Association between grip strength to weight ratio and new-onset cardiovascular and cerebrovascular diseases: a big data analysis of the China Health and Retirement Longitudinal Study

doi:10.12307/2026.629

Abstract

Abstract: BACKGROUND: Middle-aged and elderly individuals are particularly susceptible to sarcopenic obesity, a significant characteristic observed in patients with cardiovascular and cerebrovascular diseases. Grip strength tests may not provide an accurate assessment of muscle quality. Given that skeletal muscle is an insulin-sensitive tissue, there may be complex relationships between muscle strength, insulin resistance, and cardiovascular diseases.
OBJECTIVE: To analyze the relationship between grip strength to weight ratio (GSWR), grip strength, chair-stand test, and cardiovascular and cerebrovascular diseases in middle-aged and elderly individuals, and to explore the mediating role of the triglyceride-glucose index (TyG) in this context.
METHODS: This study, derived from the China Health and Retirement Longitudinal Study, included a total of 4 543 participants with no history of cardiovascular and cerebrovascular diseases and observed whether there are new-onset cardiovascular and cerebrovascular diseases within 7 years following the baseline survey. COX regression analyses were performed based on TyG index, grip strength, chair-stand test, and GSWR ratio at baseline. In addition, the TyG index was used as a mediating variable to test the mediating effect based on regression analysis.
RESULTS AND CONCLUSION: (1) Of the 4 543 participants, 675 were newly diagnosed with cardiovascular and cerebrovascular diseases, with the incidence of 14.9%. (2) In the multivariate COX proportional hazard regression adjusted for all covariates, TyG [hazard ratio (HR): 1.18, 95% confidence interval (CI): 1.05-1.32], suspected sarcopenia (HR: 1.22, 95% CI: 1.03-1.44, P=0.02), chair-stand test (HR: 1.302, 95% CI: 1.104-1.536, P=0.002), GSWR (HR: 1.288, 95% CI: 1.083-1.531, P=0.004) were all significant, while grip strength (HR: 0.988, 95% CI: 0.776-1.258, P=0.92) was not significant. (3) In addition, TyG was found to mediate the relationship between GSWR and new-onset cardiovascular and cerebrovascular diseases (total natural indirect effect: HR: 1.024, 95% CI: 1.005–1.043), with the direction of effect being consistent. Part of the mechanism by which an increased GSWR raises the risk of cardiovascular and cerebrovascular diseases is through its impact on TyG. To conclude, middle-aged and elderly individuals can assess muscle quality through the GSWR, which provides a reference for evaluating insulin resistance and the risk of cardiovascular and cerebrovascular diseases.

Key words: middle-aged and elderly individuals, muscle strength, grip strength to body weight index, 5-time chair-stand test, triglyceride-glucose index, insulin resistance, cardiovascular disease

CLC Number:

Wang Shijie, Hu Xiaoyu, Duan Zhuoran, Tang Yingfeng, Wang Wei . Association between grip strength to weight ratio and new-onset cardiovascular and cerebrovascular diseases: a big data analysis of the China Health and Retirement Longitudinal Study[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(12): 3190-3197.

Figures/Tables 6

2.1 基线特征描述 4 543例无心脑血管疾病史的参与者在7年随访期间，有675例新发生了心脑血管疾病，发病率为14.9%。在TyG指数的第三分位水平发病率为17%，而在TyG指数第一分位水平时发病率为11.7%。如表1所示，根据TyG指数的三分位数描述了参与人群的基线特征，总体年龄四分位数为58岁(51岁，65岁)，3组之间年龄差异无显著性意义(P > 0.05)。在TyG指数较高水平的人群中，女性的比例也相对较高，且随着TyG指数水平升高，体质量水平也增高，高血压、糖尿病和血脂异常的患病率也随之增加，而握力体质量比则降低。3组之间坐起测试时间相比差异无显著性意义(P > 0.05)。3组在性别、高血压史、糖尿病史、血脂异常史、吸烟状况、饮酒状况、收缩压、舒张压、体质量、握力、握力体质量比、三酰甘油、血葡萄糖、TyG指数、总胆固醇、高密度脂蛋白、低密度脂蛋白、血小板计数、血肌酐、C-反应蛋白等方面差异均有显著性意义(P < 0.05)。详见表1。 2.2 与新发心脑血管疾病的风险相关分析使用COX比例风险回归分析TyG指数、握力体质量比(分类变量)、握力(分类变量)、坐起测试(分类变量)与新发心脑血管疾病之间的风险关系。 2.2.1 单因素分析如表2 所示，新发心脑血管疾病的人群中，可能肌少症的患病率为40.6%，而未发生心脑血管疾病的人群中患病率为32.9%，单因素分析显示可能肌少症与新发心脑血管疾病呈显著正相关(风险比HR=1.364，P < 0.001)，存在可能肌少症的人群新患心脑血管疾病的风险是对照人群的1.364倍，此外新发心脑血管疾病的参与者中坐起测试≥12 s的人群占36%，而对照组中为27.3%，差异有显著性意义(HR=1.458，P < 0.001)。但握力降低的比例在两组之间无明显差异，分别为12.3%和11%，COX回归分析结果不显著(HR=1.125，P=0.313)。握力体质量比与新发心脑血管疾病显著相关(HR= 1.476，P < 0.001)，握力体质量比< 0.5的人群新发心脑血管疾病的风险是握力体质量比≥0.5的1.476倍。TyG指数也与新发心脑血管疾病风险显著正相关(HR=1.315，P < 0.001)。 2.2.2 多因素分析调整了协变量的COX回归模型中也未观察到握力与新发心脑血管疾病之间的显著性关系，而调整协变量后可能肌少症、坐起测试、握力体质量比和TyG指数仍与新发心脑血管疾病风险显著相关。在调整了所有协变量的Model3中，可能肌少症(HR=1.22，P=0.02)、坐起测试(HR=1.302，P=0.002)、握力体质量比(HR=1.288，P=0.004)与新发心脑血管疾病均有显著相关性，握力体质量比< 0.5的人群新发心脑血管疾病的风险较对照组增高1.288倍。结果见表3。 2.3 非线性关系分析进一步分析握"

力体质量比与新发心脑血管疾病风险之间是否存在非线性关系，采用限制性立方样条绘制曲线，节点数设置为3，使用调整了所有协变量的Model3进行分析。参考过去类似研究，限制性立方样条分析多推荐3-5个节点，根据最小信息准则(akaike information criterion，AIC)[24]，宜选择AIC值较小时的节点，此次研究分别计算了3，4，5个节点时的模型AIC值，其中节点数为3时AIC值最小。限制性立方样条分析曲线如图2所示，握力体质量比与新发心脑血管疾病之间未观察到非线性关系(P for nonliner=0.142)。 2.4 亚组分析按性别、年龄、高血压、糖尿病、血脂异常、TyG指数、可能肌少症、坐起测试、握力进行分层，探讨了握力体质量比与新发心脑血管疾病风险之间的关系。年龄以60岁节点转化为二分类变量，TyG指数以中位数(8.6)为节点转化为二分类变量。结果见图3。 2.5 TyG指数的中介效应分析在上述的单因素和多因素分析中均观察到了握力体质量比、可能肌少症、坐起测试、TyG指数与新发心脑血管疾病风险显著相关，进一步探索TyG指数在其中是否存在介导作用。以TyG指数为中介变量(M)，是否新发心脑血管疾病为因变量(Y)，分别以握力体质量比、疑似肌少症、坐起测试为自变量(X)进行中介效应检验，中介关系示意图见图4。此次模型中因变量为二分类变量，进行COX回归分析路径b、b’和c，而中介变量为连续变量，进行线性回归检验路径a。COX回归分析的中介模型可以使用R中的“CMAverse”包的“cmest”函数进行中介效应检验[23]，采用Bootstrap法随机重复抽样，计算出总效应、总自然直接效应、总自然间接效应。中介效应检验结果见表4，握力体质量比的自然总效应为HR=1.29，95%CI：1.08-1.54，纳入中介变量后，握力体质量比对结局变量自然直接效应为HR=1.26，95%CI：1.05-1.50，总自然间接效应为HR=1.024，95%CI：1.005-1.043，中介效应和总效应结"

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