414-P: Hand-Grip Strength and Type 2 Diabetes Are Mutually Independent Predictors of Cardiovascular Events and of Mortality in Patients with Established Cardiovascular Disease

Impaired skeletal muscle function is involved in the pathogenesis of type 2 diabetes (T2DM) as well as of cardiovascular disease (CVD). Hand grip strength (HGS) is a simple, inexpensive and non-invasive diagnostic parameter for muscle function. Its association with cardiovascular events and mortality in patients with established CVD is unclear and is addressed in the present study. We prospectively recorded cardiovascular events over a mean follow up time of 8.9±3.2 years in a cohort of 876 patients with established CVD (672 patients with angiographically proven coronary artery disease and 204 patients with sonographically proven peripheral artery disease). From our patients, 274 (31.3%) had T2DM at baseline; HGS did not differ significantly between patients with T2DM and nondiabetic subjects (35.3±11.9 vs. 36.6±11.9 kg; p=0.082). Prospectively, cardiovascular events occurred in 387 patients, and 278 patients died during follow-up. T2DM and low HGS after multivariate adjustment in Cox regression models proved to be mutually independent predictors of cardiovascular events (adjusted HR 1.52 [1.23-1.89]; p<0.001 and standardized adjusted HR 0.85 [0.74-0.99]; p=0.032, respectively) as well as mortality (adjusted HR 1.79 [1.39-2.29]; p<0.001 and standardized adjusted HR 0.69 [0.58-0.83]; p<0.001, respectively). We conclude that low HGS and T2DM are mutually independent predictors of cardiovascular events as well as of mortality in patients with established CVD.