical variables.

Results: The risk of cardiovascular mortality was significantly higher in individuals with D/AO compared with ND/NAO (SHR 1.85; 95% CI: 1.15-2.97). D/NAO was also associated with cardiovascular mortality (SHR: 1.62; 95% CI: 1.08-2.44).

Conclusion: Dynapenic abdominal obesity is associated with cardiovascular mortality, with a larger effect size compared to dynapenia alone in individuals older than 50 years. Thus, prevention strategies and clinical interventions that enable mitigating the harmful effects of these conditions should be adopted to diminish such risk.

Keywords: English Longitudinal Study of Ageing (ELSA) study; abdominal obesity; cardiovascular disease; dynapenia; mortality; older people.

Figure 1

Cumulated incidence function for cardiovascular mortality according to dynapenic abdominal obesity status in presence of competing risks in 7,030 participants of ELSA (2004–2012). ND/NAO: non-dynapenic/non-abdominal obesity; ND/AO: non-dynapenic/abdominal obesity; D/NAO: dynapenic/non-abdominal obesity; D/AO: dynapenic/abdominal obesity. P < 0.001.