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Grip strength may predict risk for mortality, CVD
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Reduced muscle strength, as assessed by grip strength using a Jamar dynamometer, was associated with greater risk for all-cause and CV mortality and incidence of CVD, according to new data published in The Lancet.
“Our study suggests that measurement of grip strength is a simple, inexpensive, risk-stratifying method to assess risk of death, particularly in individuals who develop major illnesses, and that muscle strength is a risk marker for incident [CVD] in a number of countries and populations,” Darryl P. Leong, PhD, from the Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada, and colleagues wrote.
Leong and colleagues used data from the longitudinal prospective cohort PURE study to examine the prognostic value of grip strength. The analysis included participants aged 35 to 70 years from 17 high-, middle- and low-income countries. Overall, 139,691 participants with known vital status were enrolled in the PURE study from 2003 to 2009 and included in this analysis.
The researchers measured grip strength in dominant and nondominant hands using a Jamar dynamometer to determine whether muscle strength was an accurate predictor of all-cause and CV mortality, MI, stroke, diabetes, cancer, chronic obstructive pulmonary disease, respiratory diseases, injury due to a fall and fracture. Results were adjusted for demographics, diet, physical activity levels, education levels, tobacco and alcohol use, BMI, BP, CV risk factors, prior stroke, cancer and other comorbid disorders. Grip strength values were adjusted for age, sex, height and economic status.
During a median follow-up of 4 years, 2% of participants died.
The association between grip strength and each outcome was similar across all country-income strata, with the exception of cancer and hospital admission for respiratory illness.
A 5-kg reduction in grip strength was associated with increased risk for all-cause mortality (HR = 1.16; 95% CI, 1.13-1.2), CV mortality (HR = 1.17; 95% CI, 1.11-1.24), non-CV mortality (HR = 1.17; 95% CI, 1.12-1.21), MI (HR = 1.07; 95% CI, 1.02-1.11) and stroke (HR = 1.09; 95% CI, 1.05-1.15).
The association between grip strength and mortality was similar in men and women and across age groups.
Greater grip strength was associated with lower rates of fatality in participants with incident MI, stroke, cancer, pneumonia, chronic obstructive pulmonary disease and injury from a fall or fracture.
“Grip strength was a stronger predictor of all-cause and [CV] mortality than systolic [BP],” Leong and colleagues wrote. In a post-hoc analysis, grip strength was a more reliable predictor of mortality compared with systolic BP (P < .0001) and had a similar reliability as a predictor of CV mortality (P < .0001).
The researchers reported no significant association between grip strength and diabetes, risk for hospitalization for chronic obstructive pulmonary disease or pneumonia, falls or fracture.
In high-income countries, participants with low grip strength were less likely to develop cancer (HR = 0.92; 95% CI, 0.89-0.95), although the researchers wrote this finding warrants further investigation.
“An intriguing implication is that grip strength might act as a biomarker of aging across the life course,” Avan Aihi Sayer, BSc, MBBS, MSc, PhD, FRCP, from the University of Southampton, and Thomas Kirkwood, MSc, PhD, from Newcastle University, wrote in an accompanying commentary. “This is not a new idea, but findings from PURE add support. Loss of grip strength is unlikely to lie on a single final common pathway for the adverse effects of aging, but it might be a particularly good marker of underlying aging processes, perhaps because of the rarity of muscle-specific diseases contributing to change in muscle function.”
Leong and colleagues concluded that additional research is needed to analyze how individuals with low muscle strength can improve their outcomes. – by Stephanie Viguers
Disclosure: The PURE study is partially funded by unrestricted grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, King Pharma, Novartis, Sanofi-Aventis and Servier. Leong reports receiving support from McMaster University. Sayer and Kirkwood report no relevant financial disclosures.
Perspective
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Michael H. Davidson, MD
An easy-to-measure grip strength (every 5-kg reduction) was inversely associated with all-cause mortality as well as non-CV and CV mortality. Grip strength was a stronger predictor of all-cause and CV mortality than systolic BP. The PURE study, which is a large (142,861 people aged 35 to 70 years), longitudinal, population study done in 17 countries of varying incomes and sociocultural settings, found a simple measure that was highly associated with hard outcomes. Sometimes, in clinical practice, easy-to-apply functional measures are overlooked in favor of more expensive and technologically advanced testing. The challenge for the grip test is how to modify treatment based on the results of this test. From my perspective, low grip strength can alert a physician to more aggressively promote exercise with more muscle training. As patients age, the inevitable sarcopenia associated with aging leads to fragility, which sets off a downward spiral of less activity and further muscle wasting. A simple grip strength test can illustrate to the patient the need to increase activity and hopefully prevent the potential disability associated with aging.
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