Ethnic differences in resting heart rate variability: a systematic review and meta-analysis

Reducing Psychological Stress in Peripartum Women With Heart Rate Variability Biofeedback: A Systematic Review

Peripartum women are exposed to a variety of stressors that have adverse health consequences for the maternal-child dyad (e.g., impaired bonding). To combat these adverse health consequences, heart rate variability biofeedback (HRVBF) may be implemented by holistic nurses to aid peripartum women experiencing a high level of stress. A systematic review was completed using the guidelines established in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. To be included in the review, studies had to meet the following criteria: (a) published scientific articles, (b) studies published in English, (c) experimental, quasi-experimental, or case reports, (d) use of HRVBF as the main treatment, (e) use of psychological stress as a dependent variable, and (f) studies published until December 2017. The major findings of this review can be described as follows: (a) HRVBF and psychological stress in peripartum women are related concepts, (b) peripartum women who completed HRVBF report a reduction in stress compared with participants who did not receive HRVBF, and (c) there is currently no information on the effectiveness of HRVBF on psychological stress in the first and early second trimester of pregnancy. Overall, this systematic review of the literature provides objective evidence that HRVBF may be a potential beneficial adjuvant treatment for stress management in peripartum women.

RESULTS OF THE 4­YEAR PROSPECTIVE OBSERVATION IN THE PROSPECTIVE TRIAL INTEREPID: FACTORS INFLUENCING MORBIDITY AND MORTALITY IN THE POPULATION OF RURAL REGIONS OF RUSSIA AND KYRGYZ REPUBLIC

Recent decades, cardiovascular diseases (CVD) remain the leading cause of mortality throughout the world. The prevalence of the main risk factors (RF) for CVD varies ethnically and geographically. Single observations witness that native and non­native populations inhabiting various, often quite contrast climatic and geographical, as socialeconomic conditions, might show a broad variety in CVD and RF prevalence.

Aim. To evaluate the 4­year survival rate in association with the RF and cardiovascular morbidity and mortality among rural inhabitants of Russia and Kyrgyz Republic, with analysis of ethnic specifics (by the data from trial “Interepid”).

Material and methods. The study was conducted under the framework of international project “Interepid” that included momentary epidemiological study of the prevalence of the main chronic non­communicable diseases and RF, and prospective step in small town and rural settlements of two countries — Russia and Kyrgyz Republic. In the analysis the results included of representative selections of rural inhabitants of the Volzhskiy region of Samarskaya Oblast of Russia (n=1050), and of Chuyskaya Oblast of Kyrgyz Republic (n=1341), age 20­64 y. o. In Russia and in Kyrgyz Republic the study was done by one protocol Interepid with specifically developed surveys (2011­2012). To the analysis, the endpoints included: all­cause mortality, CVD mortality, non­fatal cardiovascular events: non­fatal myocardial infarction, non­fatal stroke or transient ischemia, unstable angina, revascularization of any vascular pool — coronary bypass, endovascular revascularization, carotid endarterectomy, lower limbs arteries revascularization.

Results. The standardised by age survival rate was higher among the Kyrgyz Republic inhabitants — 98,8%, and in Samarskaya oblast — 95,7%. In Kyrgyz Republic the fatal and non­fatal cardiovascular endpoints were registered in 14,7% responders, with no ethnical differences, and in Samarskaya oblast — only in 2,1% (p<0,01). Smoking had significant influence on adverse outcomes only in males in both selections. The influence of arterial hypertension was non­significant for the outcomes in Samarskaya Oblast during 4­year observation, however there was significant influence of this RF in Kyrgyz Republic. Overconsumption of animal fat among the Kyrgyz Republic inhabitants associated with the development of non­fatal cardiovascular outcomes, with no ethnical differences.

Conclusion. The comparison of the results in three groups of population showed different impact of RF on development of the analyzed adverse outcomes in 4 years of prospective follow­up. Regardless the not that long term follow­up, the data obtained at the moment witness on reliable and prognostically significantly adverse influence of smoking, arterial hypertension and overconsumption of animal fat on the development of analyzed outcomes among the studied populations with ethnical and local differences. All these point the necessity is clear for development of differential management programs and events in Russian population and in native inhabitants of Kyrgyz Republic, including the specifics of CVD RF prevalence and influence on life prognosis.

Heart Rate Variability and Its Relation to Chronic Kidney Disease: Results From the PREVEND Study

OBJECTIVE

In the general population, reduced heart rate variability (HRV) has been associated with cardiovascular disease. However, its relation to chronic kidney disease (CKD) is debated. We therefore investigated the relation between low HRV and renal outcomes.

METHODS

In the population-based Prevention of REnal and Vascular ENdstage Disease study, renal outcomes (CKD, estimated glomerular filtration rate [eGFR], urinary albumin) were measured at baseline and three consecutive examinations. HRV measures (among which SDNN [standard deviation of normal-to-normal RR intervals]) were calculated from time series of beat-to-beat pulse wave recordings at baseline. The lowest (risk) quartile was compared with the upper three quartiles combined, in multivariable survival and linear mixed-effects analyses.

RESULTS

In 4605 participants (49% males, age range = 33-80, 0.6% blacks), we observed 341 new participants of CKD during a median follow-up duration of 7.4 years. Low SDNN was associated with higher incidence of CKD (crude HR = 1.66, 95% CI = 1.30 to 2.12, p < .001), but this association was no longer significant after adjustment for age, sex, and cardiovascular risk factors (adjusted HR = 1.13, 95% CI = 0.86 to 1.48, p = .40, similar for other HRV measures). No associations between SDNN and eGFR trajectories were found in the total sample. However, in a subgroup of participants with baseline CKD (n = 939), we found a significant association of low SDNN (but not other HRV measures) with lower baseline eGFR, even after multivariable adjustment (adjusted βlevel difference = -3.73 ml/min/1.73 m, 95% CI = -6.70 to -0.75, p = .014), but not with steeper eGFR decline.

CONCLUSIONS

These results suggest that reduced HRV may be a complication of CKD rather than a causal factor.

Resting Heart Rate Variability, Facets of Rumination and Trait Anxiety: Implications for the Perseverative Cognition Hypothesis

The perseverative cognition hypothesis (PCH) posits that perseveration, defined as the repetitive or sustained activation of cognitive representations of a real or imagined stressor, is a primary mechanism linking psychological (or stress) vulnerability with poor health and disease. Resting vagally mediated heart rate variability (vmHRV) is an important indicator of self-regulatory abilities, stress vulnerability and overall health. Those with lower resting vmHRV are more vulnerable to stress, and thus more likely to engage in perseverative cognition and experience subsequent negative mental health outcomes such as anxiety. Recent research suggests that rumination—one of the core mechanisms underlying perseveration—is a construct containing (at least) two maladaptive (depressive and brooding) and one adaptive (reflective) types of rumination. However, to date, research has not examined how the association between resting vmHRV may differ between these three facets of rumination, in addition to these facets’ mechanistic role in linking lower resting vmHRV with greater trait anxiety. The current cross-sectional study explores these relationships in a sample of 203 participants (112 females, 76 ethnic minorities, mean age = 19.43, standard deviation = 1.87). Resting vmHRV was assessed during a 5-min-resting period using an Electrocardiogram (ECG). Both trait rumination (including the three facets) and anxiety were assessed via self-report scales. Significant negative associations were found between resting vmHRV and maladaptive, but not adaptive, forms of perseveration. Similarly, mediation analyses showed a significant indirect relationship between resting vmHRV and anxiety through maladaptive, but not adaptive, facets of rumination. Our findings support the PCH such that those with stress vulnerability, as indexed by lower resting vmHRV, are more likely to engage in maladaptive perseverative cognition and thus experience negative outcomes such as anxiety. Our data also lend a novel outlook on the PCH; resting vmHRV is not related to reflective rumination and thus, this facet of perseveration may be a neutral, but not beneficial, factor in the link between stress vulnerability and psychological well-being.

From psychological moments to mortality: A multidisciplinary synthesis on heart rate variability spanning the continuum of time

Heart rate variability (HRV) indexes functioning of the vagus nerve, arguably the most important nerve in the human body. The Neurovisceral Integration Model has provided a structural framework for understanding brain-body integration, highlighting the role of the vagus in adaptation to the environment. In the present paper, we emphasise a temporal framework in which HRV may be considered a missing, structural link between psychological moments and mortality, a proposal we label as Neurovisceral Integration Across a Continuum of Time (or NIACT). This new framework places neurovisceral integration on a dimension of time, highlighting implications for lifespan development and healthy aging, and helping to bridge the gap between clearly demarcated disciplines such as psychology and epidemiology. The NIACT provides a novel framework, which conceptualizes how everyday psychological moments both affect and are affected by the vagus in ways that have long-term effects on mortality risk. We further emphasize that a longitudinal approach to understanding change in vagal function over time may yield novel scientific insights and important public health outcomes.

Genetic loci associated with heart rate variability and their effects on cardiac disease risk

Reduced cardiac vagal control reflected in low heart rate variability (HRV) is associated with greater risks for cardiac morbidity and mortality. In two-stage meta-analyses of genome-wide association studies for three HRV traits in up to 53,174 individuals of European ancestry, we detect 17 genome-wide significant SNPs in eight loci. HRV SNPs tag non-synonymous SNPs (in NDUFA11 and KIAA1755), expression quantitative trait loci (eQTLs) (influencing GNG11, RGS6 and NEO1), or are located in genes preferentially expressed in the sinoatrial node (GNG11, RGS6 and HCN4). Genetic risk scores account for 0.9 to 2.6% of the HRV variance. Significant genetic correlation is found for HRV with heart rate (-0.74 Collapse

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MESH Headings

• Blood Pressure
• Cohort Studies
• Genetic Predisposition to Disease
• Genome-Wide Association Study
• Heart Diseases/genetics
• Heart Diseases/physiopathology
• Heart Rate
• Humans
• Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels/genetics
• Muscle Proteins/genetics
• Polymorphism, Single Nucleotide
• Potassium Channels/genetics
• Quantitative Trait Loci
• RGS Proteins/genetics
• Risk Factors
• White People/genetics

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Grants

• R01 HL120393 NHLBI NIH HHS
• U01 HL130114 NHLBI NIH HHS
• P01 GM099568 NIGMS NIH HHS
• UL1 TR000124 NCATS NIH HHS
• R01 HL105756 NHLBI NIH HHS
• S10 OD020069 NIH HHS
• K23 HL114724 NHLBI NIH HHS
• R01 HL116747 NHLBI NIH HHS
• P30 DK063491 NIDDK NIH HHS
• I01 BX002558 BLRD VA
• MC_UU_12019/1 Medical Research Council
• UL1 TR001881 NCATS NIH HHS
• P2C HD050924 NICHD NIH HHS

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Affiliation(s)

Ilja M. Nolte Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
M. Loretto Munoz Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Vinicius Tragante Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands
Azmeraw T. Amare Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands Department of Epidemiology, School of Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar 6000, Ethiopia
Rick Jansen Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ inGeest, Amsterdam 1081 BT, The Netherlands
Ahmad Vaez Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands School of Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
Benedikt von der Heyde Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala 75237, Sweden Science for Life Laboratory, Uppsala University, Uppsala 75237, Sweden
Christy L. Avery Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA
Joshua C. Bis Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington 98104, USA
Bram Dierckx Department of Child and Adolescent Psychiatry/Psychology, Department of Child and Adolescent Psychiatry, PO Box 2060, Rotterdam 3000 CB, The Netherlands The Generation R Study Group, Erasmus MC, PO Box 2060, Rotterdam 3000 CB, The Netherlands
Jenny van Dongen Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands
Stephanie M. Gogarten Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
Philippe Goyette Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8
Jussi Hernesniemi Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere 33014, Finland Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere 33521, Finland
Ville Huikari Center for Life Course Health Research, University of Oulu, Oulu 90014, Finland
Shih-Jen Hwang Framingham Heart Study, Framingham, Massachusetts 01702, USA Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892, USA
Deepali Jaju Department of Clinical Physiology, Sultan Qaboos University Hospital, Muscat—Al Khoudh 123, Sultanate of Oman
Kathleen F. Kerr Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
Alexander Kluttig Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale) 06097, Germany
Bouwe P. Krijthe Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands
Jitender Kumar Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala 75237, Sweden Science for Life Laboratory, Uppsala University, Uppsala 75237, Sweden
Sander W. van der Laan Laboratory of Experimental Cardiology, Department of Heart and Lung, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
Leo-Pekka Lyytikäinen Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere 33014, Finland
Adam X. Maihofer Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA Center for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, California 92161, USA
Arpi Minassian Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA Center for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, California 92161, USA
Peter J. van der Most Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Martina Müller-Nurasyid Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg 85764, Germany Department of Medicine, University Hospital Munich, Ludwig-Maximilians-University, Munich 80539, Germany DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich 80336, Germany
Michel Nivard Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands EMGO+ Institute for Health and Care Research, VU University & VU University Medical Center, Amsterdam 1081 HV, The Netherlands
Erika Salvi Department of Health Sciences, University of Milano, Milano 20122, Italy
James D. Stewart Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina 27599, USA
Julian F. Thayer Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, Ohio 43210, USA
Niek Verweij Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Andrew Wong MRC Unit for Lifelong Health and Ageing, University College London, 33 Bedford Place, London WC1B 5JU, UK
Delilah Zabaneh Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK University College London Genetics Institute, University College London, London WC1E 6BT, UK
Mohammad H. Zafarmand Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam 1105 AZ, The Netherlands Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
Abdel Abdellaoui Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands EMGO+ Institute for Health and Care Research, VU University & VU University Medical Center, Amsterdam 1081 HV, The Netherlands
Sulayma Albarwani Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat Al-Khoudh 123, Sultanate of Oman
Christine Albert Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
Alvaro Alonso Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA
Foram Ashar McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
Juha Auvinen Center for Life Course Health Research, University of Oulu, Oulu 90014, Finland Unit of Primary Health Care, Oulu University Hospital, Oulu 90220, Finland
Tomas Axelsson Department of Medical Sciences, Molecular Medicine, Uppsala University, Uppsala 75237, Sweden
Dewleen G. Baker Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA Center for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, California 92161, USA
Paul I. W. de Bakker Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Matteo Barcella Department of Health Sciences, University of Milano, Milano 20122, Italy
Riad Bayoumi College of Medicine, Mohammed Bin Rashid University, PO Box 505055, Dubai Healthcare City, United Arab Emirates
Rob J. Bieringa Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Dorret Boomsma Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands EMGO+ Institute for Health and Care Research, VU University & VU University Medical Center, Amsterdam 1081 HV, The Netherlands
Gabrielle Boucher Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8
Annie R. Britton Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
Ingrid Christophersen Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02114, USA Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Rud 1346, Norway
Andrea Dietrich Department of Child- and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
George B. Ehret Center for Complex Disease Genomics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA Cardiology, Department of Specialties of Internal Medicine, Geneva University Hospital, Geneva 1211, Switzerland
Patrick T. Ellinor Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02114, USA Cardiac Arrhythmia Service & Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
Markku Eskola Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere 33521, Finland Department of Cardiology, University of Tampere School of Medicine, Tampere 33014, Finland
Janine F. Felix Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands
John S. Floras University Health Network and Mount Sinai Hospital Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada M5S Toronto General Research Institute, University Health Network, Toronto, Canada
Oscar H. Franco Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands
Peter Friberg Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
Maaike G. J. Gademan Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
Mark A. Geyer Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA
Vilmantas Giedraitis Department of Public Health and Caring Sciences, Molecular Geriatrics, Uppsala University, Uppsala 75237, Sweden
Catharina A. Hartman Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Daiane Hemerich Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands CAPES Foundation, Ministry of Education of Brazil, Brasília DF 70040-020, Brazil
Albert Hofman Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands
Jouke-Jan Hottenga Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands EMGO+ Institute for Health and Care Research, VU University & VU University Medical Center, Amsterdam 1081 HV, The Netherlands
Heikki Huikuri Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu 90220, Finland
Nina Hutri-Kähönen Department of Pediatrics, Tampere University Hospital, Tampere 33521, Finland Department of Pediatrics, University of Tampere School of Medicine, Tampere 33014, Finland
Xavier Jouven INSERM U970, Paris Descartes University, Paris 75006, France
Juhani Junttila Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu 90220, Finland
Markus Juonala Department of Medicine, University of Turku, Turku 20520, Finland Division of Medicine, Turku University Hospital, Turku 20521, Finland
Antti M. Kiviniemi Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu 90220, Finland
Jan A. Kors Department of Medical Informatics, Erasmus Medical Center, Rotterdam 3015 CE, The Netherlands
Meena Kumari Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK ISER, Essex University, Colchester, Essex CO4 3SQ, UK
Tatiana Kuznetsova Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven 3000, Belgium
Cathy C. Laurie Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
Joop D. Lefrandt Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Yong Li Division of Genetic Epidemiology, Institute for Medical Biometry and Statistics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79110, Germany
Yun Li Department of Genetics, University of North Carolina, Chapel Hill, North Carolina 27599, USA Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina 27599, USA Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina 27599, USA
Duanping Liao Division of Epidemiology, Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania 17033, USA
Marian C. Limacher Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida 32611, USA
Henry J. Lin Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA Division of Medical Genetics, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California 90502, USA
Cecilia M. Lindgren Li Ka Shing Centre for Health Information and Discovery, The Big Data Institute, University of Oxford, Oxford OX3 7BN, UK Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
Steven A. Lubitz Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02114, USA Cardiac Arrhythmia Service & Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
Anubha Mahajan Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
Barbara McKnight Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington 98104, USA Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
Henriette Meyer zu Schwabedissen Biopharmacy, Department Pharmaceutical Sciences, University of Basel, Basel CH-4056, Switzerland
Yuri Milaneschi Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ inGeest, Amsterdam 1081 BT, The Netherlands
Nina Mononen Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere 33014, Finland
Andrew P. Morris Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
Mike A. Nalls Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA
Gerjan Navis Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Melanie Neijts Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands EMGO+ Institute for Health and Care Research, VU University & VU University Medical Center, Amsterdam 1081 HV, The Netherlands
Kjell Nikus Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere 33521, Finland Department of Cardiology, University of Tampere, School of Medicine, Tampere 33014, Finland
Kari E. North Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, North Carolina 27599, USA
Daniel T. O'Connor Department of Medicine, University of California, San Diego, San Diego, California 92093, USA
Johan Ormel Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Siegfried Perz Institute of Epidemiology II, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg 85764, Germany
Annette Peters DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich 80336, Germany Institute of Epidemiology II, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg 85764, Germany German Center for Diabetes Research, Neuherberg 85764, Germany
Bruce M. Psaty Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington 98104, USA Departments of Epidemiology and Health Services, University of Washington, Seattle, Washington 98195, USA Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101, USA
Olli T. Raitakari Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku 20521, Finland Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku 20520, Finland
Victoria B. Risbrough Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA Center for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, California 92161, USA
Moritz F. Sinner Department of Medicine, University Hospital Munich, Ludwig-Maximilians-University, Munich 80539, Germany DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich 80336, Germany
David Siscovick The New York Academy of Medicine, New York, New York 10029, USA
Johannes H. Smit Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ inGeest, Amsterdam 1081 BT, The Netherlands
Nicholas L. Smith Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101, USA Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195, USA Seattle Epidemiologic Research and Information Center, Veterans Affairs Office of Research and Development, Seattle, Washington 98108, USA
Elsayed Z. Soliman Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
Nona Sotoodehnia Cardiovascular Health Research Unit, Division of Cardiology, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington 98101, USA
Jan A. Staessen Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven 3000, Belgium
Phyllis K. Stein Heart Rate Variability Lab, Washington University School of Medicine, St Louis, Missouri 63108, USA
Adrienne M. Stilp Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
Katarzyna Stolarz-Skrzypek First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Cracow 31-008, Poland
Konstantin Strauch Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg 85764, Germany Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich 81377, Germany
Johan Sundström Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala 751 85, Sweden
Cees A. Swenne Department of Cardiology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
Ann-Christine Syvänen Department of Medical Sciences, Molecular Medicine, Uppsala University, Uppsala 75237, Sweden
Jean-Claude Tardif Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8 Université de Montréal, Montreal, Quebec, Canada H3T IJ4
Kent D. Taylor Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90509, USA
Alexander Teumer Institute for Community Medicine, University Medicine Greifswald, Greifswald 17475, Germany
Timothy A. Thornton Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
Lesley E. Tinker Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
André G. Uitterlinden Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands Department of Internal Medicine, Erasmus University Medical Center, Rotterdam 3015 CE, The Netherlands Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging NCHA), Leiden 2300 RC, The Netherlands
Jessica van Setten Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands
Andreas Voss Institute of Innovative Health Technologies—IGHT Jena Ernst-Abbe-Hochschule Jena, Jena 07745, Germany
Melanie Waldenberger Institute of Epidemiology II, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg 85764, Germany Research Unit of Molecular Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg 85764, Germany
Kirk C. Wilhelmsen Departments of Genetics and Neurology University of North Carolina, Chapel Hill, North Carolina 27599, USA The Renaissance Computing Institute, Chapel Hill, North Carolina 27599, USA
Gonneke Willemsen Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands EMGO+ Institute for Health and Care Research, VU University & VU University Medical Center, Amsterdam 1081 HV, The Netherlands
Quenna Wong Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
Zhu-Ming Zhang Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
Alan B. Zonderman Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland 21224, USA
Daniele Cusi Institute of Biomedical Technologies, CNR—Italian National Research Council, Milan 20090, Italy KOS Genetic SRL, Bresso (Milano) 20091, Italy
Michele K. Evans Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland 21224, USA
Halina K. Greiser German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg 69210, Germany
Pim van der Harst Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Mohammad Hassan Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat Al-Khoudh 123, Sultanate of Oman
Erik Ingelsson Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala 75237, Sweden Science for Life Laboratory, Uppsala University, Uppsala 75237, Sweden Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California 94305, USA
Marjo-Riitta Järvelin Center for Life Course Health Research, University of Oulu, Oulu 90014, Finland Unit of Primary Health Care, Oulu University Hospital, Oulu 90220, Finland Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, St Mary’s campus, Imperial College London, London W2 1PG, UK Biocenter Oulu University of Oulu, Oulu 90014, Finland
Stefan Kääb Department of Medicine, University Hospital Munich, Ludwig-Maximilians-University, Munich 80539, Germany DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich 80336, Germany
Mika Kähönen Department of Clinical Physiology, Tampere University Hospital, Tampere 33521, Finland Department of Clinical Physiology, University of Tampere, School of Medicine, Tampere 33014, Finland
Mika Kivimaki Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
Charles Kooperberg Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
Diana Kuh MRC Unit for Lifelong Health and Ageing, University College London, 33 Bedford Place, London WC1B 5JU, UK
Terho Lehtimäki Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere 33014, Finland
Lars Lind Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala 751 85, Sweden
Caroline M. Nievergelt Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA Center for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, California 92161, USA
Chris J. O'Donnell Framingham Heart Study, Framingham, Massachusetts 01702, USA Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892, USA Cardiology Section, Boston Veteran’s Administration Healthcare, Boston, Maryland 02132, USA
Albertine J. Oldehinkel Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Brenda Penninx Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ inGeest, Amsterdam 1081 BT, The Netherlands
Alexander P. Reiner Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195, USA
Harriëtte Riese Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Arie M. van Roon Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
John D. Rioux Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8 Université de Montréal, Montreal, Quebec, Canada H3T IJ4
Jerome I. Rotter Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90509, USA
Tamar Sofer Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
Bruno H. Stricker Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands Inspectorate for Health Care, The Hague 2511 VX, The Netherlands
Henning Tiemeier Department of Child and Adolescent Psychiatry/Psychology, Department of Child and Adolescent Psychiatry, PO Box 2060, Rotterdam 3000 CB, The Netherlands Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands
Tanja G. M. Vrijkotte Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
Folkert W. Asselbergs Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands Institute of Cardiovascular Science, University College London, 222 Euston Road, London NW1 2DA, UK Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht 3501 DG, The Netherlands
Bianca J. J. M. Brundel Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1118, Amsterdam 1081 HV, The Netherlands
Susan R. Heckbert Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington 98104, USA Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195, USA
Eric A. Whitsel Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA Department of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA
Marcel den Hoed Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala 75237, Sweden Science for Life Laboratory, Uppsala University, Uppsala 75237, Sweden
Harold Snieder Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
Eco J. C. de Geus Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands EMGO+ Institute for Health and Care Research, VU University & VU University Medical Center, Amsterdam 1081 HV, The Netherlands

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Racial differences in the association between heart rate variability and left ventricular mass

NEW FINDINGS

What is the central question of this study? Decreased heart rate variability (HRV) is associated with increased cardiovascular disease (CVD) risk, including greater left ventricular mass (LVM). Despite their enhanced CVD risk profile, African Americans have been shown to exhibit higher HRV, relative to Whites; however, it is unclear whether this pattern extends to the association between HRV and LVM. What is the main finding and its importance? Using ECG and echocardiographic data, HRV was positively associated with LVM in a non-clinical sample of African Americans. These findings suggest that current assumptions regarding the meaning of higher HRV might not be universal, which might have implications for HRV as a risk marker among African Americans. Increased left ventricular mass (LVM) is an early precursor of target organ damage attributable to hypertension. Diminished parasympathetic cardiac control has been linked to both hypertension onset and left ventricular impairment; however, emerging evidence suggests that this pattern might be different in African Americans. The present study sought to determine whether race impacts the relationship between parasympathetic cardiac control and LVM. The LVM was assessed via echocardiography in a sample (n = 148) of African American and White adults (mean age 33.20 ± 5.71 years) with normal or mildly elevated blood pressure. Parasympathetic cardiac control was assessed by a measure of high-frequency heart rate variability (HF-HRV) determined from ECG recordings during 5 min of rest. In regression analysis, greater HF-HRV was associated with greater LVM among African Americans (P = 0.002) but was not related to LVM in Whites (P = 0.919). These are the first data to demonstrate that race moderates the relationship between HRV and LVM and further suggest that race might be an important factor in the association between parasympathetic cardiac control and other cardiovascular disease risk factors.

Acute stress impairs inhibitory control based on individual differences in parasympathetic nervous system activity

Identifying environmental influences on inhibitory control (IC) may help promote positive behavioral and social adjustment. Although chronic stress is known to predict lower IC, the immediate effects of acute stress are unknown. The parasympathetic nervous system (PNS) may be a mechanism of the stress-IC link, given its psychophysiological regulatory role and connections to prefrontal brain regions critical to IC. We used a focused assessment of IC (the stop-signal task) to test whether an acute social stressor (the Trier Social Stress Test) affected participants' pre- to post-IC performance (n=58), compared to a control manipulation (n=31). High frequency heart-rate variability was used as an index of PNS activity in response to the manipulation. Results indicated that stress impaired IC performance, blocking the practice effects observed in control participants. We also investigated the associations between PNS activity and IC; higher resting PNS activity predicted better pre-manipulation IC, and greater PNS stressor reactivity protected against the negative effects of stress on IC. Together, these results are the first to document the immediate effects of acute stress on IC and a phenotypic marker (PNS reactivity to stressors) of susceptibility to stress-induced IC impairment. This study suggests a new way to identify situations in which individuals are likely to exhibit IC vulnerability and related consequences such as impulsivity and risk taking behavior. Targeting PNS regulation may represent a novel target for IC-focused interventions.

The hierarchical basis of neurovisceral integration

The neurovisceral integration (NVI) model was originally proposed to account for observed relationships between peripheral physiology, cognitive performance, and emotional/physical health. This model has also garnered a considerable amount of empirical support, largely from studies examining cardiac vagal control. However, recent advances in functional neuroanatomy, and in computational neuroscience, have yet to be incorporated into the NVI model. Here we present an updated/expanded version of the NVI model that incorporates these advances. Based on a review of studies of structural/functional anatomy, we first describe an eight-level hierarchy of nervous system structures, and the contribution that each level plausibly makes to vagal control. Second, we review recent work on a class of computational models of brain function known as "predictive coding" models. We illustrate how the computational dynamics of these models, when implemented within our proposed vagal control hierarchy, can increase understanding of the relationship between vagal control and both cognitive performance and emotional/physical health. We conclude by discussing novel implications of this updated NVI model for future research.

Measures of Heart Rate Variability in Individuals With Somatic Symptom Disorder

OBJECTIVE

Little is known about autonomic nervous system activity in individuals with somatic symptom disorder (SSD) as defined by DSM-V criteria. The aims of this study were to investigate whether individuals with SSD differ from healthy controls in heart rate variability (HRV) measures of autonomic nervous system activity and whether sex has a moderating effect on this association.

METHODS

We recruited 168 individuals with SSD (35.1% men) and 106 healthy controls (27.4% men). Demographics, HRV, and psychological factors were measured using the Patient Health Questionnaire-15, Health Anxiety Questionnaire, Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory. Multiple regression analysis was used to examine the association of SSD with HRV, adjusting for demographic and psychological measures.

RESULTS

Individuals with SSD had lower levels of total-power HRV and low-frequency HRV, but no differences in high-frequency (HF)-HRV were found. HRV differences between SSD and controls varied by sex and age (triple interaction TP-HRV β = -0.222, p < .001; low-frequency HRV β = -0.332, p < .001; and HF-HRV β = -0.167, p = .006). Whole-sample multiple regression analyses revealed significant sex differences in the magnitudes of the association between BDI-II with HF-HRV (β of sex*BDI-II: 0.761, p = .005) and analyses stratified by sex indicated that HF-HRV was significantly correlated with depression in men with SSD (r = -0.491, p < .001) but not in women with SSD (r = 0.057, p = .558).

CONCLUSIONS

These results suggest that patients with SSD demonstrate different patterns of HRV and the patterns of association between HRV indices and psychological factors vary between men and women.

Trait hostility and cortisol sensitivity following a stressor: The moderating role of stress-induced heart rate variability

Hostility and adverse health outcomes are inconsistently associated in the literature. Self-regulation and cortisol secretion may play important roles in differentiating those hostile individuals who are at greater risk of negative health outcomes from those who are not. In the present study, we sought to examine if having high self-regulatory strength, as indexed by high stress-induced high-frequency heart rate variability (HF-HRV), buffered the effects of hostility on cortisol secretion. Participants (N=213) completed a self-report measure of hostility and measurement of HF-HRV at rest and during a social stress task. Saliva samples were collected immediately before (one sample), and over a 50min period after (six samples), the stress task to evaluate cortisol secretion over time. Hostile individuals were less likely to demonstrate cortisol sensitivity (i.e., high change in cortisol over time) when they had high stress-induced HF-HRV. Such findings are important given that cortisol sensitivity increases risk of metabolic and inflammatory disorders via glucocorticoid resistance and inflammation. Therefore, interventions that increase stress-induced HF-HRV may reduce the impact of hostility on health outcomes.

Examining the association between perceived discrimination and heart rate variability in African Americans

OBJECTIVE

Previous research attempting to delineate the role of discrimination in racial/ethnic disparities in hypertension has focused largely on blood pressure, which is chiefly governed by the sympathetic branch of the autonomic nervous system. Consequently, few studies have considered the role of the parasympathetic branch and particularly its regulation of the heart via the vagus nerve.

METHOD

In the present cross-sectional study, we employed hierarchical linear regressions to examine associations between perceived ethnic discrimination and resting heart rate variability (HRV), an important biomarker of parasympathetic cardiac modulation and overall health, in a sample (N = 103) of young, healthy African American participants (58% female, M_age = 19.94 years, SD = 2.84).

RESULTS

After accounting for demographic factors and health status characteristics, lifetime discrimination emerged as an inverse predictor of HRV. When subdomains of discrimination were considered, discrimination attributable to threats or actual acts of aggression was also predictive of lower HRV.

CONCLUSIONS

Our findings suggest that a greater lifetime burden of discrimination and discriminatory harassment and/or assault is associated with lower resting HRV in African Americans. The implications of these findings are discussed in the context of past, present and emerging research emphasizing biological linkages between discrimination and health. (PsycINFO Database Record

Impact of Diabetes Type 1 in Children on Autonomic Modulation at Rest and in Response to the Active Orthostatic Test

Introduction

Cardiovascular autonomic neuropathy is one of the most common complications of diabetes mellitus type 1 (DM1), of which one of the first subclinical manifestations is changes in heart rate variability (HRV). Thus, analysis of HRV associated with the autonomic active orthostatic test is important in this population.

Objectives

To analyze the autonomic modulation responses induced by the implementation of the active orthostatic test, in children with DM1, and study the autonomic modulation by means of HRV indices.

Method

Data of 35 children were analyzed, of both sexes, aged between 7 and 15 years, who were divided into two groups: Diabetic (n = 16) and Control (n = 19). The following variables were collected initially: weight, height, body fat percentage, heart rate, blood pressure and casual blood glucose. Subsequently, for analysis of autonomic modulation, the beat-to-beat heart rate was captured by a heart rate monitor in the supine position for 30 minutes and after 10 minutes standing during performance of the active orthostatic test. HRV indices were calculated in the time and frequency domains. For data analysis, covariance analysis was used to compare groups and ANOVA for repeated measures to compare the effects of the active orthostatic test. These data were adjusted for age, sex, ethnicity, body fat percentage and casual blood glucose, with a 5% significance level.

Results

The results suggested that diabetic children at rest present a decrease in SDNN (50.4 vs. 75.2), rMSSD (38.7 vs 57.6) and LF [ms²] (693.6 vs 1874.6). During the active orthostatic test the children in both groups demonstrated a reduction in SDNN, RMSSD and LF [ms²] compared to the resting position, and this response was less pronounced in the diabetic group.

Conclusion

We conclude that regardless of age, sex, ethnicity, body fat percentage and casual blood glucose, performing the active orthostatic test promoted increased sympathetic modulation and reduced parasympathetic modulation in both groups, and this response was less pronounced in diabetic children, who presented reduced overall variability and parasympathetic modulation.

Race and Resting-State Heart Rate Variability in Brazilian Civil Servants and the Mediating Effects of Discrimination: An ELSA-Brasil Cohort Study

OBJECTIVES

African Americans are characterized by higher heart rate variability (HRV), a finding ostensibly associated with beneficial health outcomes. However, these findings are at odds with other evidence that blacks have worse cardiovascular outcomes. Here, we examine associations in a large cohort from the ELSA-Brasil study and determined whether these effects are mediated by discrimination.

METHODS

Three groups were compared on the basis of self-declared race: "black" (n = 2,020), "brown" (n = 3,502), and "white" (n = 6,467). Perceived discrimination was measured using a modified version of the Everyday Discrimination Scale. Resting-state HRV was extracted from 10-minute resting-state electrocardiograms. Racial differences in HRV were determined by regression analyses weighted by propensity scores, which controlled for potentially confounding variables including age, sex, education, and other health-related information. Nonlinear mediation analysis quantified the average total effect, comprising direct (race-HRV) and indirect (race-discrimination-HRV) pathways.

RESULTS

Black participants displayed higher HRV relative to brown (Cohen's d = 0.20) and white participants (Cohen's d = 0.31). Brown relative to white participants also displayed a small but significantly higher HRV (Cohen's d = 0.14). Discrimination indirectly contributed to the effects of race on HRV.

CONCLUSIONS

This large cohort from the Brazilian population shows that HRV is greatest in black, followed by brown, relative to white participants. The presence of higher HRV in these groups may reflect a sustained compensatory psychophysiological response to the adverse effects of discrimination. Additional research is needed to determine the health consequences of these differences in HRV across racial and ethnic groups.

Linking Daily Stress Processes and Laboratory-Based Heart Rate Variability in a National Sample of Midlife and Older Adults

OBJECTIVE

This study evaluates the associations between people's trait-like patterns of stress in daily life (stressor frequency, perceived stressor severity, affective reactivity to stressors, and negative affect) and laboratory-assessed heart rate variability (HRV).

METHODS

Data were collected from 909 participants aged 35 to 85 years in the Midlife in the United States Study. Participants reported negative affect and minor stressful events during telephone interviews on 8 consecutive evenings. On a separate occasion, HRV was measured from electrocardiograph recordings taken at rest during a laboratory-based psychophysiology protocol. Regression models were used to evaluate the associations between daily stress processes and three log-transformed HRV indices: standard deviation of R-R intervals (SDRR), root mean square of successive differences (RMSSD), and high-frequency power (high-frequency HRV [HF-HRV]). Analyses were adjusted for demographics, body mass index, comorbid conditions, medications, physical activity, and smoking.

RESULTS

Stressor frequency was unrelated to HRV (r values ranging from -0.04 to -0.01, p values >.20). However, people with greater perceived stressor severity had lower resting SDRR (fully adjusted B [standard error {SE}] = -0.05 [0.02]), RMSSD (-0.08 [0.03]), and HF-HRV (-0.16 [0.07]). Individuals with more pronounced affective reactivity to stressors also had lower levels of all three HRV indices (SDRR: B [SE] = -0.28 [0.14]; RMSSD: -0.44 [0.19]; HF-HRV: -0.96 [0.37]). Furthermore, aggregated daily negative affect was linked to reduced RMSSD (B [SE] = -0.16 [0.08]) and HF-HRV (-0.35 [0.15]).

CONCLUSIONS

In a national sample, individual differences in daily negative affect and responses to daily stressors were more strongly related to cardiovascular autonomic regulation than the frequency of such stressors.

Heart rate variability is associated with amygdala functional connectivity with MPFC across younger and older adults

The ability to regulate emotion is crucial to promote well-being. Evidence suggests that the medial prefrontal cortex (mPFC) and adjacent anterior cingulate (ACC) modulate amygdala activity during emotion regulation. Yet less is known about whether the amygdala-mPFC circuit is linked with regulation of the autonomic nervous system and whether the relationship differs across the adult lifespan. The current study tested the hypothesis that heart rate variability (HRV) reflects the strength of mPFC-amygdala interaction across younger and older adults. We recorded participants' heart rates at baseline and examined whether baseline HRV was associated with amygdala-mPFC functional connectivity during rest. We found that higher HRV was associated with stronger functional connectivity between the amygdala and the mPFC during rest across younger and older adults. In addition to this age-invariant pattern, there was an age-related change, such that greater HRV was linked with stronger functional connectivity between amygdala and ventrolateral PFC (vlPFC) in younger than in older adults. These results are in line with past evidence that vlPFC is involved in emotion regulation especially in younger adults. Taken together, our results support the neurovisceral integration model and suggest that higher heart rate variability is associated with neural mechanisms that support successful emotional regulation across the adult lifespan.

Cumulative stress and autonomic dysregulation in a community sample

Whether cumulative stress, including both chronic stress and adverse life events, is associated with decreased heart rate variability (HRV), a non-invasive measure of autonomic status which predicts poor cardiovascular outcomes, is unknown. Healthy community dwelling volunteers (N = 157, mean age 29 years) participated in the Cumulative Stress/Adversity Interview (CAI), a 140-item event interview measuring cumulative adversity including major life events, life trauma, recent life events and chronic stressors, and underwent 24-h ambulatory ECG monitoring. HRV was analyzed in the frequency domain and standard deviation of NN intervals (SDNN) calculated. Initial simple regression analyses revealed that total cumulative stress score, chronic stressors and cumulative adverse life events (CALE) were all inversely associated with ultra low-frequency (ULF), very low-frequency (VLF) and low-frequency (LF) power and SDNN (all p < 0.05). In hierarchical regression analyses, total cumulative stress and chronic stress each was significantly associated with SDNN and ULF even after the highly significant contributions of age and sex, with no other covariates accounting for additional appreciable variance. For VLF and LF, both total cumulative stress and chronic stress significantly contributed to the variance alone but were not longer significant after adjusting for race and health behaviors. In summary, total cumulative stress, and its components of adverse life events and chronic stress were associated with decreased cardiac autonomic function as measured by HRV. Findings suggest one potential mechanism by which stress may exert adverse effects on mortality in healthy individuals. Primary preventive strategies including stress management may prove beneficial.

Sex differences in healthy human heart rate variability: A meta-analysis

The present meta-analysis aimed to quantify current evidence on sex differences in the autonomic control of the heart, indexed by measures of heart rate variability (HRV) in healthy human subjects. An extensive search of the literature yielded 2020 titles and abstracts, of which 172 provided sufficient reporting of sex difference in HRV. Data from 63,612 participants (31,970 females) were available for analysis. Meta-analysis yielded a total of 1154 effect size estimates (k) across 50 different measures of HRV in a cumulated total of 296,247 participants. Females showed a significantly lower mean RR interval and standard deviation of RR intervals (SDNN). The power spectral density of HRV in females is characterized by significantly less total power that contains significantly greater high- (HF) and less low-frequency (LF) power. This is further reflected by a lower LF/HF ratio. Meta-regression revealed significant effects of age, respiration control and the length of recording available for analysis. Although women showed greater mean heart rate, they showed greater vagal activity indexed by HF power of HRV. Underlying mechanisms of these findings are discussed.

The role of heart rate variability in sports physiology

Heart rate variability (HRV) is a relevant marker reflecting cardiac modulation by sympathetic and vagal components of the autonomic nervous system (ANS). Although the clinical application of HRV is mainly associated with the prediction of sudden cardiac death and assessing cardiovascular and metabolic illness progression, recent observations have suggested its applicability to physical exercise training. HRV is becoming one of the most useful tools for tracking the time course of training adaptation/maladaptation of athletes and in setting the optimal training loads leading to improved performances. However, little is known regarding the role of HRV and the internal effects of physical exercise on an athlete, which may be useful in designing fitness programs ensuring sufficient training load that may correspond with the specific ability of the athlete. In this review, we offer a comprehensive assessment of investigations concerning the interrelation between HRV and ANS, and examine how the application of HRV to physical exercise may play a role in sports physiology.

Are Changes in Heart Rate Variability in Middle-Aged and Older People Normative or Caused by Pathological Conditions? Findings From a Large Population-Based Longitudinal Cohort Study

Background

No study to date has investigated longitudinal trajectories of cardiac autonomic modulation changes with aging; therefore, we lack evidence showing whether these changes occur naturally or are secondary to disease or medication use. This study tested whether heart rate variability (HRV) trajectories from middle to older age are largely normative or caused by pathological changes with aging in a large prospective cohort. We further assessed whether HRV changes were modified by socioeconomic status, ethnicity, or habitual physical activity.

Methods and Results

This study involved 3176 men and 1238 women initially aged 44 to 69 years (1997–1999) from the UK Whitehall II population‐based cohort. We evaluated time‐ and frequency‐domain HRV measures of short‐term recordings at 3 time points over a 10‐year period. Random mixed models with time‐varying covariates were applied. Cross‐sectionally, HRV measures were lower for men than for women, for participants with cardiometabolic conditions, and for participants reporting use of medications other than beta blockers. Longitudinally, HRV measures decreased significantly with aging in both sexes, with faster decline in younger age groups. HRV trajectories were not explained by increased prevalence of cardiometabolic problems and/or medication use. In women, cardiometabolic problems were associated with faster decline in the standard deviation of all intervals between R waves with normal‐to‐normal conduction, in low‐frequency HRV, and in low‐frequency HRV in normalized units. Socioeconomic status, ethnicity, and habitual physical activity did not have significant effects on HRV trajectories.

Conclusions

Our investigation showed a general pattern and timing of changes in indices of cardiac autonomic modulation from middle to older age. These changes seem likely to reflect the normal aging process rather than being secondary to cardiometabolic problems and medication use.

Respiratory Sinus Arrhythmia Is Prospectively Associated With Early Trajectories of Acculturation Among New International Students

Respiratory sinus arrhythmia (RSA) is a marker of parasympathetic activity hypothesized to index a neurophysiological system supporting social engagement behaviors. Following migration, people must navigate and adapt to a new sociocultural environment. Whether RSA affects this psychological acculturation process is unknown. This longitudinal study investigated whether resting RSA on arrival in the receiving country was related to changes in cultural orientations toward both mainstream and heritage cultural groups during the first 5 months following migration. Sixty new international students provided information on their cultural orientations toward the mainstream and heritage cultural groups shortly after arrival in the new country and 2 and 5 months after the first assessment. Results indicated that both heritage and mainstream orientations increased linearly over time. Furthermore, greater resting RSA at baseline was prospectively associated with larger increases in positive orientation toward the mainstream culture but not the heritage culture, over and above individual differences in extraversion, depression, and anxiety. These data provide longitudinal evidence that higher RSA promotes an approach-oriented stance toward a novel cultural environment.

Association Strength of Three Adiposity Measures with Autonomic Nervous System Function in Apparently Healthy Employees

OBJECTIVES

To investigate the association of different measures of central (abdominal) and overall adiposity with autonomic nervous system (ANS) function, indexed by heart rate variability (HRV), in apparently healthy human adults.

DESIGN AND MEASUREMENTS

Cross-sectional data of 8,538 participants (20% female, age: 41 ± 11 years, body mass index (BMI): 24 ± 4 kg/m2, waist circumference (WC): 91 ± 12 cm, waist-to-height ratio (WHtR): 0.45 ± 0.08) were available for analysis.

RESULTS

All measures of adiposity were inversely correlated with vagally-mediated HRV indexed by RMSSD (all p<0.001). Strongest associations were found with WC and RMSSD (r = -0.29). Associations were stronger in males (WC r = -0.32) than in females (WC r = -0.23). Partial correlations revealed the same pattern for RMSSD (WC all pcc = -0.12 p<0.001; WC male pcc = -0.14 p<0.001; WC female pcc = -0.06 p<0.05). Correlation strength of BMI and WHtR with RMSSD were similar and significantly weaker compared to WC (p < .001) in unadjusted analysis. Overall, nonparametric Kendall's τb led to the same conclusions.

CONCLUSION

The present data supports previous findings, that HRV is related to measures of adiposity in healthy individuals. In line with previous research, we found that WC is more strongly related to measures of HRV, indicating that WC best captures adiposity related risk.

Cardiovascular Health and Related Health Care Use of Moluccan-Dutch Immigrants

OBJECTIVE

Studies regularly show a higher incidence, prevalence and mortality of cardiovascular disease among immigrant groups from low-income countries. Despite residing in the Netherlands for over 60 years, the Moluccan-Dutch cardiovascular disease profile and health care use are still unknown. We aimed to compare (a) the clinical prevalence of cardiovascular diseases and (b) the use of health care services by cardiovascular disease patients of 5,532 Moluccan-Dutch to an age-sex matched control group of 55,320 native Dutch.

METHODS

We performed a cross-sectional analysis of data of the Achmea health insurance company for the period of 1 January 2009 to 31 December 2010. We collected information on health care use, including diagnostic information. Linear and logistic regression models were used for comparison.

RESULTS

Moluccans had a higher clinical prevalence of ischemic heart diseases (odds ratio 1.26; 95% confidence interval 1.03-1.56), but tended to have a lower prevalence of cerebrovascular accidents (0.79; 0.56-1.11) and cardiac failure (0.67; 0.44-1.03). The clinical prevalence of cardiovascular diseases together tended to be lower among Moluccans (0.90; 0.80-1.00). Consultation of medical specialists did not differ. Angiotensin II inhibitors (1.42; 1.09-1.84), antiplatelet agents (1.27; 1.01-1.59) and statins (1.27; 1.00-1.60) were prescribed more frequently to Moluccans, as were cardiovascular agents in general (1.27; 0.94-1.71).

CONCLUSION

The experience of Moluccans in the Netherlands suggests that, in the long run, cardiovascular risk and related health care use of ethnic minority groups may converge towards that of the majority population.

Resting heart rate variability predicts self-reported difficulties in emotion regulation: a focus on different facets of emotion regulation

The Model of Neurovisceral Integration suggests that vagally mediated heart rate variability (vmHRV) represents a psychophysiological index of inhibitory control and thus, is associated with emotion regulation capacity. Over the past decade, growing empirical evidence supports this notion, showing that those with higher resting vmHRV can regulate negative emotions more adequately. However, to our knowledge, no study has previously examined how resting vmHRV may relate to everyday perceived difficulties in emotion regulation. The present study attempts to examine such relationship in 183 undergraduate students (98 female, 60 minority, mean Age = 19.34). Resting vmHRV was collected during a 5-min resting baseline period, and everyday difficulties in emotion regulation were assessed using the Difficulties in Emotion Regulation Scale (DERS). Controlling for potential covariates (including both trait anxiety and rumination), results revealed a negative relationship between resting vmHRV and DERS such that lower resting vmHRV was associated with greater difficulties in emotional regulation, especially a lack of emotional clarity and impulse control, as indicated by the respective subscales of the DERS. These findings provide further evidence for the Neurovisceral Integration Model, suggesting that emotion regulation and autonomic regulation share neural networks within the brain. Moreover, the present study extends prior research by highlighting two distinct facets of emotion regulation (impulse control and emotional clarity) that should be of particular interest when investigating the link between emotion regulation, resting vmHRV, and related health outcomes including morbidity and mortality.

Racial and ethnic disparities in health: examining the contexts that shape resilience and risk

Race, ethnicity, and social class differences in the prevalence and effects of cardiovascular risk factors have been observed in many studies. Understanding the drivers of these differences is critical to efforts aimed at reducing racial disparities in health. Two articles in this volume of Psychosomatic Medicine contribute to our understanding of the underlying mechanisms driving racial disparities in health. The first article confirms the deleterious effects of psychosocial stressors on neuroendocrine function and suggests that the effects of stress on cortisol patterning are worse for Black and Latino individuals than for White individuals. The second meta-analysis article indicates that, in comparison to Whites, Black individuals display higher levels of high frequency heart rate variability, a measure of parasympathetic activity that may be an indicator of potential resilience to stress. To interpret these effects, it can be useful to move beyond assessments of phenotype and to consider the psychosocial context in which people live and assessments of risk are made. The psychosocial context includes variables and processes that influence the type, timing, and frequency of stress exposure, and the levels of background stress. Ultimately, these variables may create race and class differences in the underlying mechanisms that contribute to the development of different risk factors for adverse health outcomes such as cardiovascular disease, diabetes, and cancer. This editorial describes the relevance of incorporating the variables associated with psychosocial context when building new models in the next generation of research on health disparities.

Focusing neurovisceral integration: cognition, heart rate variability, and cerebral blood flow

The neurovisceral integration hypothesis suggests in part that cerebral control of autonomic function conveys comparable control of executive function and, hence, correlation among vagally determined high frequency heart rate variability (HF-HRV), executive function, and regional cerebral blood flow (CBF). In 440 middle-aged men and women, resting HF-HRV was related to regional CBF derived from a resting arterial spin-labeled MRI scan and to seven neuropsychological tests of executive function. Despite some intercorrelations, regression modeling failed to support integrated central control of HF-HRV and executive function. Integration between autonomic and cognitive control appears more circumscribed than the general integration suggested by the neurovisceral integration hypothesis.