Abstract Body: Background: Cardiovascular Disease (CVD) - including coronary artery disease, heart failure, stroke, and hypertension - disproportionately affects Black and Hispanic populations. However, the mediating role of physical activity and sleep in these disparities has not been fully explored.

Objectives: To examine the extent to which physical activity and sleep mediate the relationship between race/ethnicity and cardiovascular outcomes among adults aged 35 and older.

Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2020. CVD outcomes were defined as self-reported diagnosis of coronary heart disease, heart failure, or stroke. Physical activity was assessed using a self-reported survey, minutes/week of physical activity were categorized as poor (<1 min/week), intermediate (1-149 min/week), or ideal (≥150 min/week) based on recommended guidelines. Sleep was evaluated using self-reported trouble sleeping (yes/no). Survey-weighted logistic regression models were fitted, and mediation analyses (separate models for each racial/ethnic group) were conducted.

Results: Among a sample of 19,714 participants, the mean age was 55.7 years old (SD: 11.5), 53% female. Both sleep and physical activity as exposures were significantly associated with CVD outcomes. Sleep trouble was associated with increased odds of CVD (OR = 1.45, 95% CI: 1.24, 1.70, Table), with varying effects across racial/ethnic groups. This association was highest among non-Hispanic Asian adults (OR = 2.36, 95% CI: 1.37, 4.07), followed by Hispanic (OR = 2.16, 95% CI: 1.73, 2.70), non-Hispanic Black (OR = 1.40, 95% CI: 1.04, 1.88), and non-Hispanic White (OR = 1.38, 95% CI: 1.12, 1.68) groups. Both intermediate (OR = 0.67, 95% CI: 0.53, 0.83) and ideal (OR = 0.63, 95% CI: 0.53, 0.76) physical activity levels were associated with lower odds of CVD compared to poor activity levels. Mediation analysis showed significant indirect effects of sleep trouble for all groups. For physical activity, significant indirect effects were observed across all racial/ethnic groups for both intermediate and ideal levels, among non-Hispanic White, and non-Hispanic Black adults.

Conclusion: Our findings suggest that physical activity and sleep play an important role in the relationship between race and ethnicity and cardiovascular outcomes. Interventions on improving sleep quality and increasing physical activity should be tailored.