Hand grip strength in venous thromboembolism: risk of recurrence and mortality

Resting Heart Rate and Risk of Incident Venous Thromboembolism: The Tromsø Study

While resting heart rate (RHR) is associated with multiple diseases, conflicting information exists on the association between RHR and venous thromboembolism (VTE). We, therefore, aimed to investigate the association between RHR and risk of VTE in a population-based cohort.Participants (n = 36,395) were followed from inclusion in the Tromsø 4 to 7 surveys (1994-2016) throughout 2020. RHR was measured in beats per minute (bpm) at each survey (repeated measurements for those attending several surveys). All first-time VTEs during follow-up were recorded. Hazard ratios (HR) for VTE with 95% confidence intervals (CIs) according to RHR categories (61-70, 71-80, and >80 bpm) with ≤60 bpm as reference were estimated using Cox regression models, and adjusted for age, sex, body mass index, cardiovascular disease, cancer, and physical activity. We also performed age-stratified analyses (<60 and ≥60 years).During a median of 6.6 years of follow-up, 1,072 participants experienced a VTE. Fully adjusted HRs (95% CI) for overall VTE were 1.12 (0.93-1.35), 1.35 (1.11-1.63), and 1.19 (0.97-1.47) for RHR categories 61 to 70, 71 to 80, and >80 bpm, respectively. Corresponding HRs for unprovoked VTE were 1.56 (1.14-2.14), 1.76 (1.28-2.43), and 1.60 (1.13-2.25), whereas no association was observed for provoked VTE. The association was more consistent in those ≥60 years, with HRs for overall VTE, >80 bpm versus ≤60 bpm of 1.30 (1.02-1.65) and for unprovoked VTE of 1.86 (1.24-2.81).Our findings suggest that higher RHR may be a risk factor for VTE and more consistently so for those ≥60 years. The VTE risk by higher RHR was particularly pronounced for unprovoked events.

Reduced calf muscle pump function is not explained by handgrip strength measurements

OBJECTIVE

Reduced calf muscle pump function (CPF) is an independent risk factor for venous thromboembolism and mortality. We aimed to evaluate the relationship between handgrip strength (HGS) and CPF.

METHODS

Patients referred to the Gonda Vascular Laboratory for noninvasive venous studies were identified and consented. Patients underwent standard venous air plethysmography protocol. CPF (ejection fraction) was measured in each lower extremity of ambulatory patients by comparing refill volume after ankle flexes and passive refill volumes. The cutoff for reduced CPF (rCPF) was defined as an ejection fraction of <45%. Maximum HGS bilaterally was obtained (three trials per hand) using a dynamometer. HGS and CPF were compared (right hand to calf, left hand to calf) and the correlation between the measures was evaluated.

RESULTS

115 patients (mean age, 59.2 ± 17.4 years; 67 females, mean body mass index, 30.83 ± 6.46) were consented and assessed for HGS and CPF. rCPF was observed in 53 right legs (46%) and 67 left legs (58%). CPF was reduced bilaterally in 45 (39%) and unilaterally in 30 (26%) patients. HGS was reduced bilaterally in 74 (64.3%), unilaterally in 23 (20%), and normal in 18 (15.7%) patients. Comparing each hand/calf pair, no significant correlations were seen between HGS and CPF. The Spearman's rank correlation coefficients test yielded values of 0.16 for the right side and 0.10 for the left side.

CONCLUSIONS

There is no significant correlation between HGS and CPF, demonstrating that HGS measurements are not an acceptable surrogate for rCPF, indicating different pathophysiological mechanisms for each process.