Sarcopenia, but not excess weight or increased caloric intake, is associated with coronary subclinical atherosclerosis in the very elderly


      • Population aging is rapidly increasing worldwide, especially in developing countries.
      • Incidence and mortality due to cardiovascular diseases are extremely high in the very elderly population.
      • There is no specific algorithm for the atherosclerotic cardiovascular disease risk estimation in the short, medium or long-term in very elderly individuals.
      • It is important to assess the main risk factors that could lead the very elderly individuals to manifest atherosclerotic disease, to adopt a strategy of prevention.


      Background and aims

      Excess weight is a widespread condition related to increased risk of coronary heart disease (CHD). Sarcopenia is a catabolic pathway common of the aging process and also associated with CHD. In the elderly, both changes occur concurrently and it remains unclear the relative contribution on CHD risk. We aimed to investigate whether sarcopenia, excess weight, or both are associated with subclinical atherosclerosis and/or endothelial dysfunction in very elderly individuals.


      We performed a cross-sectional study of cohort enrolled individuals, aged 80 years or older (n = 208), who had never manifested cardiovascular diseases. Blood tests, medical and nutritional evaluations, cardiac computed tomography, flow-mediated dilation (FMD) and physical performance tests were obtained at the study admission. Odds ratio (OR) was calculated by multivariate regression models using coronary calcium score (CCS) categories and FMD as dependent variables. Adjustment for potential confounders was done.


      Muscle mass, but not fatty mass, was inversely associated with CCS categories [OR:2.54(1.06–6.06); p = 0.018]. The lowering of gait speed was negatively related to CCS>100 [OR:2.36 (1.10–5.06); p = 0.028] and skeletal muscle index was directly associated with FMD [OR:5.44 (1.22–24.24); p = 0.026]. Total caloric intake was positively related to fatty mass [OR:2.71 (1.09–6.72); p = 0.031], but was not related to CCS.


      This study reveals that sarcopenia - comprised by reduction of muscle mass and its strength - is associated with subclinical atherosclerosis and endothelial dysfunction. Surprisingly, the excess of fatty mass seems not to be related to atherosclerotic burden in very elderly individuals.


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