101
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Vallat R, Shah VD, Redline S, Attia P, Walker MP. Broken sleep predicts hardened blood vessels. PLoS Biol 2020; 18:e3000726. [PMID: 32497046 PMCID: PMC7271997 DOI: 10.1371/journal.pbio.3000726] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/27/2020] [Indexed: 12/18/2022] Open
Abstract
Why does poor-quality sleep lead to atherosclerosis? In a diverse sample of over 1,600 individuals, we describe a pathway wherein sleep fragmentation raises inflammatory-related white blood cell counts (neutrophils and monocytes), thereby increasing atherosclerosis severity, even when other common risk factors have been accounted for. Improving sleep quality may thus represent one preventive strategy for lowering inflammatory status and thus atherosclerosis risk, reinforcing public health policies focused on sleep health. Why does poor quality sleep correlate with cardiovascular disease? A large population-based study suggests that fragmented sleep contributes to atherosclerosis in humans by increasing inflammatory-related activity of white blood cells.
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Affiliation(s)
- Raphael Vallat
- Center for Human Sleep Science, Department of Psychology, University of California, Berkeley, California, United States of America
| | - Vyoma D. Shah
- Center for Human Sleep Science, Department of Psychology, University of California, Berkeley, California, United States of America
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Peter Attia
- Attia Medical, PC, San Diego and New York City, United States of America
| | - Matthew P. Walker
- Center for Human Sleep Science, Department of Psychology, University of California, Berkeley, California, United States of America
- * E-mail:
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102
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Arbab-Zadeh A, Fuster V. From Detecting the Vulnerable Plaque to Managing the Vulnerable Patient: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 74:1582-1593. [PMID: 31537269 DOI: 10.1016/j.jacc.2019.07.062] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 01/04/2023]
Abstract
The past decades have seen tremendous progress on elucidating mechanisms leading to acute coronary syndrome and sudden cardiac death. Pathology and imaging studies have identified features of coronary atherosclerosis that precede acute coronary events. However, many factors influence the risk of adverse events from coronary atherosclerotic disease and available data support our transition from focusing on individual "vulnerable plaque," coronary arterial stenosis, and inducible myocardial ischemia to understanding coronary heart disease as multifactorial, chronic disease. The concept of the vulnerable patient has evolved, with the atheroma burden, its metabolic activity, and the disposition to vascular thrombosis building a platform for assessing central aspects of coronary heart disease. In turn, this model has directed us to a focus on controlling the activity of atherosclerotic disease and on modifying the susceptibility of vascular thrombosis which has led to reduced morbidity and mortality from coronary heart disease.
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Affiliation(s)
- Armin Arbab-Zadeh
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Valentin Fuster
- Mount Sinai Heart Center, Icahn School of Medicine at Mount Sinai, New York, New York
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103
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Wang YH, Wang J, Chen SH, Li JQ, Lu QD, Vitiello MV, Wang F, Tang XD, Shi J, Lu L, Wu SL, Bao YP. Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality. JAMA Netw Open 2020; 3:e205246. [PMID: 32442289 PMCID: PMC7244989 DOI: 10.1001/jamanetworkopen.2020.5246] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Single self-reported measures of sleep duration are associated with adverse health outcomes; however, long-term patterns of self-reported sleep duration and their association with cardiovascular events (CVEs) and all-cause mortality remain unknown. OBJECTIVE To determine whether trajectories of long-term vs single-measure sleep duration are associated with subsequent risk of CVEs and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS The Kailuan study is a prospective, population-based cohort study that began in 2006. The present cohort included 52 599 Chinese adults without atrial fibrillation, myocardial infarction, stroke, or cancer to 2010. Trajectories in sleep duration from January 1, 2006, to December 31, 2010, were identified to investigate the association with risk of CVEs and all-cause mortality from January 1, 2010, to December 31, 2017. Data analysis was conducted from July 1 to October 31, 2019. EXPOSURES Habitual self-reported nocturnal sleep durations were collected in 2006, 2008, and 2010. Trajectories in sleep duration for 4 years were identified by latent mixture modeling. MAIN OUTCOMES AND MEASURES All-cause mortality and first incident CVEs (atrial fibrillation, myocardial infarction, and stroke) from 2010 to 2017 were confirmed by medical records. Based on the baseline sleep duration and patterns over time, 4 trajectories were categorized (normal stable, normal decreasing, low increasing, and low stable). RESULTS Of the 52 599 adults included in the study (mean [SD] age at baseline, 52.5 [11.8] years), 40 087 (76.2%) were male and 12 512 (23.8%) were female. Four distinct 4-year sleep duration trajectory patterns were identified: normal stable (range, 7.4 to 7.5 hours [n = 40 262]), normal decreasing (mean decrease from 7.0 to 5.5 hours [n = 8074]), low increasing (mean increase from 4.9 to 6.9 hours [n = 3384]), and low stable (range, 4.2 to 4.9 hours [n = 879]). During a mean (SD) follow-up of 6.7 (1.1) years, 2361 individuals died and 2406 had a CVE. Compared with the normal-stable pattern and adjusting for potential confounders, a low-increasing pattern was associated with increased risk of first CVEs (hazard ratio [HR], 1.22; 95% CI, 1.04-1.43), a normal-decreasing pattern was associated with increased risk of all-cause mortality (HR, 1.34; 95% CI, 1.15-1.57), and the low-stable pattern was associated with the highest risk of CVEs (HR, 1.47; 95% CI, 1.05-2.05) and death (HR, 1.50; 95% CI, 1.07-2.10). CONCLUSIONS AND RELEVANCE In this study, sleep duration trajectories with lower or unstable patterns were significantly associated with increased risk of subsequent first CVEs and all-cause mortality. Longitudinal sleep duration patterns may assist in more precise identification of different at-risk groups for possible intervention. People reporting consistently sleeping less than 5 hours per night should be regarded as a population at higher risk for CVE and mortality.
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Affiliation(s)
- Yun-He Wang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Jing Wang
- Peking University Medical Informatics Center, Peking University, Beijing, China
| | - Shuo-Hua Chen
- Health Care Center, Kailuan Medical Group, Tangshan, China
| | - Jin-Qiao Li
- Health Care Center, Kailuan Medical Group, Tangshan, China
| | - Qing-Dong Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Michael V. Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Feng Wang
- Chinese Center for Health Education, Beijing, China
| | - Xiang-Dong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center and Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Lin Lu
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing, China
- Peking-Tsinghua Center for Life Sciences and International Data Group/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Shou-Ling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
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104
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St-Onge MP, Campbell A, Aggarwal B, Taylor JL, Spruill TM, RoyChoudhury A. Mild sleep restriction increases 24-hour ambulatory blood pressure in premenopausal women with no indication of mediation by psychological effects. Am Heart J 2020; 223:12-22. [PMID: 32135337 DOI: 10.1016/j.ahj.2020.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 02/06/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies assessing the impact of sleep restriction (SR) on blood pressure (BP) are limited by short study length, extreme SR (<4 hours a night), and lack of attention to psychological distress as a possible mediator. METHODS A community-based cohort was assembled with 237 women (age 34.1 ± 13.5 years; body mass index 25.4 ± 5.4 kg/m2), and a randomized, crossover, intervention study was conducted in 41 women (24 completed: age 30.2 ± 6.5 years; body mass index 24.3 ± 2.8 kg/m2) to determine the causal effect of SR on BP. Sleep was maintained as usual (HS) or reduced by 1.5 hours a night (SR) for 6 weeks. In the cohort, associations between sleep and psychosocial factors were evaluated using multivariable models adjusted for demographic and clinical confounders. In the intervention study, in-office BP was measured weekly; ambulatory BP was measured at end point. Psychological factors were assessed at baseline and end point. Mixed-model analyses with total sleep time (TST, main predictor), week and fraction of time spent in physical activity (covariates), and subject (random effect) were performed. RESULTS Among the community cohort, higher perceived stress, stressful events and distress, and lower resilience were associated with shorter sleep, worse sleep quality, and greater insomnia symptoms (P < .05). In the intervention, systolic BP increased as TST decreased (TST × week interaction, [coefficient ± standard error] -0.0097 ± 0.0046, P = .036). Wake ambulatory diastolic blood pressure (-0.059 ± 0.022, P = .021) and mean arterial pressure (-0.067 ± 0.023, P = .018) were higher after SR versus HS. Psychological distress variables were not affected by TST and did not mediate the effects of SR on BP. CONCLUSIONS These results suggest that SR influences CVD risk in women via mechanisms independent of psychological stressors.
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Affiliation(s)
- Marie-Pierre St-Onge
- Sleep center of excellence, Department of Medicine, Columbia University Irving Medical Center, New York, NY; Institute of Human Nutrition, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY.
| | - Ayanna Campbell
- Sleep center of excellence, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Brooke Aggarwal
- Sleep center of excellence, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jasmine L Taylor
- Institute of Human Nutrition, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Tulane Medical Center, New Orleans, LA
| | - Tanya M Spruill
- Department of Population Health, NYU School of Medicine, New York, NY
| | - Arindam RoyChoudhury
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY
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105
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Abstract
Unhealthy diet, lack of exercise, psychosocial stress, and insufficient sleep are increasingly prevalent modifiable risk factors for cardiovascular disease. Accumulating evidence indicates that these risk factors may fuel chronic inflammatory processes that are active in atherosclerosis and lead to myocardial infarction and stroke. In concert with hyperlipidemia, maladaptive immune system activities can contribute to disease progression and increase the probability of adverse events. In this review, we discuss recent insight into how the above modifiable risk factors influence innate immunity. Specifically, we focus on pathways that raise systemic myeloid cell numbers and modulate immune cell phenotypes, reviewing hematopoiesis, leukocyte trafficking, and innate immune cell accumulation in cardiovascular organs. Often, relevant mechanisms that begin with lifestyle choices and lead to cardiovascular events span multiple organ systems, including the central nervous, endocrine, metabolic, hematopoietic, immune and, finally, the cardiovascular system. We argue that deciphering such pathways provides not only support for preventive interventions but also opportunities to develop biomimetic immunomodulatory therapeutics that mitigate cardiovascular inflammation.
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Affiliation(s)
- Maximilian J Schloss
- From the Center for Systems Biology, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston (M.J.S., F.K.S., M.N.).,Department of Radiology, Massachusetts General Hospital, Boston (M.J.S., F.K.S., M.N.)
| | - Filip K Swirski
- From the Center for Systems Biology, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston (M.J.S., F.K.S., M.N.).,Department of Radiology, Massachusetts General Hospital, Boston (M.J.S., F.K.S., M.N.)
| | - Matthias Nahrendorf
- From the Center for Systems Biology, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston (M.J.S., F.K.S., M.N.).,Department of Radiology, Massachusetts General Hospital, Boston (M.J.S., F.K.S., M.N.).,Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (M.N.).,Department of Internal Medicine I, University Hospital Wuerzburg, Germany (M.N.)
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106
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Fortunato M, Adusumalli S, Chokshi N, Harrison J, Rareshide C, Patel M. Usability of Wearable Devices to Remotely Monitor Sleep Patterns Among Patients With Ischemic Heart Disease: Observational Study. JMIR Form Res 2020; 4:e14508. [PMID: 32254044 PMCID: PMC7175186 DOI: 10.2196/14508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 01/20/2020] [Accepted: 02/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background There is growing interest in using wearable devices to remotely monitor patient behaviors. However, there has been little evaluation of how often these technologies are used to monitor sleep patterns over longer term periods, particularly among more high-risk patients. Objective The goal of the research was to evaluate the proportion of time that patients with ischemic heart disease used wearable devices to monitor their sleep and identify differences in characteristics of patients with higher versus lower use. Methods We evaluated wearable device data from a previously conducted clinical trial testing the use of wearable devices with personalized goal-setting and financial incentives. Patients with ischemic heart disease established a sleep baseline and were then followed for 24 weeks. The proportion of days that sleep data was collected was compared over the 24 weeks and by study arm. Characteristics of patients were compared to groups with high, low, or no sleep data. Results The sample comprised 99 patients with ischemic heart disease, among which 79% (78/99) used the wearable device to track their sleep. During the 6-month trial, sleep data were collected on 60% (10,024/16,632) of patient-days. These rates declined over time from 77% (4292/5544) in months 1 and 2 to 58% (3188/5544) in months 3 and 4 to 46% (2544/5544) in months 5 and 6. Sleep data were collected at higher rates among the intervention group compared with control (67% vs 55%, P<.001). In the main intervention period (months 3 and 4), patients with higher rates of sleep data were on average older (P=.03), had a history of smoking (P=.007), and had higher rates of commercial health insurance (P=.03). Conclusions Among patients with ischemic heart disease in a physical activity trial, a high proportion used wearable devices to track their sleep; however, rates declined over time. Future research should consider larger evaluations coupled with behavioral interventions. Trial Registration ClinicalTrials.gov NCT02531022; https://clinicaltrials.gov/ct2/show/NCT02531022
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Affiliation(s)
- Michael Fortunato
- Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Srinath Adusumalli
- Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Neel Chokshi
- Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Joseph Harrison
- Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Charles Rareshide
- Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Mitesh Patel
- Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States.,University of Pennsylvania, Philadelphia, PA, United States
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107
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Xie M, Tang Q, Nie J, Zhang C, Zhou X, Yu S, Sun J, Cheng X, Dong N, Hu Y, Chen L. BMAL1-Downregulation Aggravates Porphyromonas Gingivalis-Induced Atherosclerosis by Encouraging Oxidative Stress. Circ Res 2020; 126:e15-e29. [PMID: 32078488 DOI: 10.1161/circresaha.119.315502] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
RATIONALE Atherosclerotic cardiovascular diseases are the leading cause of mortality worldwide. Atherosclerotic cardiovascular diseases are considered as chronic inflammation processes. In addition to risk factors associated with the cardiovascular system itself, pathogenic bacteria such as the periodontitis-associated Porphyromonas gingivalis (P gingivalis) are also closely correlated with the development of atherosclerosis, but the underlying mechanisms are still elusive. OBJECTIVE To elucidate the mechanisms of P gingivalis-accelerated atherosclerosis and explore novel therapeutic strategies of atherosclerotic cardiovascular diseases. METHODS AND RESULTS Bmal1-/- (brain and muscle Arnt-like protein 1) mice, ApoE-/- mice, Bmal1-/-ApoE-/- mice, conditional endothelial cell Bmal1 knockout mice (Bmal1fl/fl; Tek-Cre mice), and the corresponding jet-legged mouse model were used. Pgingivalis accelerates atherosclerosis progression by triggering arterial oxidative stress and inflammatory responses in ApoE-/- mice, accompanied by the perturbed circadian clock. Circadian clock disruption boosts P gingivalis-induced atherosclerosis progression. The mechanistic dissection shows that P gingivalis infection activates the TLRs-NF-κB signaling axis, which subsequently recruits DNMT-1 to methylate the BMAL1 promoter and thus suppresses BMAL1 transcription. The downregulation of BMAL1 releases CLOCK, which phosphorylates p65 and further enhances NF-κB signaling, elevating oxidative stress and inflammatory response in human aortic endothelial cells. Besides, the mouse model exhibits that joint administration of metronidazole and melatonin serves as an effective strategy for treating atherosclerotic cardiovascular diseases. CONCLUSIONS P gingivalis accelerates atherosclerosis via the NF-κB-BMAL1-NF-κB signaling loop. Melatonin and metronidazole are promising auxiliary medications toward atherosclerotic cardiovascular diseases.
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Affiliation(s)
- Mengru Xie
- From the Department of Stomatology (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.)
| | - Qingming Tang
- From the Department of Stomatology (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.)
| | - Jiaming Nie
- From the Department of Stomatology (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.)
| | - Chao Zhang
- Department of Cardiovascular Surgery (C.Z., N.D.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Zhou
- From the Department of Stomatology (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.)
| | - Shaoling Yu
- From the Department of Stomatology (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.)
| | - Jiwei Sun
- From the Department of Stomatology (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.)
| | - Xiang Cheng
- Department of Cardiology (X.C.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery (C.Z., N.D.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology (Y.H.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lili Chen
- From the Department of Stomatology (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China (M.X., Q.T., J.N., X.Z., S.Y., J.S., L.C.)
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108
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Mayat Z, Giardina EGV, Liao M, Aggarwal B. Associations of Inflammation, Physical Activity, and Sleep in a Diverse Population of Women. J Womens Health (Larchmt) 2020; 29:1007-1016. [PMID: 32175800 DOI: 10.1089/jwh.2019.7663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of mortality in United States with a recent rise seen in young adults, particularly women. Systemic inflammation, physical activity, and sleep are each individually linked to CVD risk. Whether there is an interaction of these variables, however, is unclear. We evaluated physical activity and sleep among racially ethnically diverse women, ages 20-79 years, to assess associations with systemic inflammation. Methods: We performed a cross-sectional study of 506 women (61% racial/ethnic minority; mean (standard deviation [SD]) age = 37 [15.7] years, body mass index 26.0 [5.7] kg/m2) enrolled in the American Heart Association (AHA) Go Red for Women Strategically Focused Research Network at Columbia University Irving Medical Center (CUIMC). Inflammation, assessed by C-reactive protein (CRP), was analyzed in the Biomarkers Core Laboratory at CUIMC. Physical activity and sleep were assessed using validated questionnaires. Multivariable models adjusted for demographic and clinical confounders were used to evaluate associations between CRP, physical activity, and sleep. Results: Mean (SD) physical activity was 282 (557.2) minutes/week, and mean (SD) sleep duration was 6.75 (1.24) hours/night. Mean CRP was 2.08 (3.56), and 17% of participants were categorized as high risk for obstructive sleep apnea (OSA). Participants who slept <6 hours/night were less likely to be physically active ≥150 minutes/week (odds ratios, ORs [95% confidence interval, CI]: 0.53 [0.33-0.84]). This association was nonsignificant after adjustment. High risk of OSA was associated with CRP ≥2 mg/L (OR [95% CI]: 1.91 [1.11-3.30]) following adjustment. Stratification by race/ethnicity showed that high risk of OSA was associated with CRP ≥2 mg/L among racial/ethnic minorities but not white women (OR [95% CI]: 2.75 [1.43-5.30] vs. 0.94 [0.31-2.88]). Conclusion: High risk of OSA and elevated CRP was significantly associated in women, particularly minority women. Both play a role in CVD, highlighting potential causes for the increased risk of CVD in younger women.
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Affiliation(s)
- Zara Mayat
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Elsa-Grace V Giardina
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ming Liao
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Brooke Aggarwal
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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109
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Liao LZ, Li WD, Liu Y, Li JP, Zhuang XD, Liao XX. Causal assessment of sleep on coronary heart disease. Sleep Med 2020; 67:232-236. [DOI: 10.1016/j.sleep.2019.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/19/2019] [Accepted: 08/05/2019] [Indexed: 12/23/2022]
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110
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Chen HG, Sun B, Chen YJ, Chavarro JE, Hu SH, Xiong CL, Pan A, Meng TQ, Wang YX, Messerlian C. Sleep duration and quality in relation to semen quality in healthy men screened as potential sperm donors. ENVIRONMENT INTERNATIONAL 2020; 135:105368. [PMID: 31830732 DOI: 10.1016/j.envint.2019.105368] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Short sleep duration and poor sleep quality are increasingly prevalent in modern society and may be associated with impaired semen quality, yet studies are inconclusive. OBJECTIVES To investigate the reproducibility of semen quality parameters among 842 healthy men screened as potential sperm donors and explore the associations of sleep duration and quality with repeated measures of semen quality parameters. METHODS We assessed sleep duration (night sleep and daytime napping) and sleep quality using the Pittsburgh Sleep Quality Index (PSQI) among 842 healthy men screen as potential sperm donors. We examined sleep characteristics in relation to repeated measurements (n = 5601) of semen parameters using linear mixed-effects models. RESULTS High degrees of within-individual variability were found for total and progressive sperm motility with intraclass correlation coefficient (ICC) of 0.20 and 0.22, respectively; while fair-to-good reproducibilities were observed for sperm volume, concentration, and total count (ICC = 0.54, 0.62, and 0.50, respectively). Compared to men with total sleep duration of 8.0-8.5 h/day (h/d), men who slept less than 6.0 h/d and higher than 9.0 h/d had lower sperm volume of 12% [95% confidence interval (CI): -22%, -0.68%] and 3.9% (95% CI: -7.3%, -0.44%), respectively. Compared to men with night sleep duration of 7.5-8.0 h/d, men who slept less than 6.0 h/d had lower total and progressive sperm motility of 4.4% (95 CI:-8.4%, -0.24%) and 5.0% (95% CI: -9.2%, -0.48%), respectively. Compared to men who reported good sleep quality (total PSQI score ≤5.0), those reporting poor sleep quality (total PSQI score >5.0) had lower total sperm count, total motility, and progressive motility of 8.0% (95% CI: -15%, -0.046%), 3.9% (95% CI: -6.2%, -1.5%), and 4.0% (95% CI: -6.5%, -1.4%), respectively. CONCLUSIONS Both long and short sleep duration and poor sleep quality were associated with impaired semen quality parameters. The high within-individual variability of total and progressive sperm motility suggests that a single measurement may result in a moderate degree of classification error.
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Affiliation(s)
- Heng-Gui Chen
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Bin Sun
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Ying-Jun Chen
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Si-Heng Hu
- Center for Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Hubei Province Human Sperm Bank, Wuhan, Hubei, PR China
| | - Cheng-Liang Xiong
- Center for Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Hubei Province Human Sperm Bank, Wuhan, Hubei, PR China
| | - An Pan
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Tian-Qing Meng
- Center for Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Hubei Province Human Sperm Bank, Wuhan, Hubei, PR China.
| | - Yi-Xin Wang
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Carmen Messerlian
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4698] [Impact Index Per Article: 1174.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Kwon Y, Logan J, Pusalavidyasagar S, Kasai T, Cheong CS, Lee CH. Sleep Apnea and Heart. SLEEP MEDICINE RESEARCH 2019; 10:67-74. [PMID: 32699652 DOI: 10.17241/smr.2019.00493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Scientific investigations in the past few decades have supported the important role of sleep in various domains of health. Sleep apnea is a highly prevalent yet underdiagnosed sleep disorder representing a valid cardiovascular risk factor, particularly for hypertension. While several studies have demonstrated the benefits of sleep apnea treatment on subclinical cardiovascular measures, there is a paucity of studies proving reduction of cardiovascular events and mortality. Sufficient and high-quality sleep is also important in the maintenance of cardiovascular health. Future investigations should focus on improving identification of patients at greatest risk of adverse cardiovascular s sequalae of sleep apnea and testing the therapeutic benefit of sleep apnea treatment in this vulnerable group.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Virginia, Charlottesville, VA 22908 USA
| | - Jeongok Logan
- University of Virginia School of Nursing, Charlottesville, VA 22908 USA
| | | | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, 113-8421, Japan
| | - Crystal Sj Cheong
- Department of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre, Singapore
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113
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Van Craenenbroeck EM. Sleep deprivation and increased cardiovascular risk: A wake-up call! Eur J Prev Cardiol 2019; 28:187-188. [PMID: 33611502 DOI: 10.1177/2047487319890765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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114
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Gottlieb DJ, Bhatt DL. More Evidence That We Could All Use a Good Night's Sleep. J Am Coll Cardiol 2019; 73:145-147. [PMID: 30654885 DOI: 10.1016/j.jacc.2018.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel J Gottlieb
- VA Boston Healthcare System, Boston, Massachusetts; Brigham and Women's Hospital Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. https://twitter.com/DLBhattMD
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Spiesshoefer J, Linz D, Skobel E, Arzt M, Stadler S, Schoebel C, Fietze I, Penzel T, Sinha AM, Fox H, Oldenburg O. Sleep – the yet underappreciated player in cardiovascular diseases: A clinical review from the German Cardiac Society Working Group on Sleep Disordered Breathing. Eur J Prev Cardiol 2019; 28:189-200. [PMID: 33611525 DOI: 10.1177/2047487319879526] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022]
Abstract
Abstract
Patients with a wide variety of cardiovascular diseases, including arterial and pulmonary hypertension, arrhythmia, coronary artery disease and heart failure, are more likely to report impaired sleep with reduced sleep duration and quality, and also, sometimes, sleep interruptions because of paroxysmal nocturnal dyspnoea or arrhythmias. Overall, objective short sleep and bad sleep quality (non-restorative sleep) and subjective long sleep duration are clearly associated with major cardiovascular diseases and fatal cardiovascular outcomes. Sleep apnoea, either obstructive or central in origin, represents the most prevalent, but only one, of many sleep-related disorders in cardiovascular patients. However, observations suggest a bidirectional relationship between sleep and cardiovascular diseases that may go beyond what can be explained based on concomitant sleep-related disorders as confounding factors. This makes sleep itself a modifiable treatment target. Therefore, this article reviews the available literature on the association of sleep with cardiovascular diseases, and discusses potential pathophysiological mechanisms. In addition, important limitations of the current assessment, quantification and interpretation of sleep in patients with cardiovascular disease, along with a discussion of suitable study designs to address future research questions and clinical implications are highlighted. There are only a few randomised controlled interventional outcome trials in this field, and some of the largest studies have failed to demonstrate improved survival with treatment (with worse outcomes in some cases). In contrast, some recent pilot studies have shown a benefit of treatment in selected patients with underlying cardiovascular diseases.
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Affiliation(s)
- Jens Spiesshoefer
- Institute of Life Sciences, Scuola Superiore Sant Anna, Pisa, Italy
- Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
| | - Dominik Linz
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Erik Skobel
- Medical Care Unit Pneumology, Sleep Medicine, Allergology and Cardiology, Luisenhospital Aachen, Aachen, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Stadler
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Christoph Schoebel
- Interdisciplinary Sleep Medicine Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Ludgerus-Kliniken Münster, Clemenshospital, Department of Cardiology, Münster, Germany
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Dietary Interventions for Night Shift Workers: A Literature Review. Nutrients 2019; 11:nu11102276. [PMID: 31547547 PMCID: PMC6836085 DOI: 10.3390/nu11102276] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 12/21/2022] Open
Abstract
(1) Background: Night shift workers have greater risks of developing cardiometabolic diseases compared to day workers due to poor sleep quality and dietary habits, exacerbated by circadian misalignment. Assessing effects of dietary interventions on health outcomes among this group will highlight gaps for future research. (2) Methods: A search of studies was conducted on PubMed, Cochrane Library, Embase, Embase Classic, Ovid Emcare, and Google Scholar, from earliest to June 2019. The population-intervention-comparator-outcomes-study design format determined inclusion criteria. (3) Results: 756 articles were retrieved; five met inclusion and exclusion criteria. Six-hundred-and-seventy night shift workers were from healthcare, industrial, and public safety industries. Dietary interventions included two longer-term nutrition programs and three shorter-term adjustments of meal composition, type, and timing. Outcome measures were varied but included weight and cardiometabolic health measures. Nutrition programs found no weight improvement at both six and 12 months; low-density lipoprotein (LDL)-cholesterol levels decreased at six months. Triglycerides peaked after meals at 7:30 pm; glucose and insulin area under the curve peaked after meals at 11:30 pm. (4) Conclusions: Weight loss was not achieved in the studies reviewed but LDL-cholesterol improved. Future studies should investigate the effects of energy reduction and altering meal timing on cardiometabolic risk factors of night shift workers in randomised controlled trials, while assessing hunger, sleepiness, and performance.
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Meta-Analysis of Relation of Skipping Breakfast With Heart Disease. Am J Cardiol 2019; 124:978-986. [PMID: 31326073 DOI: 10.1016/j.amjcard.2019.06.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 12/15/2022]
Abstract
To determine whether skipping breakfast is associated with heart disease, the first meta-analysis of currently available epidemiological studies was performed. To identify case-control, cross-sectional, longitudinal, or cohort studies investigating the association of skipping breakfast with prevalence, incidence, or mortality of heart disease in adults, PubMed, and Web of Science were searched through April 2019. Adjusted (if unavailable, unadjusted) hazard ratios (HRs) or odds ratios (ORs) with their confidence interval (CIs) of prevalence, incidence, or mortality for skipping breakfast were extracted from each study. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic HRs/ORs in the random-effects model. Eight eligible studies with a total of 284,484 participants were identified and included in the present meta-analysis. The primary meta-analysis combining HRs for Q1 (first quartile, most skipping breakfast) versus Q4 (fourth quartile, least skipping breakfast) from 3 studies together with other HRs/ORs demonstrated that skipping breakfast was associated with the significantly increased risk of heart disease (pooled HR/OR 1.24; 95% CI 1.09 to 1.40; p = 0.001). In sensitivity analyses combining HRs for Q2 (second quartile, second most skipping breakfast) versus Q4 or HRs for Q3 (third quartile, second least skipping breakfast) versus Q4 from 3 studies together with other HRs/ORs, the association of skipping breakfast with the increased risk of heart disease in the primary meta-analysis was confirmed. In conclusion, skipping breakfast is associated with the increased risk of heart disease.
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118
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Herbal medicine for insomnia in elderly with hypertension: A systematic review and meta-analysis. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.100961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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119
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Mediano O, Sánchez-de-la-Torre M, García-Río F. The role of sleep disorders breathing treatment as a modifiable condition for cardiovascular risk associated hypertension. Eur Heart J 2019; 40:3207. [DOI: 10.1093/eurheartj/ehz602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Olga Mediano
- Sleep Unit, Department of Pneumology, Hospital Universitario de Guadalajara, Avda. Donantes de Sangre s/n, Guadalajara, Spain
- Department of Medicine, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel Sánchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Francisco García-Río
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Department of Pneumology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
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Abstract
Atherosclerotic cardiovascular disease is a leading cause of death and morbidity globally. Over the past several years, arterial inflammation has been implicated in the pathophysiology of athero-thrombosis, substantially confirming what pathologist Rudolf Virchow had observed in the 19th century. Lipid lowering, lifestyle changes, and modification of other risk factors have reduced cardiovascular complications of athero-thrombosis, but a substantial residual risk remains. In view of the pathogenic role of inflammation in athero-thrombosis, directly targeting inflammation has emerged as an additional potential therapeutic option; and some early promising results have been suggested by the Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS), in which canakinumab, a fully human monoclonal antibody targeting the pro-inflammatory and pro-atherogenic cytokine interleukin 1 beta, was shown to reduce cardiovascular events.
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Affiliation(s)
- Prediman K Shah
- Helga and Walter Oppenheimer Atherosclerosis Research Center, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Dalgisio Lecis
- Helga and Walter Oppenheimer Atherosclerosis Research Center, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.,Department of Cardiovascular Medicine, "Tor Vergata" University of Rome, Rome, Italy
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121
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Cho KH, Lee DH, Kim KM, Choi YH, Nam HS, Heo JH, Heo K, Kim YD. Relationship Between Sleep Apnea and Coronary Artery Calcium in Patients With Ischemic Stroke. Front Neurol 2019; 10:819. [PMID: 31417490 PMCID: PMC6684953 DOI: 10.3389/fneur.2019.00819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
Study Objectives: Coronary artery disease is considered to be the major cause of death amongst patients with ischemic stroke. The coronary artery calcium (CAC) score is related not only to sleep-disordered breathing, but also with future risk of cardiovascular mortality. We investigated the association between the severity of sleep-disordered breathing and CAC score in patients with ischemic stroke. Methods: We included 32 patients who underwent coronary multichannel computed tomography and polysomnography (within 2 years of the stroke event) amongst the patients admitted to our clinic due to acute ischemic stroke. We investigated vascular risk factors, polysomnography findings, and sleep questionnaire scores, and their relationships with the CAC score. Results: All patients were found to have sleep apnea of any degree, and 23 (72%) had severe sleep apnea. Twenty-three (72%) patients had a positive CAC score. Higher CAC scores were associated with elevated respiratory disturbance index (RDI), apnea index, oxygen desaturation index, and STOP-BANG test scores. Multivariate analysis after adjusting for potential confounding factors revealed independent relationships between the CAC score and the RDI (ß [SE] = 5.3 [2.1], p = 0.01), oxygen desaturation index (ß [SE] = 6.8 [2.8], p = 0.02), and STOP-BANG test score (ß [SE] = 90.3 [37.7], p = 0.02). Conclusion: Our findings indicate a relationship between coronary atherosclerotic burden measured by the CAC score and the severity of sleep apnea. Performing polysomnography could be useful for investigating the severity of hidden coronary artery disease among these patients.
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Affiliation(s)
- Kyoo Ho Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Ho Choi
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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122
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Sapiña-Beltrán E, Torres G, Benítez I, Santamaría-Martos F, Durán-Cantolla J, Egea C, Sánchez-de-la-Torre M, Barbé F, Dalmases M. Differential blood pressure response to continuous positive airway pressure treatment according to the circadian pattern in hypertensive patients with obstructive sleep apnoea. Eur Respir J 2019; 54:13993003.00098-2019. [PMID: 31097515 DOI: 10.1183/13993003.00098-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/21/2019] [Indexed: 01/08/2023]
Abstract
Continuous positive airway pressure (CPAP) has a heterogeneous effect on blood pressure (BP) in hypertensive patients. However, the effect of CPAP on BP in hypertensive subjects regarding circadian BP pattern has never been explored. This study aimed to assess the effect of CPAP on BP, taking into consideration the circadian BP pattern in untreated hypertensive patients.This study is a post hoc analysis of the Spanish Cohort for the Study of the Effect of CPAP in Hypertension (CEPECTA), a multicentre, randomised trial of CPAP versus sham-CPAP in patients with new-onset systemic hypertension and an apnoea-hypopnoea index >15 events·h-1 We included patients for whom 24-h ambulatory BP monitoring (ABPM) data were available at baseline and 12 weeks after the intervention. Subjects were classified based on the dipping ratio (dipper/non-dipper). We evaluated the effect of CPAP on ABPM parameters after 12 weeks of treatment.Overall, 272 hypertensive subjects were included in the analysis (113 dippers and 159 non-dippers). Baseline clinical and polysomnographic variables were similar between the groups. CPAP treatment in non-dipper patients was associated with reductions in 24-h ambulatory BP variables and night-time ambulatory BP measurements. However, a nonsignificant effect was reported in the dipper group. The differential effects of CPAP between the groups were -2.99 mmHg (95% CI -5.92-- -0.06 mmHg) for the mean 24-h ambulatory BP and -5.35 mmHg (95% CI -9.01- -1.69 mmHg) for the mean night-time ambulatory BP.Our results show a differential effect of CPAP treatment on BP in hypertensive patients depending on the circadian pattern. Only non-dipper patients benefited from CPAP treatment in terms of BP reduction.
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Affiliation(s)
- Esther Sapiña-Beltrán
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gerard Torres
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain
| | - Iván Benítez
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Fernando Santamaría-Martos
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain
| | - Joaquín Durán-Cantolla
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Bioaraba Research Institute, OSI Araba University Hospital, Dept of Medicine of Basque Country University, Vitoria-Gasteiz, Spain
| | - Carlos Egea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Unidad Funcional de Sueño, Bioaraba Research Institute, OSI Araba University Hospital, Dept of Medicine of Basque Country University, Vitoria-Gasteiz, Spain
| | - Manuel Sánchez-de-la-Torre
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferrán Barbé
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Mireia Dalmases
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain .,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Ibáñez B, Fernández-Alvira JM. Breakfast Is a Marker for Cardiovascular Risk Prediction. J Am Coll Cardiol 2019; 73:2033-2035. [DOI: 10.1016/j.jacc.2019.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 02/01/2023]
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Off the Clock: From Circadian Disruption to Metabolic Disease. Int J Mol Sci 2019; 20:ijms20071597. [PMID: 30935034 PMCID: PMC6480015 DOI: 10.3390/ijms20071597] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/20/2019] [Accepted: 03/27/2019] [Indexed: 12/18/2022] Open
Abstract
Circadian timekeeping allows appropriate temporal regulation of an organism’s internal metabolism to anticipate and respond to recurrent daily changes in the environment. Evidence from animal genetic models and from humans under circadian misalignment (such as shift work or jet lag) shows that disruption of circadian rhythms contributes to the development of obesity and metabolic disease. Inappropriate timing of food intake and high-fat feeding also lead to disruptions of the temporal coordination of metabolism and physiology and subsequently promote its pathogenesis. This review illustrates the impact of genetically or environmentally induced molecular clock disruption (at the level of the brain and peripheral tissues) and the interplay between the circadian system and metabolic processes. Here, we discuss some mechanisms responsible for diet-induced circadian desynchrony and consider the impact of nutritional cues in inter-organ communication, with a particular focus on the communication between peripheral organs and brain. Finally, we discuss the relay of environmental information by signal-dependent transcription factors to adjust the timing of gene oscillations. Collectively, a better knowledge of the mechanisms by which the circadian clock function can be compromised will lead to novel preventive and therapeutic strategies for obesity and other metabolic disorders arising from circadian desynchrony.
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125
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Sleep, Autonomic Nervous Function and Atherosclerosis. Int J Mol Sci 2019; 20:ijms20040794. [PMID: 30781734 PMCID: PMC6412503 DOI: 10.3390/ijms20040794] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 12/12/2022] Open
Abstract
Behavioral and psychosocial factors related to development of cardiovascular disease have been gaining increased attention. Notably, sleep is considered to be one of the most important behavioral factors involved in progression of atherosclerosis and cardiovascular events, with autonomic nervous function a potential mechanism. Several studies have shown associations of sleep and autonomic dysfunction with major surrogate markers of atherosclerosis, such as carotid intima-media thickness and arterial stiffness. Endocrinological, immunological, oxidative, inflammatory, and metabolic responses, as well as endothelial dysfunction may mediate the effects of the autonomic nervous system. For this review, we examined recent findings related to sleep, autonomic nervous dysfunction, and atherosclerosis, with the aim of understanding the involved pathophysiological mechanisms.
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