Long sleep duration pattern is associated with increased cardiovascular recurrence: Effect of long‐term Mediterranean diet from the CORDIOPREV study

Abstract Background Evidence suggests interactions between sleep and diet that could modify coronary heart disease (CHD) risk. This study aims to investigate the association between sleep duration and incidence of major cardiovascular events (MACE) and the impact of dietary interventions (Mediterranean or low‐fat diet) from the Coronary Diet Intervention with Olive Oil and Cardiovascular Prevention (CORDIOPREV) study (NCT00924937). Methods A total of 952 subjects were stratified into reference (>6 to <8 h per night), short (≤6 h), and long sleep duration pattern (≥8 h) based on self‐reported data from the Minnesota Leisure‐Time Physical Activity questionnaire over 7 years. The main outcome was the incidence of MACE (myocardial infarction, revascularization procedures, ischemic strokes, peripheral artery disease, and cardiovascular mortality). Results MACE occurred in 189 participants: 18.1% in the reference group, 17.7% in the short group, and 29% in the long sleep duration group. Accordingly, the long sleep duration group had a higher risk of MACE compared to the reference and short sleep groups (log‐rank p < 0.01, hazard ratio [HR]: 1.59 [95% CI: 1.12–2.26]). Participants assigned to a low‐fat diet with long sleep duration had a higher risk of MACE (HR: 1.74 [95% CI: 1.11–2.73]), whereas those assigned to a Mediterranean diet did not show significant differences in risk (HR: 1.35 [95% CI: 0.76–2.41]). Conclusions A long sleep duration pattern is associated with a higher risk of MACE among CHD patients. Long‐term adherence to a Mediterranean diet may mitigate this association. These findings highlight the importance of considering sleep as a cardiovascular risk factor in clinical practice.