Biological pathways underlying the association between habitual long-sleep and elevated cardiovascular risk in adults

Cardiovascular disease is the leading cause of death in the world. In addition to non-modifiable factors such as age and sex, cardiovascular risk is also driven by behavioral, and therefore somewhat modifiable, factors such as physical activity, diet, and sleep. It is well established that sleep duration has a U-shaped association with mortality and cardiovascular disease, with recent evidence suggesting that this association is observed even while controlling for the effects of comorbid conditions. Whereas several biological mechanisms mediating the association between chronic short sleep duration and cardiovascular risk have been established, the biological mechanisms underlying the relationship between habitual long sleep (≥9 h) duration and cardiovascular risk, in the absence of other chronic diseases, are not well understood. This review will focus on summarizing the literature investigating the mechanisms underlying the association between habitual long sleep duration and cardiovascular risk. We will also propose the mechanistic pathways, distinct from the ones for short sleep, by which habitual long sleep can increase cardiovascular disease.