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Association of Fitness and Grip Strength With Heart Failure: Findings From the UK Biobank Population-Based Study
Abstract
Objective
To investigate the associations of objectively measured cardiorespiratory fitness (CRF) and grip strength (GS) with incident heart failure (HF), a clinical syndrome that results in substantial social and economic burden, using UK Biobank data.
Patients and Methods
Of the 502,628 participants recruited into the UK Biobank between April 1, 2007, and December 31, 2010, a total of 374,493 were included in our GS analysis and 57,053 were included in CRF analysis. Associations between CRF and GS and incident HF were investigated using Cox proportional hazard models, with adjustment for known measured confounders.
Results
During a mean of 4.1 (range, 2.4-7.1) years, 631 HF events occurred in those with GS data, and 66 HF events occurred in those with CRF data. Higher CRF was associated with 18% lower risk for HF (hazard ratio [HR], 0.82; 95% CI, 0.76-0.88) per 1–metabolic equivalent increment increase and GS was associated with 19% lower incidence of HF risk (HR, 0.81; 95% CI, 0.77-0.86) per 5-kg increment increase. When CRF and GS were standardized, the HR for CRF was 0.50 per 1-SD increment (95% CI, 0.38-0.65), and for GS was 0.65 per 1-SD increment (95% CI, 0.58-0.72).
Conclusion
Our data indicate that objective measurements of physical function (GS and CRF) are strongly and independently associated with lower HF incidence. Future studies targeting improving CRF and muscle strength should include HF as an outcome to assess whether these results are causal.
... 14 A large-scale study based on the UK Biobank data reported HGS to be strongly and independently associated with lower HF incidence. 15 However, this analysis was based on a mean follow-up of only approximately 4 years; hence, these findings are potentially at risk of reverse causation bias. Furthermore, the shape and specificity of the association in relevant subgroups were not evaluated. ...
... Relative HGS was also inversely associated with CHD, whereas there was no evidence of an association with AMI. Although an association between HGS and HF risk has been reported previously using UK Biobank data, 15 participants of earlier reports were not representative of the general population, 33 and the findings could potentially be biased by reverse causation because of the short follow-up duration. An individual patient pooled meta-analysis of studies of patients with cardiac diseases (ischemic heart disease, HF, cardiomyopathies, valvulopathies, arrhythmias) has also demonstrated an increased HGS to be associated with reduced risk of cardiac and all-cause death, and hospital admission for HF, 14 which also demonstrates that muscle mass and strength may be important predictors of prognosis in patients with established HF. 34 . ...
... On the other hand, our study was based on almost 2 decades of follow-up, and sensitivity analyses excluded the first few years of follow-up to minimize the effect of reverse causation bias. Compared with previous studies, 14,15 we also took into account the effect of body mass on muscle strength by dividing the absolute value of HGS by weight in kilograms. ...
Objective
To evaluate the nature, magnitude, and specificity of the association between handgrip strength (HGS) and heart failure (HF) risk.
Patients and Methods
Handgrip strength was assessed at baseline from March 1, 1998, to December 31, 2001, by use of a hand dynamometer in the Finnish Kuopio Ischemic Heart Disease prospective population-based cohort of 770 men and women aged 61 to 74 years without a history of HF. Relative HGS was obtained by dividing the absolute value by body weight. Hazard ratios (HRs) with 95% CIs were estimated with Cox regression models. We used multiple imputation to account for missing data.
Results
During a median (interquartile range) follow-up of 17.1 (11.3-18.3) years, 177 HF events were recorded. Handgrip strength was continually associated with risk of HF, consistent with a curvilinear shape. On adjustment for several established risk factors and other potential confounders, the HR (95% CI) for HF was 0.73 (0.59-0.91) per 1 SD increase in relative HGS. Comparing the top vs bottom tertiles of relative HGS, the corresponding adjusted HR was 0.55 (0.38-0.81). The association remained similar across several clinical subgroups. Imputed results were broadly similar to the observed results.
Conclusion
Relative HGS is inversely and continually associated with the future risk of HF in the general population. Studies are warranted to evaluate whether HGS may be a useful prognostic tool for HF in the general population and to determine whether resistance exercise training may lower the risk of HF.
... Cardiorespiratory fitness reflected by endurance exercise participation is considered as the gold-standard measure of physical fitness, indeed it also portrays the level of body function maintained over time. [8,9] Cardiorespiratory fitness is arguably the strongest predictor of all-cause mortality secondary to age, with plenty of evidence emphasising its analytical and clinical validity. [10,11,12] The physiological factors that were most often associated with maximum oxygen consumption (VO2max) include stroke volume (SV), cardiac output (CO), maximum heart rate (HRmax), central adiposity and muscular strength. ...
... Even when both genders were considered together, significant relationships were rare. This lack of association in muscular strength with aerobic capacity in healthy subjects was consistent with the results of at least 1 study [8] but was contradictory to several others [82,83,84] In particular with studies that showed a positive correlation between knee extensor strength or grip strength with absolute VO2max, the range of their Pearson correlation coefficient reached up to 0.65 and 0.72 respectively. Besides, they put forward the idea that endurance exercise was a practical alternative to improve not only aerobic performance but also physical strength. ...
This is the first study to examine the relationship between maximal oxygen consumption (VO2max) and a wide range of physiological variables covering central mechanisms, body fat and muscle. Given that using age information to group participants in research is somewhat oversimplistic, with ages typically grouped into arbitrary ranges, it is questioned whether this reflects the stages of ageing and level of body functions. Here, we investigate whether VO2max is a good predictor of physiological functions and, therefore the possibility of grouping participants based on VO2max. Each participant performed a cardiopulmonary exercise test on a cycle ergometer, knee extensor strength test on a custom-built dynamometer and grip strength tested with a handgrip dynamometer. Significant correlations were observed with indices including resting systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), maximal heart rate (HRmax), body percentage of fat and high-density lipoprotein (HDL).
Interestingly, no association was found with resting stroke volume (SV) and cardiac output (CO). Even if HRmax showed the closest relationship with VO2max (r = 0.349, P = 0.025), most of the indexes showed only slight or no association with VO2max, precluding the recognition of physiological functions of any individuals. Hence, our hypothesis was rejected, suggesting VO2max is not a suitable hallmark for grouping participants in studies.
... For reporting the age at the time of the diagnosis the following question was asked 'About how old were you when you were first told by a doctor that you had a heart attack or any other heart problem?' In the cases where a participant deceased, a proxy-respondent was asked about the cause and age at the time of death. Mortality by heart, if no previous heart diseases diagnosis was observed, diseases was considered as a heart disease incident event that resulted in death (Sillars et al., 2019). ...
... Two studies performed in a cohort of Swedish men found that greater grip strength was inversely associated with CVD overall and coronary heart disease, heart failure and arrhythmia in particular (Andersen et al., 2015;Silventoinen et al., 2009). A more recent population-based cohort study of more than half a million British people indicated that grip strength was associated with a 19 % heart failure's hazard reduction per 5 kg increment and that people in the highest, middle-higher and lower-middle grip strength quartiles had less hazard of having heart failure than those in the lowest quartile (Sillars et al., 2019). In accordance with previous findings, in this study grip strength was associated with a lower risk for heart diseases. ...
Background
Few multi-country European studies have investigated the association between grip strength and heart diseases incidence. Thus, the aim of this study is to analyse the longitudinal relationship between grip strength and the diagnosis of heart diseases in European middle-aged and older adults.
Method
A prospective cohort study was conducted using data from the Survey of Health, Aging and Retirement in Europe (2004–2017). Participants were 20,829 middle-aged and older adults from 12 countries. GS was objectively measured by a dynamometer and heart diseases diagnosis was self-reported. Incidence rate of heart diseases was calculated and a Cox proportional hazard regression was performed.
Results
The heart diseases incidence rate decreased from 930 per 100,000 person-years in the lowest quartile to 380 per 100,000 person-years in the highest grip strength quartile. During the 13 years of follow-up, compared to being in the lowest grip strength quartile, being in the highest quartile decreased the hazard of being diagnosed with a heart disease in 36 % (95 % confidence interval [CI]: 0.53, 0.78) for the whole sample, 35 % (95 % CI: 0.51, 0.84) for men and 46 % (95 % CI: 0.40, 0.73) for women.
Conclusions
Grip strength seems to be inversely associated with the incidence of heart diseases among European middle-aged and older adults. Scientific evidence has highlighted the potential role of grip strength as a risk stratifying measure for heart diseases, suggesting its potential to be included in the cardiovascular risk scores used in primary care. However, further research is still needed to clarify it.
... The clinical impacts of muscle strength have been well studied in non-malignant diseases, such as diabetes 42 and cardiovascular diseases. [43][44][45][46] Patients with higher muscle strength have significant lower risk of type 2 diabetes. 42 In addition, the incidence of sudden cardiac death decreases by 69% for those with middle third of muscle strength compared with the lower third of muscle strength. ...
... 43 Lower incidence of heart failure is also observed in patients with higher handgrip strength. 44 However, there is a paucity of previous studies to systematically analyse the impacts of HGS on various cancer types. Our study extended previous evidence by reporting the findings that the HGS had varied impacts on different age, gender, and cancer type stratification. ...
Background:
Handgrip strength (HGS) is associated with poor clinical outcomes, including all-cause, non-cardiovascular, and cardiovascular mortalities. The published cut-off points for HGS are mostly based on community populations from Western countries, lacking information on cancer patients from China. The objective of this study was to establish sex-specific cut-off points for Chinese cancer patients and investigate the effect of low HGS on cancer mortality.
Methods:
We did a retrospective cohort study of patients who were diagnosed with malignant cancer from June 2012 to December 2018. HGS was measured using a hand dynamometer in 8257 cancer patients. Optimal stratification was used to solve threshold points. The hazard ratio (HR) of all cancer mortality and cancer-specific mortality was calculated using Cox proportional hazard regression models.
Results:
Among all participants, there were 3902 (47.3%) women and 4355 (52.7%) men. The median age was 58 years old. The cut-off points of HGS to best classify patients with respect to time to mortality were <16.1 kg for women and <22 kg for men. Low HGS was associated with overall cancer mortality in both women and men [HR = 1.339, 95% confidence interval (CI) = 1.170-1.531, P < 0.001; HR = 1.346, 95% CI = 1.176-1.540, P < 0.001, respectively]. For specific cancer types, low HGS was associated with breast cancer (HR = 1.593, 95% CI = 1.230-2.063, P < 0.001) in women, and lung cancer (HR = 1.369, 95% CI = 1.005-1.866, P = 0.047) and colorectal cancer (HR = 1.399, 95% CI = 1.007-1.944, P = 0.045) in men.
Conclusions:
On the basis of our sex-specific cut-off points, low HGS was strongly associated with cancer mortalities. These results indicate the usefulness of HGS measurement in routine clinical practice for improving patient assessments, cancer prognosis, and intervention.
... 16 Moreover, reduced MusS has been recently associated with greater risk for heart failure (HF). 17 In an analysis of the UK Biobank data of 374 493 participants, during a mean follow-up of 4.1 yr, every 5-kg increase of HGS was associated with a 19% RR reduction in developing HF, even after adjustment for several potential confounders (Figure 1). 17 Although MusS remains a very strong prognostic determinant of health, preserving muscular fitness over the course of the lifespan would be also desirable. ...
... 17 In an analysis of the UK Biobank data of 374 493 participants, during a mean follow-up of 4.1 yr, every 5-kg increase of HGS was associated with a 19% RR reduction in developing HF, even after adjustment for several potential confounders (Figure 1). 17 Although MusS remains a very strong prognostic determinant of health, preserving muscular fitness over the course of the lifespan would be also desirable. A recent retrospective analysis of 1104 active adult men aged 21-66 yr using an assessment that combines both MusS and muscular fitness, such as push-up capacity, found that greater push-up capacity was associated with a marked lower risk for CVD. ...
This review discusses the associations of muscular strength (MusS) with cardiovascular disease (CVD), CVD-related death, and all-cause mortality, as well as CVD risk factors, such as metabolic syndrome, diabetes, obesity, and hypertension. We then briefly review the role of resistance exercise training in modulating CVD risk factors and incident CVD.The role of MusS has been investigated over the years, as it relates to the risk to develop CVD and CVD risk factors. Reduced MusS, also known as dynapenia, has been associated with increased risk for CVD, CVD-related mortality, and all-cause mortality. Moreover, reduced MusS is associated with increased cardiometabolic risk. The majority of the studies investigating the role of MusS with cardiometabolic risk, however, are observational studies, not allowing to ultimately determine association versus causation. Importantly, MusS is also essential for the identification of nutritional status and body composition abnormalities, such as frailty and sarcopenia, which are major risk factors for CVD.
... Daljnje analize na spomenutoj skupini pokazale su jaku korelaciju između kardiorespiratornog vježbanja, jačine stiska šake i buduće incidencije HF-a. 17 Studija na 4403 bolesnika predviđena za barijatrijsku kirurgiju u Švedskoj i praćenih 22 godine pokazala je da se u 188 (9 %) od 2003 iz skupine operiranih ispitanika (25 -35 kg gubitka tjelesne težine: indeks tjelesne mase godinu dana nakon zahvata 32 kg/m 2 ) razvio HF prema 266 (13 %) iz skupine od 2030 koji nisu bili operativno liječeni (ITM nakon jedne godine praćenja 40 kg/m 2 ). 18 Iako ovi podatci upućuju na povezanost između pretilosti i rizika od razvoja HF-a, moguće je da pretilost samo provocira slične simptome. ...
... Further analyses on this population showed a strong relationship between cardio-respiratory fitness and grip strength and future incidence of heart failure. 17 A study of 4403 people considered for bariatric surgery in Sweden and followed for 22 years, found that 188 (9%) of the 2003 who had surgery (25-35 kg weight loss; BMI 1 year after surgery 32 kg/ m 2 ) developed heart failure compared with 266 (13%) of 2030 who did not (BMI after 1 year observation 40 kg/m 2 ). 18 Although these data suggest links between obesity and the risk of developing heart failure, it is possible that obesity just provokes similar symptoms. ...
... For example, in a study of 1.1 million men (aged 16-19 years), high muscular strength was associated with 35% lower CVD mortality, 8 with similar findings in the Prospective Urban Rural Epidemiology 9 and Tromsø 10 studies, as well as in analyses of the UK Biobank data, in which a lower risk of incident CVD, including heart failure, outcomes was also observed. 2,11,12 Similarly, self-reported walking pace has been found to be strongly associated with CVD mortality. For example, our recent work reported that brisk-pace walkers have a lower risk of CVD mortality and incidence than do slow-pace walkers. ...
... These findings clearly suggest that grip strength and usual walking place, both of which are cheap, fast, and easy to measure, may have utility in clinical practice in improving the identification of people at high risk of fatal and nonfatal CVD outcomes who would benefit most from primary prevention. As mentioned previously, several studies have found that higher grip strength is associated with a lower risk of a broad range of health outcomes, including CVD, 1,2,[7][8][9][10]12,[20][21][22] and the present study confirms this association with CVD. Comparatively few studies have investigated the association between walking pace and health outcomes, and many of these were in older people in whom it has been consistently found that there is an inverse association between objectively measured walking pace and allcause mortality. ...
Objective
To investigate whether the addition of grip strength and/or self-reported walking pace to established cardiovascular disease (CVD) risk scores improves their predictive abilities.
Patients and Methods
A total of 406,834 participants from the UK Biobank, with baseline measurements between March 13, 2006, and October 1, 2010, without CVD at baseline were included in this study. Associations of grip strength and walking pace with CVD outcomes were investigated using Cox models adjusting for classical risk factors (as included in established risk scores), and predictive utility was determined by changes in C-index and categorical net reclassification index.
Results
Over a median of 8.87 years of follow-up (interquartile range 3, 8.25-9.47 years), there were 7274 composite fatal/nonfatal events (on the basis of the American College of Cardiology/American Heart Association [ACC/AHA] outcome) and 1955 fatal events (on the basis of the Systematic Coronary Risk Evaluation [SCORE] risk score). Both grip strength and walking pace were inversely associated with CVD outcomes after adjusting for classical risk factors. Addition of grip strength (change in C-index: ACC/AHA, +0.0017; SCORE, +0.0047), usual walking pace (ACC/AHA, +0.0031; SCORE, +0.0130), and both combined (ACC/AHA, +0.0041; SCORE, +0.0148) improved the C-index and also improved the net reclassification index (grip, +0.55%; walking pace, +0.53%; combined, 1.12%).
Conclusion
The present study has found that the addition of grip strength or usual walking pace to existing risk scores results in improved CVD risk prediction, with an additive effect when both are added. As both these measures are cheap and easy to administer, these tools could provide an important addition to CVD risk screening, although further external validation is required.
... One leading cause of heart failure is coronary artery disease, but heart failure can be also caused by arrhythmias, hypertension, type 2 diabetes mellitus, obesity, and lifestyle factors (such as smoking). A large-scale observational study found that higher hand grip strength was independently associated with lower incidence of heart failure 48 . On the contrary, our MR study revealed that muscle weakness was causally associated with lower incidence of heart failure, which was confirm by the IVW analysis after excluding the outlying SNPs (beta-estimate: − 0.149, 95% CI − 0.241 to − 0.056, SE:0.047, ...
The causal roles of muscle weakness in cardiometabolic diseases and osteoporosis remain elusive. This two-sample Mendelian randomization (MR) study aims to explore the causal roles of muscle weakness in the risk of cardiometabolic diseases and osteoporosis. 15 single nucleotide polymorphisms (SNPs, P < 5 × 10⁻⁸) associated with muscle weakness were used as instrumental variables. Genetic predisposition to muscle weakness led to increased risk of coronary artery disease (inverse variance weighted [IVW] analysis, beta-estimate: 0.095, 95% confidence interval [CI]: 0.023 to 0.166, standard error [SE]:0.036, P-value = 0.009) and reduced risk of heart failure (weight median analysis, beta-estimate: − 0.137, 95% CI − 0.264 to − 0.009, SE:0.065, P-value = 0.036). In addition, muscle weakness may reduce the estimated bone mineral density (eBMD, weight median analysis, beta-estimate: − 0.059, 95% CI − 0.110 to − 0.008, SE:0.026, P-value = 0.023). We found no MR associations between muscle weakness and atrial fibrillation, type 2 diabetes or fracture. This study provides robust evidence that muscle weakness is causally associated with the incidence of coronary artery disease and heart failure, which may provide new insight to prevent and treat these two cardiometabolic diseases.
... Thus, we included patients with cancer with and without prior anti-cancer therapy in our study cohort. As several studies reported an association between cardiac disease and declined HGS, [35][36][37] we included only patients with cancer without any significant cardiac disease or acute infection to minimize risks of bias. Because repeat assessment of HGS was not done in all our study participants, future studies should focus more on HGS assessment over time in a larger cohort-to better understand which patients loose HGS over time and which patients do not. ...
Background
Hand grip strength (HGS) is a widely used functional test for the assessment of strength and functional status in patients with cancer, in particular with cancer cachexia. The aim was to prospectively evaluate the prognostic value of HGS in patients with mostly advanced cancer with and without cachexia and to establish reference values for a European‐based population.
Methods
In this prospective study, 333 patients with cancer (85% stage III/IV) and 65 healthy controls of similar age and sex were enrolled. None of the study participants had significant cardiovascular disease or active infection at baseline. Repetitive HGS assessment was performed using a hand dynamometer to measure the maximal HGS (kilograms). Presence of cancer cachexia was defined when patients had ≥5% weight loss within 6 months or when body mass index was <20.0 kg/m ² with ≥2% weight loss (Fearon's criteria). Cox proportional hazard analyses were performed to assess the relationship of maximal HGS to all‐cause mortality and to determine cut‐offs for HGS with the best predictive power. We also assessed associations with additional relevant clinical and functional outcome measures at baseline, including anthropometric measures, physical function (Karnofsky Performance Status and Eastern Cooperative of Oncology Group), physical activity (4‐m gait speed test and 6‐min walk test), patient‐reported outcomes (EQ‐5D‐5L and Visual Analogue Scale appetite/pain) and nutrition status (Mini Nutritional Assessment).
Results
The mean age was 60 ± 14 years; 163 (51%) were female, and 148 (44%) had cachexia at baseline. Patients with cancer showed 18% lower HGS than healthy controls (31.2 ± 11.9 vs. 37.9 ± 11.6 kg, P < 0.001). Patients with cancer cachexia had 16% lower HGS than those without cachexia (28.3 ± 10.1 vs. 33.6 ± 12.3 kg, P < 0.001). Patients with cancer were followed for a mean of 17 months (range 6–50), and 182 (55%) patients died during follow‐up (2‐year mortality rate 53%) (95% confidence interval 48–59%). Reduced maximal HGS was associated with increased mortality (per −5 kg; hazard ratio [HR] 1.19; 1.10–1.28; P < 0.0001; independently of age, sex, cancer stage, cancer entity and presence of cachexia). HGS was also a predictor of mortality in patients with cachexia (per −5 kg; HR 1.20; 1.08–1.33; P = 0.001) and without cachexia (per −5 kg; HR 1.18; 1.04–1.34; P = 0.010). The cut‐off for maximal HGS with the best predictive power for poor survival was <25.1 kg for females (sensitivity 54%, specificity 63%) and <40.2 kg for males (sensitivity 69%, specificity 68%).
Conclusions
Reduced maximal HGS was associated with higher all‐cause mortality, reduced overall functional status and decreased physical performance in patients with mostly advanced cancer. Similar results were found for patients with and without cancer cachexia.
... We extracted the RR estimates of the following health outcomes: cardiovascular disease (Wu et al. 2017), type 2 diabetes (Kunutsor et al. 2021a), depression (Huang et al. 2021), falls (Moreland et al. 2004), and fractures (Kunutsor et al. 2021b). To complement this list, given the low number of health outcomes examined in systematic reviews, we relied on large prospective cohort studies from the UK Biobank and added health outcomes such as heart failure (Sillars et al. 2019), cancer (Parra-Soto et al. 2022), and dementia incidence (Esteban-Cornejo et al. 2022) due to their availability in the published literature. Other outcomes such as hypertension or osteoporosis were not included due to either null findings or the absence of available studies. ...
We used a prevalence-based approach to estimate the economic costs associated with low muscle strength, as assessed using handgrip strength, in Canadian adults. We estimated the annual economic burden of low muscle strength at $3.0 billion, representing 2.2% of the 2021 Canadian burden of illness costs. The two most expensive chronic diseases attributable to low muscle strength were cardiovascular disease ($899 million) and type 2 diabetes ($880 million). A 10% decrease in the prevalence of low handgrip strength would save approximately $546 million per year, equivalent to an 18.1% cost reduction. Strategies to increase population-level muscle strength are needed to reduce healthcare costs and improve health.
Novelty
The economic cost associated with low muscle strength in Canadian adults is unknown.
The total annual economic burden of low muscle strength in Canadian adults represents 2.2% of the overall burden of illness costs in 2021.
We estimated that $546 million per year would be saved if the prevalence of low handgrip strength was reduced by 10%.
... This between-group difference may be due to various factors, including other comorbidities among the controls, body composition, and age. Sillars et al. 2019 found that grip strength is higher among adults who are overweight and obese, which was more common in our TJR participants. In addition, participants in the control group were approximately 6 years older than participants in the TJR group, and grip strength declines with age (Yorke et al. 2015). ...
Sarcopenia is associated with falls, and can complicate recovery following total joint replacement (TJR) surgery. We examined (1) the prevalence of sarcopenia indicators and lower-than-recommended protein intake among TJR patients and non-TJR community participants and (2) the relationships between dietary protein intake and sarcopenia indicators. We recruited adults ≥65 years of age who were undergoing TJR, and adults from the community not undergoing TJR (controls). We assessed grip strength and appendicular lean soft-tissue mass (ALSTMBMI) using DXA, and applied the original Foundation for the National Institutes of Health Sarcopenia Project cut-points for sarcopenia indicators (grip strength <26 kg for men and <16 kg for women; ALSTM <0.789 m² for men and <0.512 m² for women) and less conservative cut-points (grip strength <31.83 kg for men and <19.99 kg for women; ALSTM <0.725 m² for men and <0.591 m² for women). Total daily and per meal protein intakes were derived from 5-day diet records. Sixty-seven participants (30 TJR, 37 controls) were enrolled. Using less conservative cut-points for sarcopenia, more control participants were weak compared with TJR participants (46% versus 23%, p = 0.055), and more TJR participants had low ALSTMBMI (40% versus 13%, p = 0.013). Approximately 70% of controls and 76% of TJR participants consumed <1.2 g protein/kg/day (p = 0.559). Total daily dietary protein intake was positively associated with grip strength (r = 0.44, p = 0.001) and ALSTMBMI (r = 0.29, p = 0.03). Using less conservative cut-points, low ALSTMBMI, but not weakness, was more common in TJR patients. Both groups may benefit from a dietary intervention to increase protein intake, which may improve surgical outcomes in TJR patients.
... These pro-inflammatory molecules may further contribute to the progression of SO through their association with reduced muscle mass and strength (17). Reduced muscle mass and function may also contribute to reductions in physical activity levels in adults (18), which can reduce cardiorespiratory fitness and lead to an increased risk of CVD (19,20). ...
Background
Current cardiac rehabilitation (CR) practices focus on aerobic-style exercise with minimal nutrition advice. This approach may not be optimal for CR patients with reduced muscle mass and elevated fat mass. Higher protein, Mediterranean-style diets combined with resistance exercise (RE) may improve muscle mass and reduce the risk of future cardiovascular events, although such an approach is yet to be trialed in a CR population.
Objective
We explored patient perspectives on the proposed design of a feasibility study. Patients reflected on the acceptability of a proposed high-protein Mediterranean-style diet and RE protocol, emphasizing research methodology and the acceptability of the proposed recipes and exercises.
Design
We applied quantitative and qualitative (mixed methods) approaches. The quantitative approach involved an online questionnaire (n = 40) regarding the proposed study methodology and relevance. A subset of participants (n = 12) received proposed recipe guides and were asked to prepare several dishes and complete an online questionnaire regarding their experience. Another subset (n = 18) received links to videos of the proposed RE and completed a questionnaire regarding their impressions of them. Finally, semi-structured interviews (n = 7) were carried out to explore participants’ impressions of the proposed diet and exercise intervention.
Results
Quantitative data indicated a high level of understanding of the intervention protocol and its importance within the context of this research. There was a high degree of willingness to participate in all aspects of the proposed study (>90%). The trialed recipes were enjoyed and found to be easy to make by a majority of participants (79 and 92.1%, respectively). For the proposed exercises 96.5% of responses agreed they would be willing to perform them and, 75.8% of responses agreed they would enjoy them. Qualitative analysis revealed that participants viewed the research proposal, diet, and exercise protocol in a positive light. The research materials were considered appropriate and well explained. Participants suggested practical recommendations for improving recipe guides and requested more individual-focused exercise recommendations, and more information on the specific health benefits of the diet and exercise protocols.
Conclusion
The study methodology and the specific dietary intervention and exercise protocol were found to be generally acceptable with some suggested refinements.
... METs) CRF (Kodama et al., 2009). In addition, some studies demonstrated that CRF and grip strength have a strong inverse association with HF incidence (Sillars et al., 2019). VO 2 and VO 2 peak parameters had important prognostic values in HF (Popovic et al., 2018;Paolillo et al., 2019). ...
Objective: The study aimed to evaluate the effect of sodium–glucose transporter 2 (SGLT-2) inhibitors on various parameters of exercise capacity and provide an evidence-based basis for type 2 diabetes mellitus (T2DM) combined with heart failure (HF) patients or HF patients without T2DM who use SGLT-2 inhibitors to improve cardiorespiratory fitness (CRF).
Methods: According to the participant, intervention, comparison, and outcome (PICO) elements, the effects of SGLT-2 inhibitor administration on VO 2 or VO 2 peak were researched in this study. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated (random-effects model). Heterogeneity was assessed by the I ² test.
Results: Six studies were included according to the eligibility criteria: four were RCTs, and two were non-RCTs. Compared with the control group, the merge results of RCTs showed that SGLT-2 inhibitors could significantly increase the VO 2 peak (WMD, 2.02 ml kg ⁻¹ min ⁻¹ , 95% CI: 0.68–3.37, and p = 0.03; I ² = 0% and p = 0.40) and VAT (WMD, 1.57 ml kg ⁻¹ min ⁻¹ , 95% CI: 0.06–3.07, and p = 0.04; I ² = 0% and p = 0.52) of the obese population, patients with T2DM, and chronic HF patients with or without T2DM. Subgroup analysis showed that SGLT-2 inhibitors improved the VO 2 peak in non-HF patients (WMD, 3.57 ml kg ⁻¹ min ⁻¹ , 95% CI: 0.87–6.26, and p = 0.009; I ² = 4% and p = 0.31) more than in HF patients (WMD, 1.46 ml kg ⁻¹ min ⁻¹ , 95% CI: −0.13–3.04, and p = 0.07; I ² = 0% and p = 0.81). Moreover, the merge of single-arm studies also indicated that empagliflozin could improve VO 2 peak (MD, 1.11 ml kg ⁻¹ min ⁻¹ , 95% CI: 0.93–1.30, and p = 0.827, Δ p = 0.000 and I ² = 0%) of T2DM patients with chronic HF.
Conclusion: Despite the limited number of studies and samples involved, the meta-analysis preliminarily demonstrated that SGLT-2 inhibitors could improve some parameters of exercise capacity (VO 2 peak, VAT) in chronic HF patients with or without T2DM and obese individuals, which had a positive effect on promoting cardiopulmonary fitness to help these populations improve their prognosis.
Systematic Review Registration: [ https://www.crd.york.ac.uk/prospero/#recordDetails ], identifier [CRD42020202788].
... A partir de sus hallazgos, el grupo definió debilidad muscular, como una fuerza de prensión manual < 26 kg en hombres y < 16 kg en mujeres 22 . Estos valores se han utilizado ampliamente en nuevos estudios poblaciones dada sus asociaciones con condiciones de salud como ECNTs, enfermedades respiratorias, cáncer, entre otras 16,23,24 . Por su parte, un estudio británico analizó datos pertenecientes a 12 estudios poblacionales estableciendo como puntos de corte para debilidad muscular < 27 kg en hombres y < 16 kg en mujeres, respectivamente 25 , lo que concuerda con las recomendaciones EWGSOP2 en personas mayores 7,25 . ...
Handgrip strength as a predictor of adverse health outcomes Muscle strength can be measured through different methods and handgrip strength is one of the most used techniques in epidemiological studies. Given its easy application, high reliability, and low cost, it is considered an important health biomarker. Handgrip strength is associated with adverse health outcomes such as mortality and risk of developing chronic diseases, cardiovascular, respiratory, cancer and dementia. There is a paucity of evidence in Chile about the association of handgrip strength with these health outcomes limiting its visibility and implementation in clinical settings. Therefore, this narrative review summarizes the scientific evidence about the association of grip strength with non-communicable chronic diseases and mortality in middle age and older adults. (Rev Med Chile 2022; 150: 1075-1086)
... Handgrip strength predict health status in middle-aged and older adults [4]. In addition, some studies found that low handgrip strength was related with typical cerebrocardiovascular events, such as stroke, heart failure, and death caused by coronary heart diseases [5,6]. Notably, handgrip strength was found to be inversely associated with cardiovascular disease morbidity [7][8][9], cancer mortality [10,11], and death events [12,13]. ...
Studies have shown the indicative role of handgrip strength in health. However, there is limited evidence revealing its potential effect on death events among middle-aged and older adults in China. We aimed to prospectively evaluate if lower handgrip strength is associated with the event of death. Among 17,167 middle-aged and older adults between age 45 to 96, handgrip strength was collected by a handheld dynamometer in a Chinese longitudinal study of aging trend (CHARLS) 2011-2018. Using Cox proportional hazard models with exposures, we assessed the association between handgrip strength and death events. Elevated handgrip strength values were independently associated with the decreased death risk. These results illustrate that lower handgrip strength is an independent indicator of death risks among middle-aged and older Chinese, which highlights the significance of related intercessions. The median values of five levels of handgrip strength in the entire cohort were 16.5,23,28,33,42kg at baseline. A linear association existed between the handgrip strength values and the risk of all-cause death within 34.2kg. Handgrip strength can serve as an independent indicator for death risks.
... Kidney dysfunction has been associated with an increased risk of HF due to an altered renin-angiotensin-aldosterone system which is integral to the body's management of blood volume and blood pressure [18]. Although grip strength has been linked to cardiovascular fitness and risk of HF, we did not observe an association between grip strength and incident HF; prior data for this trait are limited, but two previous investigations reported an inverse relation [23,24]. Gait time has been associated with mortality, cardiovascular fitness, and recurrent HF in individuals with prevalent HF; we extended these findings by confirming a direct association between gait time and future HF risk in individuals without HF, which, to our knowledge, had only been reported in one previous study [22,33,34]. ...
Background
Heart failure is a multi-system disease, with non-cardiac systems playing a key role in disease pathogenesis.
Objective
Investigate whether longitudinal multi-system trajectories incrementally predict heart failure risk compared to single-occasion traits.
Methods
We evaluated 3,412 participants from the Framingham Heart Study Offspring cohort, free of heart failure, who attended examination cycle 5 and at least one examination between 1995–2008 (mean age 67 years, 54% women). We related trajectories for the following organ systems and metabolic functions to heart failure risk using Cox regression: kidney (estimated glomerular filtration rate), lung (forced vital capacity and the ratio of forced expiratory volume in one second/forced vital capacity), neuromotor (gait time), muscular (grip strength), cardiac (left ventricular mass index and heart rate), vascular function (pulse pressure), cholesterol (ratio of total/high-density lipoprotein), adiposity (body mass index), inflammation (C-reactive protein) and glucose homeostasis (hemoglobin A1c). Using traits selected via forward selection, we derived a trajectory risk score and related it to heart failure risk.
Results
We observed 276 heart failure events during a median follow up of 10 years. Participants with the ‘worst’ multi-system trajectory profile had the highest heart failure risk. A one-unit increase in the trajectory risk score was associated with a 2.72-fold increase in heart failure risk (95% CI 2.21–3.34; p<0.001). The mean c-statistics for models including the trajectory risk score and single-occasion traits were 0.87 (95% CI 0.83–0.91) and 0.83 (95% CI 0.80–0.86), respectively.
Conclusion
Incorporating multi-system trajectories reflective of the aging process may add incremental information to heart failure risk assessment when compared to using single-occasion traits.
... In humans, there is strong evidence that grip strength can provide indications of cardiovascular (mal)function (37,38,51). For example, a recent study examined the association of objectively measured grip strength (GS) with incident heart failure (HF) (52). Using the UK Biobank dataset, the authors evaluated data from 374,493 individuals. ...
Individuals affected by Huntington's disease (HD) present with progressive degeneration that results in a wide range of symptoms, including cardiovascular (CV) dysfunction. The huntingtin gene ( HTT ) and its product are ubiquitously expressed, hence, the cardiomyopathy could also be driven by defects caused by its mutated form ( mHTT ) in the cardiomyocytes themselves. In the present study, we sought to determine the contribution of the mHTT expressed in the cardiomyocytes to CV symptoms. We utilized the BACHD mouse model, which exhibits many of the HD core symptoms, including CV dysfunction. This model allows the targeted genetic reduction of mHTT expression in the cardiomyocytes while maintaining the expression of the mHTT in the rest of the body. The BACHD line was crossed with a line of mice in which the expression of Cre recombinase is driven by the cardiac-specific alpha myosin-heavy chain ( Myh6 ) promoter. The offspring of this cross (BMYO mice) exhibited a dramatic reduction in mHTT in the heart but not in the striatum. The BMYO mice were evaluated at 6 months old, as at this age, the BACHD line displays a strong CV phenotype. Echocardiogram measurements found improvement in the ejection fraction in the BMYO line compared to the BACHD, while hypertrophy was observed in both mutant lines. Next, we examined the expression of genes known to be upregulated during pathological cardiac hypertrophy. As measured by qPCR, the BMYO hearts exhibited significantly less expression of collagen1a as well as Gata4 , and brain natriuretic peptide compared to the BACHD. Fibrosis in the hearts assessed by Masson's trichrome stain and the protein levels of fibronectin were reduced in the BMYO hearts compared to BACHD. Finally, we examined the performance of the mice on CV-sensitive motor tasks. Both the overall activity levels and grip strength were improved in the BMYO mice. Therefore, we conclude that the reduction of mHtt expression in the heart benefits CV function in the BACHD model, and suggest that cardiomyopathy should be considered in the treatment strategies for HD.
... The main finding of our study was that stable low GS was strongly associated with a wide range of CVD outcomes. Several studies (9,14,(26)(27)(28) have documented the associations between GS and risk of CVD, where GS was only measured once at baseline. Our results showed that people with the low GS trajectory pattern had a double higher risk of CVD compared with those in the stable high GS group in the fully adjusted model. ...
Background: A single measurement of grip strength (GS) could predict the incidence of cardiovascular disease (CVD). However, the long-term pattern of GS and its association with incident CVD are rarely studied. We aimed to characterize the GS trajectory and determine its association with the incidence of CVD (myocardial infarction, angina, stroke, and heart failure).
Methods: This study included 5,300 individuals without CVD from a British community-based cohort in 2012 (the baseline). GS was repeatedly measured in 2004, 2008, and 2012. Long-term GS patterns were identified by the group-based trajectory model. Cox proportional hazard models were used to examine the associations between GS trajectories and incident CVD. We identified three GS trajectories separately for men and women based on the 2012 GS measurement and change patterns during 2004–2012.
Results: After a median follow-up of 6.1 years (during 2012–2019), 392 participants developed major CVD, including 114 myocardial infarction, 119 angina, 169 stroke, and 44 heart failure. Compared with the high stable group, participants with low stable GS was associated with a higher incidence of CVD incidence [hazards ratio (HR): 2.17; 95% confidence interval (CI): 1.52–3.09; P <0.001], myocardial infarction (HR: 2.01; 95% CI: 1.05–3.83; P = 0.035), stroke (HR: 1.96; 95% CI: 1.11–3.46; P = 0.020), and heart failure (HR: 6.91; 95% CI: 2.01–23.79; P = 0.002) in the fully adjusted models.
Conclusions: The low GS trajectory pattern was associated with a higher risk of CVD. Continuous monitoring of GS values could help identify people at risk of CVD.
... Further analyses on this population showed a strong relationship between cardio-respiratory fi tness and grip strength and future incidence of heart failure. 17 A study of 4403 people considered for bariatric surgery in Sweden and followed for 22 years, found that 188 (9%) of the 2003 who had surgery (25-35 kg weight loss; BMI 1 year after surgery 32 kg/m 2 ) developed heart failure compared with 266 (13%) of 2030 who did not (BMI after 1 year observation 40 kg/ m 2 ). 18 Although these data suggest links between obesity and the risk of developing heart failure, it is possible that obesity just provokes similar symptoms. ...
... Grip strength is associated with CVD after adjusting for socioeconomic and behavioral factors. Previous studies showed the association of hand grip strength with heart failure and cardiovascular risks such as high blood pressure, high blood sugar and lipid levels [51,52]. Hand grip strength in patients with type 2 diabetes is inversely associated with CVD independently from well-established cardiovascular risks [53]. ...
Despite advances in the healthcare system, cardiovascular diseases (CVDs) are still an important public health problem with disparities in the burden within and between countries. Studies among the adult population documented that socioeconomic and environmental factors play a role in the incidence and progression of CVDs. However, evidence is scarce on the socioeconomic determinants and the interplay with behavioral risks among older adults. Therefore, we identified socioeconomic and behavioral determinants of CVDs among older adults. Our sample consisted of 14,322 people aged 50 years and above from Belgium and France who responded to the waves 4, 5, 6 and/or 7 of the Survey of Health Ageing and Retirement in Europe. The effect of determinants on the occurrence of CVD was examined using a Generalized Estimating Equation (GEE) approach for binary longitudinal data. The overall rate of heart attack was 8.3%, which is 7.6% in Belgium and 9.1% in France. Whereas, 2.6% and 2.3% in Belgium and France, respectively, had experienced stroke. In the multivariable GEE model, older age [AOR: 1.057, 95%CI: 1.055–1.060], living in large cities [AOR: 1.14, 95%CI: 1.07–1.18], and retirement [AOR: 1.21, 95%CI: 1.16–1.31] were associated with higher risk of CVD. Furthermore, higher level of education [AOR: 0.82, 95%CI: 0.79–0.90], upper wealth quantile [AOR: 0.82, 95%CI: 0.76–0.86] and having social support [AOR: 0.81, 95%CI: 0.77–0.84] significantly lowers the odds of having CVD. A higher hand grip strength was also significantly associated with lower risk of CVD [AOR: 0.987, 95%CI: 0.984–0.990]. This study demonstrated that older adults who do not have social support, live in big cities, belong to the lowest wealth quantile, and have a low level of education have a higher likelihood of CVD. Therefore, community-based interventions aimed at reducing cardiovascular risks need to give more emphasis to high-risk retired older adults with lower education, no social support and those who live in large cities.
... Further analyses on this population showed a strong relationship between cardio-respiratory fitness and grip strength and future incidence of heart failure. (17) A study of 4 403 people considered for bariatric surgery in Sweden and followed for 22 years, found that 188 (9%) of the 2 003 who had surgery (25 -35kg weight loss; BMI 1 year after surgery 32kg/m 2 ) developed heart failure compared with 266 (13%) of 2 030 who did not (BMI after 1 year observation 40kg/m 2 ). (18) Although these data suggest links between obesity and the risk of developing heart failure, it is possible that obesity just provokes similar symptoms. ...
... Further analyses on this population showed a strong relationship between cardio-respiratory fitness and grip strength and future incidence of heart failure. 17 A study of 4403 people considered for bariatric surgery in Sweden and followed for 22 years, found that 188 (9%) of the 2003 who had surgery (25-35 kg weight loss; BMI 1 year after surgery 32 kg/m 2 ) developed heart failure compared with 266 (13%) of 2030 who did not (BMI after 1 year observation 40 kg/m 2 ). 18 Although these data suggest links between obesity and the risk of developing heart failure, it is possible that obesity just provokes similar symptoms. ...
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Aims
The risk of developing heart failure (HF) after acute coronary syndrome (ACS) remains high. It is unclear whether skeletal muscle strength, in addition to existing risk factors, is a predictor for developing HF after ACS. We aimed to clarify the relationship between quadriceps isometric strength (QIS), a skeletal muscle strength indicator, and the risk of developing HF in patients with ACS.
Methods
We included 1,053 patients with ACS without a prior HF or complications of HF during hospitalization. The median (IQR) age was 67 (57–74) years. The patients were classified into two groups—high and low QIS—using the sex-specific median QIS. The endpoint was HF admissions.
Results
During a mean follow-up period of 4.4±3.7 years, 75 (7.1%) HF admissions were observed. After multivariate adjustment, a high QIS was associated with a lower risk of HF (hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.32–0.87). HR (95% CI) per 5% body weight increment increase of QIS for HF incidents was 0.87 (0.80–0.95). Even when competing risks of death were taken into account, the results did not change. The inclusion of QIS was associated with increases in net reclassification improvement (0.26; 95% CI, 0.002–0.52) and an integrated discrimination index (0.01; 95% CI, 0.004–0.02) for HF.
Conclusion
The present study showed that a higher level of QIS was strongly associated with a lower risk of developing HF after ACS. These findings suggest that skeletal muscle strength could be one of the factors contributing to the risk of developing HF after ACS.
Growing evidence indicates that handgrip strength (HGS) is a conspicuous marker for assessing some diseases affecting middle-aged and elderly individuals. However, research regarding HGS and heart failure (HF) is sparse and controversial. Hence, we aimed to investigate the association between HGS and HF among adults aged 45 years and older in the United States. In this cross-sectional study, we included 4524 adults older than 45 years who were part of the National Health and Nutrition Examination Survey. A generalized additive model was used to estimate the association between HGS and HF. Age, gender, race, income, education, body mass index, smoking status, drinking status, diabetes, hypertension, stroke, vigorous physical activity, total energy intake, total protein intake, total sugars intake, and total fat intake covariates were adjusted using multiple regression models. And further subgroup analysis was conducted. We documented 189 cases of HF, including 106 men and 83 women. HGS was negatively associated with HF after adjusting for all the covariates (odds ratio = 0.97, 95% confidence interval = 0.96–0.99; P < 0.001). Compared with the lowest quintile, the highest quintile was associated with an 82% lower incidence of HF (odds ratio = 0.18, 95% confidence interval = 0.08–0.43; P < 0.001). Subgroup analysis showed that the results remained stable. In US adults older than 45, HGS was negatively associated with HF after adjusting for covariates. This finding had the potential to draw attention to the physiological and pathological effects of decreased muscle function on HF and may influence further prospective studies with intervention trials.
They are necessary so that sporting activities do not endanger health and are particularly recommended.
Heart failure (HF) is a systemic inflammatory disease that causes hypotrophy and skeletal muscle loss. The Global Leadership Initiative on Malnutrition (GLIM) criteria have been developed as a novel evaluation index for malnutrition, with reported usefulness in HF caused by ischemic heart disease. However, reports on the usefulness of malnutrition evaluated by the GLIM criteria in non-ischemic dilated cardiomyopathy (NIDCM) and its relationship with psoas muscle volume are lacking. We investigated the prognostic value of malnutrition evaluated using the GLIM criteria and its association with psoas muscle volume in patients with NIDCM. We enrolled 139 consecutive patients with NIDCM between December 2000 and June 2020. Malnutrition was evaluated using the GLIM criteria on admission. The median follow-up period was 4.7 years. Cardiac events were defined as a composite of cardiac death, hospitalization for worsening HF, and lethal arrhythmia. Furthermore, we measured the psoas muscle volume using computed tomography volumetry in 48 patients. At baseline, the median age was 50 years, and 132 patients (95.0%) had New York Heart Association functional class I or II HF. The median psoas muscle volume was 460.8 cm3. A total of 26 patients (18.7%) were malnourished according to the GLIM criteria. The Kaplan-Meier survival analysis showed that malnourished patients had more cardiac events than non-malnourished patients (log-rank, P < 0.001). The multivariate Cox proportional hazards regression analysis revealed that GLIM criteria-based malnutrition was an independent determinant of cardiac events (hazard ratio, 2.065; 95% confidence interval, 1.166-3.656; P = 0.014). Psoas muscle volume, which was assessed in a total of 48 patients, was lower in malnourished than in non-malnourished patients (median, 369.0 vs. 502.3 cm3; P = 0.035) and correlated with body mass index (r = 0.441; P = 0.002). Nutritional screening using the GLIM criteria may be useful in predicting future cardiac events in patients with NIDCM, reflecting a potential relationship between malnutrition and a low psoas muscle volume.
Objective
Evidence is limited regarding the impact of frailty phenotype with cardiovascular disease (CVD) among younger people and life expectancy.
Methods
The present study included 449971 participants who were enrolled between 2006 and 2010. We used separate cox proportional hazard models stratified by sex to investigate the association of frailty status and each fraity phenotype with CVD events. Using flexible parametric survival models with age as the time scale, we calculated the number of years of life expectancy lost due to frailty status and frailty phenotypes.
Results
The present analysis included 449,971 (38–73 years old) participants, including 199,617 (44.36%) men in the UK Biobank Study. Both frailty and pre-frailty status significantly were associated with an increase of the CVD incidence and all-cause mortality across a wider age range. For individuals with a pre-frailty status, life expectancy at age 45 had a significant reduction of 2.05 (95% CI, 1.75–2.34) years in men and 1.63 (95% CI, 1.34–1.93) years in women; life expectancy at age 65 had a significant reduction of 1.75 (95% CI, 1.49–2.00) years in men and 1.44 (95% CI, 1.18–1.70) years in women.
Conclusions
In this prospective cohort study, frailty was associated with higher risks of CVD incidence and all-cause mortality across a wider age range, and led to a reduction in life expectancy. These findings highlight the importance of not only considering frailty modification in older people but also extending preventive efforts to younger people.
Objective:
Evaluate the association between prefrailty and the risk of heart failure (HF) among older adults.
Design, setting, and participants:
This prospective, community-based cohort study included participants from the Atherosclerotic Risk in Communities study who underwent detailed frailty assessment using Fried Criteria and physical function assessment using the Short Performance Physical Battery (SPPB) score. Individuals with prevalent HF and frailty were excluded.
Main outcomes and measures:
Adjusted association between prefrailty (vs robust), physical function measures (SPPB score, grip strength, and gait speed), and incident HF (overall and HF subtypes, HF with reduced [HFrEF, EF < 50%] and preserved ejection fraction [HFpEF]) were assessed using Cox proportional hazards models.
Results:
Among 5210 participants (mean age 75 years, 58% women), 2565 (49.2%) were identified as prefrail. In cross-sectional analysis, prefrail individuals had a higher burden of chronic myocardial injury (troponin, Std β = 0.08 [0.05-0.10]) and neurohormonal stress (NT-ProBNP, Std β = 0.03 [0.02-0.05]) after adjustment for potential confounders. Over a median follow-up of 4.6 years, there were 232 (4.5%) HF events (HFrEF: 102; HFpEF: 97). Prefrailty was associated with an increased risk of HF after adjusting for potential clinical confounders and cardiac biomarkers (aHR [95% CI] = 1.65 [1.24-2.20]). Among HF subtypes, prefrailty was associated with an increased risk of HFpEF but not HFrEF (aHR [95% CI] = 1.73 [1.11-2.70] and 1.38 [0.90-2.10], respectively). A lower SPPB score was also associated with an increased risk of overall HF and HFpEF, but not HFrEF. Among individual components, increased gait speed were associated with a lower risk of HFpEF, but not HFrEF.
Conclusions and relevance:
Subtle abnormalities in physiological reserve (prefrailty) and impairment in physical function (SPPB) were both significantly associated with a higher risk of incident HF, particularly HFpEF. These findings highlight the potential role of routine assessment of geriatric syndromes for early identification of HF risk.
Hand Grip Strength (HGS) is an indicator of muscle strength tha has been a predictor of physical capacity and long-term health. There has been a a decrease in HGS among youth and is related with several factors such us body mass index (BMI) and protein intake, but the available researches are still inconsistent. This cross sectional study examined the level of HGS and it’s relationship with BMI and protein intake among female college student of UHAMKA Jakarta. HGS were measured by Smedley Dynamometer and were carried out according to the Southampton Protocol. Anthropometric measurements and self 3-day food records were performed to obtain BMI and total protein intake. Chi square test was performed to reveal the difference proportion of low HGS among various groups. The results showed that the average HGS score was 21.70 ± 7.09 kg, of which 48.7% of respondents were classified as low HGS. There was no significant difference of low HGS proportion between normal BMI and abnormal BMI (less and more) (P value = 0.481). However, the proportion of low HGS was significantly higher among those who had deficit protein intake compared to normal (P value = 0,000). Therefore, an adequate protein intake is needed to maintain muscle strength among youth. Keywords: Muscle strength, hand grip strength, BMI, protein intake, youth
Higher levels of physical activity (PA) and cardiorespiratory fitness (CRF) are associated with lower risk of incident cardiovascular disease (CVD). However, the relationship of aerobic PA and CRF with risk of atherosclerotic CVD outcomes and heart failure (HF) seem to be distinct. Furthermore, recent studies have raised concerns of potential toxicity associated with extreme levels of aerobic exercise, with higher levels of coronary artery calcium and incident atrial fibrillation noted among individuals with very high PA levels. In contrast, the relationship between PA levels and measures of left ventricular structure and function and risk of HF is more linear. Thus, personalizing exercise levels to optimal doses may be key to achieving beneficial outcomes and preventing adverse CVD events among high risk individuals. In this report, we provide a comprehensive review of the literature on the associations of aerobic PA and CRF levels with risk of adverse CVD outcomes and the preceding subclinical cardiac phenotypes to better characterize the optimal exercise dose needed to favorably modify CVD risk.
Background: Type 2 diabetes mellitus (T2DM) is associated with higher risk for heart failure (HF). The impact of a lifestyle intervention and changes in cardiorespiratory fitness (CRF), and body mass index (BMI) on risk for HF is not well-established.
Methods: Participants from the Look AHEAD (Action for Health in Diabetes) trial without prevalent HF were included. Time to event analyses were used to compare the risk of incident HF between the intensive lifestyle intervention (ILI) vs. diabetes support and education (DSE) groups. The associations of baseline measures of CRF estimated from a maximal treadmill test, BMI, and longitudinal changes in these parameters with risk of HF were evaluated using multivariable adjusted Cox models.
Results: Among the 5,109 trial participants, there was no significant difference in the risk of incident HF (n = 257) between the ILI vs. DSE groups [HR (95% CI) = 0.96 (0.75 to 1.23)] over a median follow-up of 12.4 years. In the most adjusted Cox models, the risk of HF was 39% and 62% lower among moderate fit [Tertile 2: HR (95% CI) = 0.61 (0.44 to 0.83)] and high fit [Tertile 3: HR (95% CI) = 0.38 (0.24 to 0.59)] groups, respectively (referent group: low fit, Tertile 1). Among HF subtypes, after adjustment for traditional CV risk factors and interval incidence of MI, baseline CRF was not significantly associated with risk of incident HFrEF. In contrast, the risk of incident HFpEF was 40% lower in moderate fit and 77% lower in the high fit groups. Baseline BMI was also not associated with risk of incident HF, HFpEF, or HFrEF after adjustment for CRF and traditional CV risk factors. Among participants with repeat CRF assessments (n = 3,902), improvements in CRF and weight loss over 4-year follow-up was significantly associated with lower risk of HF [HR (95% CI) per 10% increase in CRF = 0.90 (0.82 to 0.99), per 10% decrease in BMI = 0.80 (0.69 to 0.94)].
Conclusions: Among participants with T2DM in the Look AHEAD trial, the ILI did not appear to modify the risk of HF. Higher baseline CRF and sustained improvements in CRF and weight loss were associated with lower risk of HF.
Clinical Trial Registration: URL: https://www.clinicaltrials.gov Unique identifier: NCT00017953
Large-scale cross-sectional and cohort studies have transformed our understanding of the genetic and environmental determinants of health outcomes. However, the representativeness of these samples may be limited-either through selection into studies, or by attrition from studies over time. Here we explore the potential impact of this selection bias on results obtained from these studies, from the perspective that this amounts to conditioning on a collider (i.e. a form of collider bias). Whereas it is acknowledged that selection bias will have a strong effect on representativeness and prevalence estimates, it is often assumed that it should not have a strong impact on estimates of associations. We argue that because selection can induce collider bias (which occurs when two variables independently influence a third variable, and that third variable is conditioned upon), selection can lead to substantially biased estimates of associations. In particular, selection related to phenotypes can bias associations with genetic variants associated with those phenotypes. In simulations, we show that even modest influences on selection into, or attrition from, a study can generate biased and potentially misleading estimates of both phenotypic and genotypic associations. Our results highlight the value of knowing which population your study sample is representative of. If the factors influencing selection and attrition are known, they can be adjusted for. For example, having DNA available on most participants in a birth cohort study offers the possibility of investigating the extent to which polygenic scores predict subsequent participation, which in turn would enable sensitivity analyses of the extent to which bias might distort estimates.
A total of 230 670 women and 190 057 men free from prevalent cancer and cardiovascular disease were included from UK Biobank. Usual walking pace was self-defined as slow, steady/average or brisk. Handgrip strength was assessed by dynamometer. Cox-proportional hazard models were adjusted for social deprivation, ethnicity, employment, medications, alcohol use, diet, physical activity, and television viewing time. Interaction terms investigated whether age, body mass index (BMI), and smoking status modified associations. Over 6.3 years, there were 8598 deaths, 1654 from cardiovascular disease and 4850 from cancer. Associations of walking pace with mortality were modified by BMI. In women, the hazard ratio (HR) for all-cause mortality in slow compared with fast walkers were 2.16 [95% confidence interval (CI): 1.68–2.77] and 1.31 (1.08–1.60) in the bottom and top BMI tertiles, respectively; corresponding HRs for men were 2.01 (1.68–2.41) and 1.41 (1.20–1.66). Hazard ratios for cardiovascular mortality remained above 1.7 across all categories of BMI in men and women, with modest heterogeneity in men. Handgrip strength was associated with cardiovascular mortality in men only (HR tertile 1 vs. tertile 3 = 1.38; 1.18–1.62), without differences across BMI categories, while associations with all-cause mortality were only seen in men with low BMI. Associations for walking pace and handgrip strength with cancer mortality were less consistent.
A simple self-reported measure of slow walking pace could aid risk stratification for all-cause and cardiovascular mortality within the general population.
Background:
It is well established that cardiorespiratory fitness (CRF) is inversely associated with cardiovascular and all-cause mortality. However, little is known regarding the association between CRF and incidence of heart failure (HF).
Methods and results:
Between 1987 and 2014, we assessed CRF in 21 080 HF-free subjects (58.3±11 years) at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, CA. Subjects were classified by age-specific quintiles of CRF. Multivariable Cox models were used to determine the association between HF incidence and clinical and exercise test variables. Reclassification characteristics of fitness relative to standard clinical risk factors were determined using the category-free net reclassification improvement and integrated discrimination improvement indices. During the follow-up (mean 12.3±7.4 years), 1902 subjects developed HF (9.0%; average annual incidence rate, 7.4 events per 1000 person-years). When CRF was considered as a binary variable (unfit/fit), low fitness was the strongest predictor of risk for HF among clinical and exercise test variables (hazard ratio, 1.91; 95% confidence interval, 1.74-2.09; P<0.001). In a fully adjusted model with the least-fit group as the reference, there was a graded and progressive reduction in risk for HF as fitness level was higher. Risks for developing HF were 36%, 41%, 67%, and 76% lower among increasing quintiles of fitness compared with the least-fit subjects (P<0.001). Adding CRF to standard risk factors resulted in a net reclassification improvement of 0.37 (P<0.001).
Conclusions:
CRF is strongly, inversely, and independently associated with the incidence of HF in veterans referred for exercise testing.
Objective
To investigate the association between active commuting and incident cardiovascular disease (CVD), cancer, and all cause mortality.
Design
Prospective population based study.
Setting
UK Biobank.
Participants
263 450 participants (106 674 (52%) women; mean age 52.6), recruited from 22 sites across the UK. The exposure variable was the mode of transport used (walking, cycling, mixed mode v non-active (car or public transport)) to commute to and from work on a typical day.
Main outcome measures
Incident (fatal and non-fatal) CVD and cancer, and deaths from CVD, cancer, or any causes.
Results
2430 participants died (496 were related to CVD and 1126 to cancer) over a median of 5.0 years (interquartile range 4.3-5.5) follow-up. There were 3748 cancer and 1110 CVD events. In maximally adjusted models, commuting by cycle and by mixed mode including cycling were associated with lower risk of all cause mortality (cycling hazard ratio 0.59, 95% confidence interval 0.42 to 0.83, P=0.002; mixed mode cycling 0.76, 0.58 to 1.00, P<0.05), cancer incidence (cycling 0.55, 0.44 to 0.69, P<0.001; mixed mode cycling 0.64, 0.45 to 0.91, P=0.01), and cancer mortality (cycling 0.60, 0.40 to 0.90, P=0.01; mixed mode cycling 0.68, 0.57 to 0.81, P<0.001). Commuting by cycling and walking were associated with a lower risk of CVD incidence (cycling 0.54, 0.33 to 0.88, P=0.01; walking 0.73, 0.54 to 0.99, P=0.04) and CVD mortality (cycling 0.48, 0.25 to 0.92, P=0.03; walking 0.64, 0.45 to 0.91, P=0.01). No statistically significant associations were observed for walking commuting and all cause mortality or cancer outcomes. Mixed mode commuting including walking was not noticeably associated with any of the measured outcomes.
Conclusions
Cycle commuting was associated with a lower risk of CVD, cancer, and all cause mortality. Walking commuting was associated with a lower risk of CVD independent of major measured confounding factors. Initiatives to encourage and support active commuting could reduce risk of death and the burden of important chronic conditions.
Aims To investigate the association between cardiorespiratory fitness (CRF) and muscle strength in late adolescence and the long-term risk of heart failure (HF). Methods A cohort was created of Swedish men enrolled in compulsory military service between 1968 and 2005 with measurements for CRF and muscle strength ( n = 1,226,623; mean age 18.3 years). They were followed until 31 December 2014 for HF hospitalization as recorded in the Swedish national inpatient registry. Results During the follow-up period (median (interquartile range) 28.4 (22.0-37.0) years), 7656 cases of first HF hospitalization were observed (mean ± SD age at diagnosis 50.1 ± 7.9 years). CRF and muscle strength were estimated by maximum capacity cycle ergometer testing and strength exercises (knee extension, elbow flexion and hand grip). Inverse dose-response relationships were found between CRF and muscle strength with HF as a primary or contributory diagnosis with an adjusted hazards ratio (95% confidence interval) of 1.60 (1.44-1.77) for low CRF and 1.45 (1.32-1.58) for low muscle strength categories. The associations of incident HF with CRF and muscle strength persisted, regardless of adjustments for the other potential confounders. The highest risk was observed for HF associated with coronary heart disease, diabetes or hypertension. Conclusions In this longitudinal study of young men, we found inverse and mutually independent associations between CRF and muscle strength with risk of hospitalization for HF. If causal, these results may emphasize the importance of the promotion of CRF and muscle strength in younger populations.
Cathie Sudlow and colleagues describe the UK Biobank, a large population-based prospective study, established to allow investigation of the genetic and non-genetic determinants of the diseases of middle and old age.
To explore the extent to which muscular strength in adolescence is associated with all cause and cause specific premature mortality (<55 years).
Prospective cohort study.
Sweden.
1 142 599 Swedish male adolescents aged 16-19 years were followed over a period of 24 years.
Baseline examinations included knee extension, handgrip, and elbow flexion strength tests, as well as measures of diastolic and systolic blood pressure and body mass index. Cox regression was used to estimate hazard ratios for mortality according to muscular strength categories (tenths).
During a median follow-up period of 24 years, 26 145 participants died. Suicide was a more frequent cause of death in young adulthood (22.3%) than was cardiovascular diseases (7.8%) or cancer (14.9%). High muscular strength in adolescence, as assessed by knee extension and handgrip tests, was associated with a 20-35% lower risk of premature mortality due to any cause or cardiovascular disease, independently of body mass index or blood pressure; no association was observed with mortality due to cancer. Stronger adolescents had a 20-30% lower risk of death from suicide and were 15-65% less likely to have any psychiatric diagnosis (such as schizophrenia and mood disorders). Adolescents in the lowest tenth of muscular strength showed by far the highest risk of mortality for different causes. All cause mortality rates (per 100 000 person years) ranged between 122.3 and 86.9 for the weakest and strongest adolescents; corresponding figures were 9.5 and 5.6 for mortality due to cardiovascular diseases and 24.6 and 16.9 for mortality due to suicide.
Low muscular strength in adolescents is an emerging risk factor for major causes of death in young adulthood, such as suicide and cardiovascular diseases. The effect size observed for all cause mortality was equivalent to that for well established risk factors such as elevated body mass index or blood pressure.
We sought to establish whether cardiorespiratory fitness had important implications for long-term cardiovascular risk among individuals classified as low risk by the Framingham Risk Score (10-year coronary heart disease risk <10%). Prognostic factors of long-term cardiovascular risk are needed for low-risk subjects who make up the largest percentage of the US population.
The study population was composed of men and women, 30 to 50 years of age, who had a baseline medical exam at the Cooper Clinic, Dallas, TX, between 1970 and 1983. Eligible individuals were defined as at low risk for coronary heart disease by Framingham Risk Score at the time of study entry and had no history of diabetes (n=11 190). Cardiorespiratory fitness was determined by maximum graded exercise treadmill tests. Over an average 27±2-year period, 15% of low-fit (quintile 1) compared to 6% of high-fit (quintile 5) individuals died (P<0.001). A 1-metabolic equivalent level increase in baseline fitness was associated with an 11% reduction in all-cause deaths and an 18% reduction in deaths due to cardiovascular disease (CVD) after adjustment for age, sex, body mass index, systolic blood pressure, total cholesterol, blood glucose levels, smoking, and early family history of coronary disease. There was an incremental decrease in CVD risk with increasing fitness quintile, such that the high fit had the lowest adjusted 30-year CVD mortality rate (hazard ratio 0.29, 95% CI: 0.16-0.51) compared to the low fit.
Cardiorespiratory fitness is associated with a significant reduction in long-term CVD among individuals identified as low risk by Framingham Risk Score. These data suggest that preventive lifestyle interventions geared to optimize cardiorespiratory fitness, even among a "low-risk" subset, should be considered to improve CVD-free survival. (J Am Heart Assoc. 2012;1:e001354 doi: 10.1161/JAHA.112.001354.).
the European Working Group on Sarcopenia in Older People has developed a clinical definition of sarcopenia based on low muscle mass and reduced muscle function (strength or performance). Grip strength is recommended as a good simple measure of muscle strength when 'measured in standard conditions'. However, standard conditions remain to be defined.
a literature search was conducted to review articles describing the measurement of grip strength listed in Medline, Web of Science and Cochrane Library databases up to 31 December 2009.
there is wide variability in the choice of equipment and protocol for measuring grip strength. The Jamar hand dynamometer is the most widely used instrument with established test-retest, inter-rater and intra-rater reliability. However, there is considerable variation in how it is used and studies often provide insufficient information on the protocol followed making comparisons difficult. There is evidence that variation in approach can affect the values recorded. Furthermore, reported summary measures of grip strength vary widely including maximum or mean value, from one, two or three attempts, with either hand or the dominant hand alone.
there is considerable variation in current methods of assessing grip strength which makes comparison between studies difficult. A standardised method would enable more consistent measurement of grip strength and better assessment of sarcopenia. Our approach is described.
To describe the survival of a population based cohort of patients with incident (new) heart failure and the clinical features associated with mortality.
A population based observational study.
Population of 151 000 served by 82 general practitioners in west London.
New cases of heart failure were identified by daily surveillance of acute hospital admissions to the local district general hospital, and by general practitioner referral of all suspected new cases of heart failure to a rapid access clinic.
All patients with suspected heart failure underwent clinical assessment, and chest radiography, ECG, and echocardiogram were performed. A panel of three cardiologists reviewed all the data and determined whether the definition of heart failure had been met. Patients were subsequently managed by the general practitioner in consultation with the local cardiologist or admitting physician.
Death, overall and from cardiovascular causes.
There were 90 deaths (83 cardiovascular deaths) in the cohort of 220 patients with incident heart failure over a median follow up of 16 months. Survival was 81% at one month, 75% at three months, 70% at six months, 62% at 12 months, and 57% at 18 months. Lower systolic blood pressure, higher serum creatinine concentration, and greater extent of crackles on auscultation of the lungs were independently predictive of cardiovascular mortality (all p < 0.001).
In patients with new heart failure, mortality is high in the first few weeks after diagnosis. Simple clinical features can identify a group of patients at especially high risk of death.
Several studies in older people have shown that grip strength predicts all-cause mortality. The mechanisms are unclear. Muscle strength declines with age, accompanied by a loss of muscle mass and an increase in fat, but the role that body composition plays in the association between grip strength and mortality has been little explored. We investigated the relation between grip strength, body composition, and cause-specific and total mortality in 800 men and women aged 65 and over.
During 197374 the UK Department of Health and Social Security surveyed random samples of men and women aged 65 and over living in eight areas of Britain to assess the nutritional state of the elderly population. The survey included a clinical examination by a geriatrician who assessed grip strength and anthropometry. We used Cox proportional hazards models to examine mortality over 24 years of follow-up.
Poorer grip strength was associated with increased mortality from all-causes, from cardiovascular disease, and from cancer in men, though not in women. After adjustment for potential confounding factors, including arm muscle area and BMI, the relative risk of death in men was 0.81 (95% CI 0.700.95) from all-causes, 0.73 (95% CI 0.600.89) from cardiovascular disease, and 0.81 (95% CI 0.660.98) from cancer per SD increase in grip strength. These associations remained statistically significant after further adjustment for fat-free mass or % body fat.
Grip strength is a long-term predictor of mortality from all-causes, cardiovascular disease, and cancer in men. Muscle size and other indicators of body composition did not explain these associations.
Objective To investigate the association of grip strength with disease specific incidence and mortality and whether grip strength enhances the prediction ability of an established office based risk score.
Design Prospective population based study.
Setting UK Biobank.
Participants 502 293 participants (54% women) aged 40-69 years.
Main outcome measures All cause mortality as well as incidence of and mortality from cardiovascular disease, respiratory disease, chronic obstructive pulmonary disease, and cancer (all cancer, colorectal, lung, breast, and prostate).
Results Of the participants included in analyses, 13 322 (2.7%) died over a mean of 7.1 (range 5.3-9.9) years’ follow-up. In women and men, respectively, hazard ratios per 5 kg lower grip strength were higher (all at P<0.05) for all cause mortality (1.20, 95% confidence interval 1.17 to 1.23, and 1.16, 1.15 to 1.17) and cause specific mortality from cardiovascular disease (1.19, 1.13 to 1.25, and 1.22, 1.18 to 1.26), all respiratory disease (1.31, 1.22 to 1.40, and 1.24, 1.20 to 1.28), chronic obstructive pulmonary disease (1.24, 1.05 to 1.47, and 1.19, 1.09 to 1.30), all cancer (1.17, 1.13 to 1.21, 1.10, 1.07 to 1.13), colorectal cancer (1.17, 1.04 to 1.32, and 1.18, 1.09 to 1.27), lung cancer (1.17, 1.07 to 1.27, and 1.08, 1.03 to 1.13), and breast cancer (1.24, 1.10 to 1.39) but not prostate cancer (1.05, 0.96 to 1.15). Several of these relations had higher hazard ratios in the younger age group. Muscle weakness (defined as grip strength <26 kg for men and <16 kg for women) was associated with a higher hazard for all health outcomes, except colon cancer in women and prostate cancer and lung cancer in both men and women. The addition of handgrip strength improved the prediction ability, based on C index change, of an office based risk score (age, sex, diabetes diagnosed, body mass index, systolic blood pressure, and smoking) for all cause (0.013) and cardiovascular mortality (0.012) and incidence of cardiovascular disease (0.009).
Conclusion Higher grip strength was associated with a range of health outcomes and improved prediction of an office based risk score. Further work on the use of grip strength in risk scores or risk screening is needed to establish its potential clinical utility.
Background
-Observational studies have shown inverse associations among fitness, physical activity, and cardiovascular disease. However, little is known about these associations in individuals with elevated genetic susceptibility for these diseases.
Methods
-We estimated associations of grip strength, objective and subjective physical activity, and cardiorespiratory fitness with cardiovascular events and all-cause death in a large cohort of 502635 individuals from the UK Biobank (median follow-up, 6.1 years; interquartile range, 5.4-6.8 years). Then we further examined these associations in individuals with different genetic burden by stratifying individuals based on their genetic risk scores for coronary heart disease and atrial fibrillation. We compared disease risk among individuals in different tertiles of fitness, physical activity, and genetic risk using lowest tertiles as reference.
Results
-Grip strength, physical activity, and cardiorespiratory fitness showed inverse associations with incident cardiovascular events (coronary heart disease: hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.77- 0.81; HR, 0.95; 95% CI, 0.93-0.97; and HR, 0.68; 95% CI, 0.63-0.74, per SD change, respectively; atrial fibrillation: HR, 0.75; 95% CI, 0.73- 0.76; HR, 0.93; 95% CI, 0.91-0.95; and HR, 0.60; 95% CI, 0.56-0.65, per SD change, respectively). Higher grip strength and cardiorespiratory fitness were associated with lower risk of incident coronary heart disease and atrial fibrillation in each genetic risk score group (Ptrend <0.001 in each genetic risk category). In particular, high levels of cardiorespiratory fitness were associated with 49% lower risk for coronary heart disease (HR, 0.51; 95% CI, 0.38-0.69) and 60% lower risk for atrial fibrillation (HR, 0.40; 95%, CI 0.30-0.55) among individuals at high genetic risk for these diseases.
Conclusions
- Fitness and physical activity demonstrated inverse associations with incident cardiovascular disease in the general population, as well as in individuals with elevated genetic risk for these diseases.
UK Biobank is a population-based cohort of 500,000 participants recruited between 2006 and 2010. Approximately 9.2 million individuals aged 40-69 years who lived within 25 miles of the 22 assessment centres in England, Wales and Scotland were invited, and 5.4% participated in the baseline assessment. The representativeness of the UK Biobank cohort was investigated by comparing demographic characteristics between non-responders and responders. Sociodemographic, physical, lifestyle and health-related characteristics of the cohort were compared with nationally representative data sources. UK Biobank participants were more likely to be older, women and to live in less socioeconomically deprived areas than non-participants. Compared with the general population, participants were less likely to be obese, smoke, drink alcohol on a daily basis and had fewer self-reported health outcomes. Rates of all-cause mortality and total cancer incidence (at age 70-74 years) were 46.2% and 11.8% lower in men, and 55.5% and 18.1% lower in women, respectively, than the general population of the same age. UK Biobank is not representative of the sampling population, with evidence of a 'healthy volunteer' selection bias. Nonetheless, the valid assessment of exposure-disease relationships may be widely generalizable and does not require participants to be representative of the population at large.
Aims:
To quantify the extent to which ethnic differences in muscular strength might account for the substantially higher prevalence of diabetes in black and South-Asian compared with white European adults.
Methods:
This cross-sectional study used baseline data from the UK Biobank study on 418 656 white European, black and South-Asian participants, aged 40-69 years, who had complete data on diabetes status and hand-grip strength. Associations between hand-grip strength and diabetes were assessed using logistic regression and were adjusted for potential confounding factors.
Results:
Lower grip strength was associated with higher prevalence of diabetes, independent of confounding factors, across all ethnicities in both men and women. Diabetes prevalence was approximately three- to fourfold higher in South-Asian and two- to threefold higher in black participants compared with white European participants across all levels of grip strength, but grip strength in South-Asian men and women was ~5-6 kg lower than in the other ethnic groups. Thus, the attributable risk for diabetes associated with low grip strength was substantially higher in South-Asian participants (3.9 and 4.2 cases per 100 men and women, respectively) than in white participants (2.0 and 0.6 cases per 100 men and women, respectively). Attributable risk associated with low grip strength was also high in black men (4.3 cases) but not in black women (0.4 cases).
Conclusions:
Low strength is associated with a disproportionately large number of diabetes cases in South-Asian men and women and in black men. Trials are needed to determine whether interventions to improve strength in these groups could help reduce ethnic inequalities in diabetes prevalence. This article is protected by copyright. All rights reserved.
Background:
Prior studies have demonstrated cardiorespiratory fitness (CRF) to be a strong marker of cardiovascular health. However, there are limited data investigating the association between CRF and risk of progression to heart failure (HF). The purpose of this study was to determine the relationship between CRF and incident HF.
Methods:
We included 66,329 patients (53.8% men, mean age 55 years) free of HF who underwent exercise treadmill stress testing at Henry Ford Health Systems between 1991 and 2009. Incident HF was determined using International Classification of Diseases, Ninth Revision codes from electronic medical records or administrative claim files. Cox proportional hazards models were performed to determine the association between CRF and incident HF.
Results:
A total of 4,652 patients developed HF after a median follow-up duration of 6.8 (±3) years. Patients with incident HF were older (63 vs 54 years, P<.001) and had higher prevalence of known coronary artery disease (42.3% vs 11%, P<.001). Peak metabolic equivalents (METs) of task were 6.3 (±2.9) and 9.1 (±3) in the HF and non-HF groups, respectively. After adjustment for potential confounders, patients able to achieve ≥12 METs had an 81% lower risk of incident HF compared with those achieving <6 METs (hazard ratio 0.19 [95% CI 0.14-0.29], P for trend < .001). Each 1 MET achieved was associated with a 16% lower risk (hazard ratio 0.84 [95% CI 0.82-0.86], P<.001) of incident HF.
Conclusions:
Our analysis demonstrates that higher level of fitness is associated with a lower incidence of HF independent of HF risk factors.
Background
Policy makers are being encouraged to specifically target sugar intake in order to combat obesity. We examined the extent to which sugar, relative to other macronutrients, was associated with adiposity.
Methods
We used baseline data from UK Biobank to examine the associations between energy intake (total and individual macronutrients) and adiposity [body mass index (BMI), percentage body fat and waist circumference]. Linear regression models were conducted univariately and adjusted for age, sex, ethnicity and physical activity.
Results
Among 132 479 participants, 66.3% of men and 51.8% of women were overweight/obese. There was a weak correlation (r = 0.24) between energy from sugar and fat; 13% of those in the highest quintile for sugar were in the lowest for fat, and vice versa. Compared with normal BMI, obese participants had 11.5% higher total energy intake and 14.6%, 13.8%, 9.5% and 4.7% higher intake from fat, protein, starch and sugar, respectively. Hence, the proportion of energy derived from fat was higher (34.3% vs 33.4%, P < 0.001) but from sugar was lower (22.0% vs 23.4%, P < 0.001). BMI was more strongly associated with total energy [coefficient 2.47, 95% confidence interval (CI) 2.36-2.55] and energy from fat (coefficient 1.96, 95% CI 1.91-2.06) than sugar (coefficient 0.48, 95% CI 0.41-0.55). The latter became negative after adjustment for total energy.
Conclusions
Fat is the largest contributor to overall energy. The proportion of energy from fat in the diet, but not sugar, is higher among overweight/obese individuals. Focusing public health messages on sugar may mislead on the need to reduce fat and overall energy consumption.
Aims
It is unclear whether the potential benefits of physical activity differ according to level of cardiorespiratory fitness (CRF) or strength. The aim of this study was to determine whether the association between physical activity and mortality is moderated by CRF and grip strength sufficiently to inform health promotion strategies.
Methods and results
498 135 participants (54.7% women) from the UK Biobank were included (CRF data available in 67 702 participants). Exposure variables were grip strength, CRF, and physical activity. All-cause mortality and cardiovascular disease (CVD) events were the outcomes. 8591 died over median 4.9 years [IQR 4.3–5.5] follow-up. There was a significant interaction between total physical activity and grip strength (P < 0.0001) whereby the higher hazard of mortality associated with lower physical activity was greatest among participants in the lowest tertile for grip strength (hazard ratio, HR:1.11 [95% CI 1.09–1.14]) and lowest among those in the highest grip strength tertile (HR:1.04 [1.01–1.08]). The interaction with CRF did not reach statistical significance but the pattern was similar. The association between physical activity and mortality was larger among those in the lowest tertile of CRF (HR:1.13 [1.02–1.26]) than those in the highest (HR:1.03 [0.91–1.16]). The pattern for CVD events was similar.
Conclusions
These data provide novel evidence that strength, and possibly CRF, moderate the association between physical activity and mortality. The association between physical activity and mortality is strongest in those with the lowest strength (which is easily measured), and the lowest CRF, suggesting that these sub-groups could benefit most from interventions to increase physical activity.
-Previous studies have shown that high levels of physical activity are associated with lower risk of risk factors for heart failure (HF) such as coronary heart disease, hypertension and diabetes. However, the effects of physical activity or fitness on the incidence of HF remain unclear.
-MEDLINE and EMBASE were systematically searched until November 30, 2014. Prospective cohort studies reporting measures of the association of physical activity (n=10) or fitness (n=2) with incident HF were included. Extracted effect estimates from the eligible studies were pooled using a random-effects model meta-analysis, with heterogeneity assessed with the I(2) statistic. Ten cohort studies on physical activity eligible for meta-analysis included a total of 282889 participants followed for 7 to 30 years. For the physical activity studies, maximum versus minimal amount of physical activity groups were used for analyses; with a total number of participants (n= 165,695). The pooled relative risk (95% confidence interval) for HF among those with a regular exercise pattern was 0.72 (95% CI: 0.67-0.79). Findings were similar for men (0.71 [95% CI: 0.61- 0.83]) and women (0.72 [95% CI: 0.67-0.77]) and by type of exercise. There was no evidence of publication bias (P value for Egger test: = 0.34). The pooled associated effect of physical fitness on incident HF was 0.79 (95% CI: 0.75-0.83) for each unit increase in metabolic equivalent of oxygen consumption.
-Published literature support a significant association between increased physical activity or fitness and decreased incidence of HF.
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.
Funding:
Full funding sources listed at end of paper (see Acknowledgments).
The objective of this study was to compare administrative codes with chart review for patients with acute heart failure (AHF).
Administrative databases are used in population health research; however, the validity of codes in the emergency department (ED) for AHF compared with chart review is uncertain.
A cohort of 952 patients with suspected AHF were prospectively recruited from 4 EDs in Edmonton, Alberta, Canada, from 2009 to 2012. Patients had their diagnoses adjudicated by expert physicians using a standardized scoring system and detailed chart review. ED and hospital discharge International Classification of Diseases-10th Revision (ICD-10) codes were captured in the main diagnosis or in any diagnostic field.
The 897 patients had a median age of 77 years (interquartile range: 67 to 85 years), and 806 (90%) were admitted to the hospital. Overall, 809 patients (90.2%) had AHF by adjudication and 660 (73.6%) had ICD-10 code I50.x as a main diagnosis in the ED administrative data, respectively. The positive predictive value of an AHF main diagnosis in the ED administrative data was 93.3% (95% confidence interval [CI]: 92.0% to 94.7%), with sensitivity of 76.1% (95% CI: 75.0% to 77.2%) and specificity of 50.0% (95% CI: 39.8% to 60.1%). The positive predictive value for AHF in any diagnostic field of the ED administrative data was 92.0% (95% CI: 91.1% to 93.0%), with a sensitivity of 89.4% (95% CI: 88.5% to 90.4%) and specificity of 28.4% (95% CI: 20.1% to 37.9%).
An ICD-10 I50.x diagnosis in the ED is highly predictive of AHF compared with chart-level adjudication using a validated score. Thus, the use of these codes in ED administrative databases could identify AHF for clinical and epidemiological studies.
Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Low midlife fitness is associated with higher risk for heart failure (HF). However, it is unclear to what extent this HF risk is modifiable and mediated by the burden of cardiac and non-cardiac co-morbidities. We studied the effect of cardiac and non-cardiac co-morbidities on the association of midlife fitness and fitness change with HF risk.Methods & ResultsLinking individual subject data from the Cooper Center Longitudinal Study (CCLS) with Medicare claims files, we studied 19,485 subjects (21.2% women) who survived to receive Medicare coverage from 1999 to 2009. Fitness estimated by Balke treadmill time at mean age of 49 years was analyzed as a continuous variable (in metabolic equivalents [METs]) and according to age- and sex-specific quintiles. Associations of midlife fitness and fitness change with HF hospitalization after age 65 were assessed by applying a proportional hazards recurrent events model to the failure time data with each co-morbidity entered as time-dependent covariates. After 127,110 person-years of Medicare follow up, we observed 1,038 HF hospitalizations. Higher midlife fitness was associated with a lower risk for HF hospitalization [HR 0.82 (0.76-0.87) per MET] after adjustment for traditional risk factors. This remained unchanged after further adjustment for the burden of Medicare-identified cardiac and non-cardiac co-morbidities [HR 0.83 (0.78-0.89)]. Each 1 MET improvement in midlife fitness was associated with a 17% lower risk for HF hospitalization in later life [HR 0.83 (0.74-0.93) per MET].Conclusions
Midlife fitness is an independent and modifiable risk factor for HF hospitalization at a later age.
Physical activity (PA) and cardiorespiratory fitness (CRF) both have inverse relationships to cardiovascular (CV) morbidity and mortality. Recent position papers and guidelines have identified the important role of both of these factors in CV health. The benefits of PA and CRF in the prevention of CV disease and risk factors are reviewed. In addition, assessment methodology and utilization in the research and clinical arenas are discussed. Finally, the benefits, methodology, and utilization are compared and contrasted to better understand the two (partly) distinct components and their impact on CV health.
AimTo examine the relationship between cardiorespiratory fitness (CRF) and risk of incident heart failure (HF). Methods and resultsCardiorespiratory fitness, as measured by maximal oxygen uptake (VO2max), was assessed at baseline in a prospective cohort of 1873 men aged 42–61 years without HF or chronic respiratory disease. During a mean follow-up of 20.4 years, 152 incident HF events were recorded. Within-person variability was calculated using data from repeat measurements taken 11 years apart. The age-adjusted hazard ratio (HR) per unit increase (1 mL/kg/min of VO2max) in CRF was 0.89 [95% confidence interval (CI) 0.86–0.93], which was minimally attenuated to 0.94 (95% CI 0.90–0.98) after further adjustment for established HF risk factors (body mass index, systolic blood pressure, history of cardiovascular disease, diabetes, heart rate, and LV hypertrophy) and incident coronary events as a time-varying covariate. In a comparison of extreme quartiles of CRF levels (VO2max ≥35.4 vs. ≤25.7 mL/kg/min), the corresponding HRs were 0.27 (0.15–0.50) and 0.48 (0.25–0.92), respectively. Each 1 MET (metabolic equivalent of oxygen consumption) increment in CRF was associated with a 21% (7–33%) reduction in multivariable adjusted risk of HF. Addition of CRF to a HF risk prediction model containing established risk factors did not significantly improve risk discrimination (C-index change = 0.0164, P = 0.07). Conclusions
In this Finnish population, there is a strong, inverse, and independent association between long-term CRF and HF risk, consistent with a dose–response relationship. The protective effect of CRF on HF risk warrants further evaluation.
The concept of individual differences in the response to exercise training or trainability was defined three decades ago. In a series of experimental studies with pairs of monozygotic twins, evidence was found in support of a strong genotype dependency of the ability to respond to regular exercise. In the HERITAGE Family Study, it was observed that the heritability of the maximal oxygen uptake response to 20 weeks of standardized exercise training reached 47% after adjustment for age, sex, baseline maximal oxygen uptake and baseline body mass and composition. Candidate gene studies have not yielded as many validated gene targets and variants as originally anticipated. Genome-wide explorations have generated more convincing predictors of maximal oxygen uptake trainability. A genomic predictor score based on the number of favourable alleles carried at 21 single nucleotide polymorphisms appears to be able to identify low and high training response classes that differ by at least threefold. Combining transcriptomic and genomic technologies has also yielded highly promising results concerning the ability to predict trainability among sedentary people.
Recent epidemiologic evidence points to the health risks of prolonged sitting, that are independent of physical activity, but few papers have reported the descriptive epidemiology of sitting in population studies with adults.
This paper reports the prevalence of "high sitting time" and its correlates in an international study in 20 countries.
Representative population samples from 20 countries were collected 2002-2004, and a question was asked on usual weekday hours spent sitting. This question was part of the International Prevalence Study, using the International Physical Activity Questionnaire (IPAQ). The sitting measure has acceptable reliability and validity. Daily sitting time was compared among countries, and by age group, gender, educational attainment, and physical activity.
Data were available for 49,493 adults aged 18-65 years from 20 countries. The median reported sitting time was 300 minutes/day, with an interquartile range of 180-480 minutes. Countries reporting the lowest amount of sitting included Portugal, Brazil, and Colombia (medians ≤180 min/day), whereas adults in Taiwan, Norway, Hong Kong, Saudi Arabia, and Japan reported the highest sitting times (medians ≥360 min/day). In adjusted analyses, adults aged 40-65 years were significantly less likely to be in the highest quintile for sitting than adults aged 18-39 years (AOR=0.796), and those with postschool education had higher sitting times compared with those with high school or less education (OR=1.349). Physical activity showed an inverse relationship, with those reporting low activity on the IPAQ three times more likely to be in the highest-sitting quintile compared to those reporting high physical activity.
Median sitting time varied widely across countries. Assessing sitting time is an important new area for preventive medicine, in addition to assessing physical activity and sedentary behaviors. Population surveys that monitor lifestyle behaviors should add measures of sitting time to physical activity surveillance. Moreover, the use of objective measures to capture the spectrum of sedentary (sitting) and physical activity behaviors is encouraged, particularly in low- and middle-income countries commencing new surveillance activities.
Handgrip strength is a simple measurement used to estimate overall muscle strength but might also serve as a predictor of health-related prognosis. We investigated grip strength-mortality association in a longitudinal study.
A total of 4912 persons (1695 men and 3217 women), 35 to 74 years old at baseline, were the subjects of this study. Members of the Adult Health Study (AHS) cohort in Hiroshima, Japan, these individuals underwent a battery of physiological tests, including handgrip-strength testing, between July 1970 and June 1972. Mortality was followed until the end of 1999. Estimates of relative risk (RR) of mortality associated with grip strength were adjusted for potentially confounding factors by Cox proportional hazard analysis.
Multivariate-adjusted RR of all causes of death, except for external causes, for the highest quintile of grip strength in men was 0.52 (95% confidence interval [CI], 0.33-0.80) for the age group 35-54 years, 0.72 (95% CI, 0.53-0.98) for the ages 55-64 years, and 0.67 (95% CI, 0.49-0.91) for the ages 65-74 years. These figures were significantly lower than the RR for the reference group (the third quintile). Similar trends were observed in women. Multivariate-adjusted RR of all causes of death except external causes for each 5-kg increment of grip strength was significantly low (RR: 0.89, 95% CI, 0.86-0.92 for men, RR: 0.87, 95% CI, 0.83-0.92 for women). Multivariate-adjusted RR for heart disease, stroke, and pneumonia in men was 0.85 (95% CI, 0.79-0.93), 0.90 (95% CI, 0.83-0.99), and 0.85 (95% CI, 0.75-0.98), respectively. RR for each 5-kg increment of grip strength remained 0.92 (95% CI, 0.87-0.96), even after more than 20 years of follow-up.
Grip strength is an accurate and consistent predictor of all causes of mortality in middle-aged and elderly persons.
The purpose of this study was to determine the association between fitness and lifetime risk for cardiovascular disease (CVD).
Higher levels of traditional risk factors are associated with marked differences in lifetime risks for CVD. However, data are sparse regarding the association between fitness and the lifetime risk for CVD.
We followed up 11,049 men who underwent clinical examination at the Cooper Institute in Dallas, Texas, before 1990 until the occurrence of CVD death, non-CVD death, or attainment of age 90 years (281,469 person-years of follow-up, median follow-up 25.3 years, 1,106 CVD deaths). Fitness was measured by the Balke protocol and categorized according to treadmill time into low, moderate, and high fitness, with further stratification by CVD risk factor burden. Lifetime risk for CVD death determined by the National Death Index was estimated for fitness levels measured at ages 45, 55, and 65 years, with non-CVD death as the competing event.
Differences in fitness levels (low fitness vs. high fitness) were associated with marked differences in the lifetime risks for CVD death at each index age: age 45 years, 13.7% versus 3.4%; age 55 years, 34.2% versus 15.3%; and age 65 years, 35.6% versus 17.1%. These associations were strongest among persons with CVD risk factors.
A single measurement of low fitness in mid-life was associated with higher lifetime risk for CVD death, particularly among persons with a high burden of CVD risk factors.
The rule of thumb that logistic and Cox models should be used with a minimum of 10 outcome events per predictor variable (EPV),
based on two simulation studies, may be too conservative. The authors conducted a large simulation study of other influences
on confidence interval coverage, type I error, relative bias, and other model performance measures. They found a range of
circumstances in which coverage and bias were within acceptable levels despite less than 10 EPV, as well as other factors
that were as influential as or more influential than EPV. They conclude that this rule can be relaxed, in particular for sensitivity
analyses undertaken to demonstrate adequate control of confounding.
To examine the associations between inflammatory proteins and muscle strength and to determine whether this association varies between overweight and nonoverweight adolescents.
Cross-sectional study.
A total of 416 Spanish adolescents (230 boys and 186 girls) aged 13 to 18(1/2) years.
Muscle strength score was computed as the mean of the handgrip and standing broad jump standardized values. The adolescents were categorized as overweight (including obese) or nonoverweight according to body mass index. Body fat and fat-free mass were derived from skinfold thickness.
C-reactive protein, complement factors C3 and C4, ceruloplasmin, and prealbumin levels.
The results of the regression analysis showed that C-reactive protein, C3, and ceruloplasmin were negatively associated with muscle strength after controlling for sex, age, pubertal status, weight, height, socioeconomic status, and cardiorespiratory fitness. Moreover, C-reactive protein and prealbumin levels were associated with muscle strength in overweight adolescents after controlling for potential confounders, including body fat and fat-free mass.
Low-grade inflammation is negatively associated with muscle strength in adolescents. The patterns of these associations seem more relevant in overweight adolescents, suggesting that having high levels of muscle strength may counteract the negative consequences ascribed to body fat.
National Institute for Cardiovascular Outcomes Research website
- Akosua Donkor
- J C Mcdonagh
- T Hardman
- S Shote
Akosua Donkor JC, McDonagh T, Hardman S, Shote A. National Heart Failure Audit: April 2014-March 2015. National
Institute for Cardiovascular Outcomes Research website.
https://www.nicor.org.uk/wp-content/uploads/2019/02/annual_
report_2014_15_v2.pdf. Accessed January 5, 2019.
Stroke Council. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a Scientific Statement From the
American Heart Association
Physical Activity Committee of the Council on Lifestyle and
Cardiometabolic Health; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Cardiovascular
and Stroke Nursing; Council on Functional Genomics and
Translational Biology; Stroke Council. Importance of assessing
cardiorespiratory fitness in clinical practice: a case for fitness
as a clinical vital sign: a Scientific Statement From the American
Heart Association. Circulation. 2016;134(24):e653-e699.
American Heart Association Advocacy Coordinating Committee, Council on Clinical Cardiology, and Council on Nutrition, Physical Activity and Metabolism. The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the
American Heart Association Advocacy Coordinating Committee, Council on Clinical
Cardiology, and Council on Nutrition, Physical Activity and
Metabolism. The importance of cardiorespiratory fitness in
the United States: the need for a national registry: a policy
statement from the American Heart Association. Circulation.
2013;127(5):652-662.
Obesity: preventing and managing the global epidemic
Obesity: preventing and managing the global epidemic. Report
of a WHO consultation. World Health Organ Tech Rep Ser.
2000;894. i-xii, 1-253.
Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ) -Short Form
- Ipaq The
- Group
The IPAQ Group. Guidelines for data processing and analysis
of the International Physical Activity Questionnaire (IPAQ) -Short Form,Version 2.0 [article online]. www.ipaq.ki.se 2004.
Accessed July 22, 2015.