“Associations of Handgrip Strength Weakness and Asymmetry With New‐Onset Stroke in Older European Adults: A Prospective Cohort Study” by Luo and Luo

Dear Editor,

1.

We read with great interest the recent article by Luo and Luo examining the associations of handgrip strength, weakness, and asymmetry with incident stroke in older European adults. The authors should be commended for utilizing a large multinational cohort with a long follow‐up period and for exploring both independent and combined effects of handgrip weakness and asymmetry on stroke risk. Their findings add to the growing body of evidence supporting muscle strength as an important marker of vascular health and age‐related decline.

While the study offers valuable insights, several broader issues deserve further discussion to aid in the interpretation of the findings and their potential clinical application.

First, while asymmetry and handgrip weakness were statistically linked to incident stroke, the connection for asymmetry alone was only mild (HR: 1.13, 95% CI: 1.02–1.24). In large cohorts, statistical significance can not necessarily translate into useful clinical applications. Risk markers should be assessed not only by their correlation with outcomes but also by their capacity to enhance risk prediction beyond current models, according to recent guidelines on prognostic research. It is not always the case that a marker will improve clinical decision‐making, calibration, or discrimination just because it shows an independent connection. Therefore, it would have been possible to ascertain whether handgrip asymmetry offers incremental value over conventional stroke risk factors like hypertension, diabetes, smoking, and obesity by using metrics like net reclassification improvement, integrated discrimination improvement, and changes in C‐statistics [1, 2].

Second, the results cast doubt on the biological significance of handgrip asymmetry in general. Due to hand dominance, human motor function is inherently asymmetrical. Research has demonstrated that, although this varies by age, sex, and occupation, dominant and non‐dominant hand strength frequently differ by about 10% in healthy persons [3]. As a result, some degree of asymmetry may not be indicative of disease but rather of normal physiological variation. The lack of a widely recognized threshold for identifying clinically significant handgrip asymmetry has also been brought to light by recent reviews [4]. This lack of consistency may make it more difficult to translate research findings into mainstream clinical practice and restrict comparability among investigations. Establishing clinically recognized asymmetry levels associated with significant health effects should be the goal of future research.

Third, rather than being a risk factor exclusive to stroke, the observed relationships may indicate the function of handgrip strength as a measure of overall biological aging. A growing body of research indicates that several negative outcomes, such as cardiovascular disease, cognitive decline, frailty, disability, hospitalization, and mortality, are linked to low muscle strength [5, 6, 7]. According to this viewpoint, decreased grip strength might be a general sign of deteriorating physiological reserve rather than a direct cause of stroke. Future research should focus on determining whether grip strength provides special information regarding cerebrovascular risk that is different from general aging processes.

Finally, the study emphasizes how basic physical performance metrics are becoming more widely used as instruments for evaluating cardiovascular risk. However, multimodal risk assessment that takes into account vascular, metabolic, functional, and social determinants of health is emphasized in modern stroke preventive frameworks [8]. Instead of being viewed as a stand‐alone screening tool, handgrip evaluation may ultimately be most helpful when incorporated into more comprehensive geriatric and cardiovascular risk assessment techniques. Therefore, future studies should investigate whether identifying high‐risk older persons is improved by integrating handgrip assessments with well‐established risk prediction techniques.

In conclusion, Luo and Luo offer significant proof that handgrip asymmetry and weakness are linked to an increased risk of stroke in older European adults. However, more research is necessary to address concerns about the therapeutic value of asymmetry, the lack of standard definitions, and the potential that grip strength is more a reflection of general biological aging than stroke‐specific causes. Future research on these topics may shed light on the best ways to integrate handgrip assessment into geriatric risk assessment and stroke preventive tactics.

Ethics Statement

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that supports the findings of this study are available in this article.