期刊
LANCET
卷 386, 期 9990, 页码 266-273出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(14)62000-6
关键词
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资金
- EJ Moran Campbell Award, McMaster University, Canada
- Marion Burke Chair of the Heart and Stroke Foundation of Canada
- Population Health Research Institute, Canada
- Canadian Institutes of Health Research, Canada
- Heart and Stroke Foundation of Ontario, Canada
- AstraZeneca (Sweden)
- Sanofi-Aventis (France)
- AstraZeneca (Canada)
- AstraZeneca (Turkey)
- Sanofi-Aventis (Canada)
- Sanofi-Aventis (Turkey)
- Boehringer Ingelheim (Germany)
- Boehringer Ingelheim (Canada)
- Servier
- GlaxoSmithKline
- Novartis
- King Pharma
- Bangladesh Independent University, Bangladesh
- Mitra and Associates, Bangladesh
- Unilever Health Institute, Brazil
- Public Health Agency of Canada
- Champlain Cardiovascular Disease Prevention Network, Canada
- Universidad de la Frontera, Chile
- National Center for Cardiovascular Diseases, China
- Colciencias, Colombia [6566-04-18062]
- Indian Council of Medical Research, India
- Ministry of Science, Technology and Innovation, Malaysia [07-05-IFN-MEB010]
- Ministry of Higher Education, Malaysia [600-RMI/LRGS/5/3]
- Universiti Kebangsaan Malaysia, Malaysia [UKM-Hejim-Komuniti-15-2010]
- Ministry of Science and Higher Education, Poland [290/W-PURE/2008/0]
- Wroclaw Medical University, Poland
- North-West University, South Africa
- South Africa Netherlands Research Programme on Alternatives in Development (SANPAD)
- National Research Foundation
- Medical Research Council of South Africa
- South Africa Sugar Association (SASA), South Africa
- Faculty of Community and Health Sciences (UWC), South Africa
- Council for Working Life and Social Research, Sweden
- Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, Sweden
- Swedish Heart and Lung Foundation, Sweden
- Swedish Research Council
- Swedish State under LUA (LakarUtbildningsAvtalet)
- Vastra Gotaland Region (FOUU), Sweden
- Metabolic Syndrome Society
- Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences, Dubai Health Authority, Dubai, the United Arab Emirates
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.
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