Abstract 36: The Role of Sleep as a Cardiovascular Health Metric: Does It Improve Cardiovascular Disease Risk Prediction? Results From The Multi-Ethnic Study of Atherosclerosis

Abstract

Background: The AHA Life’s Simple 7 (LS7) is a measure of cardiovascular health (CVH). Sufficient and healthy sleep has been linked to higher LS7 scores and lower cardiovascular disease (CVD) risk, but sleep has not been included as a CVH metric. Hypothesis: A CVH score that includes the LS7 plus sleep metrics would be more strongly associated with CVD outcomes than the LS7 score. Methods: Participants were n=1920 diverse adults (mean age: 69.5 y) in the MESA Sleep Study who completed 7 days of wrist actigraphy, overnight in-home polysomnography, and sleep questionnaires. Logistic regression and Cox proportional hazards models were used to compare the LS7 score and 4 new CVH scores that incorporate aspects of sleep in relation to CVD prevalence and incidence (Table). There were 95 prevalent CVD events at the Sleep Exam and 93 incident cases during a mean follow up of 4.4y. Results: The mean LS7 score was 7.3, and the means of the alternate CVH scores ranged from 7.4 to 7.8. Overall, 63% of participants slept <7h, 10% had sleep efficiency <85%, 14% and 36% reported excess daytime sleepiness and insomnia, respectively, 47% had obstructive sleep apnea, and 39% and 25% had high night-to-night variability in sleep duration and sleep onset timing. The LS7 score was not significantly associated with CVD prevalence or incidence (Table). Those in the highest vs. lowest tertile of CVH score 1, that included sleep duration, and CVH score 2, that included sleep characteristics linked to CVD in the literature, had lower odds of prevalent CVD. Those in the highest vs. lowest tertile of CVH scores 3 and 4, which included sleep characteristics linked to cardiovascular risk in MESA, had lower odds of prevalent CVD and lower risk of developing CVD. Conclusions: CVH scores that include sleep were more strongly associated with CVD prevalence and incidence than the traditional LS7 score. The incorporation of sleep as a metric of CVH, akin to other health behaviors, may improve CVD risk prediction. Findings warrant confirmation in larger samples and over longer follow-up.