Chronodisruption and diet associated with increased cardiometabolic risk in coronary heart disease patients: the CORDIOPREV study

Authors: ROMERO-CABRERA, JUAN-LUIS - Universidad De Cordoba; GARAULET, MARTA - Universidad De Murcia; JIMENEZ-TORRES, JOSE - Universidad De Cordoba; ALCALA-DIAZ, JUAN - Universidad De Cordoba; QUINTANA-NAVARRO, GRACIA - Universidad De Cordoba; MARTIN-PIEDRA, LAURA - Universidad De Cordoba; TORRES-PENA, JOSE - Universidad De Cordoba; RODRIGUEZ-CANTALEJO, FERNANDO - University Hospital Reina Sofia; RANGEL-ZUNIGA, ORIOL - Universidad De Cordoba; YUBERO-SERRANO, ELENA - Universidad De Cordoba; LUQUE, RAUL - Universidad De Cordoba; ORDOVAS, JOSE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; LOPEZ-MIRANDA, JOSE - Universidad De Cordoba; PEREZ-MARTINEZ, PABLO - Universidad De Cordoba; GARCIA-RIOS, ANTONIO - Universidad De Cordoba

Submitted to: Translational Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/1/2021
Publication Date: 11/6/2021
Citation: Romero-Cabrera, J., Garaulet, M., Jimenez-Torres, J., Alcala-Diaz, J.F., Quintana-Navarro, G.M., Martin-Piedra, L., Torres-Pena, J.D., Rodriguez-Cantalejo, F., Rangel-Zuniga, O.A., Yubero-Serrano, E.M., Luque, R.M., Ordovas, J.M., Lopez-Miranda, J., Perez-Martinez, P., Garcia-Rios, A. 2021. Chronodisruption and diet associated with increased cardiometabolic risk in coronary heart disease patients: the CORDIOPREV study. Translational Research. https://doi.org/10.1016/j.trsl.2021.11.001.
DOI: https://doi.org/10.1016/j.trsl.2021.11.001

Interpretive Summary: Cardiovascular disease continues to be a major cause of morbidity and mortality, and it is not enough to control traditional risk factors. In this context, disruption of the daily rhythms, or chronodisruption, is emerging as a risk factor for cardiovascular disease. An increasing body of evidence supports that Evening-type individuals or "owls" (i.e., the preference to wake up late and feel more active during evenings or nights) are prone to suffer chronodisruption much more than morning-type individuals or "larks." The objective of this work conducted by investigators in Spain and at the HNRCA in Boston was to explore whether individual morningness and eveningness were associated with different cardiometabolic risks in patients from the CORDIOPREV study (n = 857). The analyses revealed that evening-types had higher cardiometabolic risk than morning-types, regardless of the nutritional intervention. Therefore, assessing the chronobiological status of high-risk subjects could support a new approach for the personalization and tailoring of dietary interventions. In addition to a healthy diet, recommendations on meals timing, sleep, and physical activity will improve the prevention and treatment of cardiovascular disease.

Technical Abstract: Individuals with evening chronotypes are prone to suffer chronodisruption and display worse lifestyle habits than morning-types, exhibiting higher cardiovascular diseases (CVD). However, it is unknown whether CVD patients, who are evening chronotypes, have higher cardiometabolic risk than morning-types. This study explored whether individual chronotypes were associated with cardiometabolic risk in patients from the CORDIOPREV study (n = 857). We also investigated whether potential associations were moderated by long-term consumption of two healthy diets (Mediterranean and Low-fat diets). This population was classified into chronotypes using the Morningness-Eveningness Questionnaire. Seven-day daily rhythms in wrist temperature (T), rest-activity(A) and position (P) were recorded in a subset of patients (n = 168), and an integrative variable TAP was determined. Metabolic Syndrome (MetS) was determined at baseline, and metabolic and inflammation markers were measured at baseline and yearly during the 4 years of follow-up. Differences in several lifestyle factors were analyzed according to chronotype. At all times, evening-types had higher triglycerides, C-reactive protein and homocysteine and lower high density lipoprotein cholesterol than morning-types (P < 0.05). Evening-types had a higher prevalence of MetS (OR 1.58 IC 95%[1.10 - 2.28], P = 0.01). Moreover, they were more sedentary, displayed less and delayed physical activity and ate and slept later. In addition, evening-types had lower amplitude, greater fragmentation, lower robustness and less stable circadian pattern at TAP (P < 0.01), all related to a less healthy circadian pattern. In conclusion, evening-types with CVD had higher cardiometabolic risk and less robust circadian-related rhythms than morning-types, regardless of the nutritional intervention.