Abstract 19828: Sleep Duration Modifies the Effect of Race on Major Adverse Cardiovascular Events in Post Acute Coronary Syndrome Patients
Introduction: Black–White racial disparities in cardiovascular disease (CVD) risk and sleep duration are well documented. While short sleep duration is a risk factor for incident CVD, its association with CVD prognosis, and modifying effect on racial differences in CVD, are less well established.
Hypothesis: Black race would be associated with increased risk for recurrent CVD events. Blacks with short sleep would exhibit greatest risk for recurrent CVD events than their racial and sleep duration counterparts.
Methods: Acute coronary syndrome (ACS) patients who identified as Black or White were enrolled in-hospital into a single site-prospective, observational cohort (n=722) during 2009-2012 and followed for 1 year. Self-reported average nightly sleep duration at 1-month post ACS was measured with the Pittsburgh Sleep Quality Index, and categorized as short (< 7 hours) vs. average sleep ( ≥7 hours). The composite 1-year outcome of recurrent major adverse cardiovascular events (MACE) included myocardial infarction, urgent unstable angina, and all-cause mortality. Hazard ratios (HR) and 95% confidence intervals (CI) for MACE were estimated with sleep duration and race as the primary predictors and adjustments for age, sex, race, ethnicity, BMI, education, Charlson comorbidity index and GRACE risk score. Cross products (race*sleep duration) were entered into the final model to test for effect modification.
Results: Over 1-year follow-up, there were 62 recurrent MACE events. Black race relative to White race was associated with increased risk of MACE in multivariable unadjusted and adjusted models (adjusted HR: 2.31, 95% CI 1.32-4.05). There was a significant race*sleep duration interaction (p =0.023). Black patients who slept < 7 hours/night 1-month post-ACS had a higher risk for MACE than White patients who slept < 7 hours/night (HR 3.85, 95% CI 1.82-8.17). Black race was not associated with risk of MACE among patients who slept ≥7 hours/night (HR 1.05, 95% CI 0.38-2.85).
Conclusion: Racial disparities in risk for recurrent CVD events were only observed among those who reported short sleep (< 7 hours/night) 1-month post ACS. Further research is needed to understand the psycho-physiological mechanisms linking short sleep duration to CVD disparities.
Author Disclosures: L. Oyesiku: None. K.M. Diaz: None. E. Denton: None. S. Ye: None. E. McGlinchey: None. K.W. Davidson: None. C. Alcantara: None.
- © 2016 by American Heart Association, Inc.