Association of Life's Essential 8 and risk of fragility fractures: a large cohort study

Cardiovascular health (CVH) score is not only associated with cardiovascular diseases, but also some disorders in other systems. This study aims to investigate the association between CVH score and the risk of fragility fractures. The analysis enrolled 89,464 participants at baseline in Kailuan study initiated in 2006-2007. All participants were then followed up every 2 years and the incidence of fragility fractures was recorded annually. A total CVH score was classified as low (0-49 points), moderate (50-79 points) and ideal (80-100 points). The primary outcome was incident fragility fractures before December 31, 2021. Kaplan-Meier was used to estimate cumulative incidence. Multivariable adjusted Cox proportional hazards regression models and time-dependent Cox hazards regression models were used to estimate fragility fracture hazard ratios (aHR) and 95% confidence intervals (95%CI). After 13.98±2.84 years of follow-up, a total of 1,534 cases of fragility fractures were identified, with an incidence density of 1.23 per 1000 person-years. Compared with the low CVH group, the risk of fragility fractures was significantly lower in moderate (aHR=0.78, 95%CI:0.66-0.92) and ideal CVH groups (aHR=0.65, 95%CI:0.51-0.83), particularly in the age <60 group (aHR=0.72, 95%CI:0.59-0.88; aHR=0.55, 95%CI:0.41-0.73, respectively). Time-dependent Cox hazards regression models, sensitivity analysis and death competition model confirmed the reliability of these findings. The ideal CVH score is associated with a decreased risk of fragility fractures. With the increase of CVH score, the risk of fragility fracture decreases. This article is protected by copyright. All rights reserved.