Hand Grip Strength May Help Predict Cardiovascular Events in Type 2 Diabetes

Hand grip strength in patients with type 2 diabetes appears to be inversely associated with vascular events, independent of well-established cardiovascular (CV) risk factors and from the angiographically determined baseline coronary artery disease (CAD) state, according to a new Austrian study.

The results were presented at the American College of Cardiology’s (ACC) 65th Scientific Sessions in Chicago.

Researchers studied a high-risk cohort of 209 patients with type 2 diabetes who underwent coronary angiography for the evaluation of stable CAD at baseline. The researchers determined hand grip strength through forearm muscle dynamometry in the dominant arm the day before angiography. 

“This is the first study to show this,” said lead study author Christoph Saely, MD, professor of preventive cardiology and consultant at the Academic Teaching Hospital Feldkirch in Austria. “We did know that physical strength is associated with cardiovascular outcomes and here we wanted to find an easier measurement to use as a tool.”

While muscle fitness is an established indicator of overall health, the power to predict CV end points in patients with type 2 diabetes using hand grip strength had not been well studied, according to Dr Saely. In their current investigation, the researchers found that grip strength (measured in kilograms at baseline) did not differ significantly between patients with significant CAD and those who did not have significant CAD (3412 kg vs 3112 kg). However, they found that hand grip strength significantly prospectively predicted the incidence of major CV events (n=65) after adjustment for age, gender, BMI, smoking, systolic and diastolic blood pressure, and LDL and HDL cholesterol levels. 

Dr Saely said the results were the same after further adjustment for the angiographically determined baseline CAD state (hazard ratio [HR]=0.72).

For this investigation, significant CAD was defined as coronary stenosis with lumen narrowing of at least 50%. The researchers used American Diabetes Association criteria to determine diabetes status, and they prospectively recorded vascular events over 5.5 years. 

Strength training affects lipids, hormones, and adipose tissue, noted Dr Saely. He said poor hand grip strength should prompt clinicians to advocate for individualized weight training programs.

“This is good news in that you have an additional tool to categorize your patients in your notes. I would recommend that,” Dr Saely told Endocrinology Advisor. 

“The study shows very clearly that your muscle strength is strongly linked to health outcomes. This should reinforce our efforts to increase physical activity and improve physical fitness. I think if you are weak and lose muscle strength, then it is a sign of low physical activity. If you do some training you will see improvements in lipids and have hormonal changes and changes in adipose tissue.”

Suzanne Arnold, MD, assistant professor of medicine at the University of Missouri in Kansas City, said the findings are not surprising. It is good to see they are looking at this issue in patients with type 2 diabetes due to their elevated risk for CAD, she explained. Dr Arnold said the findings are intriguing and must now be verified in studies with larger numbers of patients.

“This is something that is slightly out of the box of what we look at. We need to screen for frailty more,” Dr Arnold said in an interview with Endocrinology Advisor. “It is hard to tell what the link is. Grip strength is a frailty marker, but it is a bit of a stretch to say this is a measure of fitness and all the biochemical and physical changes associated with that.”

Reference

1. Rein P, Saely C, Vonbank A, Zanolin D, Drexel H. Hand Grip Strength Significantly Predicts Cardiovascular Event Risk in Patients With Type 2 Diabetes. Presented at: ACC 65th Scientific Sessions; April 2-4, 2016; Chicago, IL.