Association of Life’s Crucial 9 and gallstone disease in United States adults compared to Life’s Essential 8: NHANES 2017–2018

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OBJECTIVE: Cardiovascular health (CVH) represents a composite measure of key lifestyle behaviors and physiological factors. Life's Essential 8 (LE8) quantifies eight domains of CVH, while Life's Crucial 9 (LC9) extends this framework by incorporating depression as a ninth domain. This study aims to investigate the association between LC9 and gallstone disease (GSD). METHODS: Utilizing 2017-2018 NHANES data, we examined CVH scores' correlation with GSD using multivariate logistic regression, smoothed curve fitting, and subgroup analyses. Receiver operating characteristic curve analysis was conducted to compare the discriminative effectiveness of LC9 and LE8. RESULTS: Analyzing 3478 participants, we found significant inverse associations between LE8 and LC9 scores and GSD. A standard deviation (SD) increase in LE8 and LC9 was associated with reduced odds of GSD by 29% (OR = 0.71; 95% CI, 0.63-0.80; P < 0.001) and 31% (OR = 0.69; 95% CI, 0.61-0.77; P < 0.001), respectively. LC9 demonstrated superior discrimination power over LE8 ( P = 0.021). CONCLUSIONS: The study confirms a strong inverse relationship between LC9 and GSD prevalence, with LC9 surpassing LE8 in discrimination. It highlights LC9's potential as a prevention-oriented risk indicator that reinforces lifestyle counseling to lower GSD risk.

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