Interpretation of the role of circadian rhythm health in cardiometabolic health and disease risk: the scientific statement from the American Heart Association_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

NIE Zixiong , YUE Honghua , LIANG Weitao ,  WU Zhong

Department of Cardiothoracic and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

WU Zhong, Email: wuzhong71@scu.edu.cn

Keywords：

Circadian rhythm; cardiovascular diseases; type 2 diabetes mellitus; exercise; scientific statement; interpretation

DOI：

10.7507/1007-4848.202601008

Video：

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The circadian system maintains physiological homeostasis by precisely orchestrating 24-hour cycles of metabolic and cardiovascular functions. Circadian disruption has been substantiated as a contributor to cardiometabolic dysfunction, significantly elevating the risk of obesity, type 2 diabetes, hypertension, and cardiovascular diseases, thereby emerging as a crucial target for global chronic disease prevention. In 2025, the American Heart Association (AHA) issued a dedicated scientific statement that systematically reviewed the regulatory mechanisms of circadian rhythms and their intrinsic links to cardiometabolic health. It highlighted the pivotal role of modifiable behavioral factors, including light exposure, sleep-wake patterns, meal timing, and timing of physical activity, and proposed multi-faceted intervention strategies centered on chronotherapy. Considering the distinct circadian characteristics and chronic disease epidemiology in the Chinese population compared to Western counterparts, this article, grounded in the statement's core framework and incorporating evidence from localized Chinese research, provides a systematic interpretation of the biological basis of circadian rhythms, the pathophysiological mechanisms underlying disruption-related diseases, and potential intervention pathways. It particularly discusses the applicability of the statement's conclusions to clinical practice and public health strategies in China, aiming to offer an evidence-based reference for developing a cardiometabolic health support system tailored to the national context.

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1. 翟君鎣, 王婷, 張天惟, 等. 中國中老年人體力活動水平與晝夜節律綜合征的關聯性研究. 現代預防醫學, 2025, 52(8): 1441-1447.Zhai JY, Wang T, Zhang TW, et al. Association between physical activity level and circadian syndrome in middle-aged and elderly Chinese. Mod Prev Med, 2025, 52(8): 1441-1447.
2. 王炳夫, 宋宇龍, 樊俞堅, 等. 晝夜節律誘導心臟重塑影響心血管病的孟德爾隨機化研究. 中國循證心血管醫學雜志, 2025, 17(9): 1039-1043, 1054.Wang BF, Song YL, Fan YJ, et al. Circadian rhythm-induced cardiac remodeling affects cardiovascular disease: a Mendelian randomization study. Chin J Evid Based Cardiovasc Med, 2025, 17(9): 1039-1043, 1054.
3. Knutson KL, Dixon DD, Grandner MA, et al. Role of circadian health in cardiometabolic health and disease risk: a scientific statement from the American Heart Association. Circulation, 2025, 152(21): e408-e419.
4. Crowthers R, Thi Mong Nguyen T, Martinez D. Circadian disruptions and their role in the development of hypertension. Front Neurosci, 2024, 18: 1433512.
5. Huart J, Persu A, Lengelé JP, et al. Pathophysiology of the nondipping blood pressure pattern. Hypertension, 2023, 80(4): 719-729.
6. Chellappa SL, Vujovic N, Williams JS, et al. Impact of circadian disruption on cardiovascular function and disease. Trends Endocrinol Metab, 2019, 30(10): 767-779.
7. Duffy JF, Abbott SM, Burgess HJ, et al. Workshop report. Circadian rhythm sleep-wake disorders: gaps and opportunities. Sleep, 2021, 44(5): zsaa281.
8. Dibner C, Schibler U, Albrecht U. The mammalian circadian timing system: organization and coordination of central and peripheral clocks. Annu Rev Physiol, 2010, 72: 517-549.
9. Brown TM, Brainard GC, Cajochen C, et al. Recommendations for daytime, evening, and nighttime indoor light exposure to best support physiology, sleep, and wakefulness in healthy adults. PLoS Biol, 2022, 20(3): e3001571.
10. Zeitzer JM, Dijk DJ, Kronauer R, et al. Sensitivity of the human circadian pacemaker to nocturnal light: melatonin phase resetting and suppression. J Physiol, 2000, 526 Pt 3: 695-702.
11. Dijk DJ, Archer SN. Light, sleep, and circadian rhythms: together again. PLoS Biol, 2009, 7(6): e1000145.
12. Appleman K, Figueiro MG, Rea MS. Controlling light-dark exposure patterns rather than sleep schedules determines circadian phase. Sleep Med, 2013, 14(5): 456-461.
13. Duffy JF, Kronauer RE, Czeisler CA. Phase-shifting human circadian rhythms: influence of sleep timing, social contact and light exposure. J Physiol, 1996, 495 ( Pt 1): 289-297.
14. Sletten TL, Vincenzi S, Redman JR, et al. Timing of sleep and its relationship with the endogenous melatonin rhythm. Front Neurol, 2010, 1: 137-145.
15. 劉陽彥, 余何, 黃禮嵐, 等. 輪班工作所致晝夜節律紊亂與肥胖癥的研究進展. 環境與職業醫學, 2024, 41(10): 1198-1203.Liu YY, Yu H, Huang LL, et al. Research progress on circadian rhythm disruption induced by shift work and obesity. J Environ Occup Med, 2024, 41(10): 1198-1203.
16. Lewis P, Oster H, Korf HW, et al. Food as a circadian time cue— evidence from human studies. Nat Rev Endocrinol, 2020, 16(4): 213-223.
17. 李旻典, 張艦心. 代謝生物鐘: 晝夜節律調控代謝研究的最新進展. 陸軍軍醫大學學報, 2025, 47(4): 285-289.Li MD, Zhang JX. Metabolic clock: recent advances in circadian regulation of metabolism. J Army Med Univ, 2025, 47(4): 285-289.
18. 丁蕊, 趙小艷, 李欣, 等. 晝夜節律下限時進食與2型糖尿病相關性的研究進展. 中國糖尿病雜志, 2024, 32(8): 634-637.Ding R, Zhao XY, Li X, et al. Research progress on the relationship between time-restricted eating and type 2 diabetes mellitus under circadian rhythm. Chin J Diabetes, 2024, 32(8): 634-637.
19. Yamanaka Y, Hashimoto S, Masubuchi S, et al. Differential regulation of circadian melatonin rhythm and sleep-wake cycle by bright lights and nonphotic time cues in humans. Am J Physiol Regul Integr Comp Physiol, 2014, 307(5): R546-R557.
20. Thomas JM, Kern PA, Bush HM, et al. Circadian rhythm phase shifts caused by timed exercise vary with chronotype. JCI Insight, 2020, 5(3): e134270.
21. Youngstedt SD, Elliott JA, Kripke DF. Human circadian phase-response curves for exercise. J Physiol, 2019, 597(8): 2253-2268.
22. Martin RA, Esser KA. Time for exercise? Exercise and its influence on the skeletal muscle clock. J Biol Rhythms, 2022, 37(6): 579-592.
23. 曹文燕, 馮瑤, 溫小龍, 等. 擇時運動介導時鐘基因調控糖脂代謝的研究進展. 當代體育科技, 2025, 15(5): 7-9,15.Cao WY, Feng Y, Wen XL, et al. Research progress on chrono-exercise mediating clock genes to regulate glucose and lipid metabolism. Contemp Sports Technol, 2025, 15(5): 7-9,15.
24. Chaput JP, McHill AW, Cox RC, et al. The role of insufficient sleep and circadian misalignment in obesity. Nat Rev Endocrinol, 2023, 19(2): 82-97.
25. Makarem N, Sears DD, St-Onge MP, et al. Variability in daily eating patterns and eating jetlag are associated with worsened cardiometabolic risk profiles in the American Heart Association Go Red for Women Strategically Focused Research Network. J Am Heart Assoc, 2021, 10(18): e022024.
26. Arab A, Karimi E, Garaulet M, et al. Social jetlag and obesity: a systematic review and meta-analysis. Obes Rev, 2024, 25(3): e13664.
27. Huang T, Redline S. Cross-sectional and prospective associations of actigraphy-assessed sleep regularity with metabolic abnormalities: the Multi-Ethnic Study of Atherosclerosis. Diabetes Care, 2019, 42(8): 1422-1429.
28. Zuraikat FM, Makarem N, Redline S, et al. Sleep regularity and cardiometabolic heath: is variability in sleep patterns a risk factor for excess adiposity and glycemic dysregulation? Curr Diab Rep, 2020, 20(8): 38.
29. Zhai Z, Liu X, Zhang H, et al. Associations of midpoint of sleep and night sleep duration with type 2 diabetes mellitus in Chinese rural population: the Henan Rural Cohort Study. BMC Public Health, 2021, 21: 879.
30. Raji OE, Kyeremah EB, Sears DD, et al. Chrononutrition and cardiometabolic health: an overview of epidemiological evidence and key future research directions. Nutrients, 2024, 16(14): 2332.
31. Palomar-Cros A, Srour B, Andreeva VA, et al. Associations of meal timing, number of eating occasions and night-time fasting duration with incidence of type 2 diabetes in the NutriNet-Santé cohort. Int J Epidemiol, 2023, 52(5): 1486-1497.
32. Gumz ML, Shimbo D, Abdalla M, et al. Toward precision medicine: circadian rhythm of blood pressure and chronotherapy for hypertension—2021 NHLBI Workshop Report. Hypertension, 2023, 80(3): 503-522.
33. Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation, 2023, 148(20): 1606-1635.
34. Mohandas R, Douma LG, Scindia Y, et al. Circadian rhythms and renal pathophysiology. J Clin Invest, 2022, 132(3): e148277.
35. Costello HM, Gumz ML. Circadian rhythm, clock genes, and hypertension: recent advances in hypertension. Hypertension, 2021, 78(5): 1185-1196.
36. Scheer FAJL, Morris CJ, Garcia JI, et al. Repeated melatonin supplementation improves sleep in hypertensive patients treated with beta-blockers: a randomized controlled trial. Sleep, 2012, 35(10): 1395-1402.
37. Garrison SR, Youngson ERE, Perry DA, et al. Bedtime vs morning antihypertensive medications in frail older adults: the BedMed-Frail randomized clinical trial. JAMA Netw Open, 2025, 8(5): e2513812.
38. Garrison SR, Bakal JA, Kolber MR, et al. Antihypertensive medication timing and cardiovascular events and death: the BedMed randomized clinical trial. JAMA, 2025, 333(23): 2061-2072.
39. McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J, 2024, 45(38): 3912-4018.
40. Torquati L, Mielke GI, Brown WJ, et al. Shift work and the risk of cardiovascular disease. A systematic review and meta-analysis including dose-response relationship. Scand J Work Environ Health, 2018, 44(3): 229-238.
41. Makarem N, German CA, Zhang Z, et al. Rest-activity rhythms are associated with prevalent cardiovascular disease, hypertension, obesity, and central adiposity in a nationally representative sample of US adults. J Am Heart Assoc, 2024, 13(1): e032073.
42. Huang T, Mariani S, Redline S. Sleep irregularity and risk of cardiovascular events: the Multi-Ethnic Study of Atherosclerosis. J Am Coll Cardiol, 2020, 75(9): 991-999.
43. 陳玉明, 陶舒曼, 鄒立巍, 等. 大學生社會時差和睡眠質量與心血管代謝風險的關聯. 中國學校衛生, 2024, 45(4): 492-496.Chen YM, Tao SM, Zou LW, et al. Association of social jetlag and sleep quality with cardiometabolic risk among college students. Chin J Sch Health, 2024, 45(4): 492-496.
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