skincaremanual.org

Lack of sleep tied to greater risk of heart disease

November 11, 2017

In addition, a combination of little sleep and overnight elevated blood pressure appears to be associated with an increased risk of the disease.

"Reflecting changing lifestyles, people are sleeping less in modern societies," according to background information in the article. Getting adequate sleep is essential to preventing health conditions such as obesity and diabetes as well as several risk factors for cardiovascular disease including sleep-disordered breathing and night-time hypertension (high blood pressure).

Kazuo Eguchi, M.D., Ph.D., at Jichi Medical University, Tochigi, Japan, and colleagues monitored the sleep of 1,255 individuals with hypertension (average age 70.4) and followed them for an average of 50 months. Researchers noted patients' sleep duration, daytime and nighttime blood pressure and cardiovascular disease events such as stroke, heart attack and sudden cardiac death.

During follow-up, 99 cardiovascular disease events occurred. Sleep duration of less than 7.5 hours was associated with incident cardiovascular disease. "The incidence of cardiovascular disease was 2.4 per 100 person-years in subjects with less than 7.5 hours of sleep and 1.8 per 100 person-years in subjects with longer sleep duration," the authors write.

Patients with shorter sleep duration plus an overnight increase in blood pressure had a higher incidence of heart disease than those with normal sleep duration plus no overnight increase in blood pressure, but the occurrence of cardiovascular disease in those with a longer sleep duration vs. those with a shorter sleep duration was similar in those who did not experience an overnight elevation in blood pressure.

"In conclusion, shorter duration of sleep is a predictor of incident cardiovascular disease in elderly individuals with hypertension," particularly when it occurs with elevated nighttime blood pressure, the authors note. "Physicians should inquire about sleep duration in the risk assessment of patients with hypertension."

archinte.ama-assn/

The study of 17,802 apparently healthy men and women was stopped early on March 30 after about 2 years because of the strong positive results. The researchers found that a daily dose of a commonly used statin, rosuvastatin (Crestor), reduced the risk of heart attack, stroke, and death by nearly half (44 percent) in individuals with high levels of hsCRP (2.0 mg/L or higher) but with normal or low levels of LDL (130mg/dL or lower). The treatment reduced LDL cholesterol by 50 percent and hsCRP by 37 percent. Supported by AstraZeneca, U.S., the study was presented today at the AHA Scientific Sessions and appears online in the New England Journal of Medicine (November 20, 2008, print issue).

These studies expand our understanding of the role of inflammation in detecting early signs of cardiovascular disease and identifying adults who are at risk for heart attack or stroke. These findings suggest that adding hsCRP levels to traditional risk factors could identify millions more adults for whom treatment with statins appears to lower the risk of heart attack.

Many clinicians now offer hsCRP testing to their patients, but until now the value of hsCRP levels to treatment decisions, especially in adults with desirable cholesterol levels, was unclear. As with any medical discovery, however, broadly adopting a new approach to detect or treat a condition should first be critically tested, preferably through large-scale event-based randomized clinical trials like JUPITER, and proven to bear greater benefits than risks, including costs.

As part of the NHLBI strategic plan, we have engaged an expert panel to review and update the scientific evidence regarding the assessment and management of cardiovascular risk factors. Today's findings will be part of the rigorous scientific review to distill the scientific evidence and generate an evidence-based, comprehensive, set of clinical guidelines for primary care practitioners to help adult patients reduce their risk for cardiovascular disease.

In the meantime, however, we must not lose sight of the essential truth of what we already know to prevent heart disease: Cholesterol still counts, and we have proven ways to lower it and lessen its impact. The value of following a heart-healthy eating plan, being physically active, maintaining a healthy weight, and not smoking cannot be overestimated. And, statins can significantly reduce the risk of heart attack in those at high risk.

Let us continue to use our current knowledge as well as apply new discoveries based on solid evidence to take action for the betterment of individual and public health.

nhlbi.nih/