The Association Between Arterial Stiffness and Muscle Indices Among Healthy Subjects and Subjects With Cardiovascular Risk Factors: An Evidence-Based Review

Abstract

Skeletal muscle is one of the major tissues in the body and is important for performing daily physical activity. Previous studies suggest that vascular dysfunction contributes to reduced skeletal muscle mass. However, the association between vascular dysfunction and muscle mass, muscle strength and muscle flexibility are less established. Therefore, the focus of this review was to investigate the association between arterial stiffness (AS) which is a marker of vascular function, and muscle indices among healthy and those with cardiovascular risk factors. Three databases were used to search for relevant studies. These keywords were used: “arterial stiffness” OR “vascular stiffness” OR “aortic stiffness” OR “pulse wave velocity” OR “carotid femoral pulse wave velocity” OR “pulse wave analysis” AND “muscle” OR “skeletal” OR “flexibility” OR “range of motion” OR “articular” OR “arthrometry” OR “strength” OR “hand strength” OR “pinch strength” OR “mass” OR “lean” OR “body composition.” The criteria were; (1) original, full-text articles, (2) articles written in English language, (3) human studies involving healthy adults and/or adults with cardiovascular disease (CVD) or CVD risk factors (4) articles that reported the relationship between AS (measured as carotid-femoral pulse wave velocity or brachial-ankle pulse wave velocity) and muscle indices (measured as muscle mass, muscle flexibility and muscle strength) after adjusting for relevant confounders. The search identified 2295 articles published between 1971 and June 2021. Only 17 articles fulfilled the criteria. Two studies showed an inverse association between AS and muscle strength in healthy subjects, whereas in subjects with CVD risk factors, five out of seven studies found an inverse correlation between the two parameters. Eleven studies showed an inverse association between AS and muscle mass in subjects with CVD and CVD risk factors. The association between AS and muscle flexibility was not studied in any of the articles reviewed. In conclusion, there is an inverse correlation between muscle indices and AS in healthy adults and those with CVD or CVD risk factors. However, most of the studies were cross-sectional studies, hence the need for future prospective studies to address this issue.

Non-linear Associations Between Visceral Adiposity Index and Cardiovascular and Cerebrovascular Diseases: Results From the NHANES (1999–2018)

“…Further, the VAI was associated with chronic inflammation and insulin resistance, due to increases in free fatty acids, interleukin-6, tumor necrosis factor-α, and decreased adiponectin production, related to VAT (23). Inflammatory cytokines and reactive oxygen species lead to decreased nitric oxide concentrations, which are associated with a higher risk of arterial stiffness (24)(25)(26)(27). Additionally, large quantities of fatty acids, due to accumulative visceral adiposity and chronic inflammation, can promote the likelihood of insulin resistance, which is associated with atherosclerosis (28)(29)(30)(31).…”

Cross‐sectional and longitudinal associations between body flexibility and sarcopenia

“…Recent studies proposed that reduced blood flow with aging might contribute to the development of sarcopenia. 11 , 12 , 29 , 30 , 31 Reduced blood flow with aging impaired the delivery of oxygen and nutrients to skeletal muscle, which could accelerate the loss of muscle mass and strength. Vascular dysfunction and decreased capillarity were key factors that restrict blood flow and muscle perfusion.…”

“…Vascular dysfunction and decreased capillarity were key factors that restrict blood flow and muscle perfusion. 11 , 12 , 30 , 31 Population‐based studies had observed that flexibility was associated with vascular dysfunction, 32 , 33 and human trials reported that increasing flexibility enhanced blood flow and capillary growth in skeletal muscle and improved vascular function. 9 , 10 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 Animal‐based studies also found that muscle stretching enhanced blood flow, improved vessel function and induced capillarization of aged skeletal muscle.…”

“…Other factors such as blood flow might link flexibility to sarcopenia. Recent studies proposed that reduced blood flow with aging might contribute to the development of sarcopenia 11,12,29–31 . Reduced blood flow with aging impaired the delivery of oxygen and nutrients to skeletal muscle, which could accelerate the loss of muscle mass and strength.…”

Benefits of combined exercise training on arterial stiffness and blood pressure in spontaneously hypertensive rats treated or not with dexamethasone

“…Regular exercise training is an effective non-pharmacological therapy to control hypertension ( Pescatello et al, 2015 ; Whelton et al, 2018 ; Williams et al, 20182018 ; Unger et al, 2020 ; Barroso et al, 2021 ) and is able to attenuate pathological cardiac remodeling ( Cattadori et al, 2018 ) and to improve arterial stiffness ( Lopes et al, 2021 ) in hypertensive humans. Combined exercise training, which consists of aerobic and resistance exercise on alternate days, has been associated with better responses in controlling cardiovascular risk factors for cardiovascular diseases ( Figueroa et al, 2011 ; Ho et al, 2012 ; Schroeder et al, 2019 ; Dias et al, 2020a ; Aminuddin et al, 2021 ). However, the impact of combined exercise training on arterial stiffness and cardiac remodeling in SHR are still unclear.…”