Association of Handgrip Strength and Cardiovascular Disease Risk Among Middle-Aged Postmenopausal Women: An Analysis of the Korea National Health and Nutrition Examination Survey 2014–2019

Figures & data

Figure 1 Flowchart of the study participant selection process.

Table 1 General Characteristics of the Study Population According to the 2014–2019 KNHANES Survey

Variables*	Participants (N=2019) (N, Weighted %) / (Mean, SE)		Overall Population (N, weighted %) / (Mean, SE)
Age (years)	56.82	0.11	40.68	0.18
Education
≤ elementary school	437	20.8%	14,515	26.2%
Middle school graduate	446	21.5%	4670	10.8%
High school graduate	772	39.8%	11,134	30.1%
College graduate+	364	18.0%	12,036	33.0%
Household income
1st quartile	229	10.9%	7856	14.6%
2nd quartile	516	25.4%	11,289	24.7%
3rd quartile	574	28.9%	12,804	30.1%
4th quartile	700	34.7%	12,868	30.6%
Alcohol consumption
No	1278	61.9%	19,076	45.5%
Yes	741	38.1%	19,112	54.5%
Physical activity^†
No	1128	54.2%	18,849	50.4%
Yes	891	45.8%	16,198	49.6%
Smoking
No	1951	96.3%	38,629	82.5%
Yes	68	3.7%	6393	17.5%
Diabetes diagnosis
No	352	17.5%	16,871	36.1%
Yes	1667	82.5%	28,151	63.9%
Treatment for hypertension
No	1559	77.9%	36,295	84.5%
Yes	460	22.1%	8727	15.5%
Total cholesterol (mg/dL)	206.86	1.00	187.91	0.26
HDL cholesterol (mg/dL)	54.62	0.33	51.30	0.09
LDL cholesterol (mg/dL)	124.33	1.56	114.36	0.44
Triglycerides (mg/dL)	125.36	1.88	133.16	0.82
Systolic blood pressure (mmHg)	119.49	0.43	116.53	0.14
AST (IU/L)	23.27	0.22	22.81	0.09
ALT (IU/L)	20.88	0.33	22.33	0.13
Hemoglobin (g/dL)	13.43	0.02	14.27	0.01
Hematocrit (%)	40.90	0.07	43.15	0.04
Fasting glucose (mg/dL)	100.60	0.55	99.14	0.16
HbA1c (%)	5.80	0.20	5.63	0.01
TSH (uU/mL)	3.16	0.20	2.74	0.05
Free thyroxine (ng/dL)	1.15	0.01	1.27	0.01
Height (cm)	156.43	0.14	160.36	0.11
Weight (kg)	58.21	0.20	60.81	0.11
Waist circumference (cm)	80.27	0.22	79.07	0.10
Body mass index (kg/㎡)	23.79	0.08	23.02	0.03
Age at menarche(years)	14.48	0.05	13.63	0.02
Age at menopause (years)	50.40	0.09	49.09	0.61
Duration of breastfeeding	21.92	0.44	29.41	0.40
< 12 months	495	25.0%	3312	27.9%
≥ 12 months	1524	75.0%	10,185	72.1%
Handgrip strength	24.78	0.11	32.29	0.76
< 18Kg ^‡	106	5.2%	3338	3.9%
≥ 18Kg	1913	94.8%	34,913	93.1%
Relative Handgrip Strength
1st quartile	504	25.2%	7082	14.7%
2nd quartile	505	24.8%	5038	11.6%
3rd quartile	505	24.4%	5276	12.8%
4th quartile	505	25.6%	20,763	60.9%
ASCVD 10-year risk	5.07	0.09	6.19	0.30
Low risk (< 7.5%)	1553	79.0%	23,146	68.5%
High risk (≥ 7.5%)	466	21.0%	14,565	31.5%

Notes: *Properties included in the dependent variable were excluded from the independent variable. ^†Physical activity was considered adequate if the participant engaged in any of the following for at least 1 week: moderate-intensity physical activity for at least 2 hours and 30 minutes, vigorous-intensity physical activity for at least 1 hour and 15 minutes, or a combination of both. ^‡Considered for sarcopenia.

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; ASCVD, atherosclerotic cardiovascular disease; HbA1c, glycated hemoglobin; HDL, high-density lipoprotein; LDL, low-density lipoprotein; TSH, thyroid-stimulating hormone.

Table 2 Relationship Between Participant Characteristics and the 10-Year ASCVD Risk

Variables*	ASCVD 10-Year Risk (Weighted %)		Design-Based p-value
	Low-Risk (<7.5%)	High-Risk (≥ 7.5%)
Education			<0.001
≤ elementary school	59.3%	40.7%
Middle school graduate	79.5%	20.5%
High school graduate	84.2%	15.8%
College graduate+	89.5%	10.5%
Household income			<0.001
1st quartile	64.8%	35.2%
2nd quartile	71.7%	28.3%
3rd quartile	79.0%	21.0%
4th quartile	88.7%	11.3%
Alcohol consumption			0.009
No	76.8%	23.2%
Yes	82.5%	17.5%
Physical activity^†			0.042
No	77.0%	23.0%
Yes	81.2%	18.8%
Duration of breastfeeding			<0.001
< 12 months	88.3%	11.7%
≥ 12 months	75.8%	24.2%
Age at menarche	14.42±0.05	14.73±0.09	0.002
Relative Grip Strength			<0.001
1st quartile	71.7%	28.3%
2nd quartile	74.5%	25.5%
3rd quartile	82.6%	17.4%
4th quartile	86.9%	13.1%

Notes: * Properties included in the dependent variable were excluded from the independent variable. ^†Physical activity was considered adequate if the participant engaged in any of the following for at least 1 week: moderate-intensity physical activity for at least 2 hours and 30 minutes, vigorous-intensity physical activity for at least 1 hour and 15 minutes, or a combination of both.

Table 3 Weighted Logistic Regression Analysis of Factors Affecting the 10-Year ASCVD Risk (N = 2019)

Variables	OR (Exp ß)*	95% CI	p-value
Education
≤Elementary school^†	–	–	–
Middle school graduate	2.187	1.587–3.015	<0.001
High school graduate	2.554	1.827–3.561	<0.001
College graduate	3.440	2.188–5.406	<0.001
Household income
First quartile^†	–	–	–
Second quartile	1.189	0.815–1.735	0.370
Third quartile	1.480	0.986–2.223	0.059
Fourth quartile	2.536	1.654–3.887	<0.001
Alcohol consumption
No^†	–	–	–
Yes	1.536	1.153–2.046	0.003
Physical activity^‡
No^†	-	-	-
Yes	1.111	0.851–1.450	0.438
Duration of breastfeeding
<12 months^†	–	–	–
≥12 months	0.588	0.422–0.820	0.002
Age at menarche	1.004	0.933–1.080	0.923
Relative grip strength
First quartile^†	–	–	–
Second quartile	0.994	0.711–1.388	0.970
Third quartile	1.534	1.092–2.155	0.014
Fourth quartile	1.926	1.304–2.843	0.001

Notes: * Odds ratio of low risk group (<7.5% 10-year ASCVD risk) compared to high risk group (≥ 7.5% 10-year ASCVD risk). ^†Reference group. ^‡The amount of physical activity was considered adequate if one engaged in moderate-intensity physical activity for at least 2 hours and 30 minutes, vigorous-intensity physical activity for more than one hour and 15 minutes, or a combination thereof for one week.

Abbreviation: ASCVD atherosclerotic cardiovascular disease, OR odds ratio.