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Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the ATTICA study
  1. Stefanos Tyrovolas1,2,3,
  2. Demosthenes Panagiotakos3,4,
  3. Ekavi Georgousopoulou3,4,5,
  4. Christina Chrysohoou6,
  5. Dimitrios Tousoulis6,
  6. Josep Maria Haro1,2,7,
  7. Christos Pitsavos6
  1. 1 Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
  2. 2 Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5. Pabellón 11, 28029, Madrid, Spain
  3. 3 Department of Science of Dietetics and Nutrition, School of Health Science and Education, Harokopio University, Athens, Greece
  4. 4 Department of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
  5. 5 Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia
  6. 6 First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
  7. 7 Department of Medicine, Universidad de Barcelona, Barcelona, Spain
  1. Correspondence to Dr Stefanos Tyrovolas, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM,Dr. Antoni Pujadas, 42, 08830 – Sant Boi de Llobregat, Barcelona, Spain; s.tyrovolas{at}


Background Skeletal muscle mass (SMM) is inversely associated with cardiometabolic health and the ageing process. The aim of the present work was to evaluate the relation between SMM and 10 year cardiovascular disease (CVD) incidence, among CVD-free adults 45+ years old.

Methods ATTICA is a prospective, population-based study that recruited 3042 adults without pre-existing CVD from the Greek general population (Caucasians; age ≥18 years; 1514 men). The 10 year study follow-up (2011–2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). The working sample consisted of 1019 participants, 45+ years old (men: n=534; women: n=485). A skeletal muscle mass index (SMI) was created to reflect SMM, using appendicular skeletal muscle mass (ASM) standardised by body mass index (BMI). ASM and SMI were calculated with specific indirect population formulas.

Results The 10 year CVD incidence increased significantly across the baseline SMI tertiles (p<0.001). Baseline SMM showed a significant inverse association with the 10 year CVD incidence (HR 0.06, 95% CI 0.005 to 0.78), even after adjusting for various confounders. Additionally, participants in the highest SMM tertile had 81% (95% CI 0.04 to 0.85) lower risk for a CVD event as compared with those in the lowest SMM tertile.

Conclusions The presented findings support the importance of SMM evaluation in the prediction of long-term CVD risk among adults 45+ years old without pre-existing CVD. Preservation of SMM may contribute to CVD health.

  • ageing
  • epidemiology of cardiovascular disease
  • physiology

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  • Contributors Study design: ST and DBP. Data analysis: ST, DBP. Data interpretation: ST, DBP, ENG, CC, JMH, DT, CC, and CP. Drafting manuscript: ST and DBP. Revising manuscript content: ENG, CC, JMH, DT, CC, and CP. Approving final version of manuscript: All authors.

  • Funding The ATTICA study is supported by research grants from the Hellenic Cardiology Society (HCS2002) and the Hellenic Atherosclerosis Society (HAS2003). This work was supported by the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project, which has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 635316. Stefanos Tyrovolas’s work was supported by the Foundation for Education and European Culture (IPEP), the Sara Borrell postdoctoral program (reference no. CD15/00019 from the Instituto de Salud Carlos III (ISCIII - Spain) and the Fondos Europeo de Desarrollo Regional (FEDER).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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