# Relationship between sarcopenia and cardiovascular disease among middle-aged and older adults with normal weight in China: functional limitation plays a mediating role

## TL;DR

This study finds that sarcopenia increases cardiovascular disease risk in normal-weight older adults in China, with functional limitation playing a key mediating role.

## Contribution

Identifies functional limitation as a mediator linking sarcopenia to cardiovascular disease in normal-weight populations.

## Key findings

- Sarcopenia was associated with a 45% higher risk of cardiovascular disease in normal-weight individuals.
- Functional limitation mediated approximately 15% of the effect of sarcopenia on cardiovascular disease.
- The association remained significant after adjusting for multiple variables.

## Abstract

Cardiovascular disease (CVD) is the predominant cause of mortality in China. However, the mechanisms linking sarcopenia to CVD remain poorly understood, particularly in normal-weight populations. Individuals with the absence of overweight or obesity may tend to experience missed opportunities for timely intervention. This study aimed to investigate the longitudinal association between sarcopenia and incidence of new-onset CVD in a normal-weight population, and to examine the mediating effect of functional limitation in this relationship.

We conducted a closed-cohort analysis using a nationwide sample of 4,147 middle-aged and older adults with normal weight in China. We performed Cox proportional hazards regression analysis to explore the associations of baseline sarcopenia with incident CVD. The difference method was applied to estimate the mediation proportion of functional limitation in this association.

Over a mean follow-up period of 7.62 years, CVD occurred in 835 participants. In the multivariable-adjusted Cox model, individuals with sarcopenia exhibited a significantly higher likelihood of developing incident CVD compared to those without sarcopenia (adjusted hazard ratio [aHR] = 1.45, 95% confidence interval [CI]: 1.21–1.73, P < 0.001). Similar associations were observed for the incidence of heart disease and stroke. Functional limitation accounted for approximately 15.0% of the total effect of sarcopenia on incident CVD (P < 0.001).

Sarcopenia exerts both direct and indirect effects on incident CVD among middle-aged and older adults who are normal weight, with functional limitation serving as a significant mediator. Interventions targeting both sarcopenia and functional limitation may offer a promising strategy for enhancing cardiovascular health in this population.

The online version contains supplementary material available at https://doi.org/10.1265/ehpm.24-00351.