Life"s simple 7 and the risk of stroke in Finnish men: a prospective cohort study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): North Savo Regional Fund and Finnish Foundation for Cardiovascular Research Background Population-wide preventive measures constitute important approaches toward reducing stroke risk and its associated burden. We sought to examine the association between American Heart Association’s (AHA) Life’s Simple7 (LS7) score and the risk of stroke in men. Methods The study is based on the prospective population-based Kuopio Ischaemic Heart Disease cohort comprising men (42-60 years) without pre-existing history of stroke at baseline. LS7 was computed from AHA’s cardiovascular health metrics for 2520 men and includes data on diet, physical activity, body mass index, smoking status, blood pressures, total cholesterol and blood glucose. Participants were classified into three LS7 groups based on the number of ideal metrics: inadequate (0–2), average (3–4) and optimal (5–7). Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LS7 scores for total and ischaemic stroke. Results During a median follow-up of 26years, 428 total and 362 ischaemic incident stroke events were recorded. The risk of both stroke outcomes decreased continuously with increasing LS7 scores across the range 2 to 6. Men with optimal LS7 had 48% (HR: 0.52; 95%CI: 0.32–0.86) lower risk of total stroke when compared with those with inadequate LS7. The association was similar for the risk of ischaemic stroke, with 50% (HR: 0.50; 95%CI: 0.29–0.87) lower risk among men with an optimal LS7 compared with those with inadequate LS7. Conclusion LS7 was strongly, inversely and linearly associated with risk of total and ischaemic strokes among a middle-aged male Caucasian population. Life’s Simple 7 and the risk of stroke Total Stroke Ischaemic Stroke LS7 score 0-2† (inadequate) 3-4 (average) 5-7 (optimal) 0-2† (inadequate) 3-4 (average) 5-7 (optimal) n/N 224/1109 187/1273 17/138 192/1109 156/1273 14/138 Model 1 HR (95%CI) 1 0.65 (0.53 - 0.79) 0.49 (0.30 - 0.81) 1 0.63 (0.51 - 0.78) 0.47 (0.27 - 0.82) p value* <0.001 0.005 <0.001 0.007 Model 2 HR (95%CI) 1 0,69 (0.56 - 0.84) 0.52 (0.32 - 0.86) 1 0.67 (0.54 - 0.84) 0.50 (0.29 - 0.87) p value* <0.001 0.01 <0.001 0.014 n/N, number of events/Total; HR, hazard ratio; CI, Confidence interval *p-values for the HRs <0.05 are considered statistically significant †Reference category Model 1: adjusted for age, alcohol consumption and socioeconomic status Model 2: Model 1 plus history of coronary heart disease and history of type 2 diabetes mellitus

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Increased vascular endothelial growth factor D is associated with atrial fibrillation and ischaemic stroke

Heart ◽

10.1136/heartjnl-2018-313684 ◽

2018 ◽

Vol 105 (7) ◽

pp. 553-558 ◽

Cited By ~ 8

Author(s):

John Berntsson ◽

J Gustav Smith ◽

Linda S B Johnson ◽

Martin Söderholm ◽

Yan Borné ◽

...

Keyword(s):

Atrial Fibrillation ◽

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Ischaemic Stroke ◽

Cox Regression ◽

High Plasma ◽

Population Based ◽

Vascular Endothelial ◽

History Of ◽

Endothelial Growth Factor

ObjectiveVascular endothelial growth factor D (VEGF-D) has important functions in lymphangiogenesis and angiogenesis. High plasma levels of VEGF-D have been associated with incidence of heart failure. The association of VEGF-D with atrial fibrillation (AF) and stroke is unclear and we hypothesised that VEGF-D could also be associated with incidence of AF and ischaemic stroke.MethodsVEGF-D was measured in fasting blood samples of 4689 subjects (40% men) without a history of AF from the Malmö Diet and Cancer Study, a prospective, population-based study in Sweden. Median age was 58 years (range 46–68). Cox regression analyses, adjusted for multiple risk factors, was used to assess AF and ischaemic stroke risk in relation to VEGF-D levels.ResultsDuring a median follow-up time of 20.6 years, there were 637 cases of incident AF and 322 cases of first ischaemic stroke. After adjustment, VEGF-D was significantly associated with AF (HR 1.13(95% CI 1.04 to 1.23) per 1 SD increase) and ischaemic stroke (HR 1.14(95% CI 1.02 to 1.28) per 1 SD). The association with ischaemic stroke was explained by an increased incidence of AF-related stroke. HRs per 1 SD were 1.34 (95% CI 1.04 to 1.71) for AF-related ischaemic stroke and 1.04 (95% CI 0.90 to 1.19) for ischaemic stroke without AF.ConclusionsIncreased VEGF-D concentrations were associated with AF and ischaemic stroke. The relationship with ischaemic stroke was more pronounced in subjects with a diagnosis of AF.

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Abstract P278: Life's Simple 7 and Risk of Incident Stroke in Black and White Americans: REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.125.suppl_10.ap278 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Ambar Kulshreshtha ◽

Suzanne Judd ◽

Viola Vaccarino ◽

Virginia Howard ◽

William McClellan ◽

...

Keyword(s):

Racial Differences ◽

Lower Risk ◽

Cardiovascular Health ◽

Cox Regression ◽

Disease Incidence ◽

Heart Association ◽

P Value ◽

Life’S Simple 7 ◽

Blacks And Whites ◽

Life's Simple 7

Background: The American Heart Association has developed Life’s Simple 7 (LS-7) as a measure of cardiovascular health. In a recent study, LS-7 showed a graded relationship with cardiovascular disease incidence. The association of LS-7 with incident stroke has not been reported previously. Methods: We analyzed data from REGARDS, a national population-based cohort of 30,239 blacks and whites, aged ≥ 45 years of age, sampled from US population between 2003 and 2007. Data for LS-7 was collected by telephone, mail questionnaires, and an in-home exam. Participants were contacted every 6 months for possible stroke, which was validated by physicians using medical record review. LS-7 components (blood pressure, cholesterol, glucose, BMI, smoking, physical activity, diet) were each coded as: poor (1 point), intermediate (2 points) and ideal (3 points). An overall LS-7 score, created by summing the 7 component scores (possible range: 7 to 21), was categorized as: highest (17–21), medium (12–16) and lowest (7–11) cardiovascular health. Cox regression was used to model LS-7 score categories with stroke events. Results: There were 22,914 participants with data on LS-7 and no previous CVD. Mean age was 65 years, 40% were black, and 55% female. Over 4.9 years of follow-up, there were 432 incident strokes. Mean (SD) LS-7 score was 13.5 (2.5). After adjustment for age and sex, mean LS-7 scores were lower for blacks (12.9 ± 0.02) than whites (14.3 ± 0.02). LS-7 categories were associated with incident stroke in a graded fashion (figure). After adjusting for age, race, sex, income, and education, each better health category was associated with a 25% lower risk of incident stroke (HR=0.75, 95% CI = 0.63, 0.90). In stratified analyses, HR was similar for blacks and whites (p-value = 0.55). Conclusion: Blacks had lower levels of cardiovascular health factors than whites. Better cardiovascular health based on LS-7 score was associated with a lower risk of stroke. Results suggest that efforts to improve the LS-7 score may be useful for stroke prevention.

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Circulating Serum Magnesium and the Risk of Venous Thromboembolism in Men: A Long-Term Prospective Cohort Study

Pulse ◽

10.1159/000515409 ◽

2021 ◽

pp. 1-6

Author(s):

Setor K. Kunutsor ◽

Jari A. Laukkanen

Keyword(s):

Heart Disease ◽

Venous Thromboembolism ◽

Prospective Cohort ◽

Cox Regression ◽

Smoking Status ◽

Serum Magnesium ◽

Age Groups ◽

Atherosclerotic Cardiovascular Disease ◽

Male Population ◽

History Of

Background and Objective: Serum magnesium, an essential trace element involved in processes that regulate cardiovascular function, has been linked to the risk of atherosclerotic cardiovascular disease. However, the potential association between serum magnesium and venous thromboembolism (VTE) has not been previously investigated. We aimed to assess the prospective association of serum magnesium with the risk of VTE. Methods: Serum magnesium was measured using atomic absorption spectrometry in 2,361 men aged 42–61 years with no history of VTE at baseline in the Kuopio Ischemic Heart Disease prospective cohort. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for VTE. Results: A total of 159 incident VTE events were recorded during a median follow-up of 27.1 years. The risk of VTE per 1 SD increase in serum magnesium in the age-adjusted analysis was (HR 1.30; 95% CI 0.46–3.69). The association remained consistent in analyses adjusted for systolic blood pressure, body mass index, total cholesterol, triglycerides, smoking status, a history of type 2 diabetes, a history of coronary heart disease, medication for dyslipidemia, alcohol consumption, physical activity, socioeconomic status, serum active calcium, high-sensitivity C-reactive protein, and a history of cancer (HR 1.38; 95% CI 0.48–3.96). Comparing the extreme tertiles of serum magnesium, the corresponding adjusted HRs were 1.17 (95% CI 0.81–1.70) and 1.17 (95% CI 0.81–1.70), respectively. Conclusion: In a middle-aged Caucasian male population, serum-circulating magnesium was not associated with a future risk of VTE. Further studies in women, other age groups, and other populations are required to generalize these findings.

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Effect of physical activity on reducing the risk of diabetic retinopathy progression: 10-year prospective findings from the 45 and Up Study

PLoS ONE ◽

10.1371/journal.pone.0239214 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0239214

Author(s):

Xixi Yan ◽

Xiaotong Han ◽

Changfan Wu ◽

Xianwen Shang ◽

Lei Zhang ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Lower Risk ◽

Cox Regression ◽

Large Cohort ◽

P Value ◽

Diabetic Patients ◽

Family History Of Diabetes ◽

South Wales ◽

History Of

Objective To examine the association of physical activities (PA) with diabetic retinopathy (DR) progression based on a 10-year follow-up of a large cohort of working-aged diabetic populations in Australia. Methods Nine thousand and eighteen working-aged diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (<5 sessions/week), medium (≥5–14), and high (≥14) levels. Retinal photocoagulation (RPC) treatment during the follow-up period was used as a surrogate for DR progression and was tracked through the Medicare Benefits Schedule, which was available from 2004 to 2016. Cox regression was used to estimate the association between PA and RPC incidence. Results In the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend = 0.002; medium vs. low, hazard ratio (HR) = 0.78, 95% Confidence Interval (CI): 0.61–0.98; high vs. low, HR = 0.61, 95%CI: 0.36–0.84. In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC. Conclusions Higher PA level was independently associated with a lower risk of DR progression among working-aged diabetic populations in this large cohort study.

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Association between ideal cardiovascular health and risk of sudden cardiac death and all-cause mortality among middle-aged men in Finland

European Journal of Preventive Cardiology ◽

10.1177/2047487320915338 ◽

2020 ◽

pp. 204748732091533

Author(s):

Nzechukwu M Isiozor ◽

Setor K Kunutsor ◽

Ari Voutilainen ◽

Sudhir Kurl ◽

Jussi Kauhanen ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Cardiovascular Health ◽

Cox Regression ◽

Population Based ◽

P Value ◽

Middle Aged ◽

Ideal Cardiovascular Health ◽

All Cause Mortality ◽

Multivariable Analyses

Background Strong associations have been demonstrated between the American Heart Association’s cardiovascular health (CVH) metrics and various cardiovascular outcomes, but the association with sudden cardiac death (SCD) is uncertain. We examined the associations between these CVH metrics and the risks of SCD and all-cause mortality among men in Finland. Methods and results We used the prospective population-based Kuopio Ischaemic Heart Disease cohort study, which consists of men between 42 and 60 years of age at baseline. CVH metrics were computed for 2577 men with CVH scores at baseline ranging from 0 to 7, categorized into CVH scores of 0–2 (poor), 3–4 (intermediate) and 5–7 (ideal). Multivariate Cox regression models were used to estimate the hazards ratios (HRs) and 95% confidence intervals (CIs) of ideal CVH metrics for SCD and all-cause mortality. During a median follow-up period of 25.8 years, 280 SCDs and 1289 all-cause mortality events were recorded. The risks of SCD and all-cause mortality decreased continuously with increasing number of CVH metrics across the range 2–7 ( p value for non-linearity for all <0.05). In multivariable analyses, men with an ideal CVH score had an 85% reduced risk of SCD compared with men with a poor CVH score (HR 0.15; 95% CI 0.05–0.48; p = 0.001). For all-cause mortality, there was a 67% lower risk among men with an ideal CVH score compared with those with a poor CVH score (HR 0.33; 95% CI 0.23–0.49; p <0.001). Conclusions Ideal CVH metrics were strongly and linearly associated with decreased risks of SCD and all-cause mortality among middle-aged men in Finland.

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Association between ovarian reserve and preeclampsia: a cohort study

10.21203/rs.2.15692/v1 ◽

2019 ◽

Author(s):

Hadi Erfani ◽

Maryam Rahmati ◽

Mohammad Ali Mansournia ◽

Fereidoun Azizi ◽

Seyed Ali Montazeri ◽

...

Keyword(s):

Ovarian Reserve ◽

Smoking Status ◽

Population Based ◽

Outcome Variable ◽

P Value ◽

Eligibility Criteria ◽

Dichotomous Outcome ◽

Cardiovascular Disease In Women ◽

History Of ◽

Suitable Marker

Abstract Background The risk of cardiovascular disease in women increases after menopause. It has been shown that women with lower pre-menopausal ovarian reserve may experience increased cardiovascular risk. We sought to determine whether there is any association between ovarian reserve, as assessed by Anti-Mullerian hormone (AMH), and preeclampsia (PE).Methods Subjects of this study were selected from among participants of the Tehran Lipid and Glucose Study (TLGS), a population-based cohort with a 15-year follow-up (1998-2014). Out of 2412 women aged 20-50 years, there were 781 women who met eligibility criteria, including having comprehensive data on their reproductive assessment and ovarian reserve status, identified based on age-specific AMH levels according to the exponential–normal three-parameter model. There were 80 and 701 participants in the preeclampsia and non-PE groups, respectively. The association between dichotomous outcome variable PE and age-specific AMH quartiles was evaluated using pooled logistic regression.Results PE was observed in 23 (11.1%), 12 (6.4%), 26 (13.3%) and 19 (10%) women in the 1st, 2nd, 3rd and 4th quartiles of age-specific AMH, respectively (P = 0.16). Median and inter-quartile range of serum AMH levels was 1.05 (0.36 – 2.2) mg/L in women who experienced PE compared with 0.85 (0.28 – 2.1) mg/L in women with normotensive pregnancies (P = 0.53). Based on the pooled logistic regression analysis, the effect of age-specific AMH quartiles on PE progression (adjusted for age, BMI, smoking status, and family history of hypertension) were not significant (OR1st vs 4th: 1.5, P-value: 0.1, CI: (0.9, 2.4))Conclusions Age-specific AMH may not be a suitable marker for prediction of PE. Further longitudinal studies is highly recommended for precise interpretation of the association between ovarian reserve status and PE.

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Abstract P093: Influence of Comorbidities on Outcomes in Atrial Fibrillation: A Population-based Case-control Study

Circulation ◽

10.1161/circ.133.suppl_1.p093 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Alanna Chamberlain ◽

Alvaro Alonso ◽

Bernard Gersh ◽

Sheila Manemann ◽

Jill Killian ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Conditions ◽

Cox Regression ◽

Smoking Status ◽

Population Based ◽

Chronic Obstructive ◽

P Value ◽

Specific Patient ◽

The Impact ◽

Population Controls

Background: Differences in the impact of comorbid conditions on outcomes in atrial fibrillation (AF) patients compared to population controls have not been well documented. Methods: The prevalence of 19 chronic conditions and smoking status was obtained in 1430 patients with incident AF from 2000-2010 and 1430 controls matched 1:1 on sex and age (within 5 years) from Olmsted County, MN. Andersen-Gill models determined associations of each condition with all-cause hospitalizations in AF cases and controls after adjusting for all other conditions and accounting for the matching. Cox regression determined associations of each condition with death. Results: Among 1430 matched pairs (median age 76 years, 48.6% men), the prevalence of chronic conditions was higher in AF cases compared to controls for all conditions except asthma, dementia, depression, hepatitis, and osteoporosis. Over a mean follow-up of 6.3 years, 2678 hospitalizations and 812 deaths occurred. The rates of hospitalization were 59 and 26 per 100 person-years and the rates of death were 10 and 5 per 100 person-years in AF cases and controls, respectively. After adjusting for all other conditions, the risk of hospitalization was lower in AF patients compared to controls for those with coronary artery disease, arthritis, cancer, chronic obstructive pulmonary disease, and osteoporosis (figure). In contrast, the risk of hospitalization was higher in AF cases for those with diabetes and substance abuse. For deaths, the only comorbidity with different associations between AF cases and controls was depression. The hazard ratios (95% CI) for death were 2.02 (1.26-3.24) in AF cases and 0.90 (0.58-1.38) in controls (p-value for interaction=0.008). Conclusions: AF patients have a higher prevalence of chronic conditions compared to population controls. The associations of comorbidities with hospitalizations differed between AF cases and controls, suggesting that management of comorbidities in patients with AF may need to be tailored to this specific patient population.

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Association between ovarian reserve and preeclampsia: a cohort study

10.21203/rs.2.15692/v3 ◽

2019 ◽

Author(s):

Hadi Erfani ◽

Maryam Rahmati ◽

Mohammad Ali Mansournia ◽

Fereidoun Azizi ◽

Seyed Ali Montazeri ◽

...

Keyword(s):

Logistic Regression ◽

Ovarian Reserve ◽

Smoking Status ◽

Population Based ◽

Outcome Variable ◽

P Value ◽

Eligibility Criteria ◽

Dichotomous Outcome ◽

Cardiovascular Disease In Women ◽

History Of

Abstract Background The risk of cardiovascular disease in women increases after menopause. It has been shown that women with lower pre-menopausal ovarian reserve may experience increased cardiovascular risk. We sought to determine whether there is any association between ovarian reserve, as assessed by Anti-Mullerian hormone (AMH), and preeclampsia (PE).Methods Subjects of this study were selected from among participants of the Tehran Lipid and Glucose Study (TLGS), a population-based cohort with a 15-year follow-up (1998-2014). Out of 2412 women aged 20-50 years, there were 781 women who met eligibility criteria, including having comprehensive data on their reproductive assessment and ovarian reserve status, identified based on age-specific AMH levels according to the exponential–normal three-parameter model that was measured before pregnancy. There were 80 and 701 participants in the preeclampsia and non-PE groups, respectively. The association between dichotomous outcome variable PE and age-specific AMH quartiles was evaluated using pooled logistic regression.ResultsPE was observed in 23 (11.1%), 12 (6.4 %), 26 (13.3%) and 19 (10%) women in the 1st, 2nd, 3rd and 4th quartiles of pre-pregnancy age-specific AMH, respectively (P = 0.16). Median and inter-quartile range of serum AMH levels was 1.05 (0.36 – 2.2) mg/L in women who experienced PE compared with 0.85 (0.28 – 2.1) mg/L in women with normotensive pregnancies (P = 0.53). Based on the pooled logistic regression analysis, the effect of age-specific AMH quartiles on PE progression (adjusted for age, BMI, smoking status, and family history of hypertension) were not significant (OR1st vs 4th: 1.5, P-value: 0.1, CI: (0.9, 2.4))ConclusionsAge-specific AMH may not be a suitable marker for prediction of PE. Further longitudinal studies, considering pre-conception measurement of AMH, are recommended for better interpretation of the association between ovarian reserve status and PE.

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Association between ovarian reserve and preeclampsia: a cohort study

10.21203/rs.2.15692/v2 ◽

2019 ◽

Author(s):

Hadi Erfani ◽

Maryam Rahmati ◽

Mohammad Ali Mansournia ◽

Fereidoun Azizi ◽

Seyed Ali Montazeri ◽

...

Keyword(s):

Ovarian Reserve ◽

Smoking Status ◽

Population Based ◽

Outcome Variable ◽

P Value ◽

Eligibility Criteria ◽

Dichotomous Outcome ◽

Cardiovascular Disease In Women ◽

History Of ◽

Suitable Marker

Abstract Background The risk of cardiovascular disease in women increases after menopause. It has been shown that women with lower pre-menopausal ovarian reserve may experience increased cardiovascular risk. We sought to determine whether there is any association between ovarian reserve, as assessed by Anti-Mullerian hormone (AMH), and preeclampsia (PE).Methods Subjects of this study were selected from among participants of the Tehran Lipid and Glucose Study (TLGS), a population-based cohort with a 15-year follow-up (1998-2014). Out of 2412 women aged 20-50 years, there were 781 women who met eligibility criteria, including having comprehensive data on their reproductive assessment and ovarian reserve status, identified based on age-specific AMH levels according to the exponential–normal three-parameter model that was measured before pregnancy. There were 80 and 701 participants in the preeclampsia and non-PE groups, respectively. The association between dichotomous outcome variable PE and age-specific AMH quartiles was evaluated using pooled logistic regression.Results PE was observed in 23 (11.1%), 12 (6.4%), 26 (13.3%) and 19 (10%) women in the 1st, 2nd, 3rd and 4th quartiles of pre-pregnancy age-specific AMH, respectively (P = 0.16). Median and inter-quartile range of serum AMH levels was 1.05 (0.36 – 2.2) mg/L in women who experienced PE compared with 0.85 (0.28 – 2.1) mg/L in women with normotensive pregnancies (P = 0.53). Based on the pooled logistic regression analysis, the effect of age-specific AMH quartiles on PE progression (adjusted for age, BMI, smoking status, and family history of hypertension) were not significant (OR 1st vs 4th : 1.5, P-value: 0.1, CI: (0.9, 2.4))Conclusions Age-specific AMH may not be a suitable marker for prediction of PE. Further longitudinal studies, considering pre-conception measurement of AMH, are recommended for better interpretation of the association between ovarian reserve status and PE.

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Fracture Risk in Patients with Myasthenia Gravis: A Population-Based Cohort Study

Journal of Neuromuscular Diseases ◽

10.3233/jnd-200612 ◽

2021 ◽

pp. 1-8

Author(s):

Charles Kassardjian ◽

Jessica Widdifield ◽

J. Michael Paterson ◽

Alexander Kopp ◽

Chenthila Nagamuthu ◽

...

Keyword(s):

Myasthenia Gravis ◽

Lower Risk ◽

Cox Regression ◽

Large Population ◽

Population Based ◽

Osteoporosis Prevention ◽

Inception Cohort ◽

Hazard Ratios ◽

Multiple Covariates ◽

Region Of Residence

Background: Prednisone is a common treatment for myasthenia gravis (MG), and osteoporosis is a known potential risk of chronic prednisone therapy. Objective: Our aim was to evaluate the risk of serious fractures in a population-based cohort of MG patients. Methods: An inception cohort of patients with MG was identified from administrative health data in Ontario, Canada between April 1, 2002 and December 31, 2015. For each MG patient, we matched 4 general population comparators based on age, sex, and region of residence. Fractures were identified through emergency department and hospitalization data. Crude overall rates and sex-specific rates of fractures were calculated for the MG and comparator groups, as well as rates of specific fractures. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression. Results: Among 3,823 incident MG patients (followed for a mean of 5 years), 188 (4.9%) experienced a fracture compared with 741 (4.8%) fractures amongst 15,292 matched comparators. Crude fracture rates were not different between the MG cohort and matched comparators (8.71 vs. 7.98 per 1000 patient years), overall and in men and women separately. After controlling for multiple covariates, MG patients had a significantly lower risk of fracture than comparators (HR 0.74, 95% CI 0.63–0.88). Conclusions: In this large, population-based cohort of incident MG patients, MG patients were at lower risk of a major fracture than comparators. The reasons for this finding are unclear but may highlight the importance osteoporosis prevention.

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