Thread by @DrDamluji

Sarcopenia and Cardiovascular Diseases: @CircAHA

From the Geriatric Cardiology Leadership Council: @ACCinTouch

Main congratulations to @Dr_Alfaraidy: a board certified geriatrician and a cardiology fellow - she is amazing AND the best: @ParagGoyalMD 👏

Summary👇👇👇

1/ 🚨 Sarcopenia is the loss of muscle strength, mass & function, worsened by chronic illness like CVD, kidney disease, & cancer 😷🩺

2/ 👴👵 Older adults face higher risks: faster CVD progression, mortality, falls, & reduced quality of life 📉

3/ 🧬 Complex causes: imbalance in muscle homeostasis, neuronal degeneration, aging, chronic illness, malnutrition, immobility 🔄

4/ 🔍 Early detection = opportunity for interventions to reverse or delay muscle disorder & impact CVD outcomes 🎯

5/ ⚠️ BMI not reliable for screening; sarcopenic obesity common in older cardiac patients 📏❌

6/ 📚 We aimed to

(1) define sarcopenia and skeletal muscle disorder 📝 (2) summarize bidirectional association w CVDs 💔
(3) provide a diagnostic approach 🔎, management strategies 🌟, Knowledge gaps & future directions

🔮 #Sarcopenia #CVD #MuscleLoss #Aging

7/ 📚 Sarcopenia: Greek for "flesh poverty"💪, a clinical condition causing loss of independence in older adults 🚶‍♂️🚶‍♀️

Dr. Critchley (1931) 1st described the age-related muscle loss as a senile myotrophy that manifests as wasting...

History is here👇👇👇

bit.ly/3M8qb4y

8/ 📈 Later, it was found that muscle weakness & impaired mobility had better prediction of mortality & disability than low lean mass alone 🏃‍♂️🏃‍♀️

This led to a change in definition of sarcopenia.

9/ 💔 "Muscle failure": progressive loss of strength (dynapenia), mass, & function, increasing risk of disability, falls, & mortality 📉

10/ 🌐 EWGSOP2 & AWGS diagnostic algorithms are accepted as guidelines for clinical practice 🩺

11/ 🚧 Sarcopenia ≠ malnutrition/cachexia; interrelated pathophysiology, different "wasting" magnitudes & CVD susceptibility 🤔

Differences between sarcopenia, cachexia, and malnutrition are shown in Table

👇👇👇

12/ We adopted the EWGSOP2 definition of sarcopenia that combines impairments in:

🥶strength (dynapenia)
🥶mass (quantity/structure), and
🥶function (quality);

thus, we refer to sarcopenia as impairment in mass and function or strength.

But other definitions exist 👇👇👇

13/ 🌟 Sarcopenic obesity is a clinical phenotype of sarcopenia attributed to rising prevalence of obesity .

14/ 📈 📌 Sarcopenic obesity is defined as obesity combined with sarcopenia (decline in muscle mass/function). 🍔💪

❗️ Due to a lack of consensus on diagnostic criteria, there is variation in the reported prevalence and associated outcomes of sarcopenic obesity. 📊

15/ 🚑 Participants with sarcopenic obesity experience the highest incidence of cardiovascular events compared to those with other muscle disorders. ❤️

16/ 🤝 ESPEN and EASO have established an initiative to standardize the diagnostic workup for sarcopenic obesity. 🌐

🩺 Sarcopenic obesity may be diagnosed based on independent measures of obesity and sarcopenia. 📏

17/🧩 Pathophysiology of sarcopenia: complex interactions involving multiple physiological systems 🔗🧬

#Sarcopenia #Pathophysiology

18/ 🏋️‍♂️ Skeletal muscle: 2 main fiber types (slow & fast) and 3 myofiber subtypes (type I, IIa, IIb/IIx) 🧬

19/ 🏃‍♀️ Each type has a unique function & fatigue resistance level 🔄

I = slow oxidative, fatigue resistance
IIa = fast-oxidative, relatively fatigue resistance
IIb = fast-glycolytic, function in rapid and high intensity movement, and are fatigue susceptible

20/ 🚀 Satellite cells, muscle stem cells, are responsible for muscle repair & regeneration (myogenesis) 🛠️

21/ ⏳ Aging disturbs muscle homeostasis, leads to satellite cell senescence, loss of type II fibers, & functional motor units 📉

22/ 🤕 This results in muscle atrophy, decreased contractile force capacity, muscle weakness & slowness 💔

26/ 🍔 Myosteatosis: refers to ectopic fat deposition in skeletal muscles that is frequently seen in patients with cardiometabolic disease. 💉

27/ 📌 Fatty infiltration is separate from muscle mass/function loss 🤔

💢 Myosteatosis is linked to frailty & muscle mobility/function decline 📉

28/🌡️ Chronic inflammation from adipokines ➡️ insulin resistance, muscle breakdown 🔥

🤯 Fatty infiltration & muscle fibrosis can impair muscle quality without atrophy 🚧

Take care of your cardiometablic health!

28/ ⚖️ Often seen in sarcopenic obesity: chronic pro-inflammatory state, metabolic dysregulation, insulin resistance, glucose intolerance 🚨

**made mistake with numbering sorry

29/ 👵👴 Aging alters body composition: muscle & bone mass ↓, body fat, visceral adiposity, & fatty infiltration ↑ 🔄

🎯 Older adults more susceptible to myosteatosis & sarcopenic obesity development 🎯

Stay active!

30/More discussion on muscle homeostasis, anabolic resistance, inflammation and mitochondrial dysfunction, and neuronal pathway in muscle disorder is here: 👇👇👇

ahajournals.org/doi/10.1161/CI…

31/ 🌐 Mechanism: age- and non-age related -- multifaceted involving biological, environmental, socioeconomic & genetic factors 🧩

32/ 🔄 Interaction of multiple domains affects muscle loss with aging 🏋️‍♀️

33/ 😷 Chronic diseases, sedentary lifestyle, smoking & malnutrition can exacerbate muscle loss 🚬🍔

📈 Midlife obesity linked to sarcopenia later in life 📊

34/ 💡 Lifestyle factors partly explain increased CV risk in sarcopenic obesity - 💪

🧪 Sarcopenia common in kidney disease, especially end-stage renal disease on hemodialysis ⚠️

🔬 Chronic kidney disease as a model of "accelerated aging"

35/ 🕰️🦠 Sarcopenia is frequently in older cancer patients, affects prognosis & treatment response 🏥 #sarcopenia #Aging #ChronicDiseases

36/ We reviewed the association between sarcopenia and each of the following CVDs:

A. Heart Failure
B. ASCVD
C. PAD
D. TAVR
E. Cardiac Surgery

👇👇👇

ahajournals.org/doi/10.1161/CI…

Check supplement for each study!

37/ 🔍 Screening for sarcopenia is critical to initiate effective interventions before development of advanced forms of muscle dysfunction 🚩

38/ 📋 Various clinical tools available for screening, but no consensus on the best one for practice (Table 3) 🧪

SARC-F
SARC-F Calf
Ishii
MSRA
SarSA-Mod
Grip Strength
Chair rise

👇👇

39/ ⚠️ Symptoms to trigger screening: falls, subjective weakness, slow walking speed, difficulty rising, weight loss & ADL difficulties 🚶‍♂️

40/ 🍽️ Concurrently screen for malnutrition as it often co-exists with sarcopenia 🥗

41/ ❌ BMI not a reliable screening tool for older adults due to sarcopenic obesity 📏

👩‍🦳 Complex body composition changes in older adults make tracking sarcopenia difficult during weight gain/loss ⚖️

42/ 📐 Consider waist circumference & waist-to-hip ratio to predict CVD events & risk of death across BMI categories 💓 #Sarcopenia #Screening #BMI #Aging

43/ 💉 Confirmatory Testing for sarcopenia: imaging & body composition assessment tools, physical performance, and lab tests 🧪

🔬 Imaging Modalities: CT, MRI (gold standard), muscle ultrasound, DXA scan, and BIA 📸

Each has positives/negatives...

44/

🔬 Lab Biomarkers: D3-Cr dilution method, sarcopenia index (serum creatinine/serum cystatin C) x 100 🧫

🏃‍♀️ Physical Performance Tests: EWGSOP & SDOC recommendations, influenced by comorbid conditions and geriatric syndromes 🧓

45/ Interventions like resistance training & nutritional supplements show promise, but more research is required to develop skeletal muscle therapeutics.

Algorithm classifies management into inflammatory, nutritional, metabolic, & atrophic:

👇👇

46/ FUTURE DIRECTION @nih_nhlbi

A. Standardization of sarcopenia definitions
B. Improvement in diagnostic tools
C. Novel biomarkers
D. Ethnic differences in muscle disorders
E. Effective interventions
F. Leveraging cardiac rehab infrastructures
G. Pharmacotherapeutics: big!

47/ In conclusion, sarcopenia is a significant in cardiac patients, and its early recognition and Rx can prevent or slow its progression.

Interventions such as resistance training and protein supplements are promising, but work is needed in area of skeletal muscle therapeutics