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

Leong, D P and Teo, K K and Rangarajan, Sumathy and Lopez-Jaramillo, Patricio and Avezum, Alvaro and Orlandini, Andres and Seron, Pamela and Ahmed, Suad H and Rosengren, Annika and Kelishadi, Roya and Rahman, Omar and Swaminathan, Sumathi and Iqbal, Romaina and Gupta, Rajeev and Lear, Scott A and Oguz, A and Yusoff, K and Zatonska, K and Chifamba, Jephat and Igumbor, E and Mohan, V and Anjana, R M and Gu, H and Li, Wei and Yusuf, S (2015) Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet, 386 (9990). p. 266. ISSN 01406736

[img]PDF
Restricted to MDRF users only. Others may ->

422Kb

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 signifi cant 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

Item Type:Article
Official URL/DOI:http://dx.doi.org/10.1016/S0140-6736(14)62000-6
Uncontrolled Keywords:PURE; Epidemiology; grip strength
Subjects:Diabetes
Diabetes > Diabetes Diseases
Divisions:Department of Epidemiology
Department of Diabetology
ID Code:926
Deposited By:surendar radha
Deposited On:24 Jul 2015 12:23
Last Modified:24 Jul 2015 12:23

Repository Staff Only: item control page