Prevalence of sarcopenia among older adults with cardiovascular disease

Background: According to various resources, the prevalence of sarcopenia ranges from approximately 10% to 40% due to different methodology, diagnostic criteria and populations selected. Sarcopenia is associated with faster progression of cardiovascular disease (CVD), increased mortality, risk of falls, and reduced quality of life among older patients. Due to a lack of consistency in assessment tools, sarcopenia is not diagnosed in routine practice. Ultrasound measurement of the anterior thigh muscle thickness is a simple, easily available, and inexpensive method that can reliably and early diagnose sarcopenia. According to Souza et al. [1], a strong correlation was observed between the thickness of the anterior thigh muscles measured by ultrasound and computed tomography (p<0.001). Purpose: To evaluate prevalence of sarcopenia among older adults with cardiovascular disease. Methods: We identified a total of 120 consecutive patients with CVD aged ≥ 65 years old, referred to II phase cardiac rehabilitation. We performed gait speed (with cut-off value of <0.8 m/s) and hand grip (with cut-off values of <27 kg for males, <16 kg for females) tests to estimate physical performance. Furthermore, we obtained anterior thigh muscle thickness measurements using ultrasound. The sonographic thigh adjustment ratio (STAR) index was calculated by dividing the anterior thigh thickness by the body mass index (BMI). According to the STAR index, values below 1.4 for men and 1.0 for women were indicative of low muscle mass. We identified participants with normal physical performance tests and STAR index as not sarcopenic. If any of the 2 physical performance tests was abnormal and STAR index value was low, it is suggested to identified participant as sarcopenic. We identified participants with normal physical performance tests and low STAR index as presarcopenic. All patients participated in comprehensive, exercise based cardiac rehabilitation. All statistical analyses were performed using SPSS 23.0 (IBM Corporation, New York, NY). In all analyses, two-tailed P < 0.05 was taken to indicate statistical significance. Results: The mean age of the study population was 75.7±6.4 years, and 52.5% of the participants were men. The mean handgrip strength, gait speed, and STAR index were 30.1 ± 10.8 kg, 0.68 ± 0.33 m/s, and 0.79 ± 0.26, respectively. Total of 55.8 % participants were sarcopenic and 34.2% were presarcopenic. The prevalence rate of sarcopenia increased with age (P < 0.001). There was no significant difference between genders in prevalence of sarcopenia. There was significant increase of gait speed 0.71±0.32 m/s vs 0.94±0.33 m/s (P <0.001) after cardiac rehabilitation program. Conclusions: Sarcopenia is highly prevalent among elderly patients with CVD in a setting of cardiac rehabilitation. The use of complex rehabilitation measures may have a significant impact on gait speed that indicates better clinical outcomes.