Prognostic Usefulness of Arm and Calf Circumference in Patients ≥65 Years of Age With Cardiovascular Disease

Am J Cardiol. 2017 Jan 15;119(2):186-191. doi: 10.1016/j.amjcard.2016.09.040. Epub 2016 Oct 8.


Current diagnostic criteria for sarcopenia require measurement of muscle function (MF) and muscle mass. Mid upper arm circumference (AC) and calf circumference (CC) are currently used as metrics of muscle mass. This study was performed to compare the prognostic predictive capabilities of AC and CC in older patients with cardiovascular disease (CVD). The study population consisted of 599 admitted patients aged ≥65 years (74.8 ± 6.3 years, 392 men) with CVD. We measured MF (gait speed and grip strength), AC, and CC before hospital discharge. The end point was all-cause mortality. During follow-up (median 1.63 years, interquartile range 2.09 years), 72 deaths occurred. Both high AC and high CC were associated with better outcome; however, only AC (adjusted hazard ratio per SD increase 0.56, p = 0.023), but not CC (adjusted hazard ratio per SD increase 0.91, p = 0.696), showed significant independent prognostic capability after adjusting for other prognostic factors. Moreover, adding AC to MF (0.71 vs 0.62, p = 0.005) but not CC to MF (0.67 vs 0.62, p = 0.188) significantly increased the area under the curve on receiver operating characteristic curve. In conclusion, a high AC, but not CC, was an independent predictor of survival and could be a readily available and simple metric for risk stratification in older patients with CVD.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Arm*
  • Body Weights and Measures
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / mortality
  • Female
  • Geriatric Assessment
  • Hand Strength
  • Humans
  • Leg*
  • Male
  • Muscle, Skeletal*
  • Predictive Value of Tests
  • Prognosis
  • ROC Curve
  • Retrospective Studies
  • Walking Speed