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Sleep duration - an independent risk factor for CVD

Comment by Eugenio Greco on behalf of EACPR Prevention, Epidemiology and Population Science Section

Prevention


Recently, it has been shown that poor sleep duration has an impact on cardiovascular disease (CVD) risk, but few studies have included sleep duration as a lifestyle factor, showing independent associations of sleep with CVD risk, and a reduction in CVD risk for a lifestyle score incorporating sleep; these studies were performed in Chinese and Japanese populations, and generalisation to European populations needs to be shown.

Marieke P Hoevenaar-Blom and colleagues in the Monitoring Project on Risk Factors for Chronic Diseases (MORGEN study) have investigated the contribution of sufficient sleep duration (> 7 hours) to lower CVD risk in addition to four traditional lifestyle factors: sufficient physical activity (> 3.5 h/week cycling or sports), a healthy diet (Mediterranean Diet Score > 5), (moderate) alcohol consumption (> 1 beverage/month), and non-smoking.

This prospective cohort study, carried out in the Netherlands between 1993 and 1997, included 8128 men and 9759 women aged 20–65 years, without CVD at baseline; cardiovascular morbidity and mortality data were provided by the National Medical Register (NMR) with the Dutch Hospital Discharge data.

During 10–14 years of follow up (mean 12 years), 607 composite CVD events occurred:

  • 129 fatal events (21%)
  • 367 nonfatal myocardial infarctions (60%)
  • 111 nonfatal strokes (18%)

The number of healthy lifestyle factors was inversely related to fatal and composite CVD: adherence to all four traditional healthy lifestyle factors was associated with a 57% lower risk of composite CVD (hazard ratio [HR] 0.43, 95% confidence intervals [CI] 0.31–0.59), and a 67% lower risk of fatal CVD (HR 0.33, 95% CI 0.16–0.68) compared with adherence to none or one.

After addition of sufficient sleep duration to adherence to all four traditional healthy lifestyle factors – thus comparing five to none or one healthy lifestyle factor – the CVD risk was even lower: HR 0.35 (95% CI 0.23– 0.52) for composite CVD and HR 0.17 (95% CI 0.07–0.43) for fatal CVD.

In this study, the combination of sufficient physical activity, a healthy diet, (moderate) alcohol consumption, and non-smoking was associated with a 57% lower risk of composite CVD and a 67% lower risk of fatal CVD compared with adherence to none or one of these healthy lifestyle factors.

The addition of sufficient sleep to adherence to all four traditional healthy lifestyle factors resulted in a 65% lower risk of composite CVD and an 83% lower risk of fatal CVD.

If all participants adhered to all five healthy lifestyle factors, 36% of composite CVD and 57% of fatal CVD could theoretically be prevented or postponed.