After excluding 44 participants lost to follow-up, 364 participants (mean 72.4 ± 8.3 years) were included in the study, nearly half (49.7%) of them were men. Table 1 shows the baseline characteristics of the study participants between the HGS symmetry and HGS asymmetry group. There were 155 (42.6%) older adults with HGS weakness, 160 (44.0%) with HGS asymmetry, and 78 (21.4%) with HGS weakness and asymmetry together. The incidence of cardiovascular outcomes during the follow-up, of which the median observation time was 21.0 months (IQR: 18.5-26.4), is shown in Table 2. 35 (9.6%) older adults developed MACE and 50 (13.7%) presented composite endpoints.
Table 1
General characteristics of participants at baseline
Characteristics
|
Total
(n=364)
|
HGS symmetry
(n=204)
|
HGS asymmetry
(n=160)
|
Age (years)
|
72.4 ± 8.3
|
70.7 ± 7.6
|
74.5 ± 8.8
|
Men, n (%)
|
181 (49.7)
|
105 (51.5)
|
76 (47.5)
|
BMI (kg/m2)
|
23.8 ± 3.5
|
24.0 ± 3.4
|
23.5 ± 3.5
|
Smoking, n (%)
|
60 (16.5)
|
38 (18.6)
|
22 (13.8)
|
Drinking, n (%)
|
27 (7.4)
|
16 (7.8)
|
11 (6.9)
|
Hypertension, n (%)
|
249 (68.4)
|
150 (73.5)
|
99 (61.9)
|
Diabetes, n (%)
|
150 (41.2)
|
92 (45.1)
|
58 (36.3)
|
Hyperlipidemia, n (%)
|
96 (26.4)
|
61 (29.9)
|
35 (21.9)
|
HF, n (%)
|
25 (6.9)
|
12 (5.9)
|
13 (8.1)
|
CHD, n (%)
|
94 (25.8)
|
48 (23.5)
|
46 (28.7)
|
HGS weakness, n (%)
|
155 (42.6)
|
77 (37.7)
|
78 (48.8)
|
FBG
|
6.03 ± 1.66
|
6.04 ± 1.55
|
6.02 ± 1.79
|
TG (mmol/L)
|
1.30
(0.93, 1.81)
|
1.33
(0.90, 1.79)
|
1.24
(0.94, 1.82)
|
TC (mmol/L)
|
4.64 ± 1.15
|
4.78 ± 1.22
|
4.47 ± 1.04
|
LDL-C (mmol/L)
|
2.86 ± 0.89
|
2.94 ± 0.89
|
2.76 ± 0.88
|
HDL-C (mmol/L)
|
1.30 ± 0.50
|
1.35 ± 0.58
|
1.23 ± 0.37
|
BMI body mass index, HF heart failure, CHD coronary heart disease, HGS handgrip strength, FBG Fasting blood glucose, TG triglycerides, TC total cholesterol, LDL-C low-density lipoprotein protein cholesterol, HDL-C High-density lipoprotein cholesterol |
Table 2
The incidence of major outcomes in elderly outpatients during the follow-up
Outcomes
|
Total (n=364)
|
Composite endpoints, n (%)
|
50 (13.7)
|
All-cause mortality, n (%)
|
16 (4.4)
|
MACE, n (%)
|
35 (9.6)
|
Cardiac death, n (%)
|
1 (0.3)
|
Acute myocardial infarction, n (%)
|
7 (1.9)
|
Unstable angina, n (%)
|
4 (1.1)
|
Congestive heart failure, n (%)
|
18 (4.9)
|
Acute stroke, n (%)
|
5 (1.4)
|
Composite endpoints: a composite of all-cause mortality, acute myocardial infarction, hospitalization for unstable angina, hospitalization for congestive heart failure, and acute stroke. MACE: a composite of cardiac death, acute myocardial infarction, hospitalization for unstable angina, hospitalization for congestive heart failure, and acute stroke. |
Participants with HGS weakness developed more cardiovascular outcomes with a higher incidence of MACE (P for trend = 0.001) and composite endpoints (P for trend < 0.001) than the normal HGS group. Likewise, the incidence of MACE (P for trend = 0.006) and composite endpoints (P for trend = 0.006) in the HGS asymmetry group were higher than that in the HGS symmetry group. Combined with HGS weakness and HGS asymmetry, older adults were classified into three groups: normal and symmetric HGS group (n = 127), HGS weakness or asymmetry only (n = 159), and HGS weakness and asymmetry group (n = 78). Participants with HGS weakness and asymmetry together had the highest incidence of MACE (P for trend < 0.001) and composite endpoints (P for trend < 0.001) between the three groups (Figure 1).
In the survival analysis, MACE-free survival rates and composite endpoints survival rates of the HGS weakness groups (P < 0.001) and HGS asymmetry groups (P = 0.007) were statistically significant according to the log-rank test of the Kaplan–Meier curve. Significant differences also existed among normal and symmetric HGS group, HGS weakness or asymmetry only group, and HGS weakness and asymmetry group (P < 0.001, Figure 2).
HGS handgrip strength. MACE: a composite of cardiac death, acute myocardial infarction, unstable hospitalization for unstable angina, hospitalization for congestive heart failure, and acute stroke. Composite endpoints: a composite of all-cause mortality, acute myocardial infarction, hospitalization for unstable angina, hospitalization for congestive heart failure, and acute stroke.
Cox-regression analysis was performed to assess the association of HGS weakness and HGS asymmetry separately on cardiovascular outcomes in elderly outpatients (Table 3). The hazard ratio (HR) in the fully adjusted (Model 3) model of HGS weakness for predicting MACE was 2.763 (95% CI: 1.217-6.272, P = 0.015) and composite endpoints was 2.842 (95% CI: 1.399-5.774, P = 0.004). However, HGS asymmetry could not predict MACE (HR: 1.944, 95% CI: 0.918-4.116, P = 0.083) and composite endpoints (HR: 1.714, 95% CI: 0.920-3.193, P = 0.089).
In Table 4, participants with HGS weakness and asymmetry had a 5.229 (95%CI: 1.559-17.542) higher HR for MACE and a 4.002 (95%CI: 1.558-10.277) higher HR for composite endpoints, whereas HGS weakness or asymmetry only group had no statistical significance for predicting MACE and composite endpoints (P >0.05).
Table 3
Association of HGS weakness and HGS asymmetry separately on cardiovascular outcomes in elderly outpatients
|
HGS weakness
|
|
HGS asymmetry
|
|
|
HR (95% CI)
|
P value
|
HR (95% CI)
|
P value
|
MACE
|
|
|
|
|
Model 1
|
3.386 (1.657-6.919)
|
0.001
|
2.509 (1.248-5.042)
|
0.010
|
Model 2
|
2.261 (1.046-4.888)
|
0.038
|
2.109 (1.036-4.292)
|
0.040
|
Model 3
|
2.763 (1.217-6.272)
|
0.015
|
1.944 (0.918-4.116)
|
0.083
|
Composite endpoints
|
|
|
|
|
Model 1
|
3.965 (2.137-7.356)
|
<0.001
|
2.138 (1.208-3.784)
|
0.009
|
Model 2
|
2.588 (1.332-5.027)
|
0.005
|
1.796 (1.004-3.213)
|
0.048
|
Model 3
|
2.842 (1.399-5.774)
|
0.004
|
1.714 (0.920-3.193)
|
0.089
|
HGS handgrip strength. MACE: a composite of cardiac death, acute myocardial infarction, hospitalization for unstable angina, hospitalization for congestive heart failure, and acute stroke. Composite endpoints: a composite of all-cause mortality, acute myocardial infarction, hospitalization for unstable angina, hospitalization for congestive heart failure, and acute stroke. Model 1: unadjusted. Model 2: adjusted for age and gender. Model 3: adjusted as Model 2 with BMI, smoking, drinking, hypertension, diabetes, hyperlipidemia, HF, and CHD.
Table 4
Association of HGS weakness and asymmetry together on cardiovascular outcomes in elderly outpatients
|
Normal and symmetric HGS
(n=127)
|
|
HGS weakness or asymmetry only
(n=159)
|
|
HGS weakness and asymmetry
(n=78)
|
|
|
HR (95% CI)
|
P value
|
HR (95% CI)
|
P value
|
HR (95% CI)
|
P value
|
MACE
|
|
|
|
|
|
|
Model 1
|
1 (control)
|
-
|
3.210 (1.065-9.675)
|
0.038
|
7.562 (2.527-22.629)
|
<0.001
|
Model 2
|
1 (control)
|
-
|
2.863 (0.945-8.671)
|
0.063
|
4.737 (1.491-15.052)
|
0.008
|
Model 3
|
1 (control)
|
-
|
3.179 (0.994-10.172)
|
0.051
|
5.229 (1.559-17.542)
|
0.007
|
Composite endpoints
|
|
|
|
|
|
|
Model 1
|
1 (control)
|
-
|
2.308 (0.970-5.491)
|
0.059
|
6.458 (2.782-14.995)
|
<0.001
|
Model 2
|
1 (control)
|
-
|
2.021 (0.845-4.833)
|
0.114
|
3.927 (1.604-9.614)
|
0.003
|
Model 3
|
1 (control)
|
-
|
1.944 (0.774-4.883)
|
0.157
|
4.002 (1.558-10.277)
|
0.004
|
HGS handgrip strength; MACE: a composite of cardiac death, acute myocardial infarction, hospitalization for unstable angina, hospitalization for congestive heart failure, and acute stroke. Composite endpoints: a composite of all-cause mortality, acute myocardial infarction, hospitalization for unstable angina, hospitalization for congestive heart failure, and acute stroke. Model 1: unadjusted. Model 2: adjusted for age and gender. Model 3: adjusted as Model 2 with BMI, smoking, drinking, hypertension, diabetes, hyperlipidemia, HF, and CHD.