The association of vitamin D levels and sleep status with cardiovascular disease among the elderly: a cohort study
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摘要: 目的 探讨老年人群的维生素D水平及睡眠状态与心血管疾病的关联。方法 基于前瞻性队列研究，于2016年8月—2020年7月招募年龄大于60岁的体检老人7837人，每年随访1次，平均随访3年。基线时志愿者做一份结构化问卷，并采集静脉血检测维生素D水平。睡眠状态由5个睡眠问题组成，包括持续时间、睡眠类型、失眠、打鼾和白天过度嗜睡，分为好、中、差3组。结局指标为脑卒中、心肌梗死、冠心病等心血管疾病。结果 本研究人群，平均年龄为(68.86±14.16)岁，心血管疾病发生率为12.0%。睡眠状态好、中、差的比例分别为23.1%、63.6%和13.3%。与维生素D严重缺乏组比较，维生素D轻度缺乏组(HR=0.56，95%CI：0.48，0.66)及非缺乏组(HR=0.41，95%CI：0.34，0.51)心血管疾病发生风险较低。睡眠状态差可增加心血管疾病发生风险。维生素D水平与睡眠状态存在交互作用(P=0.002)，在维生素D严重缺乏人群中，与睡眠状态差组比较，睡眠状态中等组(HR=0.64，95%CI：0.47，0.88)及睡眠状态好组(HR=0.36，95%CI：0.23，0.54)心血管疾病发生风险较低，而在维生素D非缺乏人群中未发现这种关联。结论 高维生素D水平及健康的睡眠可降低老年人群的心血管疾病发生风险，较高的维生素D水平可减弱不健康睡眠所带来的危害。Abstract: Objective To investigate the association of vitamin D levels and sleep status with cardiovascular disease in an elderly population.Methods Based on a prospective cohort study, 7837 seniors attending medical examinations aged>60 years were recruited from August 2016 to July 2020 and followed up once a year for a mean follow-up period of 3 years. Volunteers were given a structured questionnaire at baseline and venous blood was collected for vitamin D levels. Sleep status consisted of five sleep problems, including sleep duration, chronotype, insomnia, snoring, and daytime sleepiness, divided into three groups: healthy, moderate, and poor. The outcomes were stroke, myocardial infarction, and coronary artery disease.Results In this study population, the mean age was(68.86±14.16) years and the incidence of cardiovascular disease was 12.0%. The percentage of healthy, moderate, and poor sleep status was 23.1%, 63.6%, and 13.3%, respectively. The risk of cardiovascular disease was lower in the mild vitamin D deficient group(HR=0.56, 95%CI: 0.48, 0.66) and the non-deficient group(HR=0.41, 95%CI: 0.34, 0.51) compared with the severe vitamin D deficient group. The risk of cardiovascular disease was higher in the poor sleep status group. There was an interaction between vitamin D levels and sleep status(P=0.002), with a lower risk of cardiovascular disease in the moderate sleep status group(HR=0.64, 95%CI: 0.47, 0.88) and the healthy sleep status group(HR=0.36, 95%CI: 0.23, 0.54) compared with the poor sleep status group in the severe vitamin D deficient population, and in the no such association was found in the vitamin D non-deficient group.Conclusion High vitamin D levels and healthy sleep reduce the risk of cardiovascular disease in the elderly population, and higher levels of vitamin D attenuate the adverse effects of unhealthy sleep.
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Key words:
- sleep /
- vitamin D /
- aged /
- cardiovascular disease
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图 1 维生素D分层后老年人群睡眠状态与CVD的关联
Figure 1. The association between sleep and CVD stratified by vitamin d status among elder people
表 1 不同维生素D状态的老年人群基线特征分析
Table 1. Characteristics of the elder population in different vitamin D status
例(%), X±S 项目 维生素D F/χ2值 P值 严重缺乏组(1636例) 轻度缺乏组(4106例) 非缺乏组(2095例) 一般人口学特征 年龄/岁 68.93±14.15 68.91±14.23 68.72±14.02 1.663 0.190 男性 732(44.7) 1868(45.5) 894(42.7) 1.491 0.106 小学及以下 1009(61.7) 2526(61.5) 1346(64.2) 1.720 0.094 月收入 < 3000元 1186(72.5) 2880(70.1) 1482(70.7) 3.135 0.209 健康状况 BMI/(kg·m-2) 21.71±3.061) 21.38±2.802) 20.94±2.653) 36.106 < 0.001 总胆固醇/(mmol·L-1) 6.05±0.951) 5.94±0.952) 5.81±0.923) 12.921 < 0.001 高密度脂蛋白胆固醇/(mmol·L-1) 1.99±0.39 2.01±0.36 2.00±0.36 0.208 0.812 空腹血糖/(mmol·L-1) 4.55±0.441) 4.50±0.402) 4.46±0.393) 18.562 < 0.001 收缩压/mmHg 141.62±15.551) 140.28±14.622) 138.34±14.143) 55.187 < 0.001 慢性病史(高血压、冠心病等) 728(44.5) 1740(42.4)2) 797(38.0)3) 17.570 < 0.001 慢性病用药 409(25.0) 1019(24.8) 486(23.2) 2.344 0.310 生活方式 吸烟 684(41.8) 1673(40.7) 846(40.4) 0.830 0.660 饮酒 576(35.2) 1526(37.2) 800(38.2) 3.562 0.168 体力活动 < 5次/周a) 730(44.6) 1814(44.2) 955(45.6) 1.109 0.574 晒太阳 < 5次/周b) 179(10.9) 478(11.6)2) 320(15.3)3) 21.186 < 0.001 与维生素D轻度缺乏组比较，1)P < 0.05；与维生素D非缺乏组比较，2)P < 0.05；与维生素D严重缺乏组比较，1)P < 0.05。a)体力活动定义为每天30 min以上的中等程度活动；b)晒太阳定义为每天不少于30 min的阳光接触。 
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表 2 老年人群维生素D状态与CVD的关联
Table 2. The association between vitamin D status and CVD among elder people
例(%) 维生素D状态 CVD P值 单因素模型 多因素模型 严重缺乏 306(18.7) 1.00 1.00 轻度缺乏 463(11.3) < 0.001 0.55(0.47，0.64) 0.56(0.48，0.66) 非缺乏 171(8.2) 0.39(0.62，0.47) 0.41(0.34，0.51) 注：多因素模型调整睡眠、年龄、性别、教育程度、收入、BMI、空腹血糖、高密度脂蛋白胆固醇、总胆固醇、收缩压、吸烟、饮酒、体力活动及晒太阳频率。
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表 3 老年人群睡眠状态与CVD的关联
Table 3. The association between sleep status and CVD among elder people
睡眠状态 维生素D/(nmol·L-1)1) CVD 例(%)1) 单因素模型 多因素模型 差 38.47±17.93 172(16.5) 1.00 1.00 中 40.88±18.65 618(12.4) 0.71(0.59，0.86) 0.73(0.61，0.88) 好 40.99±17.69 150(8.3) 0.46(0.36，0.57) 0.44(0.35，0.56) 注：多因素模型调整维生素D状态、年龄、性别、教育程度、收入、BMI、空腹血糖、高密度脂蛋白胆固醇、总胆固醇、收缩压、吸烟、饮酒、体力活动及晒太阳频率。1)P < 0.05。
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