Association between grip strength and major adverse cardiovascular events in patients with metabolic dysfunction-associated steatotic liver disease: a prospective cohort study in the UK Biobank.
Xie Y, Lin R, Zhang Z, Lian L • Frontiers in endocrinology • 2026
In individuals with MASLD, lower grip strength was associated with an increased risk of MACE, with a stronger association observed in women, highlighting grip strength as a potential marker of cardiovascular risk among individuals with MASLD.
Key Findings
Results
Low grip strength was associated with a 35% higher risk of major adverse cardiovascular events (MACE) compared to high grip strength in patients with MASLD.
HR = 1.35, 95% CI: 1.29–1.41, P < 0.001 for low vs. high grip strength group
119,004 participants with MASLD were included from the UK Biobank
Mean age was 57.24 (SD 7.89) years; 58.3% were men
During a median follow-up of 13.6 (IQR 12.7–14.4) years, 14,137 (11.9%) incident MACE cases were recorded
Participants were categorized into high, medium, and low grip strength groups based on sex-specific tertiles
Results
Low grip strength was associated with a 52% higher risk of heart failure in MASLD patients compared to high grip strength.
HR = 1.52, 95% CI: 1.42–1.62, P < 0.001
Heart failure was one of three MACE components examined alongside myocardial infarction and stroke
This was the strongest association observed among the individual MACE components
Results
Low grip strength was associated with a 26% higher risk of myocardial infarction in MASLD patients compared to high grip strength.
HR = 1.26, 95% CI: 1.19–1.34, P < 0.001
Cox proportional hazards models were used to estimate hazard ratios
This was the smallest elevated risk among the three individual MACE components
Results
Low grip strength was associated with a 33% higher risk of stroke in MASLD patients compared to high grip strength.
HR = 1.33, 95% CI: 1.21–1.45, P < 0.001
Stroke was evaluated as one of three components of the composite MACE outcome
The association magnitude was intermediate between heart failure and myocardial infarction
Results
The association between low grip strength and MACE was significantly stronger in women than in men among MASLD patients.
A significant interaction between grip strength and sex was observed (P for interaction = 0.001)
In women, HR = 1.45, 95% CI: 1.34–1.56, P < 0.001
In men, HR = 1.29, 95% CI: 1.16–1.45, P < 0.001
No significant interaction was observed for age
Background
Cardiovascular disease represents the primary cause of mortality among individuals with metabolic dysfunction-associated steatotic liver disease (MASLD).
This epidemiological context motivated the investigation of grip strength as a cardiovascular risk marker specifically in MASLD patients
The study used a prospective cohort design within the UK Biobank to examine this association
What This Means
This research suggests that a simple, inexpensive measurement — grip strength — may help identify people with a fatty liver condition called metabolic dysfunction-associated steatotic liver disease (MASLD) who are at higher risk of serious heart problems. The study followed over 119,000 UK Biobank participants with MASLD for about 13.6 years and found that those with the weakest grip strength were 35% more likely to experience a major cardiovascular event (such as heart attack, stroke, or heart failure) compared to those with the strongest grip strength. The link was especially pronounced for heart failure, where low grip strength was associated with 52% higher risk.
One notable finding was that the relationship between weak grip strength and cardiovascular risk was stronger in women than in men. Women with low grip strength had a 45% higher cardiovascular risk compared to those with high grip strength, while the increased risk for men was 29%. This sex difference was statistically significant, suggesting that grip strength may be a particularly useful screening tool for women with MASLD.
This research suggests that measuring grip strength — which is quick, cheap, and non-invasive — could serve as a practical marker to flag MASLD patients who may need closer cardiovascular monitoring or preventive interventions. Since cardiovascular disease is the leading cause of death in people with MASLD, identifying at-risk individuals early could have meaningful health implications. However, as an observational study, it cannot prove that weak grip strength directly causes cardiovascular events; both may share common underlying causes such as physical inactivity or muscle loss.
Xie Y, Lin R, Zhang Z, Lian L. (2026). Association between grip strength and major adverse cardiovascular events in patients with metabolic dysfunction-associated steatotic liver disease: a prospective cohort study in the UK Biobank.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1914934