Myopenic Obesity Determined by Fat Mass Percentage Predicts Risk of Aspirin-Induced Bleeding in Chinese Older Adults

Abstract

Background Body mass index (BMI) correlates with aspirin-induced bleeding risk. However, skeletal muscle mass (SMM) loss and fat gain commonly occur with aging, making BMI not a reasonable marker of bleeding risk in older individuals. In the present study, we aimed to investigate the prognostic value of myopenic obesity based on the percent of fat mass (%FM) for aspirin-induced bleeding in Chinese patients over 60 years old. Methods We prospectively analyzed 185 patients taking aspirin for primary and secondary prevention of cardiovascular diseases. Body composition parameters were estimated using bioelectrical impedance analysis. We defined myopenic obesity (MO) as a height-adjusted appendicular SMM <7.0 kg/m 2 in males and <5.7 kg/m 2 in females with a %FM >29% in males and >41% in females or a BMI ≥25 kg/m 2 . The patients were categorized into four groups by the presence or absence of myopenia and obesity. Results Based on the %FM grouping, the bleeding risk was significantly higher in the MO group, followed by the nonmyopenic obesity, myopenic nonobesity, and nonmyopenic nonobesity groups (P = 0.044). No statistically significant differences in the probability of bleeding events were observed among the four BMI-based groups (P = 0.502). Multivariate Cox analysis indicated that MO (hazard ratio [HR] 2.724, 95% confidence interval [CI] 1.073–6.918, P = 0.035), aspirin dose (100 vs 50 mg/day, HR 2.609, 95% CI 1.291–5.273, P = 0.008), concomitant use of histamine-2 receptor antagonists and proton pump inhibitors (HR 1.777, 95% CI 1.007–3.137, P = 0.047), and hemorrhage history (HR 2.576, 95% CI 1.355–4.897, P = 0.004) were associated with bleeding events independently. Conclusion %FM-based MO was an independent predictor of aspirin-induced bleeding in older Chinese individuals. Reducing %FM rather than BMI should be an optimal strategy for the management of myopenic obesity.