Eating right, exercising, abstaining from smoking, and moderately consuming alcohol are all behaviors that help protect the body from cardiovascular disease (CVD). Research from the National Institute of Public Health and the Environment in the Netherlands has found that these traditional healthful lifestyle behaviors are even better when supported by a good night’s sleep. The report, published in the European Journal of Preventive Cardiology is the first to focus on how sleep duration works in conjunction with these four factors of a healthy lifestyle.

This research is based data from on the Monitoring Project on Risk Factors for Chronic Diseases (MORGEN), a prospective cohort study in the Netherlands. The researchers studied data from 6,672 men and 7,767 women who were aged 20-65 and had no cardiovascular disease at the outset. The cohort was followed for up to a mean of 12 years. Data was collected on the subjects’ exercise habits, diet, smoking, alcohol consumption and sleep duration.

Results showed that each of the traditional lifestyle behaviors diminished the risk for CVD on its own to a certain extent, but that sufficient sleep duration had the largest individual impact. A combination of the four healthy habits without sufficient sleep resulted in 57% lower risk of both fatal and non-fatal cardiovascular disease. When combined with the other four lifestyle factors, there was a 65% lower risk for composite CVD and an 83% lower risk of fatal CVD. In fact, simply getting enough sleep—without any of the other factors—diminished the risk of composite CVD was decreased by 22% and fatal CVD decreased by 43% when compared to people getting insufficient sleep.

According to the report, “If all participants adhered to all five healthy lifestyle factors, 36% of composite CVD and 57% of fatal CVD could theoretically be postponed. The public health impact of sufficient sleep duration, in addition to the traditional healthy lifestyle factors, could be substantial.”

The research team explained that previous studies have linked insufficient sleep to being overweight or obese, hypertension, higher blood pressure, and other conditions that are risk factors for cardiovascular disease. This could explain why getting more sleep is associated with less cardiovascular disease. Head investigator, Dr. Monique Vershuren also commented that seven hours—the average sleep duration—is likely sufficient for most adults.

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