Sex differences in the association between circadian rest-activity rhythms and cardiovascular disease among middle-aged and elderly adults

Aberrant accelerometry-derived circadian rest-activity rhythm (CRAR) is associated with an increased risk of cardiovascular disease (CVD), yet the potential sex differences in this association among middle-aged and elderly adults remain unclear. This study investigates sex-specific associations between CRAR, CVD, and mortality in a large, diverse U.S. population. We analyzed data from participants aged ≥45 y in the National Health and Nutrition Examination Survey (NHANES) 2011-2014 who completed 7 d wrist actigraphy and had at least four valid 24-h accelerometer recordings. Parametric CRAR measures, including amplitude, mesor, pseudo-F, and acrophase, were derived using an extended cosinor model. Weighted multivariable logistic regression assessed the associations between CRAR measures and the prevalent CVD, while Cox regression models evaluated the associations of CRAR with all-cause and cardiovascular mortality. Among 4893 participants, those in the lowest quintile of CRAR amplitude had 64% higher odds of CVD than those in higher quintiles (95% CI, 1.11-2.43). Low amplitude and mesor were significantly linked to increased risks of all-cause and cardiovascular mortality. Associations between CRAR disruption and outcomes appeared stronger in women, with significant interactions observed for several cardiovascular outcomes. Maintaining a robust circadian rhythm may be important for cardiovascular health and longevity, particularly among women.