The Circadian Syndrome Is a Significant and Stronger Predictor for Cardiovascular Disease than the Metabolic Syndrome—The NHANES Survey during 2005–2016
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Sample
2.2. Exposure measures: Metabolic Syndrome and Circadian Syndrome
2.3. Outcome Measure: Self-Reported History of CVD and CVD Mortality
2.4. Covariates
2.5. Statistical Analyses
3. Results
4. Discussion
Comparison with Other Studies
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Measure | Categorical Cut Points | Included in MetS * | Included in CircS |
---|---|---|---|
Elevated waist circumference | ≥102 cm in men, ≥88 in women | √ | √ |
Elevated triglycerides (drug treatment for elevated triglycerides is an alternate indicator) | ≥150 mg/dL (1.7 mmol/L) | √ | √ |
Low HDL-C (drug treatment for reduced HDL-C is an alternate indicator) | <40 mg/dL (1.0 mmol/L) in men; <50 mg/dL (1.3 mmol/L) in women | √ | √ |
Elevated blood pressure (antihypertensive drug treatment in a patient with a history of hypertension is an alternate indicator) | Systolic ≥130 mm Hg and/or diastolic ≥85 mm Hg | √ | √ |
Elevated fasting glucose (drug treatment of elevated glucose is an alternate indicator) | ≥100 mg/dL | √ | √ |
Short sleep | ≤6 h/day | √ | |
Depression symptom | PHQ-9 score ≥5 | √ | |
Definition criteria | ≥3 components | ≥4 components |
Total | Normal | CircS Alone | MetS Alone | MetS and CircS | p-Value * | |
---|---|---|---|---|---|---|
n = 12,156 | n = 6060 (49.9%) | n = 259 (2.1%) | n = 1131 (9.3%) | n = 4706 (38.7%) | ||
Age (years) (mean, SD) | 49.8 (17.7) | 42.5 (16.6) | 47.6 (15.8) | 54.0 (16.6) | 58.3 (15.1) | <0.001 |
Age (years) | <0.001 | |||||
20–39 | 32.6% | 49.4% | 34.0% | 22.4% | 13.4% | |
40–59 | 33.6% | 32.4% | 41.7% | 35.5% | 34.1% | |
60+ | 33.8% | 18.2% | 24.3% | 42.1% | 52.5% | |
Sex | <0.001 | |||||
Men | 50.3% | 50.8% | 43.6% | 55.1% | 48.9% | |
Women | 49.7% | 49.2% | 56.4% | 44.9% | 51.1% | |
Education | <0.001 | |||||
<11 grade | 25.3% | 21.4% | 33.2% | 24.6% | 30.1% | |
High school | 22.9% | 21.1% | 25.5% | 24.0% | 24.7% | |
Some college | 28.6% | 28.9% | 26.3% | 28.0% | 28.6% | |
Higher than college | 23.2% | 28.6% | 15.1% | 23.3% | 16.7% | |
Race | <0.001 | |||||
Non-Hispanic White | 45.6% | 43.4% | 35.9% | 49.7% | 48.0% | |
Non-Hispanic Black | 19.4% | 19.6% | 30.1% | 15.2% | 19.6% | |
Mexican American/Hispanic | 15.7% | 15.9% | 15.8% | 17.0% | 15.2% | |
Others | 19.3% | 21.1% | 18.1% | 18.1% | 17.3% | |
Income to poverty ratio | <0.001 | |||||
<1.30 | 31.2% | 29.5% | 43.9% | 27.3% | 33.7% | |
1.3–3.5 | 37.8% | 37.1% | 34.3% | 37.1% | 39.2% | |
>3.5 | 31.0% | 33.5% | 21.8% | 35.6% | 27.1% | |
Smoking | <0.001 | |||||
Never | 53.8% | 58.1% | 49.8% | 53.3% | 48.5% | |
Former | 25.1% | 20.1% | 15.8% | 30.1% | 30.9% | |
Current smoker | 21.1% | 21.8% | 34.4% | 16.6% | 20.5% | |
Drinking | <0.001 | |||||
No | 18.0% | 12.9% | 22.8% | 17.9% | 24.5% | |
Yes | 68.0% | 74.6% | 64.1% | 67.9% | 59.8% | |
Missing | 13.9% | 12.5% | 13.1% | 14.1% | 15.7% | |
Physical activity (METs minutes/week) | <0.001 | |||||
<600 | 39.6% | 32.3% | 43.8% | 40.2% | 48.7% | |
600–1200 | 11.4% | 11.4% | 12.0% | 12.5% | 11.2% | |
≥1200 | 49.0% | 56.3% | 44.2% | 47.3% | 40.1% | |
BMI (kg/m2) (mean, SD) | 29.0 (6.7) | 26.3 (5.5) | 29.8 (7.0) | 30.3 (6.1) | 32.0 (6.8) | <0.001 |
CVD | 10.9% | 3.5% | 9.3% | 8.8% | 21.0% | <0.001 |
Hypertension | 36.3% | 13.0% | 32.4% | 42.1% | 65.1% | <0.001 |
Central obesity | 56.5% | 32.4% | 64.1% | 69.6% | 84.0% | <0.001 |
Elevated glucose | 53.3% | 28.0% | 40.2% | 68.7% | 83.0% | <0.001 |
Elevated triglycerides | 42.1% | 10.0% | 21.2% | 49.8% | 82.8% | <0.001 |
Elevated blood pressure | 48.6% | 22.4% | 47.9% | 59.9% | 79.7% | <0.001 |
Reduced HDL-C | 44.4% | 13.3% | 26.6% | 52.1% | 83.6% | <0.001 |
Depression symptoms | 23.5% | 17.0% | 100.0% | 0.0% | 33.4% | <0.001 |
Sleep ≤ 6 h/day | 35.2% | 32.2% | 100.0% | 0.0% | 44.0% | <0.001 |
Circadian syndrome | 40.8% | 0.0% | 100.0% | 0.0% | 100.0% | <0.001 |
Metabolic syndrome | 48.0% | 0.0% | 0.0% | 100.0% | 100.0% | <0.001 |
Died during follow-up | 11.3% | 6.7% | 10.0% | 13.0% | 17.0% | <0.001 |
Died from CVD during follow-up | 3.5% | 1.8% | 2.7% | 4.3% | 5.7% | <0.001 |
MetS | CircS | ||||
---|---|---|---|---|---|
Per one of MetS components (continuous) | MetS (yes vs. no) | Per one of CircS components (continuous) | CircS (yes vs. no) | ||
Prevalent CVD | |||||
Men (n = 6113) | |||||
Model 1 * | 1.54 (1.39–1.71) | 3.20 (2.38–4.30) | 1.53 (1.41–1.66) | 3.01 (2.28–3.97) | |
Model 2 † | 1.56 (1.40–1.72) | 3.20 (2.38–4.30) | 1.51 (1.39–1.64) | 2.92 (2.21–3.86) | |
Women (n = 6043) | |||||
Model 1 * | 1.57 (1.43–1.72) | 3.62 (2.55–5.14) | 1.59 (1.47–1.71) | 4.02 (2.87–5.63) | |
Model 2 † | 1.49 (1.36–1.64) | 3.04 (2.15–4.30) | 1.50 (1.39–1.63) | 3.27 (2.34–4.59) | |
CVD mortality | |||||
Men (n = 6108) | |||||
Model 1 * | 1.11 (0.99–1.25) | 1.20 (0.81–1.77) | 1.16 (1.04–1.29) | 1.32 (0.93–1.88) | |
Model 2 † | 1.10 (0.97–1.24) | 1.14 (0.77–1.71) | 1.12 (1.00–1.25) | 1.20 (0.85–1.70) | |
Women (n = 6041) | |||||
Model 1 * | 1.16 (1.05–1.27) | 1.52 (1.07–2.15) | 1.23 (1.12–1.36) | 1.76 (1.30–2.38) | |
Model 2 † | 1.12 (1.00–1.25) | 1.36 (0.93–1.99) | 1.19 (1.07–1.33) | 1.55 (1.12–2.13) |
Health Status | |||||
---|---|---|---|---|---|
Normal | CircS alone | MetS alone | CircS and MetS | ||
Prevalent CVD | |||||
Men (n = 6113) | |||||
Model 1 * | 1.00 | 1.49 (0.62–3.56) | 1.83 (1.16–2.90) | 3.67 (2.69–5.02) | |
Model 2 † | 1.00 | 1.16 (0.48–2.79) | 1.88 (1.18–2.98) | 3.61 (2.65–4.94) | |
Women (n = 5908) | |||||
Model 1 * | 1.00 | 4.15 (2.00–8.61) | 1.65 (0.81–3.35) | 4.64 (3.19–6.74) | |
Model 2 † | 1.00 | 2.60 (1.25–5.42) | 1.54 (0.78–3.04) | 3.75 (2.59–5.42) | |
CVD mortality | |||||
Men (n = 6108) | |||||
Model 1 * | 1.00 | 2.87 (0.69–11.89) | 1.09 (0.64–1.87) | 1.32 (0.89–1.95) | |
Model 2 † | 1.00 | 1.83 (0.43–7.75) | 1.10 (0.63–1.92) | 1.22 (0.82–1.80) | |
Women (n = 5906) | |||||
Model 1 * | 1.00 | 3.16 (1.03–9.64) | 1.03 (0.47–2.23) | 1.74 (1.22–2.49) | |
Model 2 † | 1.00 | 2.52 (0.82–7.76) | 1.01 (0.47–2.20) | 1.54 (1.04–2.26) |
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Shi, Z.; Tuomilehto, J.; Kronfeld-Schor, N.; Alberti, G.; Stern, N.; El-Osta, A.; Chai, Z.; Bilu, C.; Einat, H.; Zimmet, P. The Circadian Syndrome Is a Significant and Stronger Predictor for Cardiovascular Disease than the Metabolic Syndrome—The NHANES Survey during 2005–2016. Nutrients 2022, 14, 5317. https://doi.org/10.3390/nu14245317
Shi Z, Tuomilehto J, Kronfeld-Schor N, Alberti G, Stern N, El-Osta A, Chai Z, Bilu C, Einat H, Zimmet P. The Circadian Syndrome Is a Significant and Stronger Predictor for Cardiovascular Disease than the Metabolic Syndrome—The NHANES Survey during 2005–2016. Nutrients. 2022; 14(24):5317. https://doi.org/10.3390/nu14245317
Chicago/Turabian StyleShi, Zumin, Jaakko Tuomilehto, Noga Kronfeld-Schor, George Alberti, Naftali Stern, Assam El-Osta, Zhonglin Chai, Carmel Bilu, Haim Einat, and Paul Zimmet. 2022. "The Circadian Syndrome Is a Significant and Stronger Predictor for Cardiovascular Disease than the Metabolic Syndrome—The NHANES Survey during 2005–2016" Nutrients 14, no. 24: 5317. https://doi.org/10.3390/nu14245317