Leong DP, Teo KK, Rangarajan S, et al.

Lancet 2015;386:266-273

Publication date: July 18, 2015


Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is a simple, quick, and inexpensive measurement instrument.

The aim of this study by Leong et al. was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries. The authors used data from the Prospective Urban-Rural Epidemiology (PURE) study, a large, longitudinal population study conducted in 17 countries of varying incomes and sociocultural settings.

Between January 2003, and December 2009, a total of 142,861 participants aged between 35 and 70 years were enrolled in the PURE study, of whom 139,691 with known vital status were included in the analysis. During a median follow-up of 4.0 years, 3379 (2%) of 139,691 participants died. After adjustment, the association between grip strength and each outcome, with the exceptions of cancer and hospital admission due to respiratory illness, was similar across country-income strata.

Grip strength was inversely associated with all-cause mortality (hazard ratio per 5 kg reduction in grip strength 1.16, 95% CI 1.13–1.20; P<0.0001), cardiovascular mortality (HR 1.17, 95% CI 1.11–1.24; P<0.0001), non-cardiovascular mortality (HR 1.17, 95% CI 1.12–1.21; P<0.0001), myocardial infarction (HR 1.07, 95% CI 1.02–1.11; P=0.002), and stroke (HR 1.09, 95% CI 1.05–1.15; P<0.0001). Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure.

There were no significant associations between grip strength and incident diabetes, risk of hospital admission for pneumonia or COPD, injury from fall, or fracture. In high-income countries, the risk of cancer and grip strength were positively associated (HR 0.916, P<0.0001), but this association was not found in middle-income and low-income countries.

This study shows that measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease. The authors suggest that further research is needed to identify determinants of muscular strength and to test whether improvement in strength reduces mortality and cardiovascular disease.


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