Introduction
Although insufficient or prolonged sleep duration is associated with cardiovascular
disease, sleep duration is not included in most lifestyle scores. This study evaluates
the relationship between a lifestyle score, including sleep duration and cardiovascular
disease risk.
Methods
A prospective analysis among 67,250 women in the Nurses’ Health Study and 29,114 men
in Health Professionals Follow-up Study (1986–2016) was conducted in 2021. Lifestyle
factors were updated every 2–4 years using self-reported questionnaires. The traditional lifestyle score was defined as not smoking, having a normal BMI, being physically active (≥30 minutes/day
of moderate physical activity), eating a healthy diet, and drinking alcohol in moderation.
Low-risk sleep duration, defined as sleeping ≥6 to <8 hours/day, was included as an additional component
in the updated lifestyle score. Cox proportional hazard regression models were used
to estimate cardiovascular disease risk. The likelihood-ratio test and C-statistics
were used to compare both scores.
Results
A total of 11,710 incident cardiovascular disease cases during follow-up were documented.
The multivariable-adjusted hazard ratios comparing 6 with 0 low-risk factors in the
healthy lifestyle score including sleep duration were 0.17 (95% CI=0.12, 0.23) for
cardiovascular disease, 0.14 (95% CI=0.10, 0.21) for coronary heart disease, and 0.20
(95% CI=0.12, 0.33) for stroke. Approximately 66% (95% CI=56%, 75%) of cardiovascular
disease, 67% (95% CI=54%, 77%) of coronary heart disease, and 62% (95% CI=42%, 76%)
of stroke cases were attributable to poor adherence to a healthy lifestyle including
sleep. Adding sleep duration to the score slightly increased the C-statistics from
0.64 (95% CI=0.63, 0.64) to 0.65 (95% CI=0.64, 0.65) (p<0.001).
Conclusions
Adopting a healthy lifestyle including sleep recommendations could substantially reduce
the risk of cardiovascular disease in U.S. adults.
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Article Info
Publication History
Published online: March 28, 2022
Identification
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
