Rational Pharmacotherapy in Cardiology

Advanced search

Prevalence of Musculoskeletal Disorders in Patients with Coronary Artery Disease

Full Text:


Aim. To study the prevalence of musculoskeletal disorders in patients with stable coronary artery disease (CAD).

Material and methods. Patients with stable CAD (n=387) were included in the study. The subjects were admitted to the hospital for planned myocardial revascularization (ages of 50-82). The median age was 65 [59;69] years. Most of the sample consisted of males - 283 (73.1%). 323 (83.5%) patients had arterial hypertension (AH), 57.1% - history of myocardial infarction, and a quarter of the patients had type 2 diabetes mellitus (DM). The study of musculoskeletal system included the identification of sarcopenia in accordance with The European Working Group on Sarcopenia in Older People (EWGSOP, 2019); verification of osteopenia/osteoporosis according to the WHO criteria (2008); diagnosing osteosarcopenia in case of sarcopenia and osteopenia/osteoporosis coexistence.

Results. At the initial screening of sarcopenia in accordance with EWGSOP, clinical signs (according to the Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire) were detected in 41.3% of cases, but further examination (dynamometry, quantitative assessment of skeletal muscle) confirmed this diagnosis only in 19.9% of patients with CAD. Among the examined patients with CAD a low T-score according to DEXA was found in 53 (13.7%) of cases, and osteopenia was diagnosed 10 times more often than osteoporosis (90.6% vs. 9.4%). Furthermore, due to combination of low bone density (osteopenia/osteoporosis) and reduced muscle mass and strength (sarcopenia), osteosarcopenia was verified in one patient. Thus, the study revealed the prevalence of particular types of musculoskeletal disorders in 105 (27.1%) patients with stable CAD. The most common type of musculoskeletal disorder was sarcopenia - 52 cases (13.4%); osteopenia/osteoporosis was detected in 28 patients (7.2%), osteosarcopenia in 25 (6.5%). The most pronounced clinical manifestation of sarcopenia and osteopenia/osteoporosis, reflected by a higher score on the SARC-F questionnaire, low handgrip strength, small area of muscle tissue, low musculoskeletal index, as well as low values of bone mineral density, were observed in patients with osteosarcopenia. Patients with osteopenia/osteoporosis did not differ significantly from patients without musculoskeletal conditions in most parameters, with the exception of the T-score, the average SARC-F score, and muscle strength in men. The conducted correlation analysis revealed not only the relationship between the parameters of musculoskeletal function, but also their association with age, duration of AH, CAD, and type 2 DM.

Conclusion. Several types of musculoskeletal disorders were found in a third of patients with CAD. Sarcopenia was revealed to be the most frequent type of musculoskeletal disorder.

About the Authors

E. D. Bazdyrev
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Evgeny D. Bazdyrev - eLibrary SPIN 4545-0791


N. A. Terentyeva
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Natalia A. Terentyeva


K. E. Krivoshapova
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Kristina E. Krivoshapova - eLibrary SPIN 4272-7552


V. L. Masenko
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Vladislava L. Masenko - eLibrary SPIN 5437-0710


E. A. Wegner
Kemerovo State Medical University
Russian Federation

Elena А. Vegner


А. N. Kokov
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Alexander N. Kokov - eLibrary SPIN 8455-4271


S. A. Pomeshkina
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Svetlana А. Pomeshkina - eLibrary SPIN 2018-0860


O. L. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Olga L. Barbarash – eLibrary SPIN 5373-7620



1. Su SW, Wang D. Health-related quality of life and related factors among elderly persons under different aged care models in Guangzhou, China: a cross-sectional study. Qual Life Res. 2019;28(5):1 293303. DOI:10.1007/s11136-019-02107-x.

2. Fatima M, Brennan-Olsen SL, Duque G. Therapeutic approaches to osteosarcopenia: insights for the clinician. Ther Adv Musculoskelet Dis. 2019;1 1:1 759720X1 9867009. DOI:10.1177/1759720X19867009.

3. Kirk B, Al Saedi A, Duque G. Osteosarcopenia: a case of geroscience. Aging Med (Milton). 2019;2(3):147-56. DOI:10.1002/agm2.12080.

4. Kirk B, Zanker J, Duque G. Osteosarcopenia: epidemiology, diagnosis, and treatment - facts and numbers. J Cachexia Sarcopenia Muscle. 2020;1 1(3):609-18. DOI:10.1002/jcsm.12567.

5. Sepulveda-Loyola W, Phu S, Bani Hassan E, et al. The joint occurrence of osteoporosis and sarcopenia (osteosarcopenia): definitions and characteristics. J Am Med Dir Assoc. 2019;21 (2):220-5. D0I:10.1016/j.jamda.2019.09.005.

6. Shilov SN, Teplyakov AT, Yakovleva IV, et al. Clinical and pathogenic relationship between chronic heart failure, type 2 diabetes mellitus and osteoporosis. Complex Issues of Cardiovascular Diseases. 2018;7(1):6-13 (In Russ.) DOI:10.17802/2306-1278-2018-7-1-6-13.

7. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48(1):16-31. DOI:10.1093/ageing/afy169.

8. Mel'nichenko GA, Belaya ZhE, Rozhinskaya LYa, et al. Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis. Problems of Endocrinology. 2017;63(6):392-426 (In Russ.) DOI:10.14341/probl2017636392-426.

9. Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population based study Lancet Oncol. 2008;9(7):629-35. D0I:10.1016/S1470-2045(08)70153-0.

10. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. DOI:10.1093/ageing/afy169.

11. Chen LK, Lee WJ, Peng LN, et al. Recent advances in sarcopenia research in Asia: 2016 update from the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2016;17(8):767.e1 -7. DOI:10.1016/j.jamda.2016.05.016.

12. Springer J, Springer JI, Anker SD. Muscle wasting and sarcopenia in heart failure and beyond: update 2017. ESC Heart Fail. 2017;4(4):492-8. DOI:10.1002/ehf2.12237.

13. De Moraes Santana N, Mendes RML, da Silva NF, et al. Sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction. Einstein (Sao Paulo). 2019;17(4):eAO4632. DOI:10.31744/einstein_journal/2019AO4632.

14. Bocharova KA, Gerasimenko AV, Zhaboeva SL. Sarkopenia association with the leading somatic pathology in elderly age. Modern Problems of Science and Education. 2014;(6):1150. (In Russ.)

15. Zhang N, Zhu WL, Liu XH, et al. Prevalence and prognostic implications of sarcopenia in older patients with coronary heart disease. J Geriatr Cardiol. 2019;16(10):756-63. DOI:10.11909/j.issn.1671-5411.2019.10.002.

16. Springer J, Springer JI, Anker SD. Muscle wasting and sarcopenia in heart failure and beyond: update 2017. ESC Heart Fail 2017; 4(4):492-8. DOI:10.1002/ehf2.12237.

17. Hajahmadi M, Shemshadi S, Khalilipur E, et al. Muscle wasting in young patients with dilated cardiomyopathy, J Cachexia Sarcopenia Muscle. 2017;8(4):542-8. DOI:10.1002/jcsm.12193.

18. Wu CH, Hung WC, Chang IL, et al. Pharmacologic intervention for prevention of fractures in os-teopenic and osteoporotic postmenopausal women: systemic review and meta-analysis. Bone Rep. 2020;1 3:1 00729. DOI:10.1016/j.bonr.2020.100729.

19. Xu R, Cheng XC, Zhang Y et al. Association of severity of coronary lesions with bone mineral density in postmenopausal women. Arq Bras Cardiol. 2018;110(3):211-6. DOI:10.5935/abc.20180035.

20. Hadji P, Klein S, Gothe H, et al. The epidemiology of osteoporosis - Bone Evaluation Study (BEST): an analysis of routine health insurance data. Dtsch Arztebl Int. 2013;110(4):52-7. DOI:10.3238/arztebl.2013.0052.

21. Wright NC, Looker AC, Saag KG, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29(1 1):2520-6. DOI:10.1002/jbmr.2269.

22. Ko CH, Yu SF, Su FM, et al. High prevalence and correlates of osteoporosis in men aged 50 years and over: a nationwide osteoporosis survey in Taiwan. Int J Rheum Dis. 2018;21(12):2212-8. DOI:10.1111/1756-185X.13409.

23. Colon-Emeric CS, Pieper CF, Van Houtven CH, et al. Limited osteoporosis screening effectiveness due to low treatment rates in a national sample of older men. Mayo Clin Proc. 2018;93(1 2):1749-59. DOI:10.1016/j.mayocp.2018.06.024.

24. Kokov AN, Masenko VL, Tarasov RS, et al. Evaluation of coronary artery disease in men with os-teopenic syndrome and coronary artery disease. Terapevticheskiy Arkhiv. 2014;86(3):65-70 (In Russ.)

25. Voronkina AV, Raskina TA, Letaeva MV, et al. Association of mineral bone density and risk of osteoporotic fractures with coronary and carotid atherosclerosis in male patients with stable angina. Fundamental and Clinical Medicine. 2018;3(1):51-62 (In Russ.) DOI:10.23946/2500-0764-2018-3-1-51-62.

26. Platitsyna NG, Bolotnova TV. Bone mineral density, vitamin d status in patients with cardiovascular pathology. Medicinskaja Nauka i Obrazovanie Urala. 2019;20(1):36-42 (In Russ.)

27. Nielsen BR, Abdulla J, Andersen HE, et al. Sarcopenia and osteoporosis in older people: a systematic review and meta-analysis. Eur Geriatr Med. 2018;9:419-34. DOI :10.1007/s41999-018-0079-6.

28. Pereira FB, Leite AF, de Paula AP. Relationship between pre-sarcopenia, sarcopenia and bone mineral density in elderly men. Arch Endocrinol Metab. 2015;59(1):59-65. DOI: 10.1590/2359-3997000000011.

29. Lima RM, de Oliveira RJ, Raposo R, et al. Stages of sarcopenia, bone mineral density, and the prevalence of osteoporosis in older women. Arch Osteoporos. 2019;14(1):38. DOI:10.1007/s11657019-0591-4.

30. Locquet M, Beaudart C, Reginster JY et al. Association between the decline in muscle health and the decline in bone health in older individuals from the SarcoPhAge cohort. Calcif Tissue Int. 2019;104(3):273-84. DOI:10.1007/s00223-018-0503-4.

31. Scott D, Johansson J, McMillan LB, et al. Associations of sarcopenia and its components with bone structure and incident falls in Swedish older adults. Calcif Tissue Int. 2019;1 05(1 ):26-36. DOI:10.1007/s00223-019-00540-1.

32. Fahimfar N, Zahedi Tajrishi F, Gharibzadeh S, et al. Prevalence of osteosarcopenia and its association with cardiovascular risk factors in Iranian older people: Bushehr Elderly Health (BEH) Program. Calcif Tissue Int. 2020;106(4):364-70. DOI:10.1007/s00223-019-00646-6.

33. Cui M, Gang X, Wang G, et al. A cross-sectional study. Associations between sarcopenia and clinical characteristics of patients with type 2 diabetes. Medicine (Baltimore). 2020;99(2):e1 8708. DOI:10.1097/MD.0000000000018708.

34. Aleman-Mateo H, Lopez Teros MT, Ramirez FA, et al. Association between insulin resistance and low relative appendicular skeletal muscle mass: evidence from a cohort study in community-dwelling older men and women participants. J Gerontol A Biol Sci Med Sci. 2014;69(7):871-7. DOI:10.1093/gerona/glt193.

35. Semba RD, Bandinelli S, Sun K, et al. Relationship of an advanced glycation end product, plasma carboxymethyl-lysine, with slow walking speed in older adults: the InCHIANTI study Eur J Appl Physiol. 2010;108(1):191-5. DOI:10.1007/s00421-009-1192-5.

36. Chen X, Wang R, Chen W, et al. Decoy receptor-3 regulates inflammation and apoptosis via PI3K/AKT signaling pathway in coronary heart disease. Exp Ther Med. 2019;1 7(4):261 4-22. DOI:10.3892/etm.2019.7222.

For citation:

Bazdyrev E.D., Terentyeva N.A., Krivoshapova K.E., Masenko V.L., Wegner E.A., Kokov А.N., Pomeshkina S.A., Barbarash O.L. Prevalence of Musculoskeletal Disorders in Patients with Coronary Artery Disease. Rational Pharmacotherapy in Cardiology. 2021;17(3):369-375.

Views: 138

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)