Association of High Muscle Mass with Carotid Atherosclerosis: A Community-Based Population Cohort Study

Although low muscle mass may make an under-appreciated contribution to increasing the risk of cardiovascular diseases, no prospective studies have explored the association between low muscle mass and carotid atherosclerosis. We investigated whether muscle mass was related to a higher carotid intima-media thickness (C-IMT) and carotid artery plaque in a community-based population.

The study included 1,253 asymptomatic participants without known cardiovascular disease, who underwent carotid ultrasonography at baseline in 2013-2014 and received a re-examination in 2015-2016. The skeletal muscle mass index was estimated using a bioelectrical impedance analyzer. We assessed the relationship between the skeletal muscle mass index and the development of C-IMT and carotid plaque, both, using multivariate-adjusted logistic regression models.

During the follow up, 400 (51.0%) subjects with normal C-IMT at baseline developed elevated C-IMT and 215 (17.2%) subjects developed carotid plaque. The risk of elevated C-IMT occurrence linearly decreased with an increase in skeletal muscle mass index quintiles or its continuous data, after multivariate-adjustment in men and women, respectively (both P for trend < 0.05; both P < 0.05). Subgroup analyses showed that this association was BMI-dependent. Besides, there was an inverse association between a high skeletal muscle mass index and carotid artery plaque in women, but the association disappeared after multivariate adjustment. In men, the skeletal muscle mass index was not associated with the incidence of carotid plaque.

Skeletal muscle mass was inversely associated with the incidence of carotid atherosclerosis, suggesting muscle mass maintenance may play a role in modifying atherosclerosis.