Addition of sleep metric in updated Life’s Essential 8 predicts CVD incidence
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The incorporation of sleep as a CV health metric, as recently done with the American Heart Association’s updated Life’s Essential 8 risk calculator, may enhance CVD primordial and primary prevention efforts, data show.
“In our study, even a CV health 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,” Nour Makarem, PhD, MS, assistant professor of epidemiology at Columbia Mailman School of Public Health, said in a press release. “Notably, we also found that a CV health score that incorporated multiple dimensions of sleep health was also significantly associated with incident CVD. Our results highlight the importance of embracing a holistic vision of sleep health that includes sleep behaviors and highly prevalent, mild sleep problems rather than strictly focusing on sleep disorders when assessing an individual’s cardiovascular risk.”
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Makarem and colleagues analyzed data from 1,920 Multi-Ethnic Study of Atherosclerosis (MESA) Sleep study participants who had complete data on sleep characteristics from overnight polysomnography, 7-day wrist actigraphy, validated questionnaires and the outcome. The mean age of participants was 70 years; 54% were women. Researchers computed the Life’s Simple 7 score and four iterations of a new CV health score. Score 1 included only sleep duration; score 2 included sleep characteristics linked to CVD in the literature, such as insomnia, daytime sleepiness and obstructive sleep apnea; score 3 included sleep characteristics associated with CVD in the MESA study, such as sleep duration and efficiency; and score 4 included sleep regularity.
The findings were published in the Journal of the American Heart Association.
During mean follow-up of 4.4 years, there were 95 prevalent CVD events and 93 incident CVD cases. Researchers found that participants in the highest vs. the lowest tertile of the Life’s Simple 7 score and CV health scores 1 to 4 had up to 80% lower odds of prevalent CVD.
The Life’s Simple 7 score, which does not include sleep as a health metric, was not significantly associated with CVD incidence (HR = 0.62; 95% CI, 0.37-1.04). However, compared with participants in the lowest tertile for CV health score 1, those in the highest tertile had 43% lower risk for incident CVD (HR = 0.57; 95% CI, 0.33-0.97). For CV health score 4, participants in the highest score tertile had a 47% lower risk for incident CVD compared with those in the lowest score tertile (HR = 0.53; 95% CI, 0.32-0.89).
“Health care providers should assess their patients’ sleep patterns, discuss sleep-related problems and educate patients about the importance of prioritizing sleep to promote CV health,” Makarem said in the release. “Furthermore, the formal integration of sleep health into CV health promotion guidance will provide benchmarks for surveillance and ensure that sleep becomes an equal counterpart in public health policy to the attention and resources given to other lifestyle behaviors.”
As Healio previously reported, the enhanced Life’s Essential 8 measurement tool — formerly known as Life’s Simple 7 — was revamped to allow improved means for measuring and monitoring CV health to achieve greater health equity, and now includes the entire life course. Metrics include health behaviors like diet, physical activity, nicotine exposure and sleep, and health factors like body weight, lipids, blood glucose and BP.
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