{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:53:06Z","timestamp":1791355986618,"version":"4.3.1"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Disruption in rest\u2010activity 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\u2010analysis to assess associations between RAR characteristics and cardiovascular disease incidence or prevalence, cardiovascular mortality, and all\u2010cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">A systematic search was conducted in PubMed, Web of Science, Cochrane Library, and Embase for cohort or cross\u2010sectional studies published up to August 2025. The exposure variables were nonparametric RAR parameters, including interdaily stability (describing day\u2010to\u2010day 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\u2010cause mortality. The secondary outcomes included cardiovascular disease prevalence and incidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Seven studies involving 109\u2009365 participants were included. Pooled results showed that higher intradaily variability was associated with a significantly increased risk of all\u2010cause mortality (hazard ratio [HR], 1.05 [95% CI, 1.02\u20131.09]) and cardiovascular disease prevalence (odds ratio, 1.73 [95% CI, 1.21\u20132.47]). Lower relative amplitude was significantly associated with higher cardiovascular mortality (HR, 1.50 [95% CI, 1.13\u20131.98]) and all\u2010cause mortality (HR, 1.46 [95% CI, 1.27\u20131.68]). Interdaily stability showed no significant associations with any outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Measures of disrupted rest\u2010activity rhythms were associated with increased cardiovascular mortality, and all\u2010cause 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.048656","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:30:17Z","timestamp":1789738217000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Rest\u2013Activity Rhythm and Cardiovascular Disease, Cardiovascular Mortality, and All\u2010Cause Mortality: A\u00a0Systematic Review and Meta\u2010Analysis"],"prefix":"10.1161","volume":"15","author":[{"given":"Fengshuo","family":"Chang","sequence":"first","affiliation":[{"name":"Xiyuan Hospital, China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhao","family":"Xu","sequence":"additional","affiliation":[{"name":"Dongzhimen Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingdong","family":"Guo","sequence":"additional","affiliation":[{"name":"Xiyuan Hospital, China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8745-8352","authenticated-orcid":false,"given":"Hao","family":"Xu","sequence":"additional","affiliation":[{"name":"China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Li","sequence":"additional","affiliation":[{"name":"Dongzhimen Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0523-3615","authenticated-orcid":false,"given":"Naima","family":"Covassin","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4045-4341","authenticated-orcid":false,"given":"Virend K.","family":"Somers","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaijuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Dongzhimen Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3652-8037","authenticated-orcid":false,"given":"Yong","family":"Wang","sequence":"additional","affiliation":[{"name":"Dongzhimen Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4233-950X","authenticated-orcid":false,"given":"Jingen","family":"Li","sequence":"additional","affiliation":[{"name":"Dongzhimen Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]},{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","unstructured":"World Health Organization . 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