Abstract
BACKGROUND: Sarcopenia, an age-related condition, has an unclear association with cardiovascular disease (CVD) risk. We aimed to analyze whether sarcopenia and its individual components are associated with new-onset CVD in middle-aged and older adults. METHODS AND RESULTS: Data were derived from the China Health and Retirement Longitudinal Study, with sarcopenia defined by the Asian Working Group for Sarcopenia 2019 criteria. The primary outcome was composite CVD, comprising heart disease and stroke. Multivariable Cox proportional hazards regression analysis and Fine-Gray subdistribution hazards models were used to calculate hazard ratios (HRs), subdistribution hazard ratios (SHRs), and 95% CIs. A total of 10 649 participants (mean age 64.5±10.7 years, 47.6% male) were included. During mean follow-up of 4.60±1.06 years, there were 1649 (15.5%) cases of new-onset CVD. Possible sarcopenia was linked to increased new-onset composite CVD risk (HR, 1.21 [95% CI, 1.06-1.37]; SHR, 1.20 [95% CI, 1.05-1.35]), whereas sarcopenia and severe sarcopenia showed no association. Restricted cubic spline analysis revealed that 5-time chair stand test (5-CST) was associated with new-onset composite CVD, with significant sex-specific interaction (P-for-interaction=0.001). Compared with 5-CST≤9.0 s, higher risk of new-onset composite CVD was observed in men for 9.0 s<5-CST≤15.0 s (HR, 1.36 [95% CI, 1.16-1.59]; SHR, 1.34 [95% CI, 1.15-1.56]) and 5-CST>15.0 s (HR, 2.19 [95% CI, 1.65-2.90]; SHR, 2.00 [95% CI, 1.53-2.63]). Among women, 5-CST>8.5 s had higher risk of new-onset composite CVD compared with 5-CST≤8.5 s (HR, 1.26 [95% CI, 1.09-1.45]; SHR, 1.25 [95% CI, 1.09-1.43]). CONCLUSION: Possible sarcopenia was associated with increased risk of new-onset composite CVD, suggesting that progression to definite sarcopenia may not parallel cardiovascular risk. Longer 5-CST was linked to higher risk of new-onset composite CVD, with sex-specific association.