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

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, th...

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Published in:The Lancet
Main Authors: Leong D.P.; Teo K.K.; Rangarajan S.; Lopez-Jaramillo P.; Avezum A., Jr.; Orlandini A.; Seron P.; Ahmed S.H.; Rosengren A.; Kelishadi R.; Rahman O.; Swaminathan S.; Iqbal R.; Gupta R.; Lear S.A.; Oguz A.; Yusoff K.; Zatonska K.; Chifamba J.; Igumbor E.; Mohan V.; Anjana R.M.; Gu H.; Li W.; Yusuf S.
Format: Article
Language:English
Published: Lancet Publishing Group 2015
Online Access:https://www.scopus.com/inward/record.uri?eid=2-s2.0-84937641667&doi=10.1016%2fS0140-6736%2814%2962000-6&partnerID=40&md5=5a7c551cac9ca989b2fcd99e65988ebc
id 2-s2.0-84937641667
spelling 2-s2.0-84937641667
Leong D.P.; Teo K.K.; Rangarajan S.; Lopez-Jaramillo P.; Avezum A., Jr.; Orlandini A.; Seron P.; Ahmed S.H.; Rosengren A.; Kelishadi R.; Rahman O.; Swaminathan S.; Iqbal R.; Gupta R.; Lear S.A.; Oguz A.; Yusoff K.; Zatonska K.; Chifamba J.; Igumbor E.; Mohan V.; Anjana R.M.; Gu H.; Li W.; Yusuf S.
Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study
2015
The Lancet
386
9990
10.1016/S0140-6736(14)62000-6
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84937641667&doi=10.1016%2fS0140-6736%2814%2962000-6&partnerID=40&md5=5a7c551cac9ca989b2fcd99e65988ebc
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 139691 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 139691 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). © 2015 Elsevier Ltd.
Lancet Publishing Group
01406736
English
Article
All Open Access; Green Open Access
author Leong D.P.; Teo K.K.; Rangarajan S.; Lopez-Jaramillo P.; Avezum A.
Jr.; Orlandini A.; Seron P.; Ahmed S.H.; Rosengren A.; Kelishadi R.; Rahman O.; Swaminathan S.; Iqbal R.; Gupta R.; Lear S.A.; Oguz A.; Yusoff K.; Zatonska K.; Chifamba J.; Igumbor E.; Mohan V.; Anjana R.M.; Gu H.; Li W.; Yusuf S.
spellingShingle Leong D.P.; Teo K.K.; Rangarajan S.; Lopez-Jaramillo P.; Avezum A.
Jr.; Orlandini A.; Seron P.; Ahmed S.H.; Rosengren A.; Kelishadi R.; Rahman O.; Swaminathan S.; Iqbal R.; Gupta R.; Lear S.A.; Oguz A.; Yusoff K.; Zatonska K.; Chifamba J.; Igumbor E.; Mohan V.; Anjana R.M.; Gu H.; Li W.; Yusuf S.
Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study
author_facet Leong D.P.; Teo K.K.; Rangarajan S.; Lopez-Jaramillo P.; Avezum A.
Jr.; Orlandini A.; Seron P.; Ahmed S.H.; Rosengren A.; Kelishadi R.; Rahman O.; Swaminathan S.; Iqbal R.; Gupta R.; Lear S.A.; Oguz A.; Yusoff K.; Zatonska K.; Chifamba J.; Igumbor E.; Mohan V.; Anjana R.M.; Gu H.; Li W.; Yusuf S.
author_sort Leong D.P.; Teo K.K.; Rangarajan S.; Lopez-Jaramillo P.; Avezum A.
title Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study
title_short Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study
title_full Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study
title_fullStr Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study
title_full_unstemmed Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study
title_sort Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study
publishDate 2015
container_title The Lancet
container_volume 386
container_issue 9990
doi_str_mv 10.1016/S0140-6736(14)62000-6
url https://www.scopus.com/inward/record.uri?eid=2-s2.0-84937641667&doi=10.1016%2fS0140-6736%2814%2962000-6&partnerID=40&md5=5a7c551cac9ca989b2fcd99e65988ebc
description 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 139691 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 139691 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). © 2015 Elsevier Ltd.
publisher Lancet Publishing Group
issn 01406736
language English
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accesstype All Open Access; Green Open Access
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