Effect of muscle depletion on survival in peripheral arterial occlusive disease: Quality over quantity

Issi R Vedder, Stef Levolger, Rudi A J O Dierckx, Clark J Zeebregts, Jean-Paul P M de Vries, Alain R Viddeleer, Reinoud P H Bokkers*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objective: Patients with peripheral arterial occlusive disease (PAOD) have a poor prognosis and a high prevalence of comorbidity. This study investigated whether sarcopenia and/or myosteatosis negatively affect long-term survival in patients with PAOD.

Methods: This was a single-center, retrospective cohort study of 686 consecutive patients diagnosed and treated for PAOD and who underwent computed tomography scanning. Cross-sectional muscle measurements were obtained at the level of the third lumbar vertebra. Optimal stratification was used to define sex-specific and body mass index-specific cutoff values for sarcopenia and myosteatosis, respectively. The Cox proportional hazards model was used to determine the effect of sarcopenia and myosteatosis on overall survival.

Results: Sarcopenia was associated with age, body mass index, myosteatosis, malignancy, congestive heart failure, hemodialysis, and Fontaine 4 classification. Myosteatosis was associated with age, sarcopenia, type 2 diabetes mellitus, hypertension, chronic obstructive pulmonary disease, malignancy, congestive heart failure, ischemic stroke, and Fontaine 4 classification. Sarcopenia (hazard ratio [HP], 2.82; 95% confidence interval [CI], 2.05-3.86; P <.001) and myosteatosis (HR, 4.13; 95% CI, 3.03-5.63; P <.001) were both associated with reduced survival in univariable analysis. When adjusted for other prognostic markers, myosteatosis (HR, 2.09; 95% CI, 1.46-2.99; P <.001) was still associated with lower overall survival in the multivariable model, but sarcopenia (HR, 1.40; 95% CI, 0.97-2.01; P=.073) was not.

Conclusions: Muscle depletion is independently associated with a poorer overall survival in patients with PAOD. Myosteatosis is a stronger predictor than sarcopenia, which indicates that quality is more important than quantity. Results should be interpreted with caution owing to missing data on medication usage.

Original languageEnglish
Pages (from-to)2006-2016.e1
Number of pages12
JournalJournal of Vascular Surgery
Issue number6
Early online date21-Apr-2020
Publication statusPublished - Dec-2020


  • PAOD
  • Sarcopenia
  • Myosteatosis
  • Intramuscular fat
  • Survival
  • Outcome
  • MASS

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