The Correlation Between Sleep Duration and The Severity of Coronary Heart Disease*

The Correlation Between Sleep Duration and The Severity of Coronary Heart Disease* | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Correlation Between Sleep Duration and The Severity of Coronary Heart Disease * Zhang Bing¹ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9275471/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: This study aimed to investigate the correlation between sleep duration and the severity of coronary heart disease. Methods: This study included patients who were hospitalized and underwent coronary angiography at Fengcheng Hospital in Fengxian District, Shanghai from October 2023 to February 2025. Collect demographic characteristics, sleep duration, and coronary angiographic results. The Gensini scoring system was used to quantify the severity of coronary heart disease. Participants were stratified into three categories based on sleep duration(8-hour group). Statistical analyses were performed to evaluate the association. Results: Compared with the group with a sleep duration of 6 to 8 hours, Both 8-hour group have higher Gensini scores (P<0.001). Multivariate Logistic Regreesion showed that both 8-hour group have higher risk of falling into the high gensini score group,OR(95%CI) were 30.183 (10.066 – 90.505), 3.784(2.180 – 6.568) respectively,both P<0.001. Conclusion: There exists a U-shaped relationship between sleep duration and coronary heart disease severity. Both short and long sleep duration were linked to more severe coronary heart disease.These finding indicate that maintaining a sleep duration of 6–8 hours is good for cardiovascular health. Sleep duration severity of coronary artery disease Gensini score Introduction Cardiovascular diseases (CVD) represent a major global health problem and the primary cause of mortality. In China, it is about 330 million patients with cardiovascular diseases, of which about 11.39 million are coronary heart disease[ 1 ].With the aging of society, cardiovascular morbidity and mortality are still increasing in our country. Notably, the mortality rate in rural areas has surpassed that of urban centers, This shows that the task of preventing and treating cardiovascular disease in rural areas is more arduous.Sleep plays an important role in the body's immunity, especially in the context of comorbid diseases [ 2 ].However, modern societal changes—ranging from shift work to the pervasive use of digital devices—have disrupted circadian rhythms, leading to widespread sleep deprivation and poor sleep quality[ 3 ]. While extensive research links sleep duration to adverse outcomes like diabetes and obesity [ 4 – 10 ], the specific relationship between sleep duration and the severity of coronary heart disease remains less defined. Previous studies have obtained inconsistent results.Fengxian District, where our hospital is located, is characterized by a rapidly aging population (34.78% aged 60+).The suspected diagnosis rate of coronary heart disease is high, but the proportion of actual diagnostic evidence is very low.Most elderly patients are unwilling to undergo further examinations. This study aims to further optimize clinical diagnosis and treatment by identifying high-risk patients with potential severe coronary lesions based on their sleep duration, thereby improving diagnostic and therapeutic efficiency, reducing medical costs, and providing more evidence for the diagnosis and management of coronary heart disease. Additionally, the findings can serve as educational materials to raise awareness among healthy individuals, encouraging them to maintain good sleep habits. Methods 1.1Object A total of 367 patients who were hospitalized at Fengcheng Hospital in Fengxian District, Shanghai from October 2023 to February 2025 and underwent coronary angiography were selected. Conduct face-to-face interviews, collect basic information, sleep time, clinical data, coronary angiography results, etc., calculate the Gensini score, and analyse the relationship between sleep duration and the severity of coronary heart disease. Inclusion criteria:Hospitalized in our hospital and undergoing coronary angiography.;‚Can understand the content of the questionnaire and cooperate to complete it.And sign the informed consent form. Exclusion criteria: Unable to cooperate with the investigator or those who do not agree to join the group. 1.2Method The research objects were surveyed in the form of a questionnaire, and the survey content consisted of a series of questions. All participants signed an informed consent form before the investigation. The survey primarily collected personal information (such as name, gender, age and occupation,height, weight, blood pressure and pulse), lifestyle habits (such as drinking and smoking), the most important: sleep duration; data on glucose, lipids and other relevant data. Sleep Duration: The assessment of sleep duration is based on the answer to the following question:“How many hours do you usually sleep per day? (including naps).” Sleep duration is categorized as 8 hours. The severity of coronary heart disease dependent on Gensini score for quantitative assessment, the total score is calculated by weighting based on the degree of stenosis and the location of the lesion. The higher the score, the more severe the coronary heart disease. 1.3 Statistical methods We use R software (v4.2.1) to do statistical analysis of relevant data.The Shapiro-Wilk test were used to detect the normality of count data. Continuous variables that conform to the normal distribution are expressed as mean ± SD, while non-normal distribution data are presented as median (interquartile range)[Median(Q1,Q3)]. Categorical variables are expressed as frequencies (percentages).For inter-group comparisons: One-way ANOVA was used for continuous variables that conformed to the normal distribution, while the Kruskal-Wallis H test was applied for non-normal distribution data. Pairwise comparisons utilized the t-test. Categorical data were analyzed by the chi-square test(χ2 test), with Fisher's exact test employed where expected cell counts were less than five. Binary Logistic Regreesion was used to detect the independent relationship between sleep duration and the severity of coronary heart disease.The dependent variable was defined as the gensini score group (1 for higher than median gensini score(34 points), 0 for lower or equal with median gensini score(34 points).The model adjusted for sleep duration and potenial confunders,including age,sex,smoking drinking alcohol,glucose and lipids.data are presented as odds ratios(OR)with 95% confidence intervals(CI).Statistical significance was defined as P < 0.05 (two-tailed). Result This study included a total of 367 patients, including 242 males and 125 females. Among them, 64 patients had sleep durations of less than 6 hours, 196 patients slept for 6 to 8 hours, and 107 patients slept for more than 8 hours. The median ages in the three groups were 69 (56.5, 76) years, 67 (59, 75) years, and 67 (56.5, 74.5) years, respectively. The median sleep durations were 5 (5, 5) hours, 7 (6, 8) hours, and 9 (9, 10) hours, respectively. The median Gensini score was 34points,higher than 34 points were 4 patients, 139 patients, and 41 patients, respectively,lower or equal with 34points were 60 patients,57 patients,66patients,respectively.Totalcholesterol were4.34(3.57,5.215)mmol/l,4.22(3.545,4.79)mmol/l,4.365(3.4775,4.9075)mmol/l,respectively.Triglyceridewere1.275(0.95,1.805)mmol/l,1.31(0.97,1.865)mmol/l,1.465(1.0825,2.1325)mmol/l,respectively.High-densityli poprotein cholesterol were1.02(0.87,1.175)mmol/l,1.05(0.9,1.19)mmol/l,1.03(0.91,1.2275)mmol/l,respectively.Low-densitylipoprotein cholesterolwere2.46(1.795,2.955)mmol/l,2.23(1.75,2.82)mmol/l,2.38(1.73,2.8875)mmol/l,respectively.Glucosewere7(5.6,8.85)mmol/l,5.8(5,6.7)mmol/l,6.3(5.2,8.2)mmol/l,respectively.There were no statistically significant differences among the groups with respect to age, gender, smoking status, alcohol consumption, body weight, height, blood pressure, pulse rate, and lipid profiles (Table 1). When comparing among groups, the Gensini scores were significantly higher in the group with sleep duration less than 6 hours and in the group with sleep duration greater than 8 hours, compared to the group with sleep duration between 6 and 8 hours. The group with sleep duration less than 6 hours had the highest Gensini score. The intergroup comparisons were statistically significant (Table 2). After adjusting for confounders,Multivariate Logistic Regreesion showed that,compared with sleep duration 6-8hours,long sleep duration(>8 hours) was faced 3 times risk of falling into the high gensini score group(OR 3.784,95%CI(2.180 – 6.568),P<0.001),the short sleep duration(<6 hours) was associated with markedly increased odds of having a high gensini score( OR 30.183 ,95%CI(10.066 – 90.505),P<0.001). (Table 3). Discussion 3.1 The “U-shaped”association between sleep duration and coronary artery disease This study explored a cross-sectional analysis of 367 participants, found a significant negative correlation between sleep duration and the severity of coronary heart disease (measured by the Gensini score). Compared to the reference group that slept 6-8 hours, insufficient sleep (less than 6 hours) was associated with higher Gensini scores, suggesting severer coronary heart disease. Although the extremely high oadds ratio observer in the short sleep duration group,it may be attributed to the small sample size of this subgroup.But this finding supports previous research indicating a“U-shaped”association between sleep and cardiovascular health [10,1 1 ,1 2 ] . 3.2 Pathophysiological mechanisms of short sleep duration The results of this study show that patients in the short-sleep group exhibited a significantly greater degree of coronary heart disease, which is consistent with the findings of numerous previous studies. Xiaoqing Lian[13]Studies have shown that sleep deprivation is an independent risk factor for the severity of acute myocardial infarction and coronary heart disease.The underlying mechanisms may involve the following aspects: First, sleep deprivation activates the sympathetic nervous system, leading to increased secretion of catecholamines (such as epinephrine and norepinephrine), which in turn accelerate heart rate and elevate blood pressure, thereby increasing myocardial oxygen consumption and placing greater strain on the heart.Second,chronic sleep deprivation disrupts the hypothalamic-pituitary-adrenal (HPA) axis, promoting cortisol secretion and subsequently inducing insulin resistance, hyperglycemia,and lipid metabolism abnormalities—pathological conditions that are central to the development and progression of atherosclerosis. Moreover, sleep deprivation has been confirmed to be closely associated with systemic inflammatory responses. Inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) are significantly elevated in individuals experiencing sleep deprivation; these inflammatory factors directly contribute to endothelial damage and plaque formation in blood vessels. 3.3 Potential risks of long sleep duration and reverse causation It is worth noting that in this study, patients in the long-sleep group (>8 hours) had higher Gensini scores than control group. Although long sleep is always regarded as a healthy behavior, in the cardiovascular field, excessively long sleep is often seen as an indicator of “reverse causation”or“health damage”. Chun Shing Kwok’s [14,15] meta-analysis of existing studies indicates that compared to individuals who sleep 7-8 hours, long sleepers face a higher risk of all-cause mortality and cardiovascular events, it is even higher than short-sleepers in some studies. Long sleep may reflect underlying physical weak、depressive or excessive daytime sleepiness (which is often associated with sleep apnea). Depression and psychological stress themselves are independent risk factors for coronary heart disease and frequently accompany elevated levels of inflammation. Moreover, prolonged bed rest can further reduce physical activity, alter blood rheology, and thereby promote the progress of atherosclerosis. Therefore, while long sleep may not be a direct cause of coronary heart disease, it likely represents a consequence of severe coronary heart disease, reduce cardiac function, or the presence of other psychosocial factors. 3.4 Similarities and Differences with Previous Studies and the Significance of This Study Previous studies on the relationship between sleep and coronary heart disease have largely focused on incidence or mortality rates, and there have some disagreement on the correlation between sleep duration and cardiovascular disease.For example, Gao Xue’s [16] studies suggest that short sleep and insomnia increase the risk of coronary heart disease, whereas long sleep is not associated with disease risk; however, some studies, such as Zhuang’s [1 7 ] study pointed out that excessive sleep duration increases cardiovascular risk. The innovation of this study is that it not only takes into account sleep duration,but also use the Gensini score(a quantitative indicator)to investigate the correlation between sleep duration and the severity of coronary heart disease. This study suggest that we should pay more attention to those who complain of either insufficient or excessive sleep duration, regarding them as potentially high-risk individuals for coronary heart disease，and engaging in more proactive screening and intervention. 3.5 Study limitations This study has certain limitations. First, the duration of sleep was based on self-reported, lacking support from objective data，such as polysomnography (PSG); thus, it may have some recall bias. Second, this study is a cross-sectional design, making it impossible to establish a causal relationship between sleep duration and coronary heart disease. Third, although we controlled for confounding factors such as age, gender, smoking and lipid, there may still be unmeasured confounders,such as dietary patterns, sleep quality, and depression,that could influence the results. Finally, This study participants were hospitalized patients,there is a potential fore seletion bias,which restricts the extrapolation of our conclusions to the general population.And this study drawn from a single center.So future larger-scale, multicenter, prospective studies will be needed to further validate these findings. Conclusions There exists a U-shaped relationship between sleep duration and coronary heart disease severity. Both short and long sleep duration were linked to more severe coronary heart disease.These finding indicate that maintaining a sleep duration of 6–8 hours is good for cardiovascular health. Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical standards of the[Measures for Ethical Review of Scientific and Medical Research Involving Humans]. This study approved by the FengCheng Hospital committee on the ethics of human research. All participants are signed the informed consent before the investigate.and they consent their anonymized information to be published in this article. Consent for publication Not applicable. Availability of data and materials The data used to support the findings of this study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding Science and Technology Commission of Fengxian District, Shanghai Municipality2023YearSocial Science and Technology Development FundProject: "Analysis of the Correlation Between Sleep Duration and the Severity of Coronary Artery Disease"（Feng Ke 20231456) Authors’ contributions Liang Zhinan analyzed the data. Zhang Bing wrote the first draft of the article.Wang Qihu responsible for review and editing; Wang Jinhua,Dong Zhaohui,Zhang Qing,Sui Jinna,Deng Jianxin were responsible for project implementation and data collection. All authors have read and agreed to the published version of the manuscript. Acknowledgments The authors would like to thank all the participating institutions and the investigators for their efforts and input. We are also grateful to our study participants for their cooperative responses during data collection. About the Author: Zhang Bing (born in 1990), male, Han ethnicity, native of Shangrao City, Jiangxi Province. Master of Medicine. Main research area: Arrhythmias. Corresponding author: Wang Qihu, E-mail: [email protected] References China Cardiovascular Health and Disease Report Writing Group. Summary of the China Cardiovascular Health and Disease Report 2021. Chinese Circulation Journal, June 2022, Vol. 37, No. 6 (Total No. 288). M G Poluektov. Sleep and Immunity. Neurosci Behav Physiol, 2021;51(5):609-615. Maha Alkaid Albqoor, Abeer M Shaheen. Sleep quality, sleep latency, and sleep duration: a national comparative study of university students in Jordan. Sleep Breath, 2021 Jun;25(2):1147-1154. Jin Li, Dehong Cao, Yin Huang, et al. Sleep duration and health outcomes: an umbrella review. Sleep Breath, September 2022; 26(3):1479-1501. Christina Antza, Georgios Kostopoulos, Samiul Mostafa, et al. The links between sleep duration, obesity and type 2 diabetes mellitus. J Endocrinol, 2021 Dec 13;252(2):125-141. Shiqi Yuan, Wen Ma, Rui Yang, et al. Sleep duration, genetic susceptibility, and Alzheimer's disease: a longitudinal UK Biobank-based study. BMC Geriatr, 2022 Aug 2;22(1):638. Jing Xie, Yun Li, Yajun Zhang, et al. Sleep duration and metabolic syndrome: An updated systematic review and meta-analysis. Sleep Med Rev, 2021 Oct;59:101451. Han Han, Ying Wang, Tongtong Li, et al. Sleep Duration and Risks of Incident Cardiovascular Disease and Mortality Among People With Type 2 Diabetes. Diabetes Care, 2023 Jan 1;46(1):101-110. Jinjia Zhang, Jinxin Zhang, Huadong Wu, et al. Sleep Duration and Risk of Hyperlipidemia: A Systematic Review and Meta-Analysis of Prospective Studies. Sleep Breath, 2022 Sep;26(3):997-1010. Adeel Ahmad, S Claudia Didia. Effects of Sleep Duration on Cardiovascular Events. Curr Cardiol Rep, 2020 Feb 8;22(4):18. Xiaorong Yang, Hui Chen, Suyun Li, et al. Association of Sleep Duration with the Morbidity and Mortality of Coronary Artery Disease: A Meta-analysis of Prospective Studies. Heart, Lung and Circulation. 2015 Dec;24(12):1180-90. Iyas Daghlas, Hassan S Dashti, Jacqueline Lane, et al. Sleep Duration and Myocardial Infarction. J Am Coll Cardiol, 2019 Sep 10;74(10):1304-1314. Xiaoqing Lian, Jie Gu, Sibo Wang, et al. Effects of sleep habits on acute myocardial infarction risk and severity of coronary artery disease in the Chinese population. BMC Cardiovascular Disorders (2021) 21:481. Chun Shing Kwok, Evangelos Kontopantelis, George Kuligowski, et al. Self-Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose-Response Meta-Analysis. J Am Heart Assoc. 2018;7:e008552. Maki Jike, Osamu Itani, Norio Watanabe, et al. Long sleep duration and health outcomes: A systematic review, meta-analysis and meta-regression. Sleep Med Rev, 2018 Jun;39:25-36. Gao Xue. A Mendelian randomization study on the causal relationship between sleep and coronary heart disease. Chinese Journal of Epidemiology, April 2020, Vol. 41, No. 4. Zhenhuang Zhuang, Meng Gao, Ruotong Yang, et al. Association of physical activity, sedentary behaviors and sleep duration with cardiovascular diseases and lipid profiles: a Mendelian randomization analysis. Lipids Health Dis, 2020 May 8;19(1):86. Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 May, 2026 Reviewers agreed at journal 13 May, 2026 Reviewers agreed at journal 11 May, 2026 Reviewers invited by journal 23 Apr, 2026 Editor assigned by journal 15 Apr, 2026 Editor invited by journal 08 Apr, 2026 Submission checks completed at journal 08 Apr, 2026 First submitted to journal 08 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9275471","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":633720362,"identity":"1edde28c-f083-4c2a-8306-6d145a100256","order_by":0,"name":"Zhang Bing¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBACfmb+DwYf/7HZ8bM3EKlFsr3BoHAGG1+yZM8BIrUYnDlg8JmHTY5xw40EYm2ZkZC4mYfHjNng5uONNxhqbKIJauGXSDhsOEcijU/ydlqxBcOxtNwGwrYkthm8MTjGzHc7x0yCseEwYS0GN5LZf/Ak/GdsuHmGWC1njjEY8hxgY5xwg4dILZLtPQyGMxvYgIEM9EsCMX7hZ+ZhMPjYAIrKwxtvfKixIawFxZESCaQoh2ghVccoGAWjYBSMDAAAw/5Ao6PgL3YAAAAASUVORK5CYII=","orcid":"","institution":"Fengcheng Hospital","correspondingAuthor":true,"prefix":"","firstName":"Zhang","middleName":"","lastName":"Bing¹","suffix":""}],"badges":[],"createdAt":"2026-03-31 06:39:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9275471/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9275471/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108493896,"identity":"dc3d29a9-87b8-44fb-a10d-658a8712fae5","added_by":"auto","created_at":"2026-05-05 10:02:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":131694,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9275471/v1/73a36dcc-c751-42bd-92d8-f8f89d0f4bbe.pdf"},{"id":108450211,"identity":"c2c36d09-76bd-4999-b001-c3c4ca39b63c","added_by":"auto","created_at":"2026-05-04 19:15:12","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":116120,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-9275471/v1/54be7445fe3481779c72553c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Correlation Between Sleep Duration and The Severity of Coronary Heart Disease\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCardiovascular diseases (CVD) represent a major global health problem and the primary cause of mortality. In China, it is about 330\u0026nbsp;million patients with cardiovascular diseases, of which about 11.39\u0026nbsp;million are coronary heart disease[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].With the aging of society, cardiovascular morbidity and mortality are still increasing in our country. Notably, the mortality rate in rural areas has surpassed that of urban centers, This shows that the task of preventing and treating cardiovascular disease in rural areas is more arduous.Sleep plays an important role in the body's immunity, especially in the context of comorbid diseases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].However, modern societal changes\u0026mdash;ranging from shift work to the pervasive use of digital devices\u0026mdash;have disrupted circadian rhythms, leading to widespread sleep deprivation and poor sleep quality[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While extensive research links sleep duration to adverse outcomes like diabetes and obesity [\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], the specific relationship between sleep duration and the severity of coronary heart disease remains less defined. Previous studies have obtained inconsistent results.Fengxian District, where our hospital is located, is characterized by a rapidly aging population (34.78% aged 60+).The suspected diagnosis rate of coronary heart disease is high, but the proportion of actual diagnostic evidence is very low.Most elderly patients are unwilling to undergo further examinations. This study aims to further optimize clinical diagnosis and treatment by identifying high-risk patients with potential severe coronary lesions based on their sleep duration, thereby improving diagnostic and therapeutic efficiency, reducing medical costs, and providing more evidence for the diagnosis and management of coronary heart disease. Additionally, the findings can serve as educational materials to raise awareness among healthy individuals, encouraging them to maintain good sleep habits.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e1.1Object\u003c/p\u003e\n\u003cp\u003eA total of 367 patients who were hospitalized at Fengcheng Hospital in Fengxian District, Shanghai from October 2023 to February 2025 and underwent coronary angiography were selected. Conduct face-to-face interviews, collect basic information, sleep time, clinical data, coronary angiography results, etc., calculate the Gensini score, and analyse the relationship between sleep duration and the severity of coronary heart disease.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Inclusion criteria:Hospitalized in our hospital and undergoing coronary angiography.;‚Can understand the content of the questionnaire and cooperate to complete it.And sign the informed consent form.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: Unable to cooperate with the investigator or those who do not agree to join the group.\u003c/p\u003e\n\u003cp\u003e1.2Method\u003c/p\u003e\n\u003cp\u003eThe research objects were surveyed in the form of a questionnaire, and the survey content consisted of a series of questions. All participants signed an informed consent form before the investigation. The survey primarily collected personal information (such as name, gender, age and occupation,height, weight, blood pressure and pulse), lifestyle habits (such as drinking and smoking), the most important: sleep duration; data on glucose, lipids and other relevant data.\u003c/p\u003e\n\u003cp\u003eSleep Duration: The assessment of sleep duration is based on the answer to the following question:\u0026ldquo;How many hours do you usually sleep per day? (including naps).\u0026rdquo;\u0026nbsp;Sleep duration is categorized as \u0026lt;6 hours, 6\u0026ndash;8 hours, and \u0026gt;8 hours.\u003c/p\u003e\n\u003cp\u003eThe severity of coronary heart disease dependent on Gensini score for quantitative assessment, the total score is calculated by weighting based on the degree of stenosis and the location of the lesion. The higher the score, the more severe the coronary heart disease.\u003c/p\u003e\n\u003cp\u003e1.3 Statistical methods\u003c/p\u003e\n\u003cp\u003eWe use R software (v4.2.1) to do statistical analysis of relevant data.The Shapiro-Wilk test were used to detect the normality of count data. Continuous variables that conform to the normal distribution are expressed as mean \u0026plusmn; SD, while non-normal distribution data are presented as median (interquartile range)[Median(Q1,Q3)]. Categorical variables are expressed as frequencies (percentages).For inter-group comparisons: One-way ANOVA was used for continuous variables that conformed to the normal distribution, while the Kruskal-Wallis H test was applied for non-normal distribution data. Pairwise comparisons utilized the t-test. Categorical data were analyzed by the chi-square test(\u0026chi;2 test), with Fisher\u0026apos;s exact test employed where expected cell counts were less than five. Binary Logistic Regreesion was used to detect the independent relationship between sleep duration and the severity of coronary heart disease.The dependent variable was defined as the gensini score group (1 for higher than median gensini score(34 points), 0 for lower or equal with median gensini score(34 points).The model adjusted for sleep duration and potenial confunders,including age,sex,smoking drinking alcohol,glucose and lipids.data are presented as odds ratios(OR)with 95% confidence intervals(CI).Statistical significance was defined as P \u0026lt; 0.05 (two-tailed).\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eThis study included a total of 367 patients, including 242 males and 125 females. Among them, 64 patients had sleep durations of less than 6 hours, 196 patients slept for 6 to 8 hours, and 107 patients slept for more than 8 hours. The median ages in the three groups were 69 (56.5, 76) years, 67 (59, 75) years, and 67 (56.5, 74.5) years, respectively. The median sleep durations were 5 (5, 5) hours, 7 (6, 8) hours, and 9 (9, 10) hours, respectively. The median Gensini score was 34points,higher than 34 points\u0026nbsp;were 4 patients, 139 patients, and 41 patients, respectively,lower or equal with 34points were 60 patients,57 patients,66patients,respectively.Totalcholesterol were4.34(3.57,5.215)mmol/l,4.22(3.545,4.79)mmol/l,4.365(3.4775,4.9075)mmol/l,respectively.Triglyceridewere1.275(0.95,1.805)mmol/l,1.31(0.97,1.865)mmol/l,1.465(1.0825,2.1325)mmol/l,respectively.High-densityli poprotein cholesterol were1.02(0.87,1.175)mmol/l,1.05(0.9,1.19)mmol/l,1.03(0.91,1.2275)mmol/l,respectively.Low-densitylipoprotein cholesterolwere2.46(1.795,2.955)mmol/l,2.23(1.75,2.82)mmol/l,2.38(1.73,2.8875)mmol/l,respectively.Glucosewere7(5.6,8.85)mmol/l,5.8(5,6.7)mmol/l,6.3(5.2,8.2)mmol/l,respectively.There were no statistically significant differences among the groups with respect to age, gender, smoking status, alcohol consumption, body weight, height, blood pressure, pulse rate, and lipid profiles (Table 1).\u003c/p\u003e\n\u003cp\u003eWhen comparing among groups, the Gensini scores were significantly higher in the group with sleep duration less than 6 hours and in the group with sleep duration greater than 8 hours, compared to the group with sleep duration between 6 and 8 hours. The group with sleep duration less than 6 hours had the highest Gensini score. The intergroup comparisons were statistically significant (Table 2).\u003c/p\u003e\n\u003cp\u003eAfter adjusting for confounders,Multivariate Logistic Regreesion showed that,compared with sleep duration 6-8hours,long sleep duration(\u0026gt;8 hours) was faced 3 times risk of falling into the high gensini score group(OR 3.784,95%CI(2.180 \u0026ndash; 6.568),P\u0026lt;0.001),the short sleep duration(\u0026lt;6 hours) was associated with markedly increased odds of having a high gensini score( OR 30.183 ,95%CI(10.066 \u0026ndash; 90.505),P\u0026lt;0.001). (Table 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e3.1 The\u0026nbsp;\u0026ldquo;U-shaped\u0026rdquo;association between sleep duration and coronary artery disease\u003c/p\u003e\n\u003cp\u003eThis study explored a cross-sectional analysis of 367 participants, found a significant negative correlation between sleep duration and the severity of coronary heart disease (measured by the Gensini score). Compared to the reference group that slept 6-8 hours, insufficient sleep (less than 6 hours) was associated with higher Gensini scores, suggesting severer coronary heart disease. Although the extremely high oadds ratio observer in the short sleep duration group,it may be attributed to the small sample size of this subgroup.But this finding supports previous research indicating a\u0026ldquo;U-shaped\u0026rdquo;association between sleep and cardiovascular health\u003csup\u003e[10,1\u003c/sup\u003e\u003csup\u003e1\u003c/sup\u003e\u003csup\u003e,1\u003c/sup\u003e\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e3.2 Pathophysiological mechanisms of short sleep duration\u003c/p\u003e\n\u003cp\u003eThe results of this study show that patients in the short-sleep group exhibited a significantly greater degree of coronary heart disease, which is consistent with the findings of numerous previous studies. Xiaoqing Lian[13]Studies have shown that sleep deprivation is an independent risk factor for the severity of acute myocardial infarction and coronary heart disease.The underlying mechanisms may involve the following aspects: First, sleep deprivation activates the sympathetic nervous system, leading to increased secretion of catecholamines (such as epinephrine and norepinephrine), which in turn accelerate heart rate and elevate blood pressure, thereby increasing myocardial oxygen consumption and placing \u0026nbsp; greater strain on the heart.Second,chronic sleep deprivation disrupts the hypothalamic-pituitary-adrenal (HPA) axis, promoting cortisol secretion and subsequently inducing insulin resistance, hyperglycemia,and lipid metabolism abnormalities\u0026mdash;pathological conditions that are central to the development and progression of atherosclerosis. Moreover, sleep deprivation has been confirmed to be closely associated with systemic inflammatory responses. Inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-\u0026alpha;) are significantly elevated in individuals experiencing sleep deprivation; these inflammatory factors directly contribute to endothelial damage and plaque formation in blood vessels.\u003c/p\u003e\n\u003cp\u003e3.3 Potential risks of long sleep duration and reverse causation\u003c/p\u003e\n\u003cp\u003eIt is worth noting that in this study, patients in the long-sleep group (\u0026gt;8 hours) had higher Gensini scores than control group. Although long sleep is always regarded as a healthy behavior, in the cardiovascular field, excessively long sleep is often seen as an indicator of\u0026nbsp;\u0026ldquo;reverse causation\u0026rdquo;or\u0026ldquo;health damage\u0026rdquo;. Chun Shing Kwok\u0026rsquo;s\u003csup\u003e[14,15]\u003c/sup\u003e meta-analysis of existing studies indicates that compared to individuals who sleep 7-8 hours, long sleepers face a higher risk of all-cause mortality and cardiovascular events, it is even higher than short-sleepers in some studies. Long sleep may reflect underlying physical weak、depressive or excessive daytime sleepiness (which is often associated with sleep apnea). Depression and psychological stress themselves are independent risk factors for coronary heart disease and frequently accompany elevated levels of inflammation. Moreover, prolonged bed rest can further reduce physical activity, alter blood rheology, and thereby promote the progress of atherosclerosis. Therefore, while long sleep may not be a direct cause of coronary heart disease, it likely represents a consequence of severe coronary heart disease, reduce cardiac function, or the presence of other psychosocial factors.\u003c/p\u003e\n\u003cp\u003e3.4 Similarities and Differences with Previous Studies and the Significance of This Study\u003c/p\u003e\n\u003cp\u003ePrevious studies on the relationship between sleep and coronary heart disease have largely focused on incidence or mortality rates, and there have some disagreement on the correlation between sleep duration and cardiovascular disease.For example, Gao Xue\u0026rsquo;s\u003csup\u003e[16]\u003c/sup\u003e studies suggest that short sleep and insomnia increase the risk of coronary heart disease, whereas long sleep is not associated with disease risk; however, some studies, such as Zhuang\u0026rsquo;s\u003csup\u003e[1\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e study pointed out that excessive sleep duration increases cardiovascular risk. The innovation of this study is that it not only takes into account sleep duration,but also use the Gensini score(a quantitative indicator)to\u0026nbsp;investigate\u0026nbsp;the correlation between sleep duration and the severity of coronary heart disease. This study suggest that we should pay more attention to those who complain of either insufficient or excessive sleep duration, regarding them as potentially high-risk individuals for coronary heart disease，and engaging in more proactive screening and intervention.\u003c/p\u003e\n\u003cp\u003e3.5 Study limitations\u003c/p\u003e\n\u003cp\u003eThis study has certain limitations. First, the duration of sleep was based on self-reported, lacking support from objective data，such as polysomnography (PSG); thus, it may have some recall bias. Second, this study is a cross-sectional design, making it impossible to establish a causal relationship between sleep duration and coronary heart disease. Third, although we controlled for confounding factors such as age, gender, smoking and lipid, there may still be unmeasured confounders,such as dietary patterns, sleep quality, and depression,that could influence the results. Finally, This study participants were hospitalized patients,there is a potential fore seletion bias,which restricts the extrapolation of our conclusions to the general population.And this study drawn from a single center.So future larger-scale, multicenter, prospective studies will be needed to further validate these findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThere exists a U-shaped relationship between sleep duration and coronary heart disease severity. Both short and long sleep duration were linked to more severe coronary heart disease.These finding indicate that maintaining a sleep duration of 6\u0026ndash;8 hours is good for cardiovascular health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards of the[Measures for Ethical Review of Scientific and Medical Research Involving Humans].\u003c/p\u003e\n\u003cp\u003eThis study approved by the FengCheng Hospital committee on the ethics of human research.\u003c/p\u003e\n\u003cp\u003eAll participants are\u0026nbsp;signed the informed consent before the investigate.and they consent\u0026nbsp;their \u0026nbsp;anonymized information to be published in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to support the findings of this study are available from the\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ecorresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eScience and Technology Commission of Fengxian District, Shanghai Municipality2023YearSocial Science and Technology Development FundProject: \u0026quot;Analysis of the Correlation Between Sleep Duration and the Severity of Coronary Artery Disease\u0026quot;（Feng Ke 20231456)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiang Zhinan analyzed the data. Zhang Bing wrote the first draft of the article.Wang Qihu responsible for review and editing; Wang Jinhua,Dong Zhaohui,Zhang Qing,Sui Jinna,Deng Jianxin were responsible for project implementation and data collection. All authors have read and agreed to the published version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the participating institutions and the\u0026nbsp;\u003c/p\u003e\n\u003cp\u003einvestigators for their efforts and input. We are also grateful to our study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eparticipants for their cooperative responses during data collection.\u003c/p\u003e\n\u003cp\u003eAbout the Author: Zhang Bing (born in 1990), male, Han ethnicity, native of Shangrao City, Jiangxi Province. Master of Medicine. Main research area: Arrhythmias.\u003c/p\u003e\n\u003cp\u003eCorresponding author: Wang Qihu, E-mail:[email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChina Cardiovascular Health and Disease Report Writing Group. Summary of the China Cardiovascular Health and Disease Report 2021. Chinese Circulation Journal, June 2022, Vol. 37, No. 6 (Total No. 288).\u003c/li\u003e\n\u003cli\u003eM G Poluektov. Sleep and Immunity. Neurosci Behav Physiol, 2021;51(5):609-615.\u003c/li\u003e\n\u003cli\u003eMaha Alkaid Albqoor, Abeer M Shaheen. Sleep quality, sleep latency, and sleep duration: a national comparative study of university students in Jordan. Sleep Breath, 2021 Jun;25(2):1147-1154.\u003c/li\u003e\n\u003cli\u003eJin Li, Dehong Cao, Yin Huang, et al. Sleep duration and health outcomes: an umbrella review. Sleep Breath, September 2022; 26(3):1479-1501.\u003c/li\u003e\n\u003cli\u003eChristina Antza, Georgios Kostopoulos, Samiul Mostafa, et al. The links between sleep duration, obesity and type 2 diabetes mellitus. J Endocrinol, 2021 Dec 13;252(2):125-141.\u003c/li\u003e\n\u003cli\u003eShiqi Yuan, Wen Ma, Rui Yang, et al. Sleep duration, genetic susceptibility, and Alzheimer\u0026apos;s disease: a longitudinal UK Biobank-based study. BMC Geriatr, 2022 Aug 2;22(1):638.\u003c/li\u003e\n\u003cli\u003eJing Xie, Yun Li, Yajun Zhang, et al. Sleep duration and metabolic syndrome: An updated systematic review and meta-analysis. Sleep Med Rev, 2021 Oct;59:101451.\u003c/li\u003e\n\u003cli\u003eHan Han, Ying Wang, Tongtong Li, et al. Sleep Duration and Risks of Incident Cardiovascular Disease and Mortality Among People With Type 2 Diabetes. Diabetes Care, 2023 Jan 1;46(1):101-110.\u003c/li\u003e\n\u003cli\u003eJinjia Zhang, Jinxin Zhang, Huadong Wu, et al. Sleep Duration and Risk of Hyperlipidemia: A Systematic Review and Meta-Analysis of Prospective Studies. Sleep Breath, 2022 Sep;26(3):997-1010.\u003c/li\u003e\n\u003cli\u003eAdeel Ahmad, S Claudia Didia. Effects of Sleep Duration on Cardiovascular Events. Curr Cardiol Rep, 2020 Feb 8;22(4):18.\u003c/li\u003e\n\u003cli\u003eXiaorong Yang, Hui Chen, Suyun Li, et al. Association of Sleep Duration with the Morbidity and Mortality of Coronary Artery Disease: A Meta-analysis of Prospective Studies. Heart, Lung and Circulation. 2015 Dec;24(12):1180-90.\u003c/li\u003e\n\u003cli\u003eIyas Daghlas, Hassan S Dashti, Jacqueline Lane, et al. Sleep Duration and Myocardial Infarction. J Am Coll Cardiol, 2019 Sep 10;74(10):1304-1314.\u003c/li\u003e\n\u003cli\u003eXiaoqing Lian, Jie Gu, Sibo Wang, et al. Effects of sleep habits on acute myocardial infarction risk and severity of coronary artery disease in the Chinese population. BMC Cardiovascular Disorders (2021) 21:481.\u003c/li\u003e\n\u003cli\u003eChun Shing Kwok, Evangelos Kontopantelis, George Kuligowski, et al. Self-Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose-Response Meta-Analysis. J Am Heart Assoc. 2018;7:e008552.\u003c/li\u003e\n\u003cli\u003eMaki Jike, Osamu Itani, Norio Watanabe, et al. Long sleep duration and health outcomes: A systematic review, meta-analysis and meta-regression. Sleep Med Rev, 2018 Jun;39:25-36.\u003c/li\u003e\n\u003cli\u003eGao Xue. A Mendelian randomization study on the causal relationship between sleep and coronary heart disease. Chinese Journal of Epidemiology, April 2020, Vol. 41, No. 4.\u003c/li\u003e\n\u003cli\u003eZhenhuang Zhuang, Meng Gao, Ruotong Yang, et al. Association of physical activity, sedentary behaviors and sleep duration with cardiovascular diseases and lipid profiles: a Mendelian randomization analysis. Lipids Health Dis, 2020 May 8;19(1):86.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sleep duration, severity of coronary artery disease, Gensini score","lastPublishedDoi":"10.21203/rs.3.rs-9275471/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9275471/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThis study aimed to investigate the correlation between sleep duration and the severity of coronary heart disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study included patients who were hospitalized and underwent coronary angiography at Fengcheng Hospital in Fengxian District, Shanghai from October 2023 to February 2025. Collect demographic characteristics, sleep duration, and coronary angiographic results. The Gensini scoring system was used to quantify the severity of coronary heart disease. Participants were stratified into three categories based on sleep duration(\u0026lt;6-hour group、6-8-hour group、\u0026gt;8-hour group). Statistical analyses were performed to evaluate the association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eCompared with the group with a sleep duration of 6 to 8 hours, Both \u0026lt;6-hour group and \u0026gt;8-hour group have higher Gensini scores (P\u0026lt;0.001). Multivariate Logistic Regreesion showed that both \u0026lt;6-hour group and \u0026gt;8-hour group have higher risk of falling into the high gensini score group,OR(95%CI) were 30.183 (10.066 – 90.505), 3.784(2.180 – 6.568) respectively,both P\u0026lt;0.001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThere exists a U-shaped relationship between sleep duration and coronary heart disease severity. Both short and long sleep duration were linked to more severe coronary heart disease.These finding indicate that maintaining a sleep duration of 6–8 hours is good for cardiovascular health.\u003c/p\u003e","manuscriptTitle":"The Correlation Between Sleep Duration and The Severity of Coronary Heart Disease*","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 19:15:08","doi":"10.21203/rs.3.rs-9275471/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-13T22:07:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63127263630503222296897539083817217956","date":"2026-05-13T17:32:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175245907640140520560425714747417932288","date":"2026-05-11T06:24:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-23T20:43:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-15T07:21:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-08T17:10:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-08T11:32:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2026-04-08T11:03:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"027da824-a2e3-4fc9-818e-fe7664649438","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-13T22:07:06+00:00","index":92,"fulltext":""},{"type":"reviewerAgreed","content":"63127263630503222296897539083817217956","date":"2026-05-13T17:32:32+00:00","index":91,"fulltext":""},{"type":"reviewerAgreed","content":"175245907640140520560425714747417932288","date":"2026-05-11T06:24:22+00:00","index":89,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T19:15:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 19:15:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9275471","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9275471","identity":"rs-9275471","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}