Characteristics of Participants - Association between relative handgrip strength and cardiovasc

The general characteristics of the participants according to the muscle weakness (lowest 20%) at baseline are shown in Table 3. Among a total of 8,494 subjects, 3,802 (44.8%) were men, and 4,692 (55.2%) were women. The average age of participants was 60.7 ± 10.6 years (range, 45–98 years; men, 60.6 ± 10.3 years; women, 60.7 ± 10.9 years). Among the total subjects, 1,382 (16.3%) had weak HGS, 562 (14.8%) men and 820 (17.5%) women. In both men and women, the proportion of low muscle strength in those 65 years and over was significantly higher than those under 65 years of age (men, 31.5% vs 5.6%; p < 0.0001; and women: 36.4% vs 7.4%; p < 0.0001).

In both men and women, The means of the dominant HGS, absolute HGS, and relative HGS with normal muscle strength were significantly higher than those of the low muscle strength group (men: DHGS 35.9 ± 5.5 kg vs 23.3 ± 5.0 kg, p < 0.0001; AHGS 70.4 ± 10.6 kg vs 43.2 ± 8.21 kg, p < 0.0001; RHGS 3.0 ± 0.5 vs 2.0 ± 0.4, p = 0.001;

women: DHGS 22.7 ± 4.0 kg vs 13.7 ± 3.2 kg, p < 0.0001; AHGS 44.1 ± 7.5 kg vs 25.1 ± 5.2 kg, p < 0.0001; RHGS 1.9 ± 0.4 vs 1.1 ± 0.3, p < 0.001, respectively). In terms of chronic diseases that affect CVD, the distribution of low HGS with hypertension and diabetes was significantly higher in men than in the undiagnosed group (hypertension: 19.3% vs 13.5% p< 0.0001; diabetes: 22.1% vs 13.8%, p <

0.0001), and the trend was similar in women (hypertension: 24.4% vs 15.0%, p<

0.0001; diabetes: 27.1% vs 16.4, p< 0.0001). In addition, there was a significance difference in marital status, education level, area of residence, economic activity, regular exercise, smoking status, alcohol consumption, the ADL score, and the MMSE score among the weak and normal in both sexes (all p values < 0.05).

Table 3 General characteristics of participants for analysis according to low handgrip strength by sex at baseline (2006)

N / mean % / SD N / mean % / SD N / mean % / SD N / mean % / SD

Age <.0001 <.0001

<65 137 5.6 2,316 94.4 225 7.4 2,814 92.6

≥65 425 31.5 924 68.5 595 36.0 1,058 64.0

Dominant HGS, kg 23.3 4.92 35.9 5.51 <.0001 13.7 3.23 22.7 4.01 <.0001

Absolute HGS, kg 43.2 8.21 70.4 10.59 <.0001 25.1 5.20 44.1 7.48 <.0001

Relative HGS, kg/BMI 2.0 0.44 3.0 0.53 <.0001 1.1 0.28 1.9 0.38 <.0001

Marital status <.0001 <.0001

Married 486 13.8 3,040 86.2 394 11.6 2,992 88.4

Single 76 27.5 200 72.5 426 32.6 880 67.4

Region of residence <.0001 0.001

Metropolitan 229 13.8 1,434 86.2 367 17.2 1,773 82.9

Urban 164 12.8 1,117 87.2 237 15.4 1,300 84.6

Rural 169 19.7 689 80.3 216 21.3 799 78.7

Education level <.0001 <.0001

Elementary school or less 311 28.1 797 71.9 668 26.6 1,845 73.4

Middle school graduate 87 13.4 561 86.6 67 8.4 731 91.6

High school graduate 122 9.0 1,228 91.0 71 6.3 1,054 93.7

College graduate or higher 42 6.0 654 94.0 14 5.5 242 94.5

Economic activity <.0001 <.0001

Yes 157 6.7 2,204 93.4 110 8.7 1,157 91.3

No 405 28.1 1,036 71.9 710 20.7 2,715 79.3

Alcohol consumption <.0001 <.0001

Yes 299 11.9 2,215 88.1 105 11.4 819 88.6

No 263 20.4 1,025 79.6 715 19.0 3,053 81.0

Smoking 0.024 0.022

Yes 210 13.3 1,375 86.8 35 24.7 107 75.4

No 352 15.9 1,865 84.1 785 17.3 3,765 82.8

Regular exercise <.0001 <.0001

Yes 166 10.1 1,483 89.9 198 11.4 1,542 88.6

No 396 18.4 1,757 81.6 622 21.1 2,330 78.9

ADL <.0001 <.0001

0 525 14.0 3,217 86.0 763 16.6 3,827 83.4

≥1 37 61.7 23 38.3 57 55.9 45 44.1

BMI, kg/m² <.0001 <.0001

Underweight (<18.5) 52 39.4 80 60.6 88 43.4 115 56.7

Normal (18.5-24.9) 312 19.5 1,289 80.5 388 18.4 1,727 81.7

Overweight(≥25) 198 9.6 1,871 90.4 344 14.5 2,030 85.5

MMSE <.0001 <.0001

Suspicion of dementia (0-17) 53 63.9 30 36.1 235 57.3 175 42.7

Cognitive decline (18-23) 142 39.3 219 60.7 232 28.9 570 71.1

Normal (≥24) 367 10.9 2,991 89.1 353 10.1 3,127 89.9

Hypertension <.0001 <.0001

diagnosed 162 19.3 676 80.7 306 24.4 948 75.6

undiagnosed 400 13.5 2,564 86.5 514 15.0 2,924 85.1

Diabetes melitus <.0001 <.0001

diagnosed 97 22.1 343 78.0 132 27.1 355 72.9

undiagnosed 465 13.8 2,897 86.2 688 16.4 3,517 83.6

Total 562 14.8 3,240 85.2 820 17.5 3,872 82.5

Numeric parameters are expressed as mean and standard deviation in parentheses Categorical parameters are expressed as counts and percentages in parentheses

Cut-off value for low handgrip strength was defined as the lowest 20% of HGS of the study population. ( <26.1 kg for men and <16.0 kg for women, respectively).

Acronyms: BMI, body mass index; MMSE, Mini-mental state examination; SD, standard deviation; ADL activities of daily living

p -value Women (n=4,692)

Men ( n=3,802)

Low Normal Low Normal

p -value

B. Relative handgrip strength (HGS) was a better predictor for cardiovascular disease (CVD) than dominant or absolute handgrip strength

Table 4 shows the ORs and 95% CIs for CVD and the best fit model using the Quasi-Akaike Information Criterion (QIC) among the three HGS indices in men. After adjustment for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension, and diabetes, the relative HGS was inversely associated with CVDs (CVDs: OR per 1 SD increase in relative HGS = 0.839; 95% CI, 0.783–0.898; p < 0.0001; heart diseases: OR per 1 SD increase in relative HGS = 0.904; 95% CI, 0.835–0.979; p = 0.013; stroke: OR per 1 SD increase in relative HGS = 0.797; 95% CI, 0.716–0.887; p < 0.0001). The dominant and absolute HGS were further adjusted for BMI and used to analyze the relationship with CVDs. The dominant and absolute HGS were also inversely associated with CVDs in men (dominant HGS: OR = 0.984; 95% CI, 0.978–0.990; p

< 0.0001; absolute HGS: OR = 0.991; 95% CI, 0.988–0.994; p < 0.0001).

The QIC values, which are indicators of best fit, were almost the same for the three indicators, but the relative HGSs were the best among them in both men and women (CVDs: relative HGS = 9,120, dominant HGS = 9,131, absolute HGS = 9,121; heart diseases: relative HGS = 7,018, dominant HGS = 7,021, absolute HGS = 7,020; stroke:

relative HGS = 4,819, dominant HGS = 4,834, absolute HGS = 4,826).

Table 5 shows the ORs and 95% CIs for CVDs and the best fit model fit using the QIC among the three different HGS indices in women. Similar to men, the relative HGS was also inversely associated with CVDs, controlling age, education, marital status, region, economic activities, alcohol, smoking, exercise, ADL, MMSE, hypertension, and diabetes (CVDs: OR per 1 SD increase in relative HGS = 0.795;

95% CI, 0.726–0.870; p < 0.0001; heart diseases: OR per 1 SD increase in relative HGS = 0.870; 95% CI, 0.789–0.960; p = 0.005; stroke: OR per 1 SD increase in relative HGS = 0.665; 95% CI, 0.574–0.772; p < 0.0001). In terms of the dominant and absolute HGS, there were also inversely associated with CVDs in women (dominant HGS: OR = 0.984; 95% CI, 0.976–0.992; p < 0.0001; absolute HGS: OR

= 0.990; 95% CI, 0.986–0.999; p < 0.0001).

The QIC values for the three HGS indices were also nearly identical, but the relative HGS was the highest for women like men (CVDs: relative HGS = 11,433, dominant HGS = 11,453, absolute HGS = 11,442; heart diseases: relative HGS = 9,056, dominant HGS = 9,064, absolute HGS =9,057; stroke: relative HGS = 5,152, dominant HGS = 5,176, absolute HGS = 5,170).

Table 4 Adjusted ORs and 95% CIs for Cardiovascular diseases and QIC according to HGS indices in men

Table 5 Adjusted ORs and 95% CIs for Cardiovascular diseases and QIC according to HGS indices in women

OR P-value OR P-value OR P-value

Relative HGS* 0.839 0.783 0.898 <.0001 0.904 0.835 0.979 0.013 0.797 0.716 0.887 <.0001 QIC

Dominant HGS** 0.984 0.978 0.990 <.0001 0.990 0.984 0.997 0.007 0.980 0.972 0.989 <.0001 QIC

Absolute HGS** 0.991 0.988 0.994 <.0001 0.995 0.991 0.998 0.004 0.988 0.983 0.992 <.0001 QIC

* adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

** adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, BMI, ADL, MMSE, hypertension and diabetes Acronyms: Odds Ratio ; CI, conﬁdence interval ; HGS, Handgrip Strength ; QIC, Quasi-Akaike Information Criterion

Heart disease

Relative HGS* 0.795 0.726 0.870 <.0001 0.870 0.789 0.960 0.005 0.665 0.574 0.772 <.0001 QIC

Dominant HGS** 0.984 0.976 0.992 <.0001 0.991 0.983 1.000 0.038 0.971 0.958 0.984 <.0001 QIC

Absolute HGS** 0.990 0.986 0.994 <.0001 0.994 0.990 0.999 0.009 0.983 0.977 0.990 <.0001 QIC

* adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

Women

Table 6 shows the association between relative HGS and CVD by age in men and women according to quartiles. In men, the lowest quartiles (Q1) of relative HGS ranged from 0.01 to 2.37 kg/BMI, the second quartiles (Q2) of relative HGS ranged from 2.38 to 2.79 kg/BMI, the third quartiles (Q3) of relative HGS ranged from 2.80 to 3.18 kg/BMI, and the highest quartiles (Q4) of relative HGS ranged from 3.19 to 8.94 kg/BMI. In women, the lowest quartiles (Q1) of relative HGS ranged from 0.01 to 1.42 kg/BMI, the second quartiles (Q2) of relative HGS ranged from 1.43 to 1.73 kg/BMI, the third quartiles (Q3) of relative HGS ranged from 1.74 to 2.04 kg/BMI, and the highest quartiles (Q4) of relative HGS ranged from 2.05 to 5.72 kg/BMI.

Among men, the adjusted ORs for CVDs of Q1, Q2, and Q3 were significantly higher than Q4 (highest) (Q1= OR 1.365; 95% CI, 1.207–1.544; p < 0.0001; Q2: OR = 1.141;

95% CI, 1.010–1.291; p < 0.035; Q3: OR = 1.126; 95% CI, 1.001–1.266; p < 0.048).

As a result of subgroup analysis, based on 65 years of age, the adjusted ORs for the CVDs of Q1 were significantly higher than Q4 (highest) after adjustment for year, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension, and diabetes in both age groups. The effect was modestly stronger in the younger age group (45–64 years old) (45–65 years;

Q1 vs Q4: 1.544 (1.214–1.965); p < 0.001; 65 years and older; Q1 vs Q4: 1.280 (1.108–1.479); p < 0.001).

Among women, the adjusted ORs for CVDs tended to increase from Q3 to Q1 as

compared to Q4 (highest); however, these were only statistically significant at Q1 (Q1 = OR, 1.268; 95% CI, 1.134–1.418; p < 0.0001; Q2: OR = 1.071; 95% CI, 0.966–

1.187; p = 0.193; Q3: OR = 1.006; 95% CI, 0.911–1.110; p = 0.908). In women, in the age-specific subgroup analysis, the trend of ORs for CVDs was higher, as the relative HGS was weaker than Q4; however, only Q1 was statistically significant in both age groups. The effect was also modestly stronger in the younger age group (45–

64 years), similar to men (45–65 years; Q1 vs Q4: 1.575 (1.259–1.970); p < 0.001;

65 years and older; Q1 vs Q4: 1.180 (1.036–1.344); p = 0.013).

Table 7 shows the association between the relative HGS and heart diseases by age in men and women according to quartiles. Among men, the ORs for heart diseases tended to significantly increase as the relative HGS became weaker than Q4; this was true with the exception of Q3 vs Q4 (Q1 = OR 1.263; 95% CI; 1.091–1.462; p = 0.002;

Q2: OR = 1.209; 95% CI, 1.046–1.396; p = 0.010; Q3: OR = 1.115; 95% CI, 0.975–

1.275; p = 0.113). The age-specific subgroup results were statistically significant only in the younger age group (45–64 years), unlike CVDs (45–65 years; Q1 vs Q4: 1.436 (1.058–1.948); p = 0.020; 65 years and older; Q1 vs Q4: 1.161 (0.987–1.366); p = 0.072). Among women, the adjusted ORs of Q1 were significantly higher than Q4 alone, and the age-specific subgroup results were statistically significant only in the younger age group similar to that of men (overall; Q1 vs Q4: 1.170 (1.031–1.328); p

= 0.015; 45–65 years; Q1 vs Q4: 1.437 (1.113–1.854); p = 0.005; 65 years and older;

Q1 vs Q4: 1.139 (0.978–1.326); p = 0.095).

Table 8 indicates the association between relative HGS and stroke by age in men and women according to quartiles. The adjusted ORs for stroke tended to increase from Q3 to Q1 as compared to Q4 (highest); however, in both men and women, they were only statistically significant in Q1 (men: Q1 = OR 1.406; 95% CI, 1.152–1.714; p = 0.001; Q2: OR = 1.111; 95% CI, 0.917–1.348; p = 0.283; Q3: OR = 1.035; 95% CI 0.852–1.258; p = 0.726; women: OR 1.428; 95% CI, 1.194–1.706; p < 0.0001; Q2:

OR = 1.139; 95% CI, 0.958–1.354; p = 0.139; Q3: OR = 1.006; 95% CI, 0.861–1.174;

p = 0.945). In both age groups, among both sexes, the adjusted OR of Q1 for stroke was significantly higher than Q4 (highest) after adjustment for year, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension, and diabetes, and the effect was stronger in the younger age group (45–64 years) (men: 45–65 years; Q1 vs Q4: 1.600 (1.109–2.309); p = 0.012; 65 years and older; Q1 vs Q4: 1.375 (1.103–1.714); p = 0.005; women: 45–65 years; Q1 vs Q4: 1.806 (1.234–2.642); p = 0.002; 65 years and older; Q1 vs Q4: 1.277 (1.003–1.501); p = 0.047).

Table 6 Adjusted ORs and 95% CIs for CVDs according to HGS quartiles by age in men and women

OR P-value OR P-value OR P-value

Relative HGS

Q1 (0.01 - 2.37) 1.365 1.207 1.544 <.0001 1.544 1.214 1.965 0.000 1.280 1.108 1.479 0.001

Q2 (2.38 - 2.79) 1.141 1.010 1.291 0.035 1.331 1.087 1.630 0.006 1.123 0.964 1.309 0.136

Q3 (2.80- 3.18) 1.126 1.001 1.266 0.048 1.066 0.883 1.285 0.507 1.007 0.867 1.170 0.923

Q4 (3.19 - 8.94) ref ref ref

P for trend

OR P-value OR P-value OR P-value

Relative HGS

Q1 (0.01 - 1.42) 1.268 1.134 1.418 <.0001 1.575 1.259 1.970 <.0001 1.180 1.036 1.344 0.013

Q2 (1.43 - 1.73) 1.071 0.966 1.187 0.193 1.169 0.967 1.413 0.107 1.026 0.899 1.170 0.705

Q3 (1.74- 2.04) 1.006 0.911 1.110 0.908 0.964 0.822 1.132 0.657 1.024 0.905 1.158 0.708

Q4 (2.05 - 5.72) ref ref ref

P for trend

* Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

** Adjusted for education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

<.0001 <.0001 <.0001

Table 7 Adjusted ORs and 95% CIs for heart diseases according to HGS quartiles by age in men and women

OR P-value OR P-value OR P-value

Relative HGS

Q1 (0.01 - 2.37) 1.263 1.091 1.462 0.002 1.436 1.058 1.948 0.020 1.161 0.987 1.366 0.072

Q2 (2.38 - 2.79) 1.209 1.046 1.396 0.010 1.403 1.112 1.771 0.004 1.070 0.910 1.259 0.412

Q3 (2.80- 3.18) 1.115 0.975 1.275 0.113 1.141 0.914 1.424 0.244 1.035 0.874 1.226 0.691

Q4 (3.19 - 8.94) ref ref ref

P for trend

OR P-value OR P-value OR P-value

Relative HGS

Q1 (0.01 - 1.42) 1.170 1.031 1.328 0.015 1.437 1.113 1.854 0.005 1.139 0.978 1.326 0.095

Q2 (1.43 - 1.73) 1.027 0.914 1.156 0.651 1.004 0.803 1.256 0.969 1.043 0.902 1.206 0.567

Q3 (1.74- 2.04) 0.993 0.885 1.114 0.904 0.911 0.743 1.118 0.373 1.038 0.893 1.206 0.630

Q4 (2.05 - 5.72) ref ref ref

P for trend

* Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

** Adjusted for education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

<.0001 0.0004 0.0011

Table 8 Adjusted ORs and 95% CIs for stroke according to HGS quartiles by age in men and women

OR P-value OR P-value OR P-value

Relative HGS

Q1 (0.01 - 2.37) 1.406 1.152 1.714 0.001 1.600 1.109 2.309 0.012 1.375 1.103 1.714 0.005

Q2 (2.38 - 2.79) 1.111 0.917 1.348 0.283 1.197 0.843 1.699 0.314 1.162 0.919 1.469 0.210

Q3 (2.80- 3.18) 1.035 0.852 1.258 0.726 0.899 0.641 1.259 0.534 0.977 0.785 1.216 0.835

Q4 (3.19 - 8.94) ref ref ref

P for trend

OR P-value OR P-value OR P-value

Relative HGS

Q1 (0.01 - 1.42) 1.428 1.194 1.706 <.0001 1.806 1.234 2.642 0.002 1.227 1.003 1.501 0.047

Q2 (1.43 - 1.73) 1.139 0.958 1.354 0.139 1.499 1.095 2.051 0.012 0.954 0.786 1.159 0.638

Q3 (1.74- 2.04) 1.006 0.861 1.174 0.945 1.101 0.867 1.399 0.430 0.930 0.748 1.156 0.512

Q4 (2.05 - 5.72) ref ref ref

P for trend

* Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

** Adjusted for education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

<.0001 <.0001 <.0001

C. Prevalence of cardiovascular diseases (CVDs) according to quartiles of relative handgrip strength (HGS) and correlation with age

The prevalence of CVDs (defined as heart diseases and stroke) significantly decreased across increasing quartiles of relative HGS in men and women (men: Q1, 34.9%; Q2, 26.9%; Q3, 22.2%; and Q4, 16.0%; p < 0.0001; women: Q1, 36.3%; Q2, 28.1%; Q3, 20.6%; and Q4, 15.0%; p < 0.001) (Figure 4).

Figure 4 Prevalence of cardiovascular diseases according to quartiles of relative handgrip strength

In terms of the correlation between each of the HGS indices and age, both the

relative and dominant HGS showed a negative correlation with age in men (relative HGS: r = -0.39; p < 0.0001; dominant HGS: r = -0.47) and women (relative HGS: r

= -0.42; p < 0.0001; dominant HGS: r = -0.46). However, in women, the relative HGS showed a tendency to decrease more with time compared to men, whereas the opposite was true for the dominant HGS (Figure 5).

Figure 5 Correlation of relative handgrip strength (HGS) with age versus dominant HGS in men and women

D. Cut-off points for cardiovascular disease (CVD) based on the relative handgrip strength (HGS)

The relative HGS and dominant HGS were analyzed by the ROC Curve. On the basis of the ROC curve analysis, the relative HGS had 54.2% sensitivity, 68.2% specificity, and Area Under Curve (AUC) 65.1% in men and 56.3% sensitivity, 67.4% specificity, and the Area Under Curve (AUC) 65.1% in women, which appears to be better in comparison to the dominant HGS. According to the Youden index, which is defined as the maximum of (sensitivity + specificity -1)(Schisterman et al., 2008), the optimal relative HGS cut-off for the consideration of cardiovascular risk was 2.52 for men and 1.55 for women (Figure 6).

Figure 6 ROC curve analyses of relative and dominant handgrip strength (HGS) for the detection of cardiovascular diseases (CVDs)

E. Association between low handgrip strength (HGS) and cardiovascular diseases (CVDs)

We defined weak HGS by using a relative HGS cut-off point, and attempted to determine whether the OR for CVD was higher in those who were in the weak HGS group than the normal group. The analysis was carried out by applying cut-offs reported in previous studies (Chen et al., 2014; Cruz-Jentoft et al., 2019) in order to compare with the relative HGS cut-off.

Table 9 shows the results of investigating the relationship between low HGS and the prevalence of CVD in men and women. After adjustment for covariates, the ORs for CVDs in the low HGS group were significantly higher than the normal HGS group in all models (men: relative HGS cut-off: OR = 1.202; 95% CI, 1.112–1.300; p <

0.0001; AWGS: OR = 1.227; 95% CI, 1.119–1.345; p < 0.0001; EWGSOP2: OR = 1.191; 95% CI, 1.091–1.300; p < 0.0001; women: relative HGS cut-off: OR = 1.211; 95% CI, 1.124–1.305; p < 0.0001; AWGS: OR = 1.195; 95% CI, 1.112–

1.283; p < 0.0001; EWGSOP2: OR = 1.215; 95% CI, 1.123–1.315; p < 0.0001).

When we compared the QIC values of each model, although all values were similar, the model using the relative HGS cut-off was the best in both sexes (men: relative HGS cut-off: QIC = 9,128; AWGS: QIC = 9,134; EWGSOP2: QIC = 9,139;

women: relative HGS cut-off: QIC = 11,445; AWGS: QIC = 11,450; EWGSOP2:

QIC = 11,450).

Table 9 Association between low handgrip strength (HGS) and cardiovascular disease (CVD) Variable

OR P-value OR P-value

Weekness 1.227 1.119 1.345 <.0001 1.195 1.112 1.283 <.0001

Normal ref ref

QIC

OR P-value OR P-value

Weekness 1.191 1.091 1.300 <.0001 1.215 1.123 1.315 <.0001

Normal ref ref

QIC

OR P-value OR P-value

Weekness 1.202 1.112 1.300 <.0001 1.211 1.124 1.305 <.0001

Normal ref ref

QIC

* Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, BMI, hypertension and diabetes

** Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

MEN (<2.52) WOMEN (<1.55)

95% CI 95% CI

Acronyms: OR, Odds Ratio ; CI, conﬁdence interval ;AWGS, Asian Working Group for Sarcopenia ; EWGSOP, European Working Group on Sarcopenia in Older People; HGS, Handgrip strength

Table 10 shows the results of investigating the relationship between low HGS and prevalence of heart disease in men and women. Among men, the ORs for CVD in the low HGS group were significantly higher than the normal HGS group only in the model using relative HGS cut-off (relative HGS cut-off: OR = 1.118; 95% CI, 1.009–1.218; p = 0.033; AWGS: OR = 1.094; 95% CI, 0.979–1.223; p = 0.112;

EWGSOP2: OR = 1.065; 95% CI, 0.960–1.182; p = 0.236). However, among women, the ORs for CVD in the low HGS group were significantly higher than the normal HGS group in all models (relative HGS cut-off: OR = 1.140; 95% CI, 1.049–1.238; p = 0.002; AWGS: OR = 1.171; 95% CI, 1.081–1.268; p = 0.0001;

EWGSOP2: OR = 1.143; 95% CI, 1.045–1.251; p = 0.003). When we compared the QIC values of each model, although all values were similar, the model using the relative HGS cut-off was the best in men, and the model using the AWGS was the best in women (men: relative HGS cut-off: QIC = 7,021; AWGS: QIC = 7,027;

EWGSOP2: QIC = 7,029; women: relative HGS cut-off: QIC = 9,060; AWGS: QIC

= 9,049; EWGSOP2: QIC = 9,065).

Table 10 Association between low handgrip strength (HGS) and heart disease by sex Variable

OR P-value OR P-value

Weekness 1.094 0.979 1.223 0.112 1.171 1.081 1.268 0.000

Normal ref ref

QIC

OR P-value OR P-value

Weekness 1.065 0.960 1.182 0.236 1.143 1.045 1.251 0.003

Normal ref ref

QIC

OR P-value OR P-value

Weekness 1.108 1.009 1.218 0.033 1.140 1.049 1.238 0.002

Normal ref ref

QIC

* Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, BMI, hypertension and diabetes

** Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes Acronyms: OR, Odds Ratio ; CI, conﬁdence interval ;AWGS, Asian Working Group for Sarcopenia ; EWGSOP, European Working Group on Sarcopenia in Older People; HGS, Handgrip strength

Table 11 shows the results of investigating the relationship between low HGS and prevalence of stroke in men and women. After adjustment for covariates, the ORs for CVD in the low HGS group were significantly higher than the normal HGS group in all models (men: relative HGS cut-off: OR = 1.284, 95% CI, 1.145–1.439;

p < 0.0001; AWGS: OR = 1.364, 95% CI, 1.196–1.556; p < 0.0001; EWGSOP2:

OR = 1.331; 95% CI, 1.167–1.518; p < 0.0001; women: relative HGS cut-off: OR = 1.348; 95% CI, 1.194–1.521; p < 0.0001; AWGS: OR = 1.225, 95% CI, 1.088–

1.378; p = 0.001; EWGSOP2: OR = 1.351; 95% CI, 1.193–1.529; p < 0.0001).

When we compared the QIC values of each model, the model using the relative HGS cut-off was the best in both sexes (men: relative HGS cut-off: QIC = 4,832;

AWGS: QIC = 4,836; EWGSOP2: QIC = 4,838; women: relative HGS cut-off: QIC

= 5,162; AWGS: QIC = 5,182; EWGSOP2: QIC = 5,175).

Table 11 Association between low handgrip strength (HGS) and stroke by sex Variable

OR P-value OR P-value

Weekness 1.364 1.196 1.556 <.0001 1.225 1.088 1.378 0.001

Normal ref ref

QIC

OR P-value OR P-value

Weekness 1.331 1.167 1.518 <.0001 1.351 1.193 1.529 <.0001

Normal ref ref

QIC

OR P-value OR P-value

Weekness 1.284 1.145 1.439 <.0001 1.348 1.194 1.521 <.0001

Normal ref ref

QIC

* Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, BMI, hypertension and diabetes

** Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

4,832 5,162

Acronyms: OR, Odds Ratio ; CI, conﬁdence interval ;AWGS, Asian Working Group for Sarcopenia ; EWGSOP, European Working Group on Sarcopenia in Older People; HGS, Handgrip strength

Table 12 indicates the association between low HGS and CVDs by age group in men.

In the younger group (45–64 years), the ORs for CVDs of the low HGS group were significantly higher than the normal HGS group, with the exception of the model using the EWGSOP cut-off (relative HGS cut-off: OR = 1.369; 95% CI, 1.132–

1.657; p = 0.001; AWGS: OR = 1.298, 95% CI, 1.007–1.673; p = 0.044;

EWGSOP2: OR = 1.173, 95% CI, 0.935–1.471; p = 0.168). However, the ORs for CVDs in the low HGS group were significantly higher than the normal HGS group in all models in the 65 years and older group (relative HGS cut-off: OR = 1.167;

95% CI, 1.076–1.266; p = 0.0001; AWGS: OR = 1.246, 95% CI, 1.135–1.367; p <

0.0001; EWGSOP2: OR = 1.220, 95% CI, 1.114–1.335; p < 0.0001).

Table 13 shows the association between low HGS and heart diseases by age group in men. Among the younger group, the ORs for heart disease in the low HGS group were significantly higher than the normal HGS group only in the model using the relative HGS cut-off (relative HGS cut-off: OR = 1.300, 95% CI, 1.018–1.659; p = 0.035; AWGS: OR = 1.123; 95% CI, 0.804–1.567; p = 0.497; EWGSOP2: OR = 1.017; 95% CI, 0.761–1.359; p = 0.909), but not in the 65 years and older group except for the model using the AWGS cut-off point (relative HGS cut-off: OR = 1.052; 95% CI, 0.961–1.152; p = 0.269; AWGS: OR = 1.123; 95% CI, 1.008–1.251;

p = 0.035; EWGSOP2: OR = 1.099; 95% CI, 0.991–1.218; p = 0.073).

Table 14 shows the association between low HGS and stroke by age group in men.

Among the younger group, the ORs for heart disease in the low HGS group were significantly higher than the normal HGS group, with the exception of the model using the EWGSOP cut-off (relative HGS cut-off: OR = 1.406; 95% CI, 1.088–

1.816; p = 0.009; AWGS: OR = 1.523; 95% CI, 1.095–2.118; p = 0.013;

EWGSOP2: OR = 1.363; 95% CI, 0.987–1.884; p = 0.060). In the 65 years and older group, after adjustment for covariates, the ORs for CVD in the low HGS group were significantly higher than the normal HGS group in all models (relative HGS cut-off: OR = 1.291; 95% CI, 1.138–1.464; p < 0.0001; AWGS: OR = 1.361;

95% CI, 1.185–1.563; p < 0.0001; EWGSOP2: OR = 1.351; 95% CI, 1.177–1.550;

p < 0.0001).

Table 12 Association between low handgrip strength (HGS) and cardiovascular disease (CVD) by age in men Variable

OR P-value OR P-value

Weekness (<26kg) 1.298 1.007 1.673 0.044 1.246 1.135 1.367 <.0001

Normal (≥26) ref ref

QIC

OR P-value OR P-value

Weekness (<27kg) 1.173 0.935 1.471 0.168 1.220 1.114 1.335 <.0001

Normal (≥27kg) ref ref

QIC

OR P-value OR P-value

Weekness (<2.52) 1.369 1.132 1.657 0.001 1.167 1.076 1.266 0.000

Normal (≥2.52) ref ref

QIC

* Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, BMI, hypertension and diabetes

** Adjusted for age, education level, marital status, region, economic activity, alcohol consumption, smoking, exercise, ADL, MMSE, hypertension and diabetes

문서에서 Association between relative handgrip strength and cardiovascular disease among Korean adults aged 45 years and older (페이지 43-0)