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BMC Medicine

, 12:62

First Online: 14 April 2014Received: 10 December 2013Accepted: 13 March 2014DOI: 10.1186-1741-7015-12-62

Cite this article as: Timpka, S., Petersson, I.F., Zhou, C. et al. BMC Med 2014 12: 62. doi:10.1186-1741-7015-12-62


BackgroundIschemic heart disease and stroke are two severe types of cardiovascular disease CVD, a major contributor to the global burden of disease. The preventive framework currently includes promotion of both adequate cardiorespiratory and muscular fitness. Although muscle fitness is established as an indicator of health, it is currently unknown whether muscle strength is associated with later CVD independently of cardiorespiratory fitness.

MethodsWe studied 38,588 Swedish men who in 1969 to 1970 typically aged 18 years completed compulsory conscription. Using the mean standardized score of three isometric muscle strength tests performed at conscription hand grip, elbow flexion and knee extension, we categorized the subjects into three groups with the 25th to 75th percentile defining the reference category. We followed the cohort until 2012 for diagnosed CVD events and mortality via national health care registers and the national cause of death register. To estimate hazard ratios HR for CVD events coronary heart disease or stroke and CVD mortality we used Cox proportional hazard models adjusted for body mass index, smoking, alcohol consumption, cardiorespiratory fitness and socioeconomic status.

ResultsMen with high muscle strength in adolescence had a decreased risk of later CVD events HR 0.88, 95% confidence interval 0.77 to 0.99, whereas we observed no increased risk in men with low muscle strength 0.99, 0.86 to 1.13. However, low muscle strength was associated with increased risk of CVD mortality during middle age 1.31, 1.02 to 1.67.

ConclusionsMuscle strength in adolescent men is inversely associated with later CVD events and CVD mortality in middle age, independently of cardiorespiratory fitness and other important confounders. Thus, the role of muscle fitness in the prevention and pathogenesis of CVD warrants increased attention.

KeywordsCardiovascular disease Coronary heart disease Stroke Muscle strength Prevention Epidemiology AbbreviationsBMIBody mass index

CIConfidence interval

CRFCardiorespiratory fitness

CVDCardiovascular disease

HRHazard ratio

ICDInternational classification of disease

MHRMaximum heart rate

WHOWorld Health Organization.

Electronic supplementary materialThe online version of this article doi:10.1186-1741-7015-12-62 contains supplementary material, which is available to authorized users.

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Author: Simon Timpka - Ingemar F Petersson - Caddie Zhou - Martin Englund


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