Disclosures: The authors report no relevant financial disclosures.
November 22, 2021
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Low skeletal muscle mass, grip strength linked to CVD risk in type 2 diabetes

Disclosures: The authors report no relevant financial disclosures.
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Adults in South Korea with diabetes had a higher risk for cardiovascular disease, coronary heart disease and peripheral arterial disease if they had low appendicular skeletal muscle mass and low grip strength, according to study data.

“Previous observational studies have examined the association of skeletal muscle mass or muscle strength with CVD risk,” Jang Yel Shin, MD, PhD, of the department of internal medicine at Yonsei University, Wonju College of Medicine in South Korea, and colleagues wrote. “The present study is the first to focus on the combined association of skeletal muscle mass and muscle strength with CVD risk. In this study, low skeletal muscle mass/low grip strength was more strongly associated with the risk of CVD, CHD and peripheral arterial disease than high skeletal muscle mass/high grip strength, independent of multiple potential confounding factors.”

Adults with diabetes and low skeletal muscle mass and grip strength have a higher likelihood for CVD, CHD and peripheral artery disease. Data were derived from Park S, et al. J Diabetes. 2021;doi:10.1111/1753-0407.13216.

Researchers conducted a cross-sectional study at the Diabetes Center in Wonju Severance Christian Hospital, South Korea, between November 2017 and March 2019. There were 1,230 adults older than 30 years with type 2 diabetes enrolled in the study. Interviews were conducted to obtain medical history and lifestyle information. The use of hypoglycemic agents and anthropometric data were collected, and blood tests were conducted for each participant. Participants underwent DXA to measure appendicular skeletal muscle mass, and grip strength was measured three times using a digital hand dynamometer. CVD was defined as CHD, ischemic stroke, peripheral arterial disease or any combination of the conditions.

Higher CVD odds with low skeletal muscle mass, grip strength

Participants were categorized into four groups based on sex-specific median appendicular skeletal muscle mass and grip strength: low skeletal muscle mass and low grip strength (n = 428), low skeletal muscle mass and high grip strength (n = 182), high skeletal muscle mass and low grip strength (n = 188) and high skeletal muscle mass and high grip strength (n = 432). The prevalence of CVD, CHD, ischemic stroke and peripheral arterial disease was higher among adults with both low skeletal muscle mass and low grip strength compared with the high skeletal muscle mass and high grip strength group. The prevalence of CVD was not different between adults with an HbA1c of 7.1% or higher and those with an HbA1c lower than 7.1%.

After adjusting for age, sex, BMI, waist circumference, hypoglycemic agents, exercise habits, drinking status, smoking status, high-sensitivity C-reactive protein, blood pressure, HbA1c, estimated glomerular filtration rate, diabetes duration and homeostasis model assessment for insulin resistance, adults with low appendicular skeletal muscle mass and low grip strength were more likely to have CVD (OR = 2.9; 95% CI, 1.89-4.47), CHD (OR = 2.39; 95% CI, 1.46-3.92) and peripheral arterial disease (OR = 5.83; 95% CI, 1.58-21.48) compared with those with high appendicular skeletal muscle mass and high grip strength. No increased risk for ischemic stroke was observed.

Elevated HbA1c increases CVD odds

Adults with an HbA1c of 7.1% or higher with high skeletal muscle mass and low grip strength had increased odds for CVD (OR = 3.7; 95% CI, 1.49-9.2) and CHD (OR = 3.38; 95% CI, 1.22-9.37). Adults with higher HbA1c and low skeletal muscle mass and high grip strength also had increased odds for CVD (OR = 3.89; 95% CI, 1.64-9.24) and CHD (OR = 2.46; 95% CI, 0.92-6.57). Adults with higher HbA1c and both low skeletal muscle mass and low grip strength had the highest increased odds for CVD (OR = 7.27; 95% CI, 3.37-15.67) and CHD (OR = 6.17; 95% CI, 2.65-14.37). No significant associations were observed in adults with lower HbA1c levels.

“To understand the mechanisms underlying sarcopenia, diabetes and CVD, we need to investigate whether strict glucose control in patients with type 2 diabetes helps prevent the decline of muscle mass and muscle strength or whether exercise intervention, including aerobic and muscle strengthening activities, has a favorable effect on the reduction of CVD risk,” the researchers wrote.