Handgrip strength is inversely associated with fatal cardiovascular and all-cause mortality events

Ann Med. 2020 May-Jun;52(3-4):109-119. doi: 10.1080/07853890.2020.1748220. Epub 2020 Apr 9.


Purpose: We aimed to assess the associations of handgrip strength (HS) with cardiovascular and all-cause mortality and whether adding data on HS to cardiovascular disease (CVD) risk factors is associated with improvement in CVD mortality prediction.Design: Handgrip strength was assessed in a population-based sample of 861 participants aged 61-74 years at baseline. Relative HS was obtained by dividing the absolute value by body weight.Results: During a median (interquartile range) follow-up of 17.3 (12.6-18.4) years, 116 fatal coronary heart diseases (CHDs), 195 fatal CVDs and 412 all-cause mortality events occurred. On adjustment for several risk factors, the hazard ratios (95% confidence intervals (CIs)) for fatal CHD, fatal CVD and all-cause mortality were 0.59 (0.37-0.95), 0.59 (0.41-0.86) and 0.66 (0.51-0.84), respectively, comparing extreme tertiles of relative HS. Adding relative HS to a CVD mortality risk prediction model containing established risk factors did not improve discrimination or reclassification using Harrell's C-index (C-index change: 0.0034; p = .65), integrated-discrimination-improvement (0.0059; p = .20) and net-reclassification-improvement (-1.31%; p = .74); however, there was a significant difference in -2 log likelihood (p < .001).Conclusions: Relative HS is inversely associated with CHD, CVD and all-cause mortality events. Adding relative HS to conventional risk factors improves CVD risk assessment using sensitive measures of discrimination.KEY MESSAGESHandgrip strength (HS) assessment is simple, inexpensive and it takes only a few minutes to measure in clinical practice; however, its prognostic role for fatal cardiovascular outcomes on top of traditional risk factors in apparently healthy populations is uncertain.In a population-based prospective cohort study, good HS adjusted for body weight was associated with lower risk of fatal cardiovascular outcomes and the associations remained consistent across several clinically relevant subgroups.Handgrip strength may be a useful prognostic tool for fatal CHD and CVD events, in the general population.

Keywords: Handgrip strength; cardiovascular disease; mortality; risk prediction.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / mortality*
  • Female
  • Hand Strength / physiology*
  • Health Status
  • Heart Disease Risk Factors*
  • Humans
  • Longitudinal Studies
  • Male
  • Prospective Studies

Grants and funding

This work has been supported in part by grants from the Finnish Foundation for Cardiovascular Research, Helsinki, Finland. Dr. Setor K. Kunutsor acknowledges support from the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol.The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.