Changes in lower-extremity physical performance and upper-extremity muscle strength and risk of incident cardiovascular disease: a prospective cohort study

Background Lower-extremity physical performance (PP) and muscle strength (MS) are predictors of cardiovascular disease (CVD), but the effect of longitudinal changes remains unclear. This study examined associations of changes in lower-extremity PP and upper-extremity MS with incident CVD in Chinese adults.Methods We included 6,821 participants without baseline CVD from the China Health and Retirement Longitudinal Study. PP was assessed using the five-times chair stand test, and MS using handgrip strength in 2011 and 2015. Change patterns were classified as maintained normal, improved, worsened, or persistent low. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD.Results During 9 years of follow-up, 1,235 participants developed CVD. Compared with persistent low PP, improved PP (HR = 0.79, 95% CI: 0.64–0.98) and maintained normal PP (HR = 0.68, 95% C: 0.56–0.82) were associated with lower CVD risk, whereas worsened PP was not. No MS change pattern was significantly associated with incident CVD.Conclusion Maintaining or improving lower-extremity PP was associated with reduced CVD risk, whereas changes in upper-extremity MS were not.