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Sarcopenia is a risk factor for cardiovascular events experienced by patients with critical limb ischemia
Yutaka Matsubara1, Takuya Matsumoto1, Kentaro Inoue1
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Insights
Sarcopenia is a significant risk factor for cardiovascular events in patients with critical limb ischemia (CLI). Single antiplatelet therapy (SAPT) and statin therapy improve survival, with SAPT specifically benefiting those with sarcopenia.
Area of Science:
- Vascular Surgery
- Cardiology
- Geriatrics
- Musculoskeletal Disorders
Background:
- Critical limb ischemia (CLI) carries a poor prognosis, with cardiovascular disease as the leading cause of mortality.
- Low grip strength and sarcopenia are potential risk factors for cardiovascular events in CLI patients.
Purpose of the Study:
- To investigate whether sarcopenia is a risk factor for cardiovascular events in patients with CLI.
- To determine if identifying and managing sarcopenia can improve CLI patient outcomes.
Main Methods:
- A cohort of 114 CLI patients undergoing revascularization and CT scans between 2002-2012 was analyzed.
- Sarcopenia was defined based on L3 skeletal muscle area measurements from CT scans (<114.0 cm² for men, <89.8 cm² for women).
- Clinical characteristics, cardiovascular event-free survival, mortality, and treatment effects were assessed.
Main Results:
- Sarcopenia was identified in 46.5% of patients.
- Three-year cardiovascular event-free survival was significantly lower in patients with sarcopenia (43.1%) compared to those without (91.2%).
- Sarcopenia was associated with increased cardiovascular and ischemic heart disease mortality. Single antiplatelet therapy (SAPT) and statin therapy were independent protective factors. SAPT significantly improved survival in sarcopenic patients.
Conclusions:
- Sarcopenia is a significant risk factor for adverse cardiovascular outcomes in CLI patients.
- SAPT and statin therapy are associated with improved cardiovascular event-free survival in CLI patients.
- SAPT demonstrates a particular benefit in improving cardiovascular event-free survival among patients with sarcopenia.
Background:
Prognosis is poor for patients with critical limb ischemia (CLI), and the most frequent cause of death is cardiovascular disease. Low grip strength is a risk factor for cardiovascular events, and sarcopenia may be associated as well. Thus, we hypothesized that sarcopenia is a risk factor for cardiovascular events experienced by patients with CLI. If this is true and appropriate therapy becomes available, the prognosis of patients with CLI will improve with appropriate risk management strategies to prevent cardiovascular events. Therefore, the aim of this study was to verify this hypothesis.
Methods:
We studied 114 patients who underwent revascularization and computed tomography between January 2002 and December 2012 in the Department of Surgery and Sciences at Kyushu University in Japan. Sarcopenia was defined as skeletal muscle area measured by L3-level computed tomography scan <114.0 cm2 and <89.8 cm2 for men and women, respectively. Clinical characteristics, cardiovascular event-free survival, <2-year death, causes of death, and effective treatments for sarcopenia were investigated.
Results:
We identified 53 (46.5%) patients with sarcopenia. Three-year cardiovascular event-free survival rates were 43.1% and 91.2% for patients with and without sarcopenia, respectively (P < .01). During follow-up, cardiovascular disease caused the deaths of 4 and 15 patients without and with sarcopenia (P < .01), respectively, and in particular, ischemic heart disease caused the deaths of 0 and 5 patients without or with sarcopenia (P < .05), respectively. Single antiplatelet therapy (SAPT; hazard ratio, 0.46; 95% confidence interval, 0.24-0.82; P < .01) and statin therapy (hazard ratio, 0.38; 95% confidence interval, 0.16-0.78; P < .01) were independent factors associated with improved cardiovascular event-free survival. Three-year cardiovascular event-free survival rates for patients with sarcopenia who received SAPT, dual antiplatelet therapies, and no antiplatelet therapy were 75.3%, 21.1%, and 29.5%, respectively (P < .01).
Conclusions:
Sarcopenia is a risk factor for worse cardiovascular event-free survival, and SAPT and statin therapy reduced this risk for patients with CLI. Furthermore, SAPT but not dual antiplatelet therapy increased cardiovascular event-free survival in patients with sarcopenia.
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