Association between handgrip strength and mortality risk among cardiovascular disease patients: A cohort study from the NHANES 2011-2014.

Background: Cardiovascular disease (CVD) and handgrip strength (HGS) are recognized mortality risk factors. However, the synergistic effect of CVD and HGS on mortality remains unclear. This study investigated the relationship between HGS and mortality in CVD patients.

Methods: Data from the National Health and Nutrition Examination Survey (2011-2014) were analyzed. Weighted Cox proportional hazards models and restricted cubic splines (RCS) were used to examine associations, with subgroup, sensitivity and predictive performance analyses.

Results: Among 8,262 adults (50.56% female; 851 with CVD), 695 deaths (6.74%) occurred over a median follow-up of 80 months. Compared to non‒CVD individuals with high-HGS, CVD patients with low-HGS had the highest risk of all-cause mortality [hazard ratio (HR) = 8.76; 95% CI: 4.20-18.30] and CVD mortality (HR = 4.83; 95% CI: 3.48-6.70), while CVD patients with high-HGS showed no significant mortality risk increase. Among CVD patients, the HRs for all-cause and CVD mortality in the low-HGS group were 3.60 (95% CI, 2.21-5.86) and 4.01 (95% CI, 1.68-9.59). RCS analyses revealed that the relationships were linear (P‒nonlinear >0.05), and subgroup analyses revealed stroke status potentially modified the association for CVD mortality (P‒interaction = 0.002). The addition of HGS significantly improved the predictive performance of current models for mortality (P < 0.001).

Conclusion: Low HGS may be associated with a higher risk of all-cause and CVD mortality among CVD patients. High HGS appears to reduce mortality risk among CVD patients. These findings suggest that HGS may serve as a valuable predictor of mortality risk in CVD patients.