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.

BACKGROUND: Cardiovascular disease represents the primary cause of mortality among individuals with metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to examine the association between grip strength and the risk of incident major adverse cardiovascular events (MACE) in this population. METHODS: This prospective cohort analysis included participants with MASLD from the UK Biobank. Participants were categorized into high, medium, and low grip strength groups based on sex-specific tertiles. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between grip strength and incident MACE and its components (heart failure, myocardial infarction, and stroke). RESULTS: A total of 119, 004 participants with MASLD were included (mean [SD] age, 57.24 [7.89] years; 69, 421 men [58.3%]). During a median (IQR) follow-up of 13.6 (12.7-14.4) years, 14, 137 (11.9%) incident MACE cases were recorded. Compared with the high grip strength group, the low grip strength group exhibited a higher risk of MACE (HR = 1.35, 95% CI: 1.29-1.41, P < 0.001), heart failure (HR = 1.52, 95% CI: 1.42-1.62, P < 0.001), myocardial infarction (HR = 1.26, 95% CI: 1.19-1.34, P < 0.001), and stroke (HR = 1.33, 95% CI: 1.21-1.45, P < 0.001). A significant interaction between grip strength and sex was observed (P for interaction = 0.001), with the association between low grip strength and MACE being stronger in women (HR = 1.45, 95% CI: 1.34-1.56, P < 0.001) than in men (HR = 1.29, 95% CI: 1.16-1.45, P < 0.001). No significant interaction was observed for age. CONCLUSION: In individuals with MASLD, lower grip strength was associated with an increased risk of MACE, with a stronger association observed in women. These findings highlight grip strength as a potential marker of cardiovascular risk among individuals with MASLD.