{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:45:25Z","timestamp":1790095525265,"version":"4.0.1"},"reference-count":81,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian National Health and Medical Research Council","award":["APP1194510"],"award-info":[{"award-number":["APP1194510"]}]},{"DOI":"10.13039\/501100003593","name":"National Council for Scientific and Technological Development\u2014CNPq","doi-asserted-by":"publisher","award":["31110911109\/2023-3"],"award-info":[{"award-number":["31110911109\/2023-3"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Sleep, physical activity, and nutrition (SPAN) are major lifestyle behaviours that influence cardiovascular disease risk. We examined the multi-behaviour associations of SPAN with risk of major adverse cardiovascular events (MACE) and its subtypes (myocardial infarction (MI), heart failure (HF), and stroke).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This prospective cohort analysis included 53 242 participants from the UK Biobank (median age: 63.0 years; 56.8% male). Wearable-measured sleep (h\/day) and moderate to vigorous physical activity (MVPA; min\/day) were calculated using a machine learning-based algorithm, and diet was assessed using a 10-item diet quality score (DQS). Major adverse cardiovascular event risk was estimated across 27 joint tertile combinations of SPAN behaviours, and dose\u2013response associations of SPAN with MACE were examined using a composite score (0\u2013100). Synergistic relationships were examined using the relative excess risk due to interaction (RERI), attributable proportion (AP), and the synergy index (S). Over the 8.0-year follow-up, 2034 MACE events occurred, including 932 MI, 584 strokes, and 518 HF events. Compared with the lowest tertile for all SPAN behaviours, the optimal SPAN combination of 8.0\u20139.4\u2005h\/day sleep, 42\u2013104 min\/day MVPA, and a DQS of 32.5\u201350.0 was associated with a 57% lower risk of MACE (HR: 0.43; 95% CI: 0.30, 0.62). A median SPAN score (52.8) was associated with a 41% lower risk of MACE (HR: 0.59; 95% CI: 0.49, 0.70). The median SPAN score corresponded to an HR of 0.53 (0.38, 0.75) for HF, 0.65 (95% CI: 0.50, 0.84) for MI, and 0.52 (95% CI: 0.38, 0.71) for stroke. A minimum combined variation of an additional 11\u2005min\/day of sleep, 4.5\u2005min\/day MVPA, and 3 DQS points was associated with 10% lower MACE risk (HR: 0.90; 0.88, 0.94). No synergistic interaction was observed between the SPAN behaviours and MACE (RERI = 0.003; 95% CI: \u22120.03, 0.04; AP = 0.4%; 95% CI: \u22126 to 7%; S = 1.03; 95% CI: \u22123.32, 5.29).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Modest differences in combined SPAN behaviour levels were associated with meaningful reductions in MACE risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag141","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:40:51Z","timestamp":1774312851000},"source":"Crossref","is-referenced-by-count":9,"title":["Combined variations in sleep, physical activity, and nutrition and the risk of major adverse cardiovascular events"],"prefix":"10.1093","author":[{"given":"Nicholas A","family":"Koemel","sequence":"first","affiliation":[{"name":"Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"Turner Institute for Brain and Mental Health, Monash University School of Psychological Sciences, , Melbourne, Victoria 3800 ,","place":["Australia"]},{"name":"Charles Perkins Centre, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4294-6323","authenticated-orcid":false,"given":"Raaj Kishore","family":"Biswas","sequence":"additional","affiliation":[{"name":"Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"Charles Perkins Centre, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J","family":"Simpson","sequence":"additional","affiliation":[{"name":"Charles Perkins Centre, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"School of Life and Environmental Sciences, Faculty of Science, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7469-1399","authenticated-orcid":false,"given":"Leandro F M","family":"Rezende","sequence":"additional","affiliation":[{"name":"Chronic Disease Epidemiology Research Center, Department of Preventive Medicine, Universidade Federal de S\u00e3o Paulo , Sao Paulo 04023-062 ,","place":["Brazil"]},{"name":"Faculty of Health Sciences, Universidad Aut\u00f3noma de Chile , Providencia 7500912 ,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"Wang","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health , Sydney, New South Wales 2042 ,","place":["Australia"]},{"name":"The University of New South Wales School of Population Health, Faculty of Medicine and Health, , Sydney, New South Wales 2052 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0369-4621","authenticated-orcid":false,"given":"Adrian","family":"Bauman","sequence":"additional","affiliation":[{"name":"Charles Perkins Centre, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9050-1447","authenticated-orcid":false,"given":"David","family":"Raubenheimer","sequence":"additional","affiliation":[{"name":"Charles Perkins Centre, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"School of Life and Environmental Sciences, Faculty of Science, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Allman-Farinelli","sequence":"additional","affiliation":[{"name":"Charles Perkins Centre, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"Nutrition and Dietetics, School of Nursing, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7920-4924","authenticated-orcid":false,"given":"Peter A","family":"Cistulli","sequence":"additional","affiliation":[{"name":"Charles Perkins Centre, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales 2065 ,","place":["Australia"]},{"name":"Department of Respiratory and Sleep Medicine, Royal North Shore Hospital , Sydney, New South Wales 2065 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3115-338X","authenticated-orcid":false,"given":"Matthew N","family":"Ahmadi","sequence":"additional","affiliation":[{"name":"Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"Turner Institute for Brain and Mental Health, Monash University School of Psychological Sciences, , Melbourne, Victoria 3800 ,","place":["Australia"]},{"name":"Charles Perkins Centre, The University of Sydney , Sydney, 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