Cross-cohort insights into the association of handgrip strength transitions and burdens with cardiovascular disease risk

Background: Previous studies established handgrip strength (HGS) as a potential risk factor for cardiovascular diseases (CVD). However, existing studies focused exclusively on baseline HGS and neglected longitudinal changes in HGS during follow-up. Thus, our aim was to investigate the associations of transitions and dynamic burdens of HGS with incident CVD risk. Methods: We analyzed data from the UK Biobank (UKB), the China Health and Retirement Longitudinal Study (CHARLS), the Survey of Health, Ageing and Retirement in Europe (SHARE), and the Korean Longitudinal Study of Ageing (KLOSA). We defined HGS transitions based on HGS at baseline and the first follow-up, and created three indicators to reflect HGS burdens. Cox models were applied to examine the association of HGS transitions and burdens with incident CVD risk. The predictive value of HGS indices was also evaluated. Results: A total of 73,555 participants were retained, and 4,722 (6.4%) incident CVD cases were identified during follow-up. Transition analyses revealed that increased HGS during follow-up was associated with reduced CVD risk, whereas decreased HGS was associated with an elevated risk. Per standard deviation decrement in HGS slope, cumulative HGS and relative cumulative HGS led to a 19.8% (95%CI 1.5~41.5%), 44.0% (95%CI 10.8~87.2%) or 26.7% (95%CI 9.4~46.8%) elevated risk of CVD, respectively. These associations were independent of and more pronounced than HGS, with stronger effects observed in East Asian cohorts (CHARLS and KLOSA) compared to European cohorts (UKB and SHARE). Incorporating dynamic HGS metrics enhanced the predictive accuracy, with HGS burdens providing greater gains than HGS. For the optimal models, all HGS indices resulted in an increase of AUC up to 7.6% in Europeans and 5.9% in East Asians. Conclusions: HGS burdens outperformed in predicting cardiovascular health compared to single cross-sectional HGS itself, suggesting the clinical utility of longitudinal HGS monitoring in clinical and public health strategies for CVD prevention.