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Peer-reviewedCC BY-NC 4.0Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Association Between Rest–Activity Rhythm and Cardiovascular Disease, Cardiovascular Mortality, and All‐Cause Mortality: A Systematic Review and Meta‐Analysis

  • Fengshuo Chang1
  • Jinhao Xu2
  • Mingdong Guo1
  • Hao Xu3
  • Dan Li2
  • Naima Covassin4
  • Virend K. Somers4
  • Kaijuan Wang2
  • Yong Wang2
  • Jingen Li2,4
4 affiliations
  1. 1Department of Geriatrics Xiyuan Hospital, China Academy of Chinese Medical Sciences Beijing 100091 China
  2. 2Cardiovascular Disease Center Dongzhimen Hospital, Beijing University of Chinese Medicine Beijing 100700 China
  3. 3Cardiovascular Diseases Center, Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing 100091 China
  4. 4Department of Cardiovascular Medicine Mayo Clinic Rochester 55902 Minnesota USA
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Abstract

Background: Disruption in rest‐activity rhythm (RAR) is an emerging risk factor for cardiovascular disease (CVD) and mortality, but the strength of evidence is unclear. Therefore, we conducted a systematic review and meta‐analysis to assess associations between RAR characteristics and cardiovascular disease incidence or prevalence, cardiovascular mortality, and all‐cause mortality.

Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane Library, and Embase for cohort or cross‐sectional studies published up to August 2025. The exposure variables were nonparametric RAR parameters, including interdaily stability (describing day‐to‐day stability of the RAR), intradaily variability (a measure of RAR fragmentation), and relative amplitude (indicating robustness or strength of the RAR). The primary outcomes were cardiovascular mortality and all‐cause mortality. The secondary outcomes included cardiovascular disease prevalence and incidence.

Results: Seven studies involving 109 365 participants were included. Pooled results showed that higher intradaily variability was associated with a significantly increased risk of all‐cause mortality (hazard ratio [HR], 1.05 [95% CI, 1.02–1.09]) and cardiovascular disease prevalence (odds ratio, 1.73 [95% CI, 1.21–2.47]). Lower relative amplitude was significantly associated with higher cardiovascular mortality (HR, 1.50 [95% CI, 1.13–1.98]) and all‐cause mortality (HR, 1.46 [95% CI, 1.27–1.68]). Interdaily stability showed no significant associations with any outcome.

Conclusions: Measures of disrupted rest‐activity rhythms were associated with increased cardiovascular mortality, and all‐cause mortality. These findings support using RAR metrics as early, noninvasive risk indicators. Future work should investigate whether appropriately timed physical activity and sleep, as well as other interventions targeting RAR can mitigate cardiovascular risk.

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Cite

BibTeXRIS
BibTeX
@article{chang2026association,
  title = {{Association Between Rest–Activity Rhythm and Cardiovascular Disease, Cardiovascular Mortality, and All‐Cause Mortality: A Systematic Review and Meta‐Analysis}},
  author = {Fengshuo Chang and Jinhao Xu and Mingdong Guo and Hao Xu and Dan Li and Naima Covassin and Virend K. Somers and Kaijuan Wang and Yong Wang and Jingen Li},
  journal = {Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease},
  year = {2026},
  month = sep,
  doi = {10.1161/jaha.125.048656},
  url = {https://doi.org/10.1161/jaha.125.048656},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Association Between Rest–Activity Rhythm and Cardiovascular Disease, Cardiovascular Mortality, and All‐Cause Mortality: A Systematic Review and Meta‐Analysis
AU  - Fengshuo Chang
AU  - Jinhao Xu
AU  - Mingdong Guo
AU  - Hao Xu
AU  - Dan Li
AU  - Naima Covassin
AU  - Virend K. Somers
AU  - Kaijuan Wang
AU  - Yong Wang
AU  - Jingen Li
PY  - 2026
DA  - 2026/09/09
JO  - Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
DO  - 10.1161/jaha.125.048656
UR  - https://doi.org/10.1161/jaha.125.048656
AB  - Background: Disruption in rest‐activity rhythm (RAR) is an emerging risk factor for cardiovascular disease (CVD) and mortality, but the strength of evidence is unclear. Therefore, we conducted a systematic review and meta‐analysis to assess associations between RAR characteristics and cardiovascular disease incidence or prevalence, cardiovascular mortality, and all‐cause mortality.  Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane Library, and Embase for cohort or cross‐sectional studies published up to August 2025. The exposure variables were nonparametric RAR parameters, including interdaily stability (describing day‐to‐day stability of the RAR), intradaily variability (a measure of RAR fragmentation), and relative amplitude (indicating robustness or strength of the RAR). The primary outcomes were cardiovascular mortality and all‐cause mortality. The secondary outcomes included cardiovascular disease prevalence and incidence.  Results: Seven studies involving 109 365 participants were included. Pooled results showed that higher intradaily variability was associated with a significantly increased risk of all‐cause mortality (hazard ratio [HR], 1.05 [95% CI, 1.02–1.09]) and cardiovascular disease prevalence (odds ratio, 1.73 [95% CI, 1.21–2.47]). Lower relative amplitude was significantly associated with higher cardiovascular mortality (HR, 1.50 [95% CI, 1.13–1.98]) and all‐cause mortality (HR, 1.46 [95% CI, 1.27–1.68]). Interdaily stability showed no significant associations with any outcome.  Conclusions: Measures of disrupted rest‐activity rhythms were associated with increased cardiovascular mortality, and all‐cause mortality. These findings support using RAR metrics as early, noninvasive risk indicators. Future work should investigate whether appropriately timed physical activity and sleep, as well as other interventions targeting RAR can mitigate cardiovascular risk.
SN  - 2047-9980
ER  -