Both lower normalized grip strength and longer chair-rising time were independently associated with increased CVD risk in a dose-dependent manner, with the combination of weakest grip and slowest chair-rising time conferring the highest risk (HR = 2.12; 95% CI: 1.65-2.73) across glycemic status groups.
Key Findings
Results
Lower normalized grip strength was independently associated with increased CVD risk in a dose-dependent manner.
Study included 7,258 CVD-free middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS)
Mean follow-up of 7.8 years, during which 1,785 participants (24.6%) developed incident CVD
Adjusted HR for lowest vs. highest grip strength quartile was 1.37 (95% CI: 1.17-1.61)
P for trend < 0.001
Cox proportional hazard models and restricted cubic spline analyses were used
Results
Longer chair-rising time was independently associated with increased CVD risk in a dose-dependent manner.
Adjusted HR for longest vs. shortest chair-rising time quartile was 1.53 (95% CI: 1.32-1.77)
P for trend < 0.001
Chair-rising time served as a measure of lower-extremity muscle strength
Association was directionally consistent across all glycemic status groups
Results
The combination of weakest grip strength and slowest chair-rising time conferred the highest CVD risk.
Combined HR = 2.12 (95% CI: 1.65-2.73) for participants with both weakest grip and slowest chair-rising time
This combined measure represented a greater risk than either muscle strength measure alone
Weakest grip alone had HR of 1.37 and slowest chair-rising alone had HR of 1.53
Results
The association between lower grip strength and CVD risk reached statistical significance in the normal glucose regulation and prediabetes groups, with a similar point estimate observed in the diabetes group.
P for interaction = 0.622, indicating no statistically significant interaction between grip strength and glycemic status
Associations were directionally consistent across all glycemic status groups (normal glucose regulation, prediabetes, and diabetes)
Not all strata reached statistical significance, particularly in the diabetes group
Lower grip strength and prolonged chair-rising time were associated with elevated CVD risk across all glycemic status groups
Methods
Incident CVD was defined as physician-diagnosed heart disease and/or stroke, with 24.6% of participants developing CVD over the follow-up period.
1,785 out of 7,258 participants developed incident CVD
Mean follow-up duration was 7.8 years
Study population consisted of middle-aged and older adults from CHARLS, a prospective nationwide cohort
Muscle strength was assessed using both grip strength (upper extremity) and chair-rising time (lower extremity)
What This Means
This research suggests that muscle strength — measured by both handgrip strength and the time it takes to rise from a chair five times — is meaningfully linked to the risk of developing cardiovascular disease (CVD) such as heart disease or stroke. Among nearly 7,300 middle-aged and older Chinese adults followed for almost 8 years, about 1 in 4 developed CVD. People with the weakest grip strength were 37% more likely to develop CVD than those with the strongest grip, while people with the slowest chair-rise times were 53% more likely to develop CVD than those with the fastest times. When both measures were poor simultaneously, the risk more than doubled.
The study also found these associations held across people with different blood sugar statuses — those with normal blood sugar, prediabetes, and diabetes all showed similar directional trends, suggesting that muscle weakness is a CVD risk factor regardless of glycemic status. The relationship was dose-dependent, meaning CVD risk increased progressively as muscle strength declined, rather than showing a simple threshold effect.
This research suggests that simple, low-cost physical assessments like handgrip strength testing and chair-rise timing could be useful tools for identifying people at higher risk of cardiovascular disease across a broad population, including those with varying glucose metabolism. These findings point to the potential importance of maintaining or improving muscle strength as people age, though the study design (observational/prospective cohort) means it cannot prove that improving muscle strength would directly reduce CVD risk.
Li L, Wu W, Hou Y, Wang L, Yu P, Zhang Y, et al.. (2026). Association between Muscle Strength and Cardiovascular Disease Risk across Glycemic Status Groups: A Prospective Nationwide Cohort Study.. Biomedical and environmental sciences : BES. https://doi.org/10.3967/bes2026.076