Photo Credit: Panuwat Dangsungnoen
People with both T2D and sarcopenia appear to be at increased risk for CVD, and they may develop CVD earlier in life than people with T2D alone.
People with both type 2 diabetes (T2D) and sarcopenia appear to be at increased risk for cardiovascular disease (CVD), and they may develop CVD earlier in life than people with T2D alone, according to research published in Diabetes, Obesity and Metabolism.
“Sarcopenia in people with type 2 diabetes was associated with a higher risk of developing CVD, stroke, HF [heart failure] and MI [myocardial infarction]. Incident CVD events possibly occurred 14.5 years earlier among those with sarcopenia than those without,” wrote lead author Jirapitcha Boonpor, MSc, and coauthors. “Sarcopenia screening in patients with T2D may be useful to reduce the complications of CVD.”
Boonpor and colleagues studied 11,974 people aged 40-70 who had T2D and enrolled in the UK Biobank prospective cohort study in England, Wales, and Scotland from 2006-2010. Because the criteria to define sarcopenia vary by ethnicity and the UK Biobank contains data from relatively few non-White participants, the researchers restricted their analyses to White Europeans.
At baseline, all participants completed touch-screen questionnaires, underwent physical measurements, and provided biological samples. The researchers used Cox proportional hazard models to adjust for sociodemographic and lifestyle factors (including age, sex, education, socioeconomic status, BMI, processed meat intake, smoking status, alcohol intake, physical activity level, and T2D duration) to analyze the links between sarcopenia (assessed by grip strength, muscle mass, and gait speed) and CVD incidence. They used the rate advancement period to estimate the time it took for patients’ CVD to advance due to sarcopenia.
Over a median follow-up of 10.7 years, 1,957 participants developed CVD (742 HF, 373 stroke, and 307 MI). Compared with patients with T2D without sarcopenia, those with sarcopenia had higher risks for CVD (HR, 1.89; 95% CI, 1.61-2.21), HF (HR, 2.59; 95% CI, 2.12-3.18), stroke (HR, 1.90; 95% CI, 1.38-2.63), and MI (HR, 1.56; 95% CI, 1.04-2.33) after adjusting for all covariates.
CVD, heart failure, stroke, and MI incidence rates among participants with sarcopenia matched the rates of those without sarcopenia who were 14.5, 13.7, 13.7, and 12.8 years older, respectively.
Should Patients With T2D Be Screened for Sarcopenia?
The findings intrigue Preethika Ekanayake, MD, who was not involved in the study.
“Most international working groups for sarcopenia, such as the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS), predominantly define sarcopenia as an age-related muscle mass loss and recommend screening in older adults,” she says.
“Although we spend a lot of time evaluating, screening, and emphasizing prevention of microvascular complications like nephropathy, neuropathy, and retinopathy in patients with diabetes, we do not place much emphasis on evaluating sarcopenia,” Dr. Ekanayake notes. “These findings may encourage doctors to screen their patients for sarcopenia and to counsel them on undertaking weight-bearing and resistance exercises and physical therapy to improve muscle mass and help stave off CVD onset.”
Unanswered Questions and Need for Further Research
As the authors state, while the large sample size, long follow-up, and wide age range are strengths of the study, the lack of non-White participants limits the generalizability of the findings to other populations; UK Biobank participants having been invited, not selected, may introduce selection bias; and self-reported activity levels and diabetes duration may not be reliable.
“There is no mention of the degree of diabetes control,” Dr. Ekanayake adds. “For example, hemoglobin A1C [HbA1C] was not mentioned. I would be curious whether the patients with sarcopenia and higher CVD risk also had higher HbA1C values, which could have confounded the results. Moreover, low muscle mass did not impart higher CVD risk in the models that were minimally and maximally adjusted for confounders, which is also curious because sarcopenia is the loss of muscle mass.”
Dr. Ekanayake joins the researchers in recommending further related research. “Randomized controlled trials are needed to corroborate the findings,” she advises.
