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Skeletal muscle mass predicts long-term CVD risk

Preserving skeletal muscle mass in middle age might contribute to maintaining cardiovascular health

Louise Prime

Wednesday, 13 November 2019

Preserving skeletal muscle mass in middle age – through physical activity including resistance training – might contribute to maintaining cardiovascular health, researchers* have suggested in the Journal of Epidemiology & Community Health, after they found that skeletal muscle mass at 45+ years old was inversely associated with 10-year cardiovascular disease (CVD) event risk among people with no pre-existing CVD.

The researchers explained that skeletal muscle mass (SMM) has previously been shown to be inversely associated with cardiometabolic health and the ageing process, and they wanted to evaluate the relation between SMM and CVD incidence. In the ATTICA study, they recruited 3,042 CVD-free men and women aged 45+ years, from the general Greek population. They collected comprehensive baseline data including demographic details, dietary and lifestyle habits; triglyceride, total cholesterol, high- and low-density lipoprotein cholesterol levels; resting blood pressure; and C- reactive protein (CRP), tumour necrosis factor α (TNFα) and interleukin-6 (IL-6). They also recorded height, body weight, waist and hip circumference as well as SMM, from which they calculated a skeletal muscle mass index (SMI).

The team followed participants for 10 years; the overall fatal or non-fatal 10-year CVD incidence was 26.7%. When they compared rates of fatal and non-fatal CVD among people of different initial muscle mass they found that the 10-year CVD incidence increased significantly across the baseline SMI tertiles: 31.7% of people in the first tertile developed CVD, 34.0% of those in the second tertile, and 14.0% of those in the third. Baseline SMM was also significantly inversely associated with the 10-year CVD incidence (hazard ratio, HR 0.06), even after adjusting for various confounders. Compared with people in the lowest SMI tertile, those in the middle tertile had a 54% lower 10-year risk of CVD and those in the highest tertile had 81% lower risk.

They concluded: “The findings of this study support the importance of skeletal muscle mass evaluation in the prediction of long-term cardiovascular disease risk among middle-aged and older adults without pre-existing cardiovascular disease.”

And they said: “The prevention of SMM decline, which is becoming increasingly prevalent among middle-aged and older populations, may constitute an effective means of promoting CVD health.” They suggested that periodic physical activity, including resistance training, and a diet rich in protein, might help to preserve lean muscle mass as people age.


*Tyrovolas S, Panagiotakos D, Georgousopoulou E, et al. Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the ATTICA study. J Epidemiol Community Health. Epub ahead of print: 11 November 2019. doi:10.1136/jech-2019-212268  doi 10.1136/jeh-2019-212268.

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