CV & OTHER Comorbidities in IH
Cardiovascular, cardiometabolic, and renal (CV/CM/R) comorbidities are common in individuals diagnosed with idiopathic hypersomnia (IH)1
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Adults with IH have a greater prevalence of CV COMORBIDITIES2*†
COMPARED TO MATCHED CONTROLS WITHOUT THE DISEASE, PATIENTS WITH IH HAD:
greater odds of
CV DISEASE
greater odds of
MACE
greater odds of
STROKE
greater odds of
HYPERTENSION DIAGNOSIS OR ANTIHYPERTENSIVE USE
greater odds of
HEART FAILURE
greater odds of
ATRIAL FIBRILLATION
greater odds of
MYOCARDIAL INFARCATION
greater odds of
CORONARY REVASCULARIZATION
| 2.3x greater odds of CV DISEASE | 2.1x greater odds of MACE | 2.1x greater odds of STROKE | 2x greater odds of HYPERTENSION DIAGNOSIS OR ANTIHYPERTENSIVE USE |
| 2x greater odds of HEART FAILURE | 1.9x greater odds of ATRIAL FIBRILLATION | 1.7x greater odds of MYOCARDIAL INFARCATION | 1.6x greater odds of CORONARY REVASCULARIZATION |
*Odds ratios (95% CI): 2.26 (2.14-2.38) for CV disease, 2.08 (1.89-2.30) for MACE (inclusive of grouped instances of myocardial infarction, ischemic stroke, acute coronary syndrome, coronary artery bypass grafting, or percutaneous coronary intervention), 2.07 (1.87-2.29) for stroke, 2.02 (1.93-2.12) for hypertension diagnosis or antihypertensive use, 1.97 (1.76-2.20) for heart failure, 1.91 (1.66-2.20) for atrial fibrillation, 1.74 (1.42-2.12) for myocardial infarction, 1.58 (1.12-2.17) for coronary revascularization.2
†A retrospective analysis was conducted of administrative claims between December 2013 and February 2020 for 11,412 patients with IH compared to 57,058 matched controls without IH. Eligible patients were aged ≥18 years upon cohort entry and had 365 days of continuous medical coverage before and after cohort entry. Patients with IH were matched with up to 5 non-IH controls on age, sex, region, payer type, and cohort entry date. Odds of prevalent CV conditions or events were compared using unconditional logistic regression. Results were reported as odds ratios with 95% confidence intervals.2
Several CV & CM comorbidities are present in patients newly diagnosed with IH3‡
| Comorbidity | Prevalence, % (n=4980) |
|---|---|
| Hyperlipidemia | 30.1% |
| Diabetes | 19.8% |
| Hypertension | 15.0% |
| History of CV disease | 14.3% |
| MACE | 2.4% |
| Atrial fibrillation | 1.8% |
| Edema | 1.5% |
| Heart failure | 1.4% |
| Stroke | 0.9% |
| Myocardial infarction | 0.3% |
‡This retrospective cohort study analyzed medical claims from 1/1/2014 to 9/30/2019 of 4,980 adults newly diagnosed with IH and a general MarketScan® population cohort of 32,948,986 adults.3 Results are descriptive in nature and no statistical comparisons were made between cohorts.3
PEOPLE WITH IH HAVE HIGHER RISK OF DEVELOPING SODIUM-ASSOCIATED NEGATIVE CLINICAL OUTCOMES (NCOs)1§‖
Compared to individuals without the disease, patients with IH had higher risk for CV/CM/R CONDITIONS THAT HAVE A DIRECT RELATIONSHIP WITH SODIUM INTAKE (PRIMARY NCOs)1:
§NCOs were identified based on pragmatic literature review and discussions with clinical experts. Primary NCOs included conditions with a strong direct relationship with excess sodium intake and were examined as the following individual and composite measures: hypertension, MACE (i.e., heart failure, ischemic stroke, myocardial infarction, unstable angina, or coronary revascularization procedures), edema, renal outcomes (i.e., proteinuria, CKD or chronic/acute kidney failure), and ≥1 CV/CM/renal outcome (primary NCO composite; i.e., ≥1 NCO event associated with a primary NCO).
‖Based on a retrospective, observational cohort analysis using Komodo Research Data (KRD+) from January 2016 to January 2024. Claims were analyzed for 11,951 individuals with IH (IH cohort) and 59,755 individuals without IH (non-IH cohort). Entropy balancing was used to balance age, sex, race, health plan type, and year of index date between the IH cohort and the non-IH cohort. Weights from entropy balancing were applied to all analyses using the non-IH cohort. The risk for NCOs was compared between cohorts using weighted Cox proportional hazards models, incorporating the weights calculated from entropy balancing. Results were reported as hazard ratios with 95% confidence intervals.
Modifiable risk factors for CV conditions include smoking, physical activity, body weight, diet, and sodium intake4,5
Excessive sodium intake is known to increase CV risk6
According to a study in the New England Journal of Medicine, each 1000-mg increase in urinary sodium excretion, an accurate way to measure sodium intake, was associated with an 18% increase in CV risk6¶
#Adjusted hazard ratio (95% CI) 1.18 (1.08-1.29).6
¶A meta-analysis of 10,709 healthy participants from 6 studies showed that higher 24-hour sodium excretion was associated with higher cardiovascular risk in analyses that controlled for confounding factors. Multiple 24-hour urine samples, the most accurate method for assessing sodium intake, were obtained for each participant. Primary outcome was a cardiovascular event, defined as a composite of coronary revascularization (coronary-artery bypass grafting or percutaneous coronary intervention), fatal or nonfatal myocardial infarction, or fatal or nonfatal stroke.6
The American Heart Association recommends a total of
<1500 mg/day
as the ideal daily sodium intake limit to prevent elevated blood pressure in adults with or without hypertension.7
Daily sodium intake exceeds HHS/USDA recommendation in
~9 of 10 American adults8**
**US Department of Health and Human Services and US Department of Agriculture (HHS/USDA) recommends upper sodium-intake limit of 2300 mg/day. Based on 2003-2016 National Health and Nutrition Examination Survey data from 36,232 participants aged ≥19 years.8
CI = confidence interval; CKD = chronic kidney disease; MACE = major adverse cardiovascular event.
Do you consider CV/CM/R comorbidities and excessive sodium intake when devising a treatment plan for your patients with IH?
References:
- Data on File (SCORE Study JZP258-525). Palo Alto, CA: Jazz Pharmaceuticals, Inc.
- Saad R, Lillaney P, Profant DA, et al. Cardiovascular Burden of Individuals Diagnosed With Idiopathic Hypersomnia: Real-World Idiopathic Hypersomnia Total Health Model (CV-RHYTHM). Sleep Med. Published online May 19, 2025:106587. doi: https://doi.org/10.1016/j.sleep.2025.106587
- Saad R, Prince P, Taylor B, Ben-Joseph RH. Characteristics of adults newly diagnosed with idiopathic hypersomnia in the United States. Sleep Epidemiol. 2023;3:100059.
- Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation. 2024;149(8):e347-e913.
- Filippini T, Malavolti M, Whelton PK, et al. Blood Pressure Effects of Sodium Reduction: Dose-Response Meta-Analysis of Experimental Studies. Circulation. 2021;143(16):1542–1567.
- Ma Y, He FJ, Sun Q, et al. 24-hour urinary sodium and potassium excretion and cardiovascular risk. N Engl J Med. 2022;386(3):252-263.
- Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCPACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. Published online August 14, 2025.
- Clarke L, Schieb L, Ayala C, et al. Temporal Trends in Dietary Sodium Intake Among Adults Aged ≥19 Years — United States, 2003–2016. MMWR Morb Mortal Wkly Rep. 2021;70(42):1424–1430.