Handgrip strength is inversely associated with fatal cardiovascular and all-cause mortality events

Abstract

Purpose: We aimed to assess the associations of handgrip strength (HS) with cardiovascular and all-cause mortality and whether adding data on HS to cardiovascular disease (CVD) risk factors is associated with improvement in CVD mortality prediction. Design: Handgrip strength was assessed in a population-based sample of 861 participants aged 61-74 years at baseline. Relative HS was obtained by dividing the absolute value by body weight. Results: During a median (interquartile range) follow-up of 17.3 (12.6-18.4) years, 116 fatal coronary heart diseases (CHDs), 195 fatal CVDs and 412 all-cause mortality events occurred. On adjustment for several risk factors, the hazard ratios (95% confidence intervals (CIs)) for fatal CHD, fatal CVD and all-cause mortality were 0.59 (0.37-0.95), 0.59 (0.41-0.86) and 0.66 (0.51-0.84), respectively, comparing extreme tertiles of relative HS. Adding relative HS to a CVD mortality risk prediction model containing established risk factors did not improve discrimination or reclassification using Harrell's C-index (C-index change: 0.0034; p ¼ .65), integrated-discrimination-improvement (0.0059; p ¼ .20) and net-reclassification-improvement (-1.31%; p ¼ .74); however, there was a significant difference in -2 log likelihood (p < .001). Conclusions: Relative HS is inversely associated with CHD, CVD and all-cause mortality events. Adding relative HS to conventional risk factors improves CVD risk assessment using sensitive measures of discrimination. KEY MESSAGESHandgrip strength (HS) assessment is simple, inexpensive and it takes only a few minutes to measure in clinical practice; however, its prognostic role for fatal cardiovascular outcomes on top of traditional risk factors in apparently healthy populations is uncertain. In a population-based prospective cohort study, good HS adjusted for body weight was associated with lower risk of fatal cardiovascular outcomes and the associations remained consistent across several clinically relevant subgroups. Handgrip strength may be a useful prognostic tool for fatal CHD and CVD events, in the general population.

Handgrip strength—A risk indicator for type 2 diabetes: Systematic review and meta‐analysis of observational cohort studies

“…Assessment of HGS may represent an important approach for T2D prevention, for instance in the areas of screening of individuals at risk of T2D, recommending lifestyle modification, as well as further diabetes management strategies. We have recently shown that information on HGS augments CVD mortality risk prediction beyond that of traditional risk factors and that it may be potentially suitable for population‐level risk assessment 16 . Handgrip strength may be a potential risk assessment tool in general or specialised clinical settings to identify patients at high risk for worse outcomes including T2D, but a formal risk prediction analyses is warranted.…”

“…Handgrip strength, widely adopted as a proxy for muscular strength 10,11 and a measure of physical fitness, has also emerged as a strong risk indicator for adverse health outcomes. Several prospective studies have demonstrated HGS to be inversely and independently associated with vascular and non‐vascular disease, as well as mortality outcomes 12‐17 . High HGS reflects the ability to participate in regular muscle‐strengthening activities and also physical activity which increases or maintains CRF, may prevent morbidity and mortality by having beneficial effects on resting metabolic rate, adipose tissue, blood glucose levels, insulin response and sensitivity, and blood pressure levels 5 .…”

Genetic Risk, Muscle Strength, and Incident Stroke: Findings From the UK Biobank Study

“…In UK Biobank, muscle strength of each participant was evaluated through measurements of grip strength, which is a strong predictor of overall muscle strength [15][16][17] as well as of mortality. 18,19 Each participant's grip strength was measured with a hydraulic hand dynamometer (Jamar J00105), which is capable of assessing isometric hand grip force up to 90 kg. Participants were asked to squeeze the handle of the hand dynamometer as strongly as possible for about 3 seconds while maintaining a 90-degree angle of the elbow and sitting upright on a chair; the test protocol was performed in both hands.…”

The effects of aerobic, strength, or mixed exercise programs on schizophrenia symptomatology: a randomized clinical trial with a 10-month follow-up

“…These authors considered that interventions targeting strength tness could improve brain health and reduce the neurocognitive abnormalities associated with MDD [49]. Moreover, HGS has been suggested as a risk indicator for cancer mortality [50] and fatal cardiovascular and all-cause mortality events [51]. Furthermore, isolated strength training has been associated with a lower risk of all-cause mortality, regardless of participation in aerobic PA [52].…”