Annals of vascular surgery · 2026
Sarcopenia is an Independent Predictor of All-Cause Death and Major Adverse Cardiovascular Events in Patients with Peripheral Arterial Disease.
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Zhang Fan, Guo Yaming, Zhao Wenxin, Zhang Lei, Diao Yongpeng, Chen Zuoguan, Li Yongjun, Li Hongpu, VIP-PADS Study Collaborators
Аннотация
BACKGORUND: Peripheral arterial disease (PAD) is a chronic vascular disease with high morbidity, often accompanied by sarcopenia. However, the prognostic value and mechanistic relevance of computed tomography (CT)-defined sarcopenia in PAD remain unclear. This study aims to assess the independent impact of sarcopenia on all-cause mortality and major adverse cardiovascular events in PAD patients, and to determine optimal third lumbar vertebra skeletal muscle index (L3-SMI) cutoffs for risk stratification.
METHODS: In this retrospective cohort study, 208 PAD patients were grouped by L3-SMI into sarcopenia (n = 110) and nonsarcopenia (n = 98). Multivariate Cox regression evaluated associations with mortality and major adverse cardiovascular events (MACE), while restricted cubic spline (RCS) models explored dose-response patterns. Kaplan-Meier and log-rank tests compared survival, and Spearman correlation analyzed functional and metabolic associations.
RESULTS: The sarcopenia group exhibited significantly higher age (71.5 ± 9.38 vs. 65.81 ± 10.25 years, P < 0.001), while lower L3-SMI (36.48 ± 5.67 vs. 47.31 ± 7.88 cm2/m2, P < 0.001), lower body mass index (22.31 ± 2.96 vs. 25.77 ± 2.72 kg/m2, P < 0.001), lower albumin (37 vs. 39 g/L, P = 0.005), and lower serum phosphate (1.14 vs. 1.23 mmol/L, P = 0.009). Over a 36-month median follow-up, sarcopenia was associated with increased all-cause death (27% vs. 14%, P = 0.034) and MACE incidence (28% vs. 14%, P = 0.024). Multivariate Cox regression revealed that each 1-unit decrease in L3-SMI elevated death risk by 7% (adjusted hazard ratio [HR] = 0.93, 95% confidence interval [CI]: 0.88-0.98, P = 0.009) and MACE risk by 9% (adjusted HR = 0.92, 95% CI: 0.86-0.96, P = 0.008). RCS analysis identified nonlinear dose-response relationships: L3-SMI <40.97 cm2/m2 sharply increased death risk (HR = 3.3), while L3-SMI <48.78 cm2/m2 significantly amplified MACE risk (HR = 7.89). Correlations between L3-SMI and Barthel index (r = 0.56, P < 0.001), serum phosphate (r = 0.53, P = 0.002), and Fontaine stage (r = -0.39, P = 0.007) suggested sarcopenia might exacerbate disease progression via metabolic dysregulation, immune suppression, and functional decline.
CONCLUSION: CT-defined sarcopenia independently predicts poor outcomes in PAD. L3-SMI thresholds enable early risk stratification and support targeted interventions to improve prognosis. These findings underscore the importance of incorporating body composition assessment into routine risk evaluation for PAD patients.
METHODS: In this retrospective cohort study, 208 PAD patients were grouped by L3-SMI into sarcopenia (n = 110) and nonsarcopenia (n = 98). Multivariate Cox regression evaluated associations with mortality and major adverse cardiovascular events (MACE), while restricted cubic spline (RCS) models explored dose-response patterns. Kaplan-Meier and log-rank tests compared survival, and Spearman correlation analyzed functional and metabolic associations.
RESULTS: The sarcopenia group exhibited significantly higher age (71.5 ± 9.38 vs. 65.81 ± 10.25 years, P < 0.001), while lower L3-SMI (36.48 ± 5.67 vs. 47.31 ± 7.88 cm2/m2, P < 0.001), lower body mass index (22.31 ± 2.96 vs. 25.77 ± 2.72 kg/m2, P < 0.001), lower albumin (37 vs. 39 g/L, P = 0.005), and lower serum phosphate (1.14 vs. 1.23 mmol/L, P = 0.009). Over a 36-month median follow-up, sarcopenia was associated with increased all-cause death (27% vs. 14%, P = 0.034) and MACE incidence (28% vs. 14%, P = 0.024). Multivariate Cox regression revealed that each 1-unit decrease in L3-SMI elevated death risk by 7% (adjusted hazard ratio [HR] = 0.93, 95% confidence interval [CI]: 0.88-0.98, P = 0.009) and MACE risk by 9% (adjusted HR = 0.92, 95% CI: 0.86-0.96, P = 0.008). RCS analysis identified nonlinear dose-response relationships: L3-SMI <40.97 cm2/m2 sharply increased death risk (HR = 3.3), while L3-SMI <48.78 cm2/m2 significantly amplified MACE risk (HR = 7.89). Correlations between L3-SMI and Barthel index (r = 0.56, P < 0.001), serum phosphate (r = 0.53, P = 0.002), and Fontaine stage (r = -0.39, P = 0.007) suggested sarcopenia might exacerbate disease progression via metabolic dysregulation, immune suppression, and functional decline.
CONCLUSION: CT-defined sarcopenia independently predicts poor outcomes in PAD. L3-SMI thresholds enable early risk stratification and support targeted interventions to improve prognosis. These findings underscore the importance of incorporating body composition assessment into routine risk evaluation for PAD patients.