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Association Between Handgrip Strength and Cardiovascular Disease Risk in MASLD: A Prospective Study From UK Biobank
Tae Seop Lim1,2, Sujin Kwon3, Sung A Bae1,4
1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Reduced handgrip strength (HGS) is linked to higher cardiovascular disease (CVD) risk in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD). This large UK Biobank study highlights HGS as a key indicator for CVD in MASLD patients.
Area of Science:
- Cardiovascular Medicine
- Hepatology
- Metabolic Diseases
- Epidemiology
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent and associated with cardiometabolic complications.
- Handgrip strength (HGS) is a recognized indicator of overall health and a predictor of mortality and morbidity.
- The relationship between HGS and cardiovascular disease (CVD) risk specifically within the MASLD population requires further investigation.
Purpose of the Study:
- To investigate the association between handgrip strength (HGS) and the incidence of cardiovascular disease (CVD) in individuals diagnosed with MASLD.
- To analyze how varying levels of HGS impact CVD risk across different subgroups of MASLD patients, including stratification by sex.
- To determine if HGS is an independent predictor of CVD in MASLD, considering factors like advanced liver fibrosis.
Main Methods:
- Utilized data from the UK Biobank cohort, including 201,563 participants.
- Assessed handgrip strength (HGS) using a hydraulic hand dynamometer.
- Defined MASLD based on hepatic steatosis (Fatty Liver Index ≥ 60) and cardiometabolic criteria; advanced liver fibrosis identified by FIB-4 score > 2.67.
- Categorized participants into non-MASLD, MASLD with high HGS, MASLD with middle HGS, and MASLD with low-HGS groups for comparative analysis of CVD incidence.
Main Results:
- Out of 75,498 individuals with MASLD, CVD event frequency increased significantly with decreasing HGS in both males and females (p < 0.001).
- Multivariate analysis revealed elevated hazard ratios (HRs) for CVD in MASLD individuals with lower HGS compared to those with high HGS.
- For males with MASLD, HRs for CVD were 1.03 (high HGS), 1.14 (middle HGS), and 1.38 (low HGS).
- For females with MASLD, HRs for CVD were 1.07 (high HGS), 1.25 (middle HGS), and 1.56 (low HGS).
- The association between decreased HGS and increased CVD risk persisted regardless of advanced liver fibrosis status (p < 0.001).
Conclusions:
- This large prospective UK Biobank study demonstrates a significant association between reduced handgrip strength and an increased risk of cardiovascular disease in individuals with MASLD.
- Lower handgrip strength serves as a potential indicator for heightened CVD risk among the MASLD population, irrespective of liver fibrosis severity.
- Findings suggest that HGS assessment could be a valuable tool in risk stratification for cardiovascular events in patients with MASLD.
Background:
This study aimed to investigate the association between handgrip strength (HGS) and cardiovascular disease (CVD) in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) using data from the UK Biobank cohort.
Methods:
A total of 201 563 participants were enrolled in this study. The HGS was measured using a Jamar J00105 hydraulic hand dynamometer. MASLD was defined as the presence of hepatic steatosis accompanied by one or more cardiometabolic criteria. Hepatic steatosis was identified using a fatty liver index ≥ 60. Advanced liver fibrosis was defined by a fibrosis-4 (FIB-4) score > 2.67. To examine the differences in the incidence of CVD, male and female participants were divided into non-MASLD, MASLD with high HGS, MASLD with middle HGS, and MASLD with low-HGS groups.
Results:
Of the study participants, 75 498 (37.5%) were diagnosed with MASLD, with a mean age of 56.5 years, and 40.6% were male. The median follow-up duration was 13.1 years. The frequency of incident CVD events increased significantly across groups: 10.9% in non-MASLD, 13.3% in MASLD with high HGS, 14.8% in MASLD with middle HGS, and 18.4% in MASLD with low HGS for males (p < 0.001). In females, the frequency of incident CVD events was 6.1% in non-MASLD, 9.2% in MASLD with high HGS, 10.7% in MASLD with middle HGS, and 13.3% in MASLD with low HGS (p < 0.001). Using the non-MASLD group as a reference, multivariate-adjusted hazard ratios (HRs) (95% confidence intervals [CI]) for CVD varied according to HGS in individuals with MASLD. In males with MASLD, HRs (95% CI) were 1.03 (0.96-1.10) for high HGS, 1.14 (1.07-1.21) for middle HGS, and 1.38 (1.30-1.46) for low HGS; in females with MASLD, they were 1.07 (0.97-1.18) for high HGS, 1.25 (1.14-1.37) for middle HGS, and 1.56 (1.43-1.72) for low HGS. The incidence of CVD events increased as HGS decreased in participants with MASLD, regardless of the presence or absence of advanced liver fibrosis (all p < 0.001).
Conclusions:
This large prospective cohort study using the UK Biobank showed that in MASLD, a decrease in HGS was associated with increased CVD risk.
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