With the change of lifestyle, atherosclerotic cardiovascular disease (ASCVD) is showing a younger trend as an important component of ASCVD. Snoring as a common health problem related to sleep breathing, which is a characteristic indicator of obstructive sleep apnea-hypopnea syndrome (OSAHS) . However, there are few studies on the correlation between snoring and ASCVD, and it is still necessary to identify this factor to provide scientific basis for early intervention.

To investigate the correlation between snoring frequency and 10-year risk of ASCVD in middle-aged and elderly population.

From 2018 to 2021, a multi-stage stratified cluster sampling method was adopted to investigate the permanent residents aged 35-75 in Jing'an District. General information of the subjects was collected through questionnaire survey, and laboratory tests were used to collect total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) . Snoring frequency: snoring 1-2 times per week was considered as mild snoring, snoring 3-4 times per week was considered as moderate snoring, and snoring 5-7 times per week was considered as severe snoring; the 10-year risk of ASCVD <5%, 5%-<10%, and≥10% were defined as low-risk group, intermediate-risk group, and high-risk group, respectively. Multilevel ordinal Logistic regression analysis was used to explore the correlation of snoring with the 10-year risk of ASCVD and ASCVD risk factors.

A total of 10 898 residents participated in the study, excluding 1 079 who were unclear about their individual snoring status, for a total of 9 819 residents included in the study. The risk assessment results of ASCVD showed 5 930 in the low-risk group, 1 804 in the intermediate-risk group and 2 085 in the high-risk group. In the general population, Model 1 with multilevel ordinal Logistic regression analysis showed that both moderate and severe snoring were risk factors for the 10-year risk of ASCVD compared with no snoring (P<0.05) . Model 2 adjusted for age based on Model 1, and Model 3 adjusted for hypertension, diabetes, overweight or obesity, smoking, alcohol consumption, and educational factors based on Model 2, the results showed that increasing snoring frequency would cause an increase in the 10-year risk level of ASCVD. After further dividing the total population into males and females by gender, severe snoring was associated with a 10-year risk level of ASCVD compared with the no snoring (P<0.05) , and severe snoring in males has a greater risk than in females, but mild and moderate snoring was not associated with ASCVD risk (P>0.05) . Further analysis of the relationship between snoring and ASCVD risk factors showed that severe snoring was a risk factor for hypertriglyceridemia, hypercholesterolemia, hyper-low-density lipoproteinemia and hypo-high-density lipoproteinemia, and moderate snoring was a risk factor for hyper-low-density lipoproteinemia and hypo-high-density lipoproteinemia compared with no snoring (P<0.05) . Mild snoring was not associated with ASCVD risk factors.

The frequency of snoring is correlated with the 10-year risk and risk factors of ASCVD, and it is concentrated in moderate and severe snoring population. People with mild and moderate snoring should be regarded as the focus of early intervention to promote the early prevention and treatment of ASCVD.