Sarcopenic Obesity Increases Risk of Heart Failure Progression in Diabetes, finds study
A new study published in the journal Cardiovascular Diabetology found that sarcopenic obesity (SO), which is low skeletal muscle mass with excess fat, is associated with negative left ventricular (LV) remodeling and poorer outcomes in heart failure with reduced ejection fraction (HFrEF) and diabetes mellitus (DM). DM causes an impairment of muscle metabolism and results in muscle atrophy and fat deposition, which makes SO a specially worrisome phenotype among this population. The study was conducted by Ke Shi and fellow researchers.
283 patients with HFrEF and DM underwent cardiac MRI for the assessment of LV volume and function. Skeletal muscle mass was approximated with the help of the thoracic skeletal muscle index (SMI), and a median value of 42.75 cm²/m² as a cutoff was utilized. Patients were segregated into various groups as per SMI and BMI (≥25 kg/m²). Obese subjects with an SMI below the median were grouped under SO. Clinical parameters such as readmission for heart failure, cardiovascular death, and heart transplantation were documented during a median follow-up duration of 35.1 months.
Key Findings
The patients with SO had profoundly elevated amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and greater hypoproteinemia than non sarcopenic obese patients.
The patients with SO had more LV expansion, elevated LV mass, and more severe LV dysfunction, reflecting negative cardiac remodeling.
In follow-up, 73 patients (25.8%) had adverse cardiovascular outcomes, and the most unfavorable prognosis was in the SO group (log-rank p= 0.04).
Multivariable Cox regression analysis revealed that patients with SO were 3.03 times more likely to have adverse outcomes than those without sarcopenia or obesity (HR: 3.03, 95% CI: 1.39–6.63, p= 0.005).
The study authors concluded that SO is an independent predictor of negative cardiovascular outcomes in diabetic HFrEF patients. As a result of its close correlation with adverse LV remodeling and increased mortality risk, SO should be acknowledged as an important determinant in risk stratification and specific management approaches in these patients.
Reference:
Shi, K., Zhang, G., Xu, R. et al. Association of body composition with left ventricular remodeling and outcomes in diabetic heart failure with reduced ejection fraction: assessment of sarcopenic obesity using cardiac MRI. Cardiovasc Diabetol 24, 79 (2025). https://doi.org/10.1186/s12933-025-02639-2
