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Grip strength ‘simple test for heart disease risk’

Hand grip strength could be tested as a quick way to identify patients at high risk of heart attacks and strokes, as well as other major illnesses, researchers have said.

A large-scale study including nearly 140,000 adults from 17 countries, published today in the Lancet, has confirmed a strong link between low grip strength and poorer survival, as well as increased risks of MI and stroke, across all the different countries and regardless of other risk factors.

Overall, for every 5 kg decline in grip strength, there was a 16% increase in risk of death from any cause, and 17% increased risks of cardiovascular and non-cardiovascular deaths, while the risk of heart attacks went up by 7% and stroke by 9%. All the associations were seen after taking into account key factors related to mortality and heart disease including age, education, employment, physical activity and tobacco and alcohol use.

The authors say grip strength also proved a more powerful predictor of both all-cause and cardiovascular deaths than systolic blood pressure in a smaller, separate analysis.

The team, led by Dr Darryl Leon from McMaster University in Hamilton, Canada, concluded: ‘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 a major illness, and that muscle strength is a risk marker for incident cardiovascular disease in a number of countries and populations.’

Lancet 2015; available online 14 May

Readers' comments (4)

  • Vinci Ho

    I guess should can do more power grip of hands like part of the neurological exam,5/5 or less?
    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

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  • Yes I heard this on the news. The parting shot was, if you think it applies to you, consult your GP.

    What an earth am I meant to do about it ? That solution was missing from the news piece !

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  • Desperation to get your name published.

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  • Well, a new reason to refer to cardiology!

    Why do expensive and "controversial" health checks with sugar, cholesterol etc.; just ask all the people chucked out of benefits to check the hand grip of the worried well and there one has solved the problem or cardiovascular risk with no cost to the country, unless one counts the thousand cath labs and doubtamine stress echo`s that need to be done when people with low grip strength are referred!

    P.S can I be paid £25 per hand grip checked as seems to be more evidence than the NHS Health check!

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