Angiotensin ii receptor blocker and statin combination therapy associated with higher skeletal muscle index in patients with cardiovascular disease

Objectives: Reduction in skeletal muscle mass is the most important component in the diagnosis of sarcopenia. Aging and chronic heart failure due to cardiovascular diseases (CVDs) accelerate the reduction in skeletal muscle. However, no effective drugs for sarcopenia are available. The purpose of this study was to explore the associations of prescribed medications with higher skeletal muscle mass in patients with CVD. Design and Methods: This was a single-center, retrospective, cross-sectional analysis. The subjects were 636 inpatients with CVD who had been taking prescribed medicines for at least 4 weeks at the time of admission. Prescription data were collected from electronic medical records database. Drugs and drug combinations were selected for analysis when they were prescribed to more than 10% (64 cases) of all subjects. Because of their frequent use in clinical practice for CVD, various combinations of angiotensin II receptor blockers (ARBs), beta-blockers, calcium channel blockers (CCBs), and statins were also examined. Skeletal muscle volume was assessed with a bioelectrical impedance assay. Results: The mean age was 73 ± 12 years (male, 54.4%). The body mass index and skeletal muscle index (SMI) were 23.8 ± 4.3 kg/m2 and 6.46 ± 1.42 kg/m2, respectively. ACC/AHA stage C/D heart failure was shown in 21.4%. Single regression analysis showed that SMI was positively associated with the use of CCBs, ARBs, statins, antihyperuricemic agents, dipeptidyl peptidase-4 (DPP-4) inhibitors, oral antidiabetic agents excluding DPP-4 inhibitors, ARB/CCB combination, statin/CCB combination, ARB/statin combination, and ARB/beta-blocker combination. Diuretics, antiarrhythmic agents, and anticoagulants were negatively associated with SMI. Stepwise multivariate regression analysis revealed that ARB/statin combination was independently and positively associated with SMI whereas diuretics and antiarrhythmic agents were independently and negatively associated with SMI. After adjustment using propensity score matching, SMI was significantly higher in ARB/statin combination users than in non-users. Conclusion: Combination use of an ARB and a statin was associated with a higher SMI in patients with CVD. A future randomized, controlled trial is warranted to determine whether the ARB/statin combination will increase the SMI and prevent sarcopenia in CVD patients. The results of the present study may be useful for drug repositioning to screen for drug candidates.