Healthy Lifestyle including Sleep Patterns, Genetic Risk, and Risk of Cardiometabolic Multimorbidity

Background: Emerging evidence suggests a link between sleep patterns, healthy lifestyles, and the risk of cardiometabolic outcomes. However, few studies have explored the association between lifestyles that incorporate healthy sleep patterns and genetic factors with the risk of cardiometabolic multimorbidity (CMM). Objective/Aim : To prospectively investigate the associations between a healthy lifestyle including sleep patterns, genetic risk, and the risk of cardiometabolic multimorbidity and cardiometabolic diseases. Methods: A total of 382,448 UK Biobank participants were included in this study. A modified healthy lifestyle score (mHLS) was defined by healthy sleep patterns, diet, physical activity, smoking, alcohol consumption, and Body Mass Index (BMI). Weighted genetic risk score (GRS) for cardiometabolic outcomes was calculated. Cox proportional hazards models were used to estimate the associations between a healthy lifestyle and cardiometabolic outcomes. Results: During a median follow-up of 8.7 years, 13,388 participants developed CMM, and 54,381 participants developed at least one of those cardiometabolic diseases (CMDs) that contribute to CMM. After adjusting for major confounders, the modified healthy lifestyle score was significantly associated with lower risks of CMM and CMDs, with hazard ratios (HRs) of 0.81 (95% confidence interval [CI]: 0.74-0.90) and 0.84 (95% CI: 0.79-0.88) for the highest versus lowest mHLS groups, respectively. The association between mHLS and CMDs was stronger in women and individuals aged 65 and above ( p = 0.006 and p = 0.04, respectively). Additionally, there was an additive interaction between mHLS and GRS on CMDs, with a relative excess risk due to interaction (RERI) of 0.057 (95% CI: 0.007, 0.106). Conclusion: Our results show that adherence to a healthy lifestyle, including healthy sleep patterns, is associated with lower risks of CMM and CMDs. Women and individuals over 65 may benefit more. A healthy lifestyle can also modify the genetic predisposition to CMDs.