Title

Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study.

Authors

Darryl P. Leong, McMaster University, Hamilton, ON, Canada
ProfKoon K. Teo, McMaster University, Hamilton, ON, Canada
Sumathy Rangarajan, McMaster University, Hamilton, ON, Canada
Patricio Lopez-Jaramillo, Universidad de Santander, Colombia
Alvaro Avezum, Dante Pazzanese Institute of Cardiology, São Paulo University, Brazil
Andres Orlandini, Instituto Cardiovascular de Rosario, Rosario, Argentina
Pamela Seron, Universidad de La Frontera, Temuco, Chile
Suad H. Ahmed, Dubai Health Authority, Dubai, United Arab Emirates
Annika Rosengren, University of Gothenburg, Gothenburg, Sweden
Roya Kelishadi, Isfahan University of Medical Sciences, Isfahan, Iran
Omar Rahman, Independent University, Dhaka, Bangladesh
Sumathi Swaminathan, St. John's Research Institute, Bangalore, India
Romaina Iqbal, Aga Khan UniversityFollow
Rajeev Gupta, Fortis Escorts Hospital, Jaipur, India
Scott A. Lear, Simon Fraser University, Burnaby, BC, Canada
Aytekin Oguz, Istanbul Medeniyet University, Istanbul, Turkey
Khalid Yusoff, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
Katarzyna Zatonska, Medical University of Wrocław, Wrocław, Poland
Jephat Chifamba, University of Zimbabwe, Harare, Zimbabwe
Ehimario Igumbor, University of the Western Cape, Cape Town, South Africa
Viswanathan Mohan, Madras Diabetes Research Foundation, Chennai, India
Ranjit Mohan Anjana, Madras Diabetes Research Foundation, Chennai, India
Hongqiu Gu, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
Wei Li, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
Salim Yusuf, McMaster University, Hamilton, ON, Canada

Document Type

Article

Department

Community Health Sciences

Abstract

BACKGROUND:

Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is appealing as a simple, quick, and inexpensive means of stratifying an individual's risk of cardiovascular death. However, the prognostic value of grip strength with respect to the number and range of populations and confounders is unknown. The aim of this study was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries.

METHODS:

The Prospective Urban-Rural Epidemiology (PURE) study is a large, longitudinal population study done in 17 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35-70 years and if household members intended to stay at that address for another 4 years. Participants were assessed for grip strength, measured using a Jamar dynamometer. During a median follow-up of 4.0 years (IQR 2.9-5.1), we assessed all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, myocardial infarction, stroke, diabetes, cancer, pneumonia, hospital admission for pneumonia or chronic obstructive pulmonary disease (COPD), hospital admission for any respiratory disease (including COPD, asthma, tuberculosis, and pneumonia), injury due to fall, and fracture. Study outcomes were adjudicated using source documents by a local investigator, and a subset were adjudicated centrally.

FINDINGS:

Between January, 2003, and December, 2009, a total of 142,861 participants 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 (IQR 2.9-5.1), 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 (1.17, 1.11-1.24; p<0.0001), non-cardiovascular mortality (1.17, 1.12-1.21; p<0.0001), myocardial infarction (1.07, 1.02-1.11; p=0.002), and stroke (1.09, 1.05-1.15; p<0.0001). Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure. We found no significant association 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 (0.916, 0.880-0.953; p<0.0001), but this association was not found in middle-income and low-income countries.

INTERPRETATION:

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

FUNDING:

Full funding sources listed at end of paper (see Acknowledgments).

Publication

Lancet

Creative Commons License

Creative Commons Attribution-Noncommercial-Share Alike 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License.