Additive Effect of Sarcopenia and Anemia on the 10-Year Risk of Cardiovascular Disease in Patients with Type 2 Diabetes

Abstract

Objective. To investigate the association between sarcopenia and anemia and the 10-year cardiovascular disease risk in diabetic patients. Methods. A cross-sectional study was conducted involving 4673 hospitalized patients (2271 men and 2402 women) with type 2 diabetes mellitus, with an average age of $60.66\pm 11.93$ years, of whom 542 were followed up for a median follow-up period of 24 months. All participants underwent body composition measurements, and they were grouped by sex and presence of sarcopenia using the Framingham risk model to assess their 10-year cardiovascular risk. According to the changes in the cardiovascular risk during follow-up, the patients were divided into four groups: low-low, low-high, high-low, and high-high. Results. The prevalence of anemia was higher in the sarcopenia group than in the nonsarcopenia group (11.5% vs. 24.1% for men, $P<0.001$ ; 13.9% vs. 19.7% for women, $P<0.05$ ), and the difference remained significant after adjusting for confounders. Patients with sarcopenia and without anemia had a 46.2% increased risk of high 10-year cardiovascular disease (CVD) ( $\text{odds}\text{ratio}\left(\text{OR}\right)=1.462$ , 95% confidence interval (CI) 1.085–1.972, $P=0.013$ ), and the risk was twofold higher in patients with sarcopenia and anemia than in those without ( $\text{OR}=3.283$ , 95% CI 2.038–5.289, $P<0.001$ ). In follow-up studies, sarcopenia was associated with an increased risk of CVD at 10 years, and a reduction in appendicular skeletal muscle mass index independently predicted the increased risk of CVD. Conclusion. Sarcopenia is associated with an increased risk of anemia, and the presence of both has an additive effect on the 10-year CVD risk in patients with type 2 diabetes. Loss of muscle mass can independently predict an increased CVD risk in diabetic patients.