Researchers at Columbia University Mailman School of Public Health evaluated an expanded measure of cardiovascular health (CVH) that includes sleep as an eighth metric, in relation to cardiovascular disease risk. This represents the first examination of adding sleep to the American Heart Association’s original Life’s Simple 7 (LS7) metrics as a novel eighth CVH metric. The study is published in the Journal of the American Heart Association .
The study sample consisted of ~2000 middle-aged to older adults from the Multi-Ethnic Study of Atherosclerosis (MESA), an ongoing US study of CVD and CVD risk factors, who participated in a sleep examination and They provided complete data on their sleep characteristics.
The research evaluated multiple expanded cardiovascular health scores, including the American Heart Association’s Life’s Simple 7 (LS7) metrics, as well as different sleep health measures, to evaluate which sleep parameters should be prioritized for CVD prevention. This study is the first to show that sleep metrics add independent predictive value for CVD events above the original 7 CVH metrics.
Importantly, cardiovascular health scores that included sleep duration only as a measure of overall sleep health, as well as cardiovascular health scores that included multiple dimensions of sleep health (i.e., duration, efficiency, and sleep regularity, daytime sleepiness, and sleep disorders) were predictive of future CVD. For the sleep duration metric, sleeping 7 hours or more but less than 9 hours each night was considered indicative of ideal sleep health.
“Our results demonstrate that sleep is an integral component of CVH. "In our study, even a CVH score that includes only sleep duration, the most widely measured aspect of sleep health and the most feasible measure to obtain in a clinic or public health setting, predicted CVD incidence," he said. Nour Makarem, PhD, assistant professor of epidemiology at Columbia Mailman School of Public Health and lead author of the study. “Notably, we also found that a CVH score that incorporated multiple dimensions of sleep health was also significantly associated with incident CVD. "Our results highlight the importance of taking a holistic view of sleep health that includes sleep behaviors and mild, highly prevalent sleep problems rather than focusing strictly on sleep disorders when assessing an individual’s cardiovascular risk."
Overall, the study found that 63% of participants slept less than 7 hours per night and 30% slept less than 6 hours, while 39% and 25% had high night-to-night variability in duration. and sleep schedule, respectively; 14 percent and 36 percent reported having excessive daytime sleepiness and high insomnia symptoms, respectively; and 47 percent had moderate to severe sleep apnea (OSA), in which breathing stops and starts repeatedly.
According to Nour Makarem and colleagues, the finding that a sleep health score based solely on sleep duration, as well as a sleep health score based on multiple dimensions of sleep, improved the definition of cardiovascular health may be explained, at least in part, by the clustering of sleep problems. The study showed that people with short sleep duration were more likely to have low sleep efficiency (<85 percent time in bed after sleeping after lights out), irregular sleep patterns (i.e. variable sleep duration and time between days), excessive daytime sleepiness and sleep apnea. Notably, short sleepers also had a higher prevalence of overweight/obesity, type 2 diabetes, and hypertension, suggesting that multiple dimensions of unhealthy sleep may occur at the same time and potentially interact, further increasing risk. of heart disease.
“Healthcare providers should assess their patients’ sleep patterns, discuss sleep-related problems, and educate patients about the importance of prioritizing sleep to promote CVH,” Makarem said. “In addition, formal integration of sleep health into CVH advocacy guidance will provide benchmarks for surveillance and ensure that sleep becomes an equitable counterpart in public health policy for the care and resources they provide to other lifestyle behaviors.”
“We recommend that additional research be conducted to examine the expanded definition of CVH that encompasses sleep in relation to the lifetime risk of developing CVD. Clinical trials are also needed to evaluate the impact of screening for sleep problems and improving multiple dimensions of sleep health through sleep hygiene interventions on cardiovascular outcomes.”
David Goff, MD, PhD, director of the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), agreed. “This study provides compelling evidence that sleep metrics are an important factor in cardiovascular health,” said Goff, who was not part of the study team. “Recognizing sleep as an integral part of heart health is a transformative step toward reducing the global burden of cardiovascular disease, the leading cause of death, and reducing the health disparities associated with it. “We look forward to future sleep health research that pursues the vision of healthy hearts on a healthy planet.”
Co-authors are Marie-Pierre St-Onge and Brooke Aggarwal of Columbia University Irving Medical Center; Susan Redline, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School; Steven Shea, Columbia Mailman School of Public Health and Columbia University Irving Medical Center; Donald Lloyd-Jones and Hongyan Ning, Feinberg School of Medicine, Northwestern University. The study was supported by the NIH.
