Combined effect of skeletal muscle mass loss and elevated insulin resistance on heart failure risk in older adults: a community-based longitudinal cohort study.

IF 8.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Diabetology Pub Date : 2025-04-09 DOI:10.1186/s12933-025-02714-8

Weike Liu, Hua Zhang, Xin Wang, Huajing Song, Yanli Yao, Zhendong Liu, Juan Wang, Yuqi Guo

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引用次数: 0

Abstract

Background: Skeletal muscle mass loss and insulin resistance (IR) are associated with cardiovascular diseases risk. However, it remains unclear whether the combination of skeletal muscle mass loss and elevated IR affects heart failure (HF) risk. Here, we investigate the association between a combination of appendicular skeletal muscle mass index (ASMI) with estimated glucose disposal rate (eGDR) and HF risk in older adults.

Methods: A prospective analysis and a dual-trajectory analysis were carried out to investigate the association of the combined effect of ASMI and eGDR with HF risk. A total of 11,596 adults aged ≥ 60 years were enrolled from the community for prospective analysis. Among them, 10,489 were eligible for the dual-trajectory analysis. The temporal evolution of ASMI and eGDR was determined using a dual-trajectory model.

Results: In the prospective analysis, 1087 individuals developed HF. Restricted cubic splines analysis showed L-shaped associations between ASMI and eGDR and HF risk. HF risk decreased by 32.3% (hazard ratio (HR): 0.677, 95% confidence interval (CI): 0.623-0.734, P_adj < 0.001) for female and 9.0% (HR 0.910, 95% CI 0.831-0.996, P_adj = 0.003) for male patients per one standard deviation (SD) AMSI increment and 29.4% (HR 0.706, 95% CI 0.647-0.770, P_adj < 0.001) for female and 26.8% (HR 0.732, 95% CI 0.668-0.803, P_adj < 0.001) for male patients per one SD eGDR increment. There was a synergistic effect on HF risk per one SD ASMI and eGDR increment (P_adj < 0.001). Five distinct dual ASMI and eGDR trajectories were identified in the dual-trajectory analysis. A total of 859 (8.85 per 1000 person-years) individuals developed HF. Compared to group 4 with moderate-stable ASMI and eGDR and the lowest incident HF, the HR in group 5 characterized by low-stable ASMI and eGDR was 1.908 (95% CI 1.482-2.457, P_adj < 0.001), followed by 1.716 (95% CI 1.296-2.273, P_adj < 0.001) in group 3 with low-decrease ASMI and high-decrease eGDR.

Conclusions: Skeletal muscle mass loss and elevated IR act synergistically to increase the HF risk in older adults. Comprehensive management of muscle mass and IR might be a useful and effective strategy for preventing and controlling HF.

Trial registration: Retrospectively registered number ChiCTREOC17013598.

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骨骼肌质量损失和胰岛素抵抗升高对老年人心力衰竭风险的综合影响：一项基于社区的纵向队列研究

背景：骨骼肌质量损失和胰岛素抵抗（IR）与心血管疾病风险相关。然而，目前尚不清楚骨骼肌质量损失和IR升高是否会影响心力衰竭（HF）的风险。在这里，我们研究了老年人阑尾骨骼肌质量指数（ASMI）与估计葡萄糖处置率（eGDR）的组合与HF风险之间的关系。方法：采用前瞻性分析和双轨迹分析，探讨ASMI和eGDR联合作用与HF风险的关系。从社区共入组11596名年龄≥60岁的成人进行前瞻性分析。其中10489例符合双轨迹分析条件。采用双轨迹模型确定ASMI和eGDR的时间演化。结果：在前瞻性分析中，1087人发生HF。限制性三次样条分析显示ASMI和eGDR与HF风险呈l型相关。女性患者HF风险降低32.3%（风险比（HR）： 0.677, 95%可信区间（CI）： 0.623-0.734, Padj < 0.001）；男性患者每增加一个标准差（SD） AMSI， HF风险降低9.0% (HR 0.910, 95% CI 0.831-0.996, Padj = 0.003)；女性患者每增加一个标准差（SD） AMSI， HF风险降低29.4% (HR 0.706, 95% CI 0.647-0.770, Padj < 0.001)；男性患者每增加一个标准差（SD） eGDR， HF风险降低26.8% （HR 0.732, 95% CI 0.668-0.803, Padj < 0.001）。每增加1个SD ASMI和eGDR对HF风险有协同作用（Padj < 0.001）。在双轨迹分析中确定了5种不同的双ASMI和eGDR轨迹。共有859人（每1000人年8.85人）发生HF。与中度稳定ASMI和eGDR发生率最低的HF组相比，低稳定ASMI和eGDR组5的HR为1.908 (95% CI 1.482 ~ 2.457, Padj < 0.001)，低降低ASMI和高降低eGDR组3的HR为1.716 （95% CI 1.296 ~ 2.273, Padj < 0.001）。结论：骨骼肌质量损失和IR升高协同作用增加老年人HF的风险。肌肉质量和IR的综合管理可能是预防和控制HF的有效策略。试验注册：追溯注册号ChiCTREOC17013598。

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来源期刊

Cardiovascular Diabetology 医学-内分泌学与代谢

CiteScore

12.30

自引率

15.10%

发文量

240

审稿时长

1 months

期刊介绍： Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.