Association of muscle strength with the incidence of venous thromboembolism and all-cause mortality among patients: a prospective cohort study.

BACKGROUND: Muscle strength is a well-established indicator of overall health, yet its prospective association with the incidence and prognosis of venous thromboembolism (VTE) remains inconsistent. METHODS: This prospective cohort study included 481 945 participants without prior VTE from the UK Biobank for incidence analysis, and 14 908 patients with prevalent VTE at baseline for prognostic analysis. Muscle strength was assessed using grip strength relative to body weight and categorised into sex- and age-specific tertiles. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident VTE and all-cause mortality. RESULTS: Over a median follow-up of 13.72 years, 15 774 incident VTE events were documented. Each 1-standard deviation increase in muscle strength was associated with a 13% reduction in VTE risk (HR 0.87, 95% CI: 0.85-0.89). Compared with the low muscle strength group, participants in the middle and high tertiles had 12% (HR 0.88, 95% CI: 0.84-0.92) and 19% (HR 0.81, 95% CI: 0.77-0.84) lower risk of VTE. This inverse association remained consistent across all genetic risk strata. Among patients with VTE, 2884 deaths occurred during follow-up. Each 1-standard deviation increase was associated with a 14% lower mortality risk (HR 0.86, 95% CI: 0.82-0.90). High and middle muscle strength were associated with 21% (HR 0.79, 95% CI: 0.72-0.87) and 17% (HR 0.83, 95% CI: 0.76-0.91) lower all-cause mortality versus low strength. CONCLUSION: Higher muscle strength is associated with a lower risk of incident VTE, regardless of genetic predisposition, and with lower mortality among patients with VTE.