title: Short sleep duration and type 2 diabetes enhance the risk of cardiovascular events in hypertensive patients.
abstract: OBJECTIVE
  We tested the hypothesis that short sleep duration is not only a risk factor for diabetes, but that the two conditions in combination would be associated with the risk of incident cardiovascular disease (CVD).
  
  
  METHODS
  We analyzed 1255 hypertensive patients (mean age: 70.4±9.9 years) with (N=299) and without diabetes (N=956). Short sleep duration was defined as a sleep time <7.5 h. A Hard CVD event was defined as either myocardial infarction, stroke, or sudden cardiac death; and All CVD events as Hard CVD events plus angina, heart failure and end-stage renal disease.
  
  
  RESULTS
  When the patients were divided into 4 categories by diabetes (present or absent) and sleep duration (short or long), the diabetes+short sleep group had a significantly higher incidence of both Hard CVD events (HR=2.27, 95% CI=1.17-4.42, P=0.015) and All CVD events (HR=2.47, 95% CI=1.37-4.43, P=0.003) compared with the non-diabetes+long sleep group, independent of significant covariates. There were significant interactions between sleep duration and glycemic control on CVD events.
  
  
  CONCLUSIONS
  The combination of both diabetes and short duration of sleep was associated with higher risk of incident CVD compared with those with only one or neither condition. Altered glycemic control and short sleep duration could act synergistically to pose a risk for future CVD.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan. ke112@jichi.ac.jp
authors.forename: Kazuo
authors.initials: K
authors.lastname: Eguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshide
authors.forename: Shizukiyo
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology*; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D058246:Prehypertension / Q000150:complications* / Q000503:physiopathology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000150:complications* / Q000503:physiopathology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology