​News Release

Research led by NHCS found a potential predictor of cardiac disease in the elderly: Discovery of ‘Cardio-Sarcopenia’ syndrome from heart muscle ageing

Singapore, 1 September 2021 – A team of researchers led by the National Heart Centre Singapore (NHCS) discovered a link between the weakening of skeletal muscle function (sarcopenia) and the heart, among older adults within the community population. This significant finding could help in early identification of elderly who are at risk of heart disease and provide insights on geriatric care management for Singapore’s ageing population.

Sarcopenia, defined as the loss of muscle mass and function, is a common condition afflicting the elderly population, with age-related loss of skeletal muscle mass and function affecting 10 percent of older healthy adults1. While the occurrence of skeletal muscle degeneration with ageing is known, the impact of sarcopenia on the heart by ageing has not been identified.

In a cohort study involving over 300 older adults from the local community2, NHCS researchers studied the characteristics of heart ageing and skeletal muscle sarcopenia. Based on detailed scans and various assessments such as echocardiogram, skeletal muscle mass measurements and hand grip strength tests, the researchers found significant associations between skeletal muscle mass, function and heart structure. Over 20 percent of older adults had abnormal skeletal muscle function. Importantly, they had a distinct pattern of structurally smaller heart sizes, compared to elderly who did not have sarcopenia. This finding supported the team’s original hypothesis that a syndrome of ‘cardio-sarcopenia’ may pre-exist in community older adults, even before the development of symptomatic heart disease.

“The discovery of this pattern within the heart muscle suggests early development or progression of cardiovascular disease that occur jointly in the heart and skeletal muscle,” shared Assistant Professor Angela Koh, Senior Consultant from the Department of Cardiology at NHCS, who leads the Cardiac Ageing Study. Emphasising that this finding was discovered among community older adults, she adds, “This provides a window of opportunity to detect this syndrome early on, before heart disease occurs among our aged population.”

Next phase: Finding solutions to decelerate ‘cardio-sarcopenia’

While the clinical implication of ‘cardio-sarcopenia’ syndrome is currently under intense investigation, older adults with this syndrome may represent a subgroup with unique risks for future cardiovascular disease. Following up on cohort participants of the Cardiac Ageing Study, longitudinal health evaluations of these participants would shed more light on impact of this syndrome in the ageing population.

Further capitalising on their work, the team is exploring and evaluating possible solutions that may prevent or slow down the progression of this syndrome. Asst Prof Koh further expressed, “Hypothetically, any solution that targets this ‘cardio-sarcopenia’ syndrome will have a multiplier effect on achieving benefits in heart and skeletal muscle health – both of which are crucial determinants of health-span in ageing.”

For instance, as studies have shown that exercising promotes healthy ageing of skeletal muscle3, Asst Prof Koh and her team have recently tested a 12-week specialised exercise programme with 30 participants, to validate the outcomes of the programme in decelerating heart ageing and the benefits to overall health, which they hope to share more in subsequent research report.

The Cardiac Ageing Study received support from National Medical Research Council of Singapore, Duke-NUS Medical School and various philanthropic partners.

1. Morley JE, Anker SD, von HS. Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology-update 2014. J Cachexia Sarcopenia Muscle 2014 12;5(4):253–9. [PubMed: 25425503]
2. Keng, B. M. H., Gao, F., Teo, L. L. Y., Lim, W. S., Tan, R. S., Ruan, W., Ewe, S. H., Koh, W. P., & Koh, A.S. Associations between Skeletal Muscle and Myocardium in Aging: A Syndrome of “Cardio‐Sarcopenia”? Journal of the American Geriatrics Society, 67(12), 2568–2573. (2019) DOI: 10.1111/jgs.16132
3. Cartee, G. D., Hepple, R. T., Bamman, M. M., & Zierath, J. R. (2016). Exercise Promotes Healthy Aging of Skeletal Muscle. Cell Metabolism, 23(6), 1034–1047. DOI: 10.1016/j.cmet.2016.05.007