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CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

Sleep Apnea Impact on Cardiometabolic Health

The condition known as sleep apnea, in which a snorer briefly stops breathing, can lead to cardiovascular difficulties—and is often associated with arrhythmia, stroke, high blood pressure, and heart failure. “The evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease generally, so people really need to know that,” said Donna Arnett, PhD, dean and professor of epidemiology at the University of Kentucky College of Public Health in Lexington and former president of the American Heart Association.

While mild sleep apnea is a fairly common problem that affects one in five adults, the most common type is obstructive sleep apnea (OSA), in which weight on the upper chest and neck leads to blockage of the flow of air. OSA is associated with obesity, another major risk factor for stroke and heart disease, and additional clinical research suggests that OSA predisposes people to hypertension and atherosclerosis. Because patients with OSA are often obese, they frequently have an increased prevalence of numerous other cardiovascular risk factors, including type 2 diabetes mellitus.

Moreover, findings recently published in Diabetes Care indicate a bidirectional association between obstructive sleep apnea and diabetes. While previous research has demonstrated a more complex correlation between diabetes and OSA, this is the first study to date that has evaluated the potential relationship between the two disorders. Investigators in the study used data from the Nurses’ Health Study (2002-2012), Nurses’ Health Study II (1995-2003), and Health Professionals Follow-Up Study (1996-2012). At the outset, all participants showed no indications of diabetes, cardiovascular disease, or cancer.

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Aggressively Lowering LDL-C Reduces Cardiovascular Risk

Cardiovascular disease (CVD) is the leading cause of death in the United States, affecting more than 92 million people, with 45 million more being at an increased risk for developing CVD within 10 years. Elevated low-density lipoprotein cholesterol (LDL-C) is one of the key risk factors for CVD and several studies have shown that lowering LDL-C is one of the most important aspects of primary and secondary CVD prevention.

However, how much we should lower LDL-C to convey a cardiovascular benefit is not clear. The concept of “treat to target” is constantly evolving to “lower is better”, which has spun a growing debate in the clinical community, partly because we don’t agree about the specific target LDL-C levels that are also safe. The approval of new non-statin therapies that aggressively lower LDL-C, such as proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors, has invigorated the debate about specific LDL-C targets, with many experts advocating for achieving very low levels of LDL-C (below 50 mg/dL and in some cases, ≤20 mg/dL) early in the treatment regimen in order to maximize cardiovascular benefits.

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