ASSOCIATION OF HANDGRIP STRENGTH WITH CARDIOMETABOLIC MULTIMORBIDITY: FINDINGS FROM FOUR LONGITUDINAL COHORT STUDIES

Abstract

Objective: Cardiometabolic multimorbidity is an increasing public health burden and clinical concern. However, predictors for the development of cardiometabolic multimorbidity are poorly understood. We aimed to investigate the association between handgrip strength and the risk of cardiometabolic multimorbidity among adults aged 50 years or above from high-income and low- and middle-income countries. Design and method: In this multicohort study, we extracted individual-level data from four longitudinal cohort studies that included nationally representative samples across 20+ countries, including the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), and the China Health and Retirement Longitudinal Study (CHARLS). Handgrip strength was measured following a homogeneous procedure, in which the maximum measurements of dominant hand were used and expressed in absolute units (kg) for subsequent analysis. Cardiometabolic multimorbidity was defined as the simultaneous occurrence of two or more of the following conditions: type 2 diabetes, stroke, and heart diseases. Cox proportional hazards models were performed to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). Results: We included 50,118 participants recruited between 2011 and 2019 with a median follow-up of 7.6 years. The incident rates of cardiometabolic multimorbidity in participants from HRS, ELSA, SHARE, and CHARLS were 9.1%, 4.0%, 3.1%, and 2.7%, respectively. After adjusting for sociodemographic characteristics, lifestyle factors, and vascular risk factors, the HRs (95% CIs) of per SD increment in handgrip strength for cardiometabolic multimorbidity were 0.80 (0.73-0.87) in HRS, 0.62 (0.55-0.71) in ELSA, 0.69 (0.64-0.75) in SHARE, and 0.85 (0.75-0.96) in CHARLS. Those associations remained statistically significant for separate outcomes including diabetes, heart diseases, and stroke in all four cohorts. Conclusions: Higher grip strength was associated with a range of cardiometabolic outcomes as well as cardiometabolic multimorbidity regardless of whether they live in high-income or low- and middle-income countries. Further work on the use of grip strength in risk scores or risk screening is needed to establish its potential clinical utility.