Low appendicular skeletal muscle index increases the risk of carotid artery plaque in postmenopausal women with and without hypertension/hyperglycemia: a retrospective study

Abstract

Background: This study aimed to evaluate whether the low appendicular skeletal muscle index (ASMI) is closely associated with the risk of carotid artery plaque (CAP) in postmenopausal women with and without hypertension/hyperglycemia stratified by body mass index (BMI) categories.

Methods: A total of 2048 Chinese postmenopausal women aged 40-88 years were eventually enrolled in this retrospective study. Skeletal muscle mass was estimated by using segmental multifrequency bioelectrical impedance analysis. ASMI was defined as follows: appendicular skeletal muscle mass(kg)/[height(m)]². CAP was assessed by B-mode ultrasound. We explored the association between ASMI quartiles or low skeletal muscle mass and the risk of CAP by using multivariate-adjusted logistic regression models. A potential nonlinear relationship was also tested using restricted cubic spline regression.

Results: CAP was observed in 289/1074 (26.9%) normal-weight and 319/974 (32.8%) overweight/obese postmenopausal women. Individuals with CAP had significantly lower ASMI values than those without (P < 0.001). The ASMI value also showed a linear relationship with the CAP risk in postmenopausal women stratified by BMI category (P_{for non-linearity} > 0.05). In comparison with the highest ASMI quartile, the lowest ASMI quartile was significantly associated with a high risk of CAP development in non-hypertensive individuals with normal weight (odds ratio [OR] = 2.43; 95% confidence interval [CI]: 1.44 ~ 4.12) or overweight/obesity (OR = 4.82, 95% CI: 2.79 ~ 8.33), hypertensive individuals with normal weight (OR = 5.90, 95% CI: 1.46 ~ 11.49) or overweight/obesity (OR = 7.63, 95% CI: 1.62 ~ 35.86), non-hyperglycemic individuals with normal weight (OR = 2.61, 95% CI: 1.54 ~ 4.43) or overweight/obesity (OR = 2.94, 95% CI: 1.84 ~ 4.70), and hyperglycemic individuals with normal weight (OR = 6.66, 95% CI: 1.08 ~ 41.10) or overweight/obesity (OR = 8.11, 95% CI: 2.69 ~ 24.49). Moreover, low skeletal muscle was independently associated with the risk of CAP in postmenopausal women, regardless of the BMI category.

Conclusion: ASMI was inversely associated with the risk of CAP development in postmenopausal women, especially in patients with high blood sugar and/or hypertension, indicating that skeletal muscle mass maintenance may contribute to prevention of CAP in postmenopausal women.

Keywords: Appendicular skeletal muscle index; Carotid artery plaque; Hyperglycemia; Hypertension; Postmenopausal women.

Fig. 1

Comparison of ASMI values among groups with normal weight and overweight/obesity; ***, P < 0.001

Fig. 2

Comparison of ASMI values among groups with and without hypertension (NWNH, normal weight without hypertension; NWH, normal weight with hypertension; OONH, overweight/obesity without hypertension; OOH, overweight/obesity with hypertension); ***, P<0.001

Fig. 3

Comparison of ASMI values among groups with and without prediabetes/diabetes (NWND, normal weight without prediabetes/diabetes; NWD, normal weight with prediabetes/diabetes; OOND, overweight/obesity without prediabetes/diabetes; OOD, overweight/obesity with prediabetes/diabetes); ***, P < 0.001

Fig. 4

(1). Dose-response relationship between ASMI and risk of CAP in postmenopausal women in the normal-weight group. The long solid line indicates that OR is equal to 1, the red line and the area between the short dashed lines indicate ORs and their 95% CIs. (2). Dose-response relationship between ASMI and risk of CAP in postmenopausal women in the overweight/obese group. The long solid line indicates that OR is equal to 1, the red line and the area between the short dashed lines indicate ORs and their 95% CIs.

Fig. 5

Association between low muscle mass and CAP risk in individuals in different BMI categories stratified by hyperglycemia and hypertension status. **P < 0.01, ***P < 0.001