Abdominal aortic calcification is associated with decline in handgrip strength in the U.S. adult population ≥40 years of age

https://doi.org/10.1016/j.numecd.2020.11.003Get rights and content

Highlights

  • Handgrip strength has been proposed as a potential indicator of overall muscle strength.

  • Abdominal aortic calcification can serve as an independent predictor of coronary artery calcium presence.

  • Declines in handgrip strength, are associated with higher scores for aortic calcification in the U.S. population.

  • Longitudinal studies are required to elucidate the mechanism underlying the link between strength and vascular calcification.

Abstract

Background and aims

The present study investigated the association between abdominal aortic calcification (AAC) and handgrip strength (HGS) and the ability of HGS to predict an increased AAC phenotype in adults.

Methods and results

The analysis consisted of data for 3140 men and women aged ≥40 years (51.7% women) from the 2013–2014 NHANES. Lateral scans of the thoraco-lumbar spine (L1–L4) were scored for AAC using a validated 8-point scale (AAC-8); subjects with a score of ≥3 were considered at increased risk for cardiovascular disease due to a high AAC phenotype. HGS was assessed using a grip dynamometer. The prevalence of severe AAC in the population was 9.0%. Decline in HGS was associated with higher AAC-8 scores in men and women (p < 0.001). General linear model analysis showed that HGS levels were negatively associated with high AAC (p < 0.001) and AAC-8 status for both sexes. Likewise, for each 5-kg higher HGS, there lower odds of a high AAC phenotype (in men OR = 0.73, CI95%, 0.64–0.84) and (women OR = 0.58, CI95%, 0.47–0.70). Receiver operating characteristic curve analysis showed that the HGS threshold value to detect high risk of AAC in adults was ≥37.3 kg (AUC = 0.692) in men and 25.1 kg (AUC = 0.705) in women.

Conclusion

Lower muscular strength, as measured by HGS, is associated with higher AAC scores in the U.S. population ≥40 years of age. Accordingly, maintenance of muscular strength during aging may protect adults against vascular calcification, an independent predictor of cardiovascular events. HGS measurement seems to be a valid screening tool for detecting a high ACC phenotype in adults.

Introduction

Sarcopenia (age-related loss of muscle mass) and dynapenia (age-related loss of muscle strength) are associated with an increase in all-cause morbidity and mortality risk in older adults, as well as with a wide range of acute and chronic diseases that affect millions of people worldwide [1,2]. Both age-related conditions in addition to the gradual loss in skeletal muscle mass are linked to altered body composition [3] and reduced functional capacity, which are major contributing factors to the disabling process [4].

Handgrip strength (HGS) is a simple and quick measure of muscle function, and it has been proposed as a potential indicator of overall muscle strength [5]. Lifespan changes in HGS correlate with changes in skeletal muscle mass and overall strength that occur over time [6], and decreased muscle strength is associated with several clinically-relevant health outcomes such as metabolic syndrome [7], cardiovascular disease (CVD) [8], insulin resistance [9], chronic respiratory disease [10] and premature mortality [11]. Accordingly, declines in HGS are often used as a marker for identifying muscle weakness and are now largely considered a new “vital sign” in clinical and epidemiological settings [12].

Vascular calcification is the process of ectopic mineral deposition, primarily calcium phosphate, in major blood vessels, and is an indicator of elevated CVD risk [13]. Several epidemiological studies have reported that the presence of abdominal aortic calcification (AAC) can serve as an independent predictor of coronary artery calcium presence [14,15] and correlates with several CVD scores and cardiovascular events, including subclinical atherosclerosis [16,17]. AAC remains a significant predictor of CVD even after adjustment for established risk factors (age, diabetes mellitus, smoking, dyslipidemia and blood pressure).

Interestingly, some studies have reported that vascular calcification and musculoskeletal function are both predictive of bone loss, especially in postmenopausal women [18,19] and may share common biological pathways [20,21]. A previous cross-sectional study in healthy older men and women demonstrated that the presence and severity of AAC was associated with low muscle mass [22], and also HGS levels in women [23]. On the other hand, previous studies have shown that frailty syndrome is not associated with additional changes in the ACC during aging [24], reinforcing vascular calcification as an age-dependent entity [25]. Thus, available evidence regarding the potential association between HGS and AAC is very limited since to the best of our knowledge, only one prior study conducted among women has been published [23]. Also, no sex-specific reference thresholds for HGS associated with ACC among older adults have been investigated.

Considering that additional insights into understanding the biological pathways involved in vascular calcification and age-related musculoskeletal decline may result in targeted preventive interventions, we therefore performed a cross-sectional analysis in a middle-aged and elderly population to examine the relationship between HGS and AAC and to evaluate the ability of HGS to predict increased risk of AAC in adults.

Section snippets

Design and study population

A cross-sectional study using data from the National Health and Nutrition and Examination Surveys (NHANES 2013–2014) was conducted. The NHANES is an extensive stratified data set representative of the non-institutionalized civilian population in the USA [26]. Ethical approval was obtained through the National Center for Health Statistics Research Ethics Review Board (CDC, 2015) and subsequent approval for secondary data analyses was not required (Title 45 Code of Federal Regulations section

Results

General characteristics of the study sample are shown by AAC-8 status in Table 1. The mean age (95% CI) of the total sample (3140 participants; 51.3% women) was 58.6 (58.1–59.0), range 40–80 years. The frequency of AAC-8 score ≥3 points was 9.0% in the total sample. HGS values, BMI, systolic blood pressure, glucose, HbA1c, two-hour OGTT, and serum 25(OH)D concentration were higher in individuals with AAC-8 scores ≥3 points than in those with AAC-8 scores <2 points (p < 0.001). No significant

Discussion

We used data from the 2013–2014 NHANES, which was the first large-scale epidemiologic study to measure the total length of calcification of the anterior and posterior aortic walls in front of the L1 to L4 vertebrae. The present study demonstrates that lower in HGS values are associated with higher ACC scores in the U.S. population ≥40 years of age. There was an inverse association between HGS and the AAC phenotype (AAC-8 scores), which remained significant after full adjustment for confounders.

Author contributions

M.C.R. and R.R.V researched data and contributed to the discussion: F.L, K.G.R, A.G.H, M.I and M.C.R researched data. M.I, M.C.R and F.L reviewed/edited the manuscript. R.R.V. wrote the manuscript. R.R.V is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. AGH is a Miguel Servet Fellow (Instituto de Salud Carlos III – CP18/0150).

Declaration of competing interest

No potential conflicts of interest relevant to this article were reported.

Acknowledgments

Robinson Ramírez-Vélez training grant (ID420) as a post-doctoral research fellow with the Universidad Pública de Navarra (UPNA), Spain. Mikel Izquierdo was supported by a research grant PI17/01814 of the Ministerio de Economía, Industria y Competitividad (ISCIII, FEDER), Spain.

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