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

被引:1376
作者
Leong, Darryl P. [1 ,2 ]
Teo, Koon K. [1 ,2 ]
Rangarajan, Sumathy [1 ]
Lopez-Jaramillo, Patricio [3 ,4 ]
Avezum, Alvaro, Jr. [5 ]
Orlandini, Andres [6 ]
Seron, Pamela [7 ]
Ahmed, Suad H. [8 ]
Rosengren, Annika [9 ]
Kelishadi, Roya [10 ]
Rahman, Omar [11 ]
Swaminathan, Sumathi [12 ]
Iqbal, Romaina [13 ]
Gupta, Rajeev [14 ]
Lear, Scott A. [15 ]
Oguz, Aytekin [16 ]
Yusoff, Khalid [17 ,18 ]
Zatonska, Katarzyna [19 ]
Chifamba, Jephat [20 ]
Igumbor, Ehimario [21 ]
Mohan, Viswanathan [22 ]
Anjana, Ranjit Mohan [22 ]
Gu, Hongqiu [23 ,24 ]
Li, Wei [23 ,24 ]
Yusuf, Salim [1 ,2 ]
机构
[1] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada
[2] Hamilton Hlth Sci, Hamilton, ON, Canada
[3] Univ Santander, Fdn Oftalmolog Santander, Bucaramanga, Colombia
[4] Univ Santander, Sch Med, Bucaramanga, Colombia
[5] Univ Sao Paulo, Dante Pazzanese Inst Cardiol, BR-05508 Sao Paulo, Brazil
[6] ECLA Fdn, Inst Cardiovasc Rosario, Rosario, Argentina
[7] Univ La Frontera, Temuco, Chile
[8] Dubai Hlth Author, Dubai, U Arab Emirates
[9] Univ Gothenburg, Sahlgrenska Acad, Gothenburg, Sweden
[10] Isfahan Univ Med Sci, Isfahan Cardiovasc Res Inst, Isfahan Cardiovasc Res Ctr, Esfahan, Iran
[11] Independent Univ, Dhaka, Bangladesh
[12] St Johns Med Coll, St Johns Res Inst, Bangalore, Karnataka, India
[13] Aga Khan Univ, Dept Community Hlth Sci & Med, Karachi, Pakistan
[14] Fortis Escorts Hosp, Jaipur, Rajasthan, India
[15] Simon Fraser Univ, Dept Biomed Physiol & Kinesiol, Burnaby, BC V5A 1S6, Canada
[16] Istanbul Medeniyet Univ, Dept Internal Med, Istanbul, Turkey
[17] Univ Teknol MARA, Sungai Buloh, Selangor, Malaysia
[18] UCSI Univ, Kuala Lumpur, Malaysia
[19] Med Univ Wroclaw, Dept Social Med, Wroclaw, Poland
[20] Univ Zimbabwe, Harare, Zimbabwe
[21] Univ Western Cape, Sch Publ Hlth, Cape Town, South Africa
[22] Madras Diabet Res Fdn, Madras, Tamil Nadu, India
[23] Chinese Acad Med Sci, Fuwai Hosp, Natl Ctr Cardiovasc Dis, State Key Lab Cardiovasc Dis, Beijing 100730, Peoples R China
[24] Peking Union Med Coll, Beijing 100021, Peoples R China
基金
瑞典研究理事会; 新加坡国家研究基金会; 英国医学研究理事会; 加拿大健康研究院;
关键词
ALL-CAUSE MORTALITY; HANDGRIP STRENGTH; MUSCLE STRENGTH; CARDIORESPIRATORY FITNESS; MUSCULAR STRENGTH; BODY-COMPOSITION; QUESTIONNAIRE; ASSOCIATION; RELIABILITY; RESISTANCE;
D O I
10.1016/S0140-6736(14)62000-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:266 / 273
页数:8
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