AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Low Relative Grip Strength Identifies High-Risk Cardiometabolic Phenotype Across Glycemic Categories in United States Adults
By Rana P, Modi P, Parikh A et al.
Introduction: Grip strength independently predicts cardiovascular mortality and cardiometabolic disease beyond traditional risk factors. Whether low relative grip strength identifies elevated hypertension and metabolic syndrome risk across HbA1c-defined glycemic categories in a nationally representative U.S. sample remains unclear. Research Questions/Hypothesis: Does low BMI-normalized grip strength identify a high-risk cardiometabolic phenotype across HbA1c-defined glycemic categories? Methods: Cross-sectional analysis of NHANES 2011-2014 adults ≥18 years. Relative grip strength (maximal grip kg ÷ BMI) was categorized as low vs. normal/high using sex-specific tertiles. Glycemic status was defined by HbA1c: normal (<5.7%), prediabetes (5.7-6.4%), diabetes (≥6.5%). Six joint phenotypes combined glycemic status and grip category. Hypertension was defined by 2017 AHA criteria or self-reported diagnosis (n=9,865). Metabolic syndrome was defined by ATP III criteria in the fasting subsample using fasting weights (n=4,415). Survey-weighted logistic regression estimated ORs for each joint phenotype, adjusted for age, sex, race/ethnicity, and income-to-poverty ratio. Results: Mean age was 46.8 years; 50.6% were female; 40.7% White, 23.0% Black, 21.1% Hispanic. Overall hypertension prevalence was 49.9%; metabolic syndrome prevalence was 36.1% in the fasting subsample. For hypertension, all six joint phenotypes showed significantly elevated hypertension odds versus normoglycemic adults with normal/high grip. Normoglycemic adults with low grip had OR 1.78 (1.50-2.13) and hypertension prevalence of 57.9% - identical to prediabetic adults with normal/high grip (OR 1.23, 1.01-1.50; 57.7%). Low grip reclassified normoglycemic adults into the same hypertension risk tier as prediabetes. Prediabetic adults with low grip had OR 2.25 (1.77-2.86). Highest risk was in adults with diabetes and low grip: OR 3.54 (2.75-4.57). For metabolic syndrome, the gradient was steeper. Normoglycemic adults with low grip had OR 3.13 (2.22-4.43) and prevalence of 43.9%; prediabetic adults with normal/high grip had OR 3.06, (2.25-4.17); prevalence 39.0%. Low grip again reclassified normoglycemic adults into the same metabolic syndrome risk level as prediabetes. Adults with diabetes and low grip had OR 19.90 (12.35-32.07). Findings were consistent across sexes. Conclusions: Low relative grip strength identifies a high-risk cardiometabolic phenotype across all glycemic categories. A point-of-care grip strength assessment may improve risk stratification by identifying metabolically vulnerable adults who appear lower-risk by HbA1c alone. Further studies are needed to confirm findings.