Predictive Value of Musculoskeletal Fitness for Cardiovascular Risk Factors in Adolescents with Congenital Heart...

Objectives: We aimed to investigate the association between musculoskeletal fitness (MF) and cardiovascular risk factors in adolescents with congenital heart disease (ConHD). Methods: This cross-sectional study included 355 adolescents with ConHD (median age 12.4 years [range: 5.7-21.7]; 43.4% female). Participants completed musculoskeletal fitness (MF) tests, including handgrip strength (HGS), curl-ups, push-ups, and trunk lifts, and underwent an assessment of anthropometric indices, blood pressure, pulse wave velocity (PWV), and carotid intima-media thickness (cIMT). To account for body size, HGS was allometrically scaled to body mass with adjustment for age, sex, and ConHD severity. Clustered MF was derived by calculating z-scores for allometric HGS, curl-ups, push-ups, and trunk lifts. Results: Allometric HGS was inversely associated with anthropometric indices: waist circumference [WC] (β = -4.467, p = 0.014), waist-to-hip ratio [WHR] (β =-0.039, p = 0.005), waist-to-height ratio [WHtR] (β = -0.052, p = 0.001), and BMI (β = -3.115, p = 0.001). Push-ups were inversely related to all anthropometric indices (p < 0.05). Trunk lift showed positive associations with multiple anthropometric indices except WHR (all p < 0.05). Clustered MF was negatively associated with WHR (β = -0.004, p = 0.008) and WHtR (β = -0.006, p = 0.001). HGS (β = 0.18, p = 0.033), push-ups (β = 0.004, p = 0.041), and clustered fitness (β = 0.028, p = 0.006) were inversely associated with PWV. Conclusions: Systematically increasing MF in rehabilitation may provide a feasible strategy to mitigate CVD risk in adolescents with ConHD.