Sleep patterns, genetic susceptibility, and incident cardiovascular disease: a prospective study of 385 292 UK biobank participants

Abstract

Aims: To quantify the association of combined sleep behaviours and genetic susceptibility with the incidence of cardiovascular disease (CVD).

Methods and results: This study included 385 292 participants initially free of CVD from UK Biobank. We newly created a healthy sleep score according to five sleep factors and defined the low-risk groups as follows: early chronotype, sleep 7-8 h per day, never/rarely insomnia, no snoring, and no frequent excessive daytime sleepiness. Weighted genetic risk scores of coronary heart disease (CHD) or stroke were calculated. During a median of 8.5 years of follow-up, we documented 7280 incident CVD cases including 4667 CHD and 2650 stroke cases. Compared to those with a sleep score of 0-1, participants with a score of 5 had a 35% (19-48%), 34% (22-44%), and 34% (25-42%) reduced risk of CVD, CHD, and stroke, respectively. Nearly 10% of cardiovascular events in this cohort could be attributed to poor sleep pattern. Participants with poor sleep pattern and high genetic risk showed the highest risk of CHD and stroke.

Conclusion: In this large prospective study, a healthy sleep pattern was associated with reduced risks of CVD, CHD, and stroke among participants with low, intermediate, or high genetic risk.

Keywords: Cardiovascular disease; Genetic predisposition to disease; Sleep behaviour.

Figure 1

Incident risk of cardiovascular diseases according to healthy sleep score among 385 292 participants. Multivariable model was adjusted for age, sex, the Townsend Deprivation Index, ethnic, total physical activity level, smoking status, alcohol consumption, family history of heart diseases or stroke (only in the corresponding analysis), body mass index, prevalent hypertension, and prevalent diabetes. CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio.

Figure 2

The joint association of genetic risk and sleep pattern with CHD (A) and stroke (B) among 357 246 European ancestry participants. Multivariable model was adjusted for age, sex, the Townsend Deprivation Index, ethnic, total physical activity level, smoking status, alcohol consumption, family history of heart diseases or stroke (only in the corresponding analysis), body mass index, prevalent hypertension, and prevalent diabetes. The vertical line indicates the reference value of 1. CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio.

Take home figure

The joint association of genetic risk and sleep pattern with cardiovascular disease. Healthy sleep score to each participant was calculated by summing the binary score for each of the low-risk sleep factors: early chronotype; sleep 7–8 h per day; never or rarely insomnia; no snoring; no frequent excessive daytime sleepiness. The overall sleep pattern was defined as healthy (≥4), intermediate (2–3), and poor (≤1) based on the healthy sleep score. The overall genetic risk for each outcome was defined as high (Q5), intermediate (Q2–Q4), and low (Q1) based on the genetic risk score, separately.