LAUSR

To the Editor: We have read with great interest the recent study by Rosen DM et al. [1], which reported that self-reported snoring was not associated with incident cardiovascular disease (CVD) among the African American population. However, other epidemiological studies have revealed that self-reported snoring is an increased risk for CVD events in the American population [2, 3]. Up to now, those reports were based onWestern populations and data that display this association in Asian population are limited. Accordingly, we aimed to explore this issue in the Northeast China Rural Cardiovascular Health Study, which includes a total of 11,956 participants aged ≥ 35 years. Of the 11,956 subjects, 10,700 participants consented and were qualified for our follow-up study. A total of 10,349 participants (96.7%) completed at least one followup visit and the median follow-up was 4.66 years. In the current analyses, we excluded participants with a history of CVD (N = 821) at baseline. Complete information on co-variables from the baseline visit was required for inclusion in the current analyses. Finally, data were available for 9528 participants. Other detailed design and methods of this study were described in our previous study [4, 5]. Our results showed that among the 9,528 participants, 3,636 showed snoring, while 5892 showed no snoring. The incidence of CVD was 4.6% in the non-snorer group and 5.4% in the snorer group. In addition, snoring intensity was categorized into low, normal, strong, and very strong respectively, according to our previous study [5]. The incidence of CVDwas 5.2%, 5.3%, 5.5%, and 7.4% in low, normal, strong, and very strong intensity of snoring group respectively. Furthermore, we analyzed the correlations between selfreported snoring, snoring intensity, and incident CVD events. The results are presented in Table 1. Unadjusted in model 1, very strong intensity of snoring (HR, 1.662; 95% CI, 1.044– 2.646, P = 0.032) was significantly associated with incident CVD events; however, low (HR, 1.110; 95% CI, 0.845– 1.457, P = 0.454), normal (HR, 1.154; 95% CI, 0.883– 1.508, P = 0.294), strong (HR, 1.171; 95% CI, 0.859–1.596, P = 0.317) intensity of snoring, and self-reported snoring (HR, 1.175; 95% CI, 0.978–1.412, P = 0.084) could not predict incident CVD events. After adjustment for age, sex, education, income, current smoking status, current drinking status, hypertension, body mass index, and diabetes in model 2, selfreported snoring (HR, 1.010; 95% CI, 0.837–1.220, P = 0.915) was not significantly associated with incident CVD events. And among the four kinds of intensity of snoring, low (HR, 1.050; 95% CI, 0.798–1.381, P = 0.728), normal (HR, 0.983; 95% CI, 0.750–1.289, P = 0.903), strong (HR, 0.908; 95% CI, 0.662–1.247, P = 0.553), and very strong