Redefining Cardiovascular Health to Include Sleep: Prospective Associations With Cardiovascular Disease in the MESA Sleep Study

Nour Makarem ¹

Cecilia Castro‐Diehl ²

Marie-Pierre St-Onge ³

Susan Redline ²

Steven Shea ^{1, 3}

Donald M. Lloyd-Jones ⁴

Hongyan Ning ⁴

Brooke Aggarwal ³

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Department of Epidemiology, Mailman School of Public Heath Columbia University Irving Medical Center New York NY |

Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center Harvard Medical School Boston MA

Department of Medicine Columbia University Irving Medical Center New York NY |

⁴

Department of Preventive Medicine, Feinberg School of Medicine Northwestern University Chicago IL |

Publication type: Journal Article

Publication date: 2022-10-19

Wiley

Journal: Journal of the American Heart Association

scimago Q1

SJR: 2.126

CiteScore: 9.4

Impact factor: 5

ISSN: 20479980

DOI: 10.1161/JAHA.122.025252

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Cardiology and Cardiovascular Medicine

Abstract

Background

Although sufficient and healthy sleep is inversely associated with cardiovascular disease (CVD) and its risk factors, the American Heart Association's Life's Simple 7 (LS7), as a measure of cardiovascular health (CVH), did not include sleep. We evaluated an expanded measure of CVH that includes sleep as an eighth metric in relation to CVD risk.

Methods and Results

The analytic sample consisted of MESA (Multi‐Ethnic Study of Atherosclerosis) Sleep Study participants who had complete data on sleep characteristics from overnight polysomnography, 7‐day wrist actigraphy, validated questionnaires, and the outcome. We computed the LS7 score and 4 iterations of a new CVH score: score 1 included sleep duration, score 2 included sleep characteristics linked to CVD in the literature (sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnea), scores 3 and 4 included sleep characteristics associated with CVD in MESA (score 3: sleep duration and efficiency, daytime sleepiness, and obstructive sleep apnea; score 4: score 3+sleep regularity). Multivariable‐adjusted logistic and Cox proportional hazards models evaluated associations of the LS7 and CVH scores 1 to 4 with CVD prevalence and incidence. Among 1920 participants (mean age: 69±9 years; 54% female), there were 95 prevalent CVD events and 93 incident cases (mean follow‐up, 4.4 years). Those in the highest versus lowest tertile of the LS7 score and CVH scores 1 to 4 had up to 80% lower odds of prevalent CVD. The LS7 score was not significantly associated with CVD incidence (hazard ratio, 0.62 [95% CI, 0.37–1.04]). Those in the highest versus lowest tertile of CVH score 1, which included sleep duration, and CVH score 4, which included multidimensional sleep health, had 43% and 47% lower incident CVD risk (hazard ratio, 0.57 [95% CI, 0.33–0.97]; and hazard ratio, 0.53 [95% CI, 0.32–0.89]), respectively.

Conclusions

CVH scores that include sleep health predicted CVD risk in older US adults. The incorporation of sleep as a CVH metric, akin to other health behaviors, may enhance CVD primordial and primary prevention efforts. Findings warrant confirmation in larger cohorts over longer follow‐up.

Found

	1 2 3
Sleep	Sleep, 3, 4.17% Sleep 3 publications, 4.17%
Journal of the American Heart Association	Journal of the American Heart Association, 3, 4.17% Journal of the American Heart Association 3 publications, 4.17%
Circulation	Circulation, 3, 4.17% Circulation 3 publications, 4.17%
American Journal of Preventive Cardiology	American Journal of Preventive Cardiology, 2, 2.78% American Journal of Preventive Cardiology 2 publications, 2.78%
Current Atherosclerosis Reports	Current Atherosclerosis Reports, 2, 2.78% Current Atherosclerosis Reports 2 publications, 2.78%
JACC Advances	JACC Advances, 2, 2.78% JACC Advances 2 publications, 2.78%
Frontiers in Nutrition	Frontiers in Nutrition, 2, 2.78% Frontiers in Nutrition 2 publications, 2.78%
International Journal of Environmental Research and Public Health	International Journal of Environmental Research and Public Health, 1, 1.39% International Journal of Environmental Research and Public Health 1 publication, 1.39%
Current Cardiology Reports	Current Cardiology Reports, 1, 1.39% Current Cardiology Reports 1 publication, 1.39%
American Journal of Preventive Medicine	American Journal of Preventive Medicine, 1, 1.39% American Journal of Preventive Medicine 1 publication, 1.39%
Arteriosclerosis, Thrombosis, and Vascular Biology	Arteriosclerosis, Thrombosis, and Vascular Biology, 1, 1.39% Arteriosclerosis, Thrombosis, and Vascular Biology 1 publication, 1.39%
Metabolism: Clinical and Experimental	Metabolism: Clinical and Experimental, 1, 1.39% Metabolism: Clinical and Experimental 1 publication, 1.39%
Current Problems in Cardiology	Current Problems in Cardiology, 1, 1.39% Current Problems in Cardiology 1 publication, 1.39%
Revue Neurologique	Revue Neurologique, 1, 1.39% Revue Neurologique 1 publication, 1.39%
Sleep Medicine Reviews	Sleep Medicine Reviews, 1, 1.39% Sleep Medicine Reviews 1 publication, 1.39%
The Science of Diabetes Self-Management and Care	The Science of Diabetes Self-Management and Care, 1, 1.39% The Science of Diabetes Self-Management and Care 1 publication, 1.39%
Clinica e Investigacion en Arteriosclerosis	Clinica e Investigacion en Arteriosclerosis, 1, 1.39% Clinica e Investigacion en Arteriosclerosis 1 publication, 1.39%
Scientific Reports	Scientific Reports, 1, 1.39% Scientific Reports 1 publication, 1.39%
Journal of Occupational Science	Journal of Occupational Science, 1, 1.39% Journal of Occupational Science 1 publication, 1.39%
American Journal of Lifestyle Medicine	American Journal of Lifestyle Medicine, 1, 1.39% American Journal of Lifestyle Medicine 1 publication, 1.39%
Journal of the National Medical Association	Journal of the National Medical Association, 1, 1.39% Journal of the National Medical Association 1 publication, 1.39%
European Journal of Neurology	European Journal of Neurology, 1, 1.39% European Journal of Neurology 1 publication, 1.39%
American Journal of Physiology - Heart and Circulatory Physiology	American Journal of Physiology - Heart and Circulatory Physiology, 1, 1.39% American Journal of Physiology - Heart and Circulatory Physiology 1 publication, 1.39%
Frontiers in Sleep	Frontiers in Sleep, 1, 1.39% Frontiers in Sleep 1 publication, 1.39%
Preventive Medicine	Preventive Medicine, 1, 1.39% Preventive Medicine 1 publication, 1.39%
Nutrients	Nutrients, 1, 1.39% Nutrients 1 publication, 1.39%
Advances in Predictive, Preventive and Personalised Medicine	Advances in Predictive, Preventive and Personalised Medicine, 1, 1.39% Advances in Predictive, Preventive and Personalised Medicine 1 publication, 1.39%
Sleep Medicine	Sleep Medicine, 1, 1.39% Sleep Medicine 1 publication, 1.39%
Cardiovascular Research	Cardiovascular Research, 1, 1.39% Cardiovascular Research 1 publication, 1.39%
	1 2 3

	5 10 15 20 25
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Springer Nature	Springer Nature, 9, 12.5% Springer Nature 9 publications, 12.5%
Wiley	Wiley, 8, 11.11% Wiley 8 publications, 11.11%
Ovid Technologies (Wolters Kluwer Health)	Ovid Technologies (Wolters Kluwer Health), 7, 9.72% Ovid Technologies (Wolters Kluwer Health) 7 publications, 9.72%
Oxford University Press	Oxford University Press, 6, 8.33% Oxford University Press 6 publications, 8.33%
MDPI	MDPI, 4, 5.56% MDPI 4 publications, 5.56%
Frontiers Media S.A.	Frontiers Media S.A., 3, 4.17% Frontiers Media S.A. 3 publications, 4.17%
SAGE	SAGE, 2, 2.78% SAGE 2 publications, 2.78%
Cold Spring Harbor Laboratory	Cold Spring Harbor Laboratory, 2, 2.78% Cold Spring Harbor Laboratory 2 publications, 2.78%
BMJ	BMJ, 2, 2.78% BMJ 2 publications, 2.78%
Taylor & Francis	Taylor & Francis, 1, 1.39% Taylor & Francis 1 publication, 1.39%
American Physiological Society	American Physiological Society, 1, 1.39% American Physiological Society 1 publication, 1.39%
Research Square Platform LLC	Research Square Platform LLC, 1, 1.39% Research Square Platform LLC 1 publication, 1.39%
The Endocrine Society	The Endocrine Society, 1, 1.39% The Endocrine Society 1 publication, 1.39%
	5 10 15 20 25