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ESC Congress 2020 Register

Sleep, stress and socioeconomic status – how do they impact on cardiovascular health?

ESC Congress News 2019 - Paris, France

As well as lifestyle factors, such as lack of physical activity, tobacco use, unhealthy food habits and excess body weight, other less well-considered factors have been linked to adverse cardiovascular (CV) health. Professor Massimo Francesco Piepoli (Guglielmo da Saliceto Hospital, Piacenza, University of Parma, Italy), Editor-in-Chief of European Journal of Preventive Cardiology describes some interesting new findings:

Sleep Disorders
Stress, Psycho-Social and Cultural Aspects of Heart Disease
Risk Factors and Prevention

Prof. Massimo Piepoli“Poor sleep quality has been linked to elevated blood pressure and the development of hypertension, but here at ESC Congress yesterday, Sasaki et al presented an observational study in 3,313 elderly people showing a relationship between visit--to--visit blood pressure variability and sleep quality (Abstract P4403). This finding is pertinent given that visit-to--visit blood pressure variability is already known to be associated with incident CV disease (CVD) independent of mean blood pressure.

Sleep-disordered breathing is known to be associated with increased CV risk but is not part of standard scales used for risk stratification. On Sunday, Korostovtseva et al presented a Russian population-based study which showed that subjects with self--reported snoring were more often at high-to-very-high risk of fatal CV events according to SCORE risk charts than non-snorers (Abstract P1554). The same relationship was not seen with self-reported sleep apnoeas, but this may have been due to the subjective assessment based on the questionnaire.

It furthermore appears that impaired sleep and work stress are a deadly combination. A recent population-based German study evaluated the effect of impaired sleep and work on 1,959 hypertensive employees.1 Over a mean follow-up of 17.8 years, compared with individuals with low work stress and non-impaired sleep, subjects with work stress (hazard ratio [HR] 1.56; 95% confidence interval [CI] 0.81–2.98) or impaired sleep (HR 1.76; 95% CI 0.96–3.22) had an increased risk of CVD, while participants with both work stress and impaired sleep had the highest risk of CVD mortality (HR 2.94; 95% CI 1.18–7.33).

The impact of income level is also highlighted at ESC Congress 2019. Liao et al examined the effect of income level on adverse events in patients with atrial fibrillation (Abstract P3775). Multivariate Cox regression analysis showed that higher income was significantly associated with a lower risk of adverse events. After propensity matching, high income level was associated with a lower incidence of ischaemic stroke (adjusted  HR 0.83), intracerebral haemorrhage (adjusted HR 0.78), major bleeding (adjusted HR 0.85) and mortality (adjusted HR 0.57).

A recent study in the European Journal of Preventive Cardiology investigated socioeconomic status and CV mortality.2 After a median follow-up of 10 years, CV death was significantly higher among middle and low socioeconomic status groups (HR [95% CI]: for middle 1.92 [1.68–2.19] and for low 1.73 [1.50–2.00]) compared with the high socioeconomic status group after adjustment. An upward shift of socioeconomic status was associated with a lower risk of CV death (HR 0.46; 95% CI 0.40–0.52), while a downward shift was not a significant predictor. Socioeconomic status may have an influence on the use of preventive medications such as statins and antiplatelet agents. Improvement of quality of life may also be an appropriate prevention strategy for CV health and an increase in income may be one of the socioeconomic factors that can positively influence the quality of life.

A progressive improvement in the level of education was accompanied by reduced premature CV mortality, according to a study from Norway.3 A large proportion (over two-thirds) of the gap in premature deaths between people with the highest and the lowest education was mediated by the modifiable CV risk factors, including smoking, systolic blood pressure, total cholesterol, body mass index, triglycerides and physical activity. While public campaigns attempt to improve the public knowledge on the risks of ‘bad behaviours’, recent evidence suggests that low educational levels represent an important barrier.”



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  1. Li J, et al. Eur J Prev Cardiol 2019 Apr 27:2047487319839183. doi: 10.1177/2047487319839183. [Epub ahead of print]
  2. Sung J, et al. Eur J Prev Cardiol 2019 Jun 10:2047487319856125. doi: 10.1177/2047487319856125. [Epub ahead of print]
  3. Ariansen I, et al. Eur J Prev Cardiol 2019;26:1096–1103.

Notes to editor

About the European Society of Cardiology

The European Society of Cardiology brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2019

ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2019 takes place 31 August to 4 September at the Paris Expo Porte de Versailles, Paris - France. Explore the scientific programme