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Sammito S, Thielmann B, Klussmann A, Deußen A, Braumann KM, Böckelmann I. Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science. J Occup Med Toxicol 2024; 19:15. [PMID: 38741189 DOI: 10.1186/s12995-024-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
This updated guideline replaces the "Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science" first published in 2014. Based on the older version of the guideline, the authors have reviewed and evaluated the findings on the use of heart rate (HR) and heart rate variability (HRV) that have been published in the meantime and incorporated them into a new version of this guideline.This guideline was developed for application in clinical practice and research purposes in the fields of occupational medicine and occupational science to complement evaluation procedures with respect to exposure and risk assessment at the workplace by the use of objective physiological workload indicators. In addition, HRV is also suitable for assessing the state of health and for monitoring the progress of illnesses and preventive medical measures. It gives an overview of factors influencing the regulation of the HR and HRV at rest and during work. It further illustrates methods for measuring and analyzing these parameters under standardized laboratory and real workload conditions, areas of application as well as the quality control procedures to be followed during the recording and evaluation of HR and HRV.
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Affiliation(s)
- Stefan Sammito
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- German Air Force Centre of Aerospace Medicine, Experimental Aerospace Medicine Research, Flughafenstraße 1, Cologne, 51147, Germany.
| | - Beatrice Thielmann
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Andre Klussmann
- Competence Centre Health (CCG), Department Health Sciences, University of Applied Sciences (HAW) Hamburg, Hamburg, Germany
| | - Andreas Deußen
- Department of Physiology, Medical Faculty, TU Dresden, Dresden, Germany
| | | | - Irina Böckelmann
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Huang Y, Xie P, Zhang S, Liu M, Xiong Z, Huang R, Huang Z, Zhong X, Chen Z, Zhou Z, Zhang W, Guo Y, Yang D, Zhuang X, Liao X. Interplay of heart rate variability and resting heart rate on mortality in type 2 diabetes. Diabetes Metab Syndr 2024; 18:102930. [PMID: 38150792 DOI: 10.1016/j.dsx.2023.102930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
AIMS Heart rate variability (HRV) and resting heart rate (RHR) are usually analyzed and interpreted separately. We aimed to assess the interplay of HRV and RHR on mortality in type 2 diabetes. METHODS The study included 7,529 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. HRV metrics included standard deviation of all normal-to-normal intervals (SDNN) and root mean square of successive differences between normal-to-normal intervals (rMSSD). Abnormal values were defined based on <25th percentile for HRV and >75th percentile for RHR. Interactions of HRV status and RHR status were tested on multiplicative and additive scales. Results were validated in a subset of patients with type 2 diabetes (n = 745) from the Multi-Ethnic Study of Atherosclerosis. RESULTS Low SDNN was associated with increased all-cause mortality in the high RHR group (HR 1.60; 95% CI 1.29-1.97), but not in the normal RHR group. Compared with those who had neither low SDNN nor high RHR, the presence of either low SDNN or high RHR was not significantly associated with an increased risk of all-cause mortality. In contrast, the combination of low SDNN and high RHR was associated with a significantly increased risk of all-cause mortality (HR 1.68; 95% CI 1.43-1.97). Significant multiplicative and additive interactions were found between HRV status and RHR status on risk of all-cause mortality (all Pinteraction < 0.05). Similar findings were observed for cardiovascular mortality, in analyses using rMSSD, and in the Multi-Ethnic Study of Atherosclerosis. CONCLUSIONS The association between HRV and mortality risk is modified by RHR levels. Furthermore, low HRV and high RHR have interdependent and synergistic associations with mortality risk.
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Affiliation(s)
- Yiquan Huang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Peihan Xie
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Shaozhao Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Menghui Liu
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Zhenyu Xiong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Rihua Huang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Zhuoshan Huang
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China; Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, China
| | - Xiangbin Zhong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Zhuohui Chen
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Ziwei Zhou
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Wenjing Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Yue Guo
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Daya Yang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China
| | - Xiaodong Zhuang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China.
| | - Xinxue Liao
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China.
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Ortiz-Guzmán JE, Mollà-Casanova S, Serra-Añó P, Arias-Mutis ÓJ, Calvo C, Bizy A, Alberola A, Chorro FJ, Zarzoso M. Short-Term Heart Rate Variability in Metabolic Syndrome: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6051. [PMID: 37762990 PMCID: PMC10532399 DOI: 10.3390/jcm12186051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Our aim was to determine the differences in short-term heart rate variability (HRV) between patients with metabolic syndrome (MS) and healthy controls. METHODS We searched electronic databases for primary works with short-term HRV recordings (≤30 min) that made comparisons between individuals with MS versus healthy controls. This systematic review and meta-analysis (MA) was performed according to PRISMA guidelines and registered at PROSPERO (CRD42022358975). RESULTS Twenty-eight articles were included in the qualitative synthesis and nineteen met the criteria for the MA. Patients with MS showed decreased SDNN (-0.36 [-0.44, -0.28], p < 0.001), rMSSD (-7.59 [-9.98, -5.19], p < 0.001), HF (-0.36 [-0.51, -0.20], p < 0.00001) and LF (-0.24 [-0.38, -0.1], p = 0.001). In subsequent subanalyses, we found a decrease in SDNN (-0.99 (-1.45, -0.52], p < 0.001), rMSSD (-10.18 [-16.85, -3.52], p < 0.01) and HF (-1.04 [-1.97, -0.1] p < 0.05) in women. In men, only LF showed a significant lower value (-0.26 [-0.5, -0.02], p < 0.05). We could not perform MA for non-linear variables. CONCLUSIONS Patients with MS showed changes in time-domain analyses, with lower values in SDNN and rMSSD. Regarding frequency-domain analyses, MS patients showed a decrease in HF and LF When sex was used as a grouping variable, the MA was only possible in one of both sexes (men or women) in rMSSD and LF/HF. Lastly, when data for both men and women were available, subanalyses showed a different behavior compared to mixed analyses for SDNN, HF and LF, which might point towards a different impact of MS in men and women.
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Affiliation(s)
- Johan E. Ortiz-Guzmán
- Department of Physiology, Universitat de València, Av. Blasco Ibáñez 15, 46010 Valencia, Spain; (J.E.O.-G.); (C.C.); (A.A.)
| | - Sara Mollà-Casanova
- Department of Physiotherapy, Universitat de València, Street Gascó Oliag 5, 46010 Valencia, Spain; (S.M.-C.); (P.S.-A.)
- UBIC Research Group, Department of Physiotherapy, Universitat de València, Street Gascó Oliag 5, 46010 Valencia, Spain
| | - Pilar Serra-Añó
- Department of Physiotherapy, Universitat de València, Street Gascó Oliag 5, 46010 Valencia, Spain; (S.M.-C.); (P.S.-A.)
- UBIC Research Group, Department of Physiotherapy, Universitat de València, Street Gascó Oliag 5, 46010 Valencia, Spain
| | - Óscar J. Arias-Mutis
- CEU Cardenal Herrera, Department of Biomedical Sciences, Street Lluís Vives 1, 46115 Valencia, Spain; (Ó.J.A.-M.); (A.B.)
- Health Research Institute—Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA) Valencia, Street Menéndez y Pelayo 4, 46010 Valencia, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV) Madrid, Av. Monforte de Lemos, 3–5, Pavilion 11, Floor 0, 28029 Madrid, Spain
| | - Conrado Calvo
- Department of Physiology, Universitat de València, Av. Blasco Ibáñez 15, 46010 Valencia, Spain; (J.E.O.-G.); (C.C.); (A.A.)
- CSIC-UPV, Instrumentation for Molecular Imaging Technologies Research Institute (I3M), Universitat Politècnica de València, 46022 Valencia, Spain
| | - Alexandra Bizy
- CEU Cardenal Herrera, Department of Biomedical Sciences, Street Lluís Vives 1, 46115 Valencia, Spain; (Ó.J.A.-M.); (A.B.)
| | - Antonio Alberola
- Department of Physiology, Universitat de València, Av. Blasco Ibáñez 15, 46010 Valencia, Spain; (J.E.O.-G.); (C.C.); (A.A.)
| | - Francisco J. Chorro
- Health Research Institute—Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA) Valencia, Street Menéndez y Pelayo 4, 46010 Valencia, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV) Madrid, Av. Monforte de Lemos, 3–5, Pavilion 11, Floor 0, 28029 Madrid, Spain
- Department of Medicine, Universitat de València, Av. Blasco Ibáñez 15, 46010 Valencia, Spain
| | - Manuel Zarzoso
- Department of Physiotherapy, Universitat de València, Street Gascó Oliag 5, 46010 Valencia, Spain; (S.M.-C.); (P.S.-A.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV) Madrid, Av. Monforte de Lemos, 3–5, Pavilion 11, Floor 0, 28029 Madrid, Spain
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Hung WC, Yu TH, Wu CC, Lee TL, Tsai IT, Hsuan CF, Chen CY, Chung FM, Lee YJ, Tang WH. FABP3, FABP4, and heart rate variability among patients with chronic schizophrenia. Front Endocrinol (Lausanne) 2023; 14:1165621. [PMID: 37255976 PMCID: PMC10225495 DOI: 10.3389/fendo.2023.1165621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction The prevalence of cardiovascular disease (CVD) and CVD-related deaths in patients with schizophrenia is high. An elevated risk of CVD has been associated with low heart rate variability (HRV). There is increasing evidence that fatty acid-binding protein (FABP)3 and FABP4 play roles in the development and progression of CVD. This study aimed to explore the association of circulating FABP3/FABP4 levels with HRV in patients with chronic schizophrenia. Methods We included 265 consecutive patients with chronic schizophrenia who attended a disease management program. We used an enzyme-linked immunosorbent assay for the measurement of plasma concentrations of FABP3 and FABP4. Standard HRV was recorded at baseline following a standard protocol. Mean high- and low-frequency (HF/LF) HRV values were analyzed by tertile of FABP3 and FABP4 using one-way analysis of variance, and linear regression analysis was performed to assess trends. Results A positive association between FABP3 and creatinine was found in multiple regression analysis. In addition, negative associations between levels of hematocrit, hemoglobin, HF HRV, and estimated glomerular filtration rate (eGFR) with FABP3 were also found. Moreover, positive associations between FABP4 with body mass index, diabetes mellitus, hypertension, systolic blood pressure, low-density lipoprotein-cholesterol, triglycerides, creatinine, and FABP3 were found. Furthermore, negative associations between levels of high-density lipoprotein-cholesterol, eGFR, and HF HRV with FABP4 were found. We also found a significant inverse association between FABP3 and HF HRV (p for trend = 0.008), and significant inverse associations between FABP4 with HF and LF HRV (p for trend = 0.007 and 0.017, respectively). Discussion Together, this suggests that elevated levels of FABP3 and FABP4 may be linked to health problems related to CVD in patients with chronic schizophrenia.
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Affiliation(s)
- Wei-Chin Hung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Ching Wu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - I-Ting Tsai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Yu Chen
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yau-Jiunn Lee
- Department Head, Lee’s Endocrinologic Clinic, Pingtung, Taiwan
| | - Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, Hualien, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Nevels TL, Wirth MD, Ginsberg JP, McLain AC, Burch JB. The role of sleep and heart rate variability in metabolic syndrome: evidence from the Midlife in the United States study. Sleep 2023; 46:zsad013. [PMID: 36727300 PMCID: PMC10171632 DOI: 10.1093/sleep/zsad013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/11/2022] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVES Poor sleep and autonomic dysregulation can both disrupt metabolic processes. This study examined the individual and combined effects of poor sleep and reduced heart rate variability (HRV) on metabolic syndrome among 966 participants in the Midlife in the United States II (MIDUS II) study. METHODS Self-reported sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). HRV was acquired from 11-minute resting heart rate recordings. Spearman correlations, general linear regression, and logistic regression models were used to examine the study hypotheses. RESULTS Poor sleep quality was associated with metabolic syndrome when global PSQI scores were evaluated as a continuous (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.03 to 1.11) or categorical measure (cutoff > 5, OR: 1.58, 95% CI: 1.19 to 2.10), after adjustment for confounding. There also was an association between reduced HRV and metabolic syndrome (ln [HF-HRV] OR: 0.89, 95% CI: 0.80 to 0.99; ln [LF-HRV] OR: 0.82, 95% CI: 0.72 to 0.92; ln [SDRR] OR: 0.59, 95% CI: 0.43 to 0.79; ln [RMSSD] OR: 0.75, 95% CI: 0.60 to 0.94). When the combined effects of poor sleep and low HRV were examined, the association with metabolic syndrome was further strengthened relative to those with normal sleep and HRV. CONCLUSIONS To the best of the author's knowledge, this is the first study to suggest a combined effect of poor sleep and low HRV on the odds of metabolic syndrome.
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Affiliation(s)
- Torrance L Nevels
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Columbia Veterans Affairs Health Care System, Columbia, SC, USA
- U.S. Military Interservice Physician Assistant Program, MEDCoE, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - J P Ginsberg
- Department of Pathology, Microbiology, and Immunology, Saybrook University, Pasadena, CA, USA
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James B Burch
- Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Endukuru CK, Gaur GS, Yerrabelli D, Sahoo J, Vairappan B, Goud AC. Correlation among Poincare plot and traditional heart rate variability indices in adults with different risk levels of metabolic syndrome: a cross-sectional approach from Southern India. J Basic Clin Physiol Pharmacol 2023:jbcpp-2022-0208. [PMID: 36626361 DOI: 10.1515/jbcpp-2022-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Heart rate variability (HRV) is an important marker of cardiac autonomic modulation. Metabolic syndrome (MetS) can alter cardiac autonomic modulation, raising the risk of cardiovascular disease (CVD). Poincaré plot analysis (PPA) is a robust scatter plot-based depiction of HRV and carries similar information to the traditional HRV measures. However, no prior studies have examined the relationship between PPA and traditional HRV measures among different risk levels of MetS. We evaluated the association between the Poincare plot and traditional heart rate variability indices among adults with different risk levels of MetS. METHODS We measured anthropometric data and collected fasting blood samples to diagnose MetS. The MetS risk was assessed in 223 participants based on the number of MetS components and was classified as control (n=64), pre-MetS (n=49), MetS (n=56), and severe MetS (n=54). We calculated the Poincaré plot (PP) and traditional HRV measures from a 5 min HRV recording. RESULTS Besides the traditional HRV measures, we found that various HRV indices of PPA showed significant differences among the groups. The severe MetS group had significantly lower S (total HRV), SD1 (short-term HRV), SD2 (long-term HRV), and higher SD2/SD1. The values of S, SD1, SD2, and SD2/SD1 were significantly correlated with most traditional HRV measures. CONCLUSIONS We found gradual changes in HRV patterns as lower parasympathetic and higher sympathetic activity alongside the rising number of MetS components. The HRV indices of PPA integrating the benefits of traditional HRV indices distinguish successfully between different risk levels of MetS and control subjects.
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Affiliation(s)
- Chiranjeevi Kumar Endukuru
- Department of Physiology, Sri Siddhartha Institute of Medical Sciences & Research Centre, Bengaluru, India
| | - Girwar Singh Gaur
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dhanalakshmi Yerrabelli
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balasubramaniyan Vairappan
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Alladi Charanraj Goud
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Kumar EC, Gaur GS, Yerrabelli D, Sahoo J, Vairappan B, Goud AC. Association between metabolic syndrome components and cardiac autonomic modulation in southern Indian adults with pre-metabolic syndrome: hyperglycemia is the major contributing factor. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2023; 27:49-59. [PMID: 36575933 PMCID: PMC9806641 DOI: 10.4196/kjpp.2023.27.1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/28/2022] [Accepted: 10/13/2022] [Indexed: 12/29/2022]
Abstract
Metabolic syndrome (MetS) involves multi-factorial conditions linked to an elevated risk of type 2 diabetes mellitus and cardiovascular disease. Pre-metabolic syndrome (pre-MetS) possesses two MetS components but does not meet the MetS diagnostic criteria. Although cardiac autonomic derangements are evident in MetS, there is little information on their status in pre-MetS subjects. In this study, we sought to examine cardiac autonomic functions in pre-MetS and to determine which MetS component is more responsible for impaired cardiac autonomic functions. A total of 182 subjects were recruited and divided into healthy controls (n=89) and pre-MetS subjects (n=93) based on inclusion and exclusion criteria. We performed biochemical profiles on fasting blood samples to detect pre-MetS. Using standardized protocols, we evaluated anthropometric data, body composition, baroreflex sensitivity (BRS), heart rate variability (HRV), and autonomic function tests (AFTs). We further examined these parameters in pre-MetS subjects for each MetS component. Compared to healthy controls, we observed a significant cardiac autonomic dysfunction (CAD) through reduced BRS, lower overall HRV, and altered AFT parameters in pre-MetS subjects, accompanied by markedly varied anthropometric, clinical and biochemical parameters. Furthermore, all examined BRS, HRV, and AFT parameters exhibited an abnormal trend and significant correlation toward hyperglycemia. This study demonstrates CAD in pre-MetS subjects with reduced BRS, lower overall HRV, and altered AFT parameters. Hyperglycemia was considered an independent determinant of alterations in all the examined BRS, HRV, and AFT parameters. Thus, hyperglycemia may contribute to CAD in pre-MetS subjects before progressing to MetS.
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Affiliation(s)
- Endukuru Chiranjeevi Kumar
- Department of Physiology, Sri Siddhartha Institute of Medical Sciences & Research Centre, Bangalore 562123, India
| | - Girwar Singh Gaur
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605008, India,Correspondence Girwar Singh Gaur, E-mail:
| | - Dhanalakshmi Yerrabelli
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605008, India
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605008, India
| | - Balasubramaniyan Vairappan
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605008, India
| | - Alladi Charanraj Goud
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605008, India
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Azulay N, Olsen RB, Nielsen CS, Stubhaug A, Jenssen TG, Schirmer H, Frigessi A, Rosseland LA, Tronstad C. Reduced heart rate variability is related to the number of metabolic syndrome components and manifest diabetes in the sixth Tromsø study 2007-2008. Sci Rep 2022; 12:11998. [PMID: 35835836 PMCID: PMC9283528 DOI: 10.1038/s41598-022-15824-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Abstract
Both diabetes mellitus (DM) and the metabolic syndrome (MetS) are associated with autonomic neuropathy, which predisposes to cardiac events and death. Measures of heart rate variability (HRV) can be used to monitor the activity of the autonomic nervous system (ANS), and there are strong indications that HRV can be used to study the progression of ANS-related diabetes complications. This study aims to investigate differences in HRV in healthy, MetS and diabetic populations. Based on 7880 participants from the sixth health survey in Tromsø (Tromsø 6, 2007–2008), we found a significant negative association between the number of MetS components and HRV as estimated from short-term pulse wave signals (PRV). This decrease in PRV did not appear to be linear, instead it leveled off after the third component, with no significant difference in PRV between the MetS and DM populations. There was a significant negative association between HbA1c and PRV, showing a decrease in PRV occurring already within the normal HbA1c range. The MetS and DM populations are different from healthy controls with respect to PRV, indicating impaired ANS in both conditions. In the future, a study with assessment of PRV measurements in relation to prospective cardiovascular events seems justified.
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Affiliation(s)
- Naomi Azulay
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Roy Bjørkholt Olsen
- Department of Anesthesiology and Intensive Care, Sørlandet Hospital, Arendal, Norway
| | - Christopher Sivert Nielsen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Audun Stubhaug
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Trond Geir Jenssen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Metabolic and Renal Research Group, Faculty of Health Sciences, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Arnoldo Frigessi
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christian Tronstad
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
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9
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Romero-Martínez A, Lila M, Moya-Albiol L. Sympathetic Nervous System Predominance in Intimate Partner Violence Perpetrators After Coping With Acute Stress. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP10148-NP10169. [PMID: 33435804 DOI: 10.1177/0886260520985494] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
It has been suggested that intimate partner violence (IPV) against women perpetrators present emotional dysregulations when dealing with acute stress, which in turn could help to explain their proneness to violence. Emotional regulation can be objectively measured by means of psychophysiological parameters/variables/indicators of autonomic nervous system (ANS) activity, such as cardiorespiratory (heart rate [HR], pre-ejection period [PEP] and respiratory sinus arrythmia [RSA]) and electrodermal (skin conductance levels [SCL]) signals. Therefore, this study aims to assess whether IPV perpetrators (n = 107) present differential psychophysiological and psychological state changes when coping with an acute cognitive laboratory stressor (a set of cognitive tests performed in front of an expert committee) in comparison with nonviolent men (n = 87). Moreover, the study assesses whether psychological state variables foster the psychophysiological response to acute stress. Our results demonstrate that, compared to nonviolent controls, IPV perpetrators showed higher HR and SCL values, shorter PEP, and lower RSA values during recovery from stress. They also presented higher negative affect (i.e., more anger and worse mood) after stress. Thus, high baseline anger explained the increases in emotional arousal when measured as SCL increases. The present study contributes evidence showing that IPV perpetrators and nonviolent men cope differently with stress. These findings might help forensic science to identify characteristics of violent individuals to establish their therapeutic needs. Furthermore, it would be appropriate to combine psychophysiological measurements with self-reports, thus increasing the reliability of the assessment of violent individuals.
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Affiliation(s)
| | - M Lila
- University of Valencia, Spain
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10
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Hargens TA, Chambers S, Luden ND, Womack CJ. Reliability of the Heart Rate Variability Threshold During Treadmill Exercise. Clin Physiol Funct Imaging 2022; 42:292-299. [PMID: 35524470 PMCID: PMC9320995 DOI: 10.1111/cpf.12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
The heart rate variability threshold (HRVT) is a clinical parameter used to gain insight into autonomic balance. Prior validation of the HRVT has been with cycle ergometry, with no studies examining the viability of treadmill exercise. The purpose of this study was to examine the reliability of the HRVT during treadmill exercise, and to compare the HRVT to the ventilatory threshold (VT). Ten healthy, college‐aged males completed two maximal graded exercise tests on a treadmill. A Polar RS800CX watch was used for heart rate and HRVT data. The HRVT was determined from three HRV variables including the root mean square of successive differences of continuous R−R intervals (RMSSD), the standard deviation of normal R−R intervals (SDNN) and the standard deviation of instantaneous beat intervals (SD1). A metabolic cart was utilized to determine the VT. Results showed no difference between the HRVT (2.4 ± 0.6 and 2.2 ± 0.3 for RMSSD, 2.8 ± 0.5 and 2.7 ± 0.5 for SDNN and 2.4 ± 0.6 and 2.3 ± 0.6 for SD1) or the VT (3.0 ± 0.3 and 3.1 ± 0.3) between trials. When compared to the VT, averaged HRVT values for RMSSD (2.3 ± 0.3) and SD1 (2.3 ± 0.5) were lower than averaged VT (2.8 ± 0.4, p < 0.05). The averaged HRVT from SDNN (2.8 ± 0.5) did not differ from the VT. These results suggest that treadmill is a viable mode for HRVT determination, and that HRVT determined by SDNN may be a better comparison to the VT.
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Affiliation(s)
- Trent A Hargens
- Department of Kinesiology, Human Performance Laboratory, James Madison University, Harrisonburg, Virginia, USA
| | - Shane Chambers
- Department of Kinesiology, Human Performance Laboratory, James Madison University, Harrisonburg, Virginia, USA
| | - Nicholas D Luden
- Department of Kinesiology, Human Performance Laboratory, James Madison University, Harrisonburg, Virginia, USA
| | - Christopher J Womack
- Department of Kinesiology, Human Performance Laboratory, James Madison University, Harrisonburg, Virginia, USA
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11
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Seipäjärvi S, Tuomola A, Juurakko J, Rottensteiner M, Rissanen APE, Kurkela J, Kujala U, Laukkanen J, Wikgren J. Measuring psychosocial stress with heart rate variability-based methods in different health and age groups. Physiol Meas 2022; 43. [PMID: 35483348 DOI: 10.1088/1361-6579/ac6b7c] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/28/2022] [Indexed: 11/12/2022]
Abstract
Autonomic nervous system function and thereby bodily stress and recovery reactions may be assessed by wearable devices measuring heart rate (HR) and its variability (HRV). So far, the validity of HRV-based stress assessments has been mainly studied in healthy populations. In this study, we determined how psychosocial stress affects physiological and psychological stress responses in both young (18-30 yrs) and middle-aged (45-64 yrs) healthy individuals as well as in patients with arterial hypertension and/or either prior evidence of prediabetes or type 2 diabetes. We also studied how an HRV-based stress index (Relax-Stress Intensity, RSI) relates to perceived stress (PS) and cortisol (CRT) responses during psychosocial stress. APPROACH A total of 197 participants were divided into three groups: 1) healthy young (HY, N=63), 2) healthy middle-aged (HM, N=61) and 3) patients with cardiometabolic risk factors (Pts, N=73, 32-65 yrs). The participants underwent a group version of Trier Social Stress Test (TSST-G). HR, HRV (quantified as root mean square of successive differences of R-R intervals, RMSSD), RSI, PS, and salivary CRT were measured regularly during TSST-G and a subsequent recovery period. MAIN RESULTS All groups showed significant stress reactions during TSST-G as indicated by significant responses of HR, RMSSD, RSI, PS, and salivary CRT. Between-group differences were also observed in all measures. Correlation and regression analyses implied RSI being the strongest predictor of CRT response, while HR was more closely associated with PS. SIGNIFICANCE The HRV-based stress index mirrors responses of CRT, which is an independent marker for physiological stress, around TSST-G. Thus, the HRV-based stress index may be used to quantify physiological responses to psychosocial stress across various health and age groups.
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Affiliation(s)
- Santtu Seipäjärvi
- Department of Psychology, University of Jyväskylä, Kärki, Mattilanniemi, Jyvaskyla, 40100, FINLAND
| | - Anniina Tuomola
- Department of Psychology, University of Jyväskylä, Kärki, Mattilanniemi, Jyvaskyla, Keski-Suomi, 40100, FINLAND
| | - Joona Juurakko
- Department of Psychology, University of Jyväskylä, Kärki, Mattilanniemi, Jyvaskyla, Keski-Suomi, 40100, FINLAND
| | - Mirva Rottensteiner
- Central Finland Health Care District, Keskussairaalantie 19, Jyvaskyla, Central Finland, 40620, FINLAND
| | - Antti-Pekka E Rissanen
- Central Finland Health Care District, Keskussairaalantie, Jyvaskyla, Central Finland, 40620, FINLAND
| | - Jari Kurkela
- Department of Psychology, University of Jyväskylä, Kärki, Mattilanniemi, Jyvaskyla, Keski-Suomi, 40100, FINLAND
| | - Urho Kujala
- University of Jyväskylä Faculty of Sports and Health Sciences, Rautpohjankatu 8, Jyvaskyla, Keski-Suomi, 40700, FINLAND
| | - Jari Laukkanen
- Central Finland Health Care District, Keskussairaalantie, Jyvaskyla, Central Finland, 40620, FINLAND
| | - Jan Wikgren
- Department of Psychology, University of Jyväskylä, Kärki, Mattilanniemi, Jyvaskyla, Keski-Suomi, 40100, FINLAND
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12
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Factors Associated with Reduced Heart Rate Variability in the General Japanese Population: The Iwaki Cross-Sectional Research Study. Healthcare (Basel) 2022; 10:healthcare10050793. [PMID: 35627930 PMCID: PMC9141757 DOI: 10.3390/healthcare10050793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 12/20/2022] Open
Abstract
Although many studies have reported factors associated with reduced heart rate variability (HRV) in Western populations, evidence is limited among Asian populations. Therefore, we investigated the factors associated with reduced HRV values in a general Japanese population by measuring HRV among the participants of the Iwaki Health Promotion Project who underwent medical examination in 2019. We performed 90-s HRV measurements in 1065 participants. Of these, we evaluated the coefficient of variation in R–R intervals (CVRR) and standard deviation in R–R intervals (SDNN). Blood was collected under a fasting condition, and investigations of glucose metabolism, lipid metabolism, renal function, liver function, advanced glycation end products, and blood pressure were performed. A multivariate regression analysis of the association between CVRR or SDNN and blood test parameters and blood pressure in 987 participants with adequately completed HRV assessments showed that reduced CVRR or SDNN was associated with higher levels of glycated hemoglobin (HbA1c), glycoalbumin, blood glucose, triglycerides, creatinine, plasma pentosidine, and diastolic blood pressure. In the general Japanese population, higher levels of HbA1c, glycoalbumin, blood glucose, triglycerides, creatinine, plasma pentosidine, and diastolic blood pressure are associated with reduced CVRR or SDNN, which are typical HRV parameters.
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13
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Endukuru CK, Gaur GS, Yerrabelli D, Sahoo J, Vairappan B. Impaired baroreflex sensitivity and cardiac autonomic functions are associated with cardiovascular disease risk factors among patients with metabolic syndrome in a tertiary care teaching hospital of South-India. Diabetes Metab Syndr 2020; 14:2043-2051. [PMID: 33113471 DOI: 10.1016/j.dsx.2020.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIM Baroreflex sensitivity (BRS) and heart rate variability (HRV) have been proposed to assess early autonomic dysfunction in metabolic syndrome (MetS) patients. Autonomic dysfunction in MetS patients may increase the risk of developing cardiovascular disease (CVD). However, the association of BRS and HRV with CVD risk factors remains elusive in MetS. The primary aim of this study was to assess the BRS and HRV in MetS patients among South-Indian adults and check whether BRS and HRV are associated with CVD risk factors. METHODS We performed anthropometric indices, body composition, physiological parameters such as BRS, HRV, and other autonomic function tests in 176 subjects divided into MetS patients (n = 88) and healthy controls (n = 88). Fasting blood samples were collected for biochemical profiles and calculated insulin resistance indices, atherogenic index (AI), and rate pressure product (RPP). RESULTS When compared to controls, we found significantly reduced BRS and an increased ratio of low-frequency (LF) to high-frequency (HF) power of HRV (LF/HF) in the MetS group. We observed significant differences in body composition and biochemical profiles among the MetS group. BRS and LF/HF ratio of HRV have shown a significant association with CVD risk factors in the MetS group. CONCLUSIONS We observed autonomic dysfunction as low BRS and high LF/HF ratio of HRV in MetS patients. Additionally, the present results emphasize that the association of BRS and LF/HF ratio with anthropometric, glucose, lipid parameters, and other CVD risk factors may increase the susceptibility of MetS patients to higher CVD risk.
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Affiliation(s)
- Chiranjeevi Kumar Endukuru
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - Girwar Singh Gaur
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - Dhanalakshmi Yerrabelli
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - Balasubramaniyan Vairappan
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
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14
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Heart Rate Variability in Patients with Hypertension: the Effect of Metabolic Syndrome and Antihypertensive Treatment. Cardiovasc Ther 2020; 2020:8563135. [PMID: 33123219 PMCID: PMC7582062 DOI: 10.1155/2020/8563135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022] Open
Abstract
Metabolic syndrome (MetS) is a combination of factors which, collectively, increase cardiovascular risk to a greater extent than each of them separately. Previous studies showed high cardiovascular risk to be associated with autonomic nervous system dysfunction. The purpose of this study was to assess the effects of antihypertensive treatment on heart rate variability (HRV) in patients with hypertension (HTN), depending on cooccurrence of MetS. 118 patients with uncontrolled HTN were enrolled to the study. HRV was compared among patients with and without MetS (MetS [+], n = 70) at baseline and following 12 months antihypertensive treatment. The HRV indices measured from RR intervals recorded form using 24-hour ambulatory electrocardiography. The measured HRV domains were the standard deviation of the average of NN intervals [SDNN], square root of the mean of the sum of the squares of differences between adjacent NN intervals [rMSSD], percentage of NN50 [pNN50], low frequency [LF], high frequency [HF], total power of variance of all NN intervals [TP], and LF/HF ratio. Baseline parameters: SDNN, rMSSD, pNN50, and HF were significantly lower in the MetS[+] compared to the MetS[-] subgroup (p < 0.05). After a 12-month antihypertensive treatment, MetS[+] patients achieved a significant improvement in parameters: SDNN, rMSSD, pNN50, and TP (p < 0.05), while the changes in HRV observed in the MetS[-] subgroup were not statistically significant. The cooccurrence of HTN and other components of MetS is associated with disturbances of the autonomic balance. HTN control has a beneficial effect on HRV, with the effect being more evident in patients with MetS.
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15
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Huang WC, Liu WS, Chen TT, Chen WH, Huang WL. Parasympathetic activity as a potential biomarker of negative symptoms in patients with schizophrenia. Asia Pac Psychiatry 2020; 12:e12392. [PMID: 32452616 DOI: 10.1111/appy.12392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Autonomic dysfunction in patients with schizophrenia has raised concern considering the higher cardiovascular mortality and morbidity rate. This phenomenon has been demonstrated using various measurements and is inferred to be associated with demographics, medical treatment, and psychopathology. However, few have targeted the role of negative symptoms within schizophrenia. METHODS Schizophrenia patients with stationary psychopathology were recruited from a chronic ward, a daycare center, and a nonintensive case management program. Demographic data, medication history, the Positive and Negative Syndrome Scale (PANSS) score, the Personal and Social Performance Scale (PSP) score, and the five-minute resting-state heart rate variability (HRV) were collected at trial initiation (Time 1) and a year later (Time 2). The relationships between variables and HRV indices were evaluated using correlation and regression analyses. RESULTS A total of 63 participants were recruited at Time 1, with 29 participants remaining at Time 2. Correlation analyses showed a negative correlation between the PANSS negative score (PANSS-N) and total power (TP), low-frequency power (LF), and high-frequency power (HF) at Time 1. The results were further examined with multiple linear regression analysis and remained significant between the PANSS-N score and HF (β = -0.306, P = .012). A generalized estimating equation model revealed the above negative association to be significant considering both timepoints. DISCUSSION The negative association between negative symptom severity and parasympathetic activity was significant, which may inspire further research into the corresponding treatment, the mechanisms, and the use of HRV as an applicable biomarker for treatment response.
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Affiliation(s)
- Wei-Chia Huang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Shih Liu
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Tzu-Ting Chen
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Wen-Hao Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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16
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Liu L, Cao Z, Lu F, Liu Y, Lv Y, Qu Y, Gu H, Li C, Cai J, Ji S, Li Y, Zhao F, Shi X. Vitamin D deficiency and metabolic syndrome in elderly Chinese individuals: evidence from CLHLS. Nutr Metab (Lond) 2020; 17:58. [PMID: 32760432 PMCID: PMC7391611 DOI: 10.1186/s12986-020-00479-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives Both low vitamin D status and metabolic syndrome (MetS) are worldwide concerns, and low 25-hydroxyvitamin D [25(OH)D] levels are associated with MetS; however, related epidemiological evidence based on elderly Chinese individuals, especially those over 80 years of age, is limited. In the present study, we aimed to evaluate the association between serum 25(OH)D and MetS in elderly Chinese individuals. Method Serum 25(OH)D was measured in a cross-sectional sample of 2493 elderly people aged 65–112 years from eight areas of China in which the density of centenarians is exceptionally high. MetS was diagnosed according to blood pressure, lipid, and blood sugar levels; waist circumference; and body mass index (BMI). Adjusted multivariable logistic regression was used to analyze the associations between vitamin D and MetS based on different diagnostic criterias. Results A total of 890 (35.7%) of the recruited elderly individuals had insufficient levels of vitamin D, and 1029 participants (41.3%) were vitamin D deficient. High serum vitamin D concentrations were associated with a low prevalence of MetS according to the modified Adult Treatment Panel III (ATP III) criteria for adequate versus deficient vitamin D levels (OR: 0.63, 95% CI: 0.45, 0.88) and inadequate versus deficient vitamin D levels (OR: 0.70, 95% CI: 0.52, 0.92). Each 10 ng/ml increase in serum vitamin D was significantly associated with a decreased prevalence of MetS according to the modified ATP III criteria for people with normal waist circumference (WC) (OR: 0.55, 95% CI: 0.43,0.71). However, no significant statistical correlation was found among elderly people with a high WC. Additionally, in the analysis of the individual components, the ORs of adequate versus deficient vitamin D levels were 0.46 (95% CI: 0.30, 0.71) for elevated triglycerides and 0.64 (95% CI: 0.42, 0.97) for reduced high-density lipoprotein cholesterol (HDL-C) after adjustment for other components. Conclusions Vitamin D deficiency is very common among elderly Chinese individuals. Vitamin D deficiency may be a risk factor for MetS; however, the association was only statistically significant among elderly people with noncentral obesity. Further studies are needed to examine the causal direction of the association.
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Affiliation(s)
- Ling Liu
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Zhaojin Cao
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Feng Lu
- Beijing Municipal Health Commission Information Center, (Beijing Municipal Health Commission Policy Research Center), Beijing, 100034 China
| | - Yingchun Liu
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Yuebin Lv
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Yingli Qu
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Heng Gu
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Chengcheng Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Jiayi Cai
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Saisai Ji
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Yawei Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Feng Zhao
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
| | - Xiaoming Shi
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #29 Nanwei Road, Xicheng, Beijing, 100050 China
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17
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Gentile C, Ditto B, Deschamps A, D'Antono B. Parasympathetic Response Patterns are Associated with Metabolic Syndrome Among Older Women but Not Men. Ann Behav Med 2020; 53:515-526. [PMID: 30113625 PMCID: PMC6499413 DOI: 10.1093/abm/kay063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Little is known about the role of physiological stress responses in metabolic syndrome (MetS). Purpose To examine whether patterns of autonomic response to psychological stress are associated with MetS and whether this association is moderated by sex Methods 1121 men and women (Mage = 65.3 ± 6.77 years) with and without coronary artery disease (CAD) underwent an anger recall stressor task. Heart rate and heart-rate variability (HRV; HF, LF/HF) were assessed. Clusters of participants showing similar patterns of response across baseline, stress, and recovery periods were created using ACECLUS and FASTCLUS in SAS. Logistic regressions included clusters and interaction between clusters and sex as independent variables, controlling for relevant covariates. ANCOVAs were conducted in secondary analyses utilizing a continuous composite representation of MetS. Results Men and women showing greater tonic and phasic HR elevations were more likely to meet MetS criteria (OR = 1.45, [95% CI = 1.02–2.07], p = .037). HF-HRV cluster interacted significantly with sex (p < .001) to predict MetS. In women, those with significant parasympathetic withdrawal to stress and poor recovery were more likely to have MetS than women with a more moderate response (OR = 2.56, [95% CI = 1.23–5.41], p = .013). Women who displayed stress-related parasympathetic activation were also at greater risk of MetS (OR = 2.30, [95% CI = 1.30–4.07], p = .004). Results using a continuous measure of MetS were generally consistent with these findings. Conclusion Among older participants with CAD or other noncardiovascular disease, hyperreactivity to stress was associated with greater prevalence of MetS, particularly in women. Consistent with emerging literature, women who showed blunting or activation of parasympathetic responses to stress were similarly at greater risk.
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Affiliation(s)
- Christina Gentile
- Research Center, Montreal Heart Institute, Montreal, Canada Psychology Department, Université de Montréal, Canada
| | - Blaine Ditto
- Department of Psychology, McGill University, Montreal, Canada
| | - Alain Deschamps
- Chief, Department of Anesthesiology, Montreal Heart Institute, Montreal, Canada
| | - Bianca D'Antono
- Research Center, Montreal Heart Institute, Montreal, Canada Psychology Department, Université de Montréal, Canada
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18
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Six Dijkstra M, Soer R, Bieleman A, McCraty R, Oosterveld F, Gross D, Reneman M. Exploring a 1-Minute Paced Deep-Breathing Measurement of Heart Rate Variability as Part of a Workers' Health Assessment. Appl Psychophysiol Biofeedback 2020; 44:83-96. [PMID: 30506478 PMCID: PMC6505487 DOI: 10.1007/s10484-018-9422-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Low heart rate variability (HRV) is related to health problems that are known reasons for sick-leave or early retirement. A 1-minute-protocol could allow large scale HRV measurement for screening of health problems and, potentially, sustained employability. Our objectives were to explore the association of HRV with measures of health. Cross-sectional design with 877 Dutch employees assessed during a Workers' Health Assessment. Personal and job characteristics, workability, psychological and mental problems, and lifestyle were measured with questionnaires. Biometry was measured (BMI, waist circumference, blood pressure, glucose, cholesterol). HRV was assessed with a 1-minute paced deep-breathing protocol and expressed as mean heart rate range (MHRR). A low MHRR indicates a higher health risk. Groups were classified age adjusted for HRV and compared. Spearman correlations between raw MHRR and the other measures were calculated. Significant univariable correlations (p < 0.05) were entered in a linear regression model to explore the multivariable association with MHRR. Age, years of employment, BMI and waist circumference differed significantly between HRV groups. Significant correlations were found between MHRR and age, workability, BMI, waist circumference, cholesterol, systolic and diastolic blood-pressure and reported physical activity and alcohol consumption. In the multivariable analyses 21.1% of variance was explained: a low HRV correlates with aging, higher BMI and higher levels of reported physically activity. HRV was significantly associated with age, measures of obesity (BMI, waist circumference), and with reported physical activity, which provides a first glance of the utility of a 1-minute paced deep-breathing HRV protocol as part of a comprehensive preventive Workers' Health Assessment.
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Affiliation(s)
- Marianne Six Dijkstra
- Saxion University of Applied Sciences/AGZ, M.H. Tromplaan 28, 7500 KB, Enschede, The Netherlands.
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Remko Soer
- Saxion University of Applied Sciences/AGZ, M.H. Tromplaan 28, 7500 KB, Enschede, The Netherlands
- Groningen Spine Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - André Bieleman
- Saxion University of Applied Sciences/AGZ, M.H. Tromplaan 28, 7500 KB, Enschede, The Netherlands
| | | | - Frits Oosterveld
- Saxion University of Applied Sciences/AGZ, M.H. Tromplaan 28, 7500 KB, Enschede, The Netherlands
| | - Douglas Gross
- Department of Physiotherapy, University of Alberta, Edmonton, Canada
| | - Michiel Reneman
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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19
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Chamarthi B, Vinik A, Ezrokhi M, Cincotta AH. Circadian-timed quick-release bromocriptine lowers elevated resting heart rate in patients with type 2 diabetes mellitus. Endocrinol Diabetes Metab 2020; 3:e00101. [PMID: 31922028 PMCID: PMC6947713 DOI: 10.1002/edm2.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/09/2019] [Accepted: 10/20/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Sympathetic nervous system (SNS) overactivity is a risk factor for insulin resistance and cardiovascular disease (CVD). We evaluated the impact of bromocriptine-QR, a dopamine-agonist antidiabetes medication, on elevated resting heart rate (RHR) (a marker of SNS overactivity in metabolic syndrome), blood pressure (BP) and the relationship between bromocriptine-QR's effects on RHR and HbA1c in type 2 diabetes subjects. DESIGN AND SUBJECTS RHR and BP changes were evaluated in this post hoc analysis of data from a randomized controlled trial in 1014 type 2 diabetes subjects randomized to bromocriptine-QR vs placebo added to standard therapy (diet ± ≤2 oral antidiabetes medications) for 24 weeks without concomitant antihypertensive or antidiabetes medication changes, stratified by baseline RHR (bRHR). RESULTS In subjects with bRHR ≥70 beats/min, bromocriptine-QR vs placebo reduced RHR by -3.4 beats/min and reduced BP (baseline 130/79; systolic, diastolic, mean arterial BP reductions [mm Hg]: -3.6 [P = .02], -1.9 [P = .05], -2.5 [P = .02]). RHR reductions increased with higher baseline HbA1c (bHbA1c) (-2.7 [P = .03], -5 [P = .002], -6.1 [P = .002] with bHbA1c ≤7, >7, ≥7.5%, respectively] in the bRHR ≥70 group and more so with bRHR ≥80 (-4.5 [P = .07], -7.8 [P = .015], -9.9 [P = .005]). Subjects with bRHR <70 had no significant change in RHR or BP. With bHbA1c ≥7.5%, %HbA1c reductions with bromocriptine-QR vs placebo were -0.50 (P = .04), -0.73 (P = .005) and -1.22 (P = .008) with bRHR <70, ≥70 and ≥80, respectively. With bRHR ≥70, the magnitude of bromocriptine-QR-induced RHR reduction was an independent predictor of bromocriptine-QR's HbA1c lowering effect. CONCLUSION Bromocriptine-QR lowers elevated RHR with concurrent decrease in BP and hyperglycaemia. These findings suggest a potential sympatholytic mechanism contributing to bromocriptine-QR's antidiabetes effect and potentially its previously demonstrated effect to reduce CVD events.
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Affiliation(s)
| | - Aaron Vinik
- Eastern Virginia Medical School Strelitz Diabetes CenterNorfolkVirginia
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Sung SY, Han JH, Kim JH, Kwon KY, Park SW. The Relationship between Heart Rate Variability and Aortic Knob Width. Korean J Fam Med 2019; 40:39-44. [PMID: 30625270 PMCID: PMC6351788 DOI: 10.4082/kjfm.18.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/27/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The aortic knob width (AKW) and the heart rate variability (HRV) were suggested to be related to development of cardiovascular diseases. However, the relationship between them has not been investigated; thus, this study aimed to determine this relationship. METHODS This study included 587 Koreans aged 18-79 years. Their physical measurements, medical and social histories, blood test findings, and chest radiographs were obtained. The HRV parameters included the standard deviation of the N-N interval (SDNN), root mean square of successive differences (RMSSD), approximate entropy (ApEn), total power (TP), very low frequency (VLF), low frequency (LF), high frequency (HF), and LF/HF ratio, which were measured for 5 minutes. The AKW was measured on chest radiographs by a single reviewer. RESULTS The AKW was significantly correlated with the HRV parameters, except for the LF/HF ratio. However, RMSSD and ApEn were not significantly related to the AKW in women. After dividing the participants into quartile groups, the AKW was significantly related to the SDNN, RMSSD, TP, VLF, LF, and HF. The HRV parameter values decreased in the higher AKW quartile groups, the HRV parameter values decreased. After adjusting for sex, drinking status, exercise habits, smoking status, waist circumference, and triglyceride, low-density lipoprotein cholesterol, fasting blood sugar, and glycated hemoglobin levels, the AKW showed significant negative associations with the HRV parameters, except for the LF/HF ratio. CONCLUSION The AKW is significantly associated with the HRV parameters of SDNN, RMSSD, ApEn, TP, VLF, LF, and HF.
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Affiliation(s)
- Si-Yeun Sung
- Department of Family Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jee-Hye Han
- Department of Family Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jung-Hwan Kim
- Department of Family Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Kil-Young Kwon
- Department of Family Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Seong-Wook Park
- Department of Family Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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Murakami D, Anan F, Masaki T, Umeno Y, Shigenaga T, Eshima N, Nakagawa T. Visceral Fat Accumulation Is Associated with Asthma in Patients with Type 2 Diabetes. J Diabetes Res 2019; 2019:3129286. [PMID: 31192262 PMCID: PMC6525865 DOI: 10.1155/2019/3129286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/07/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The number of patients with type 2 diabetes has increased in Japan, and type 2 diabetes has attracted attention as a risk factor for asthma. However, the risk factors for the development of asthma in patients with type 2 diabetes have not been determined. This study was performed to clarify whether visceral fat accumulation (VFA) and insulin resistance are risk factors for the development of asthma in patients with type 2 diabetes. MATERIALS AND METHODS A cross-sectional study was conducted. The study group comprised 15 patients with type 2 diabetes with asthma, and the control group comprised 145 patients with type 2 diabetes without asthma. Their fat distribution was evaluated by measuring the VFA by abdominal computed tomography at the umbilical level. Their glucose status was assessed by measuring the fasting plasma glucose (FPG) concentration, fasting immunoreactive insulin concentration, homeostasis model assessment (HOMA) index, and hemoglobin A1c concentration. RESULTS Among patients with type 2 diabetes, VFA was significantly greater in patients with asthma than those without asthma (P < 0.0001). The FPG concentration, fasting immunoreactive insulin concentration, and HOMA index were higher in patients with asthma than those without asthma (P < 0.05, P < 0.0001, and P < 0.0001, respectively). Multiple logistic regression analysis showed that VFA and the HOMA index were significantly associated with asthma in patients with type 2 diabetes (odds ratio, 1.78; 95% confidence interval, 1.31-3.89; P = 0.0115 and odds ratio, 3.65; 95% confidence interval, 1.37-7.85; P = 0.0078, respectively). CONCLUSIONS Our data suggest that VFA and insulin resistance are associated with the development of asthma in patients with type 2 diabetes.
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Affiliation(s)
- Daisuke Murakami
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Futoshi Anan
- Department of Cardiology, Oita Red Cross Hospital, Oita, Japan
| | - Takayuki Masaki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yoshikazu Umeno
- Department of Endocrinology, Oita Red Cross Hospital, Oita, Japan
| | | | - Nobuoki Eshima
- Center for Educational Outreach and Admissions, Kyoto University, Kyoto, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Verma S, Bhati P, Ahmad I, Masroor S, Ali K, Singla D, Hussain ME. Co-Existence of hypertension worsens post-exercise cardiac autonomic recovery in type 2 diabetes. Indian Heart J 2018; 70 Suppl 3:S82-S89. [PMID: 30595327 PMCID: PMC6310903 DOI: 10.1016/j.ihj.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/08/2018] [Accepted: 06/11/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiac autonomic neuropathy (CAN) is a commonly overlooked complication of Type 2 Diabetes Mellitus (T2DM) characterized by imbalance between sympathetic and parasympathetic supply to the heart. The susceptibility of heart to dysrhythmias and fatal events increases during and after exercise due to a shift in autonomic regulation. Diabetes and hypertension (HTN) frequently occur concurrently and both conditions lead to impaired cardiac autonomic control. However, their impact together on post-exercise autonomic recovery remains to be explored. OBJECTIVE The objective of the study was to investigate the effect of co-existence of HTN on cardiac autonomic recovery (assessed by heart rate recovery and heart rate variability) in patients with T2DM. METHODS Forty eight type 2 diabetic patients (24 normotensive, 24 hypertensive), 24 non-diabetic patients with essential HTN, and 27 healthy controls, were recruited into the study and assessed for heart rate recovery (HRR) following a graded maximal test. Also, heart rate variability (HRV) was recorded before and following the bout of maximal exercise. RESULTS Heart rate recovery at 1 (HRR1min) and 2 (HRR2min) minute(s) showed significant effects for DM (p < 0.001) and HTN (p < 0.001), while DM × HTN interaction was found to be non-significant. Resting HRV showed a significant decline in time-domain variables for the DM group (p < 0.01). Recovery of HRV showed a significant effect of time (p < 0.05) for all indices, the group effect was found significant only for time-domain measures (p < 0.05). CONCLUSION Both HRR and HRV recovery were impaired in DM and HTN. Moreover, the co-existence of HTN had a synergistic effect, causing further worsening of autonomic recovery in T2DM.
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Affiliation(s)
- Shalini Verma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, 110025, India.
| | - Pooja Bhati
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, 110025, India
| | - Irshad Ahmad
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, 110025, India
| | - Sidra Masroor
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, 110025, India
| | - Kamran Ali
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, 110025, India
| | - Deepika Singla
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, 110025, India
| | - Mohammed Ejaz Hussain
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, 110025, India
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Rodrigues TS, Quarto LJG. Body Mass Index May Influence Heart Rate Variability. Arq Bras Cardiol 2018; 111:640-642. [PMID: 30365689 PMCID: PMC6199506 DOI: 10.5935/abc.20180201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022] Open
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Macagnan FE, Feoli AMP, Russomano T. Acute Physical Effort Increases Sympathovagal Balance Responses to Autonomic Stimulation in Metabolic Syndrome. Metab Syndr Relat Disord 2018; 17:67-74. [PMID: 30325696 DOI: 10.1089/met.2018.0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is little evidence of how metabolic syndrome (MS) affects sympathovagal balance responses to acute physical effort (APE) and autonomic stimulation (AS). This study aimed to evaluate the heart rate variability (HRV) responses to the combined APE and AS challenges. METHODS Fourteen subjects (8 men; 49.15 ± 8.67 years) divided into two groups: 7 healthy volunteers [control group (CG)] and 7 patients with MS. Sympathovagal balance [low frequency (LF)/high frequency (HF) ratio] was accessed by HRV through the beat-to-beat heart rate (HR) electrocardiogram. Other variables analyzed were as follows: HR, RR-interval variance (VAR/ms2), LF and HF normalized units (un). The APE consisted of a 30-min walk at 65%-75% of the age-predicted maximal HR. The AS was achieved by changing from the supine to standing position (activity orthostatic position). RESULTS At rest, all HRV variables differ with on MS, but after APE and AS LF (nu) and HF (nu) become similar to the CG. However, the LF/HF ratio responses to the AS were significantly different after APE, but only in the MS (CG rest: 367% ± 59% vs. recovery 495% ± 116%, P > 0.05; MS rest: 316% ± 88% vs. recovery: 665% ± 165%; P = 0.045). Comparing the difference between AS in rest and recovery (ΔAS = rest - recovery), the LF/HF ratio was notably higher in the MS group (CG: 94% ± 29% vs. MS: 415% ± 76%; P < 0.0001). CONCLUSIONS The APE and AS induced by body posture changes activated a clear distinction in sympathovagal balance response in MS.
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Affiliation(s)
- Fabrício Edler Macagnan
- 1 Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Ana Maria Pandolfo Feoli
- 2 Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Thais Russomano
- 3 Centre of Human and Applied Physiological Sciences, Department of Physiology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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Hu MX, Penninx BW, de Geus EJ, Lamers F, Kuan DCH, Wright AG, Marsland AL, Muldoon MF, Manuck SB, Gianaros PJ. Associations of immunometabolic risk factors with symptoms of depression and anxiety: The role of cardiac vagal activity. Brain Behav Immun 2018; 73:493-503. [PMID: 29920329 PMCID: PMC7066576 DOI: 10.1016/j.bbi.2018.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/24/2018] [Accepted: 06/15/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study examined 1) the cross-sectional relationships between symptoms of depression/anxiety and immunometabolic risk factors, and 2) whether these relationships might be explained in part by cardiac vagal activity. METHODS Data were drawn from the Adult Health and Behavior registries (n = 1785), comprised of community dwelling adults (52.8% women, aged 30-54). Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale (CES-D) and the Beck Depression Inventory-II (BDI-II), and anxious symptoms with the Trait Anxiety scale of the State-Trait Anxiety Inventory (STAI-T). Immunometabolic risk factors included fasting levels of triglycerides, high-density lipoproteins, glucose, and insulin, as well as blood pressure, waist circumference, body mass index, C-reactive protein, and interleukin-6. Measures of cardiac autonomic activity were high- and low-frequency indicators of heart rate variability (HRV), standard deviation of normal-to-normal R-R intervals, and the mean of absolute and successive differences in R-R intervals. RESULTS Higher BDI-II scores, in contrast to CES-D and STAI-T scores, were associated with increased immunometabolic risk and decreased HRV, especially HRV likely reflecting cardiac vagal activity. Decreased HRV was also associated with increased immunometabolic risk. Structural equation models indicated that BDI-II scores may relate to immunometabolic risk via cardiac vagal activity (indirect effect: β = .012, p = .046) or to vagal activity via immunometabolic risk (indirect effect: β = -.015, p = .021). CONCLUSIONS Depressive symptoms, as measured by the BDI-II, but not anxious symptoms, were related to elevated levels of immunometabolic risk factors and low cardiac vagal activity. The latter may exhibit bidirectional influences on one another in a meditational framework. Future longitudinal, intervention, an nonhuman animal work is needed to elucidate the precise and mechanistic pathways linking depressive symptoms to immune, metabolic, and autonomic parameters of physiology that predispose to cardiovascular disease risk.
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Affiliation(s)
- Mandy X. Hu
- Amsterdam Public Health Research Institute, Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands,Corresponding author at: Oldenaller 1, 1081 HJ Amsterdam, The Netherlands. (M.X. Hu)
| | - Brenda W.J.H. Penninx
- Amsterdam Public Health Research Institute, Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Eco J.C. de Geus
- Department of Biological Psychology, VU University, Amsterdam, The Netherlands
| | - Femke Lamers
- Amsterdam Public Health Research Institute, Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Dora C.-H. Kuan
- Department of Psychology, University of Pittsburgh, PA, United States
| | - Aidan G.C. Wright
- Department of Psychology, University of Pittsburgh, PA, United States
| | - Anna L. Marsland
- Department of Psychology, University of Pittsburgh, PA, United States
| | - Matthew F. Muldoon
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, PA, United States
| | - Stephen B. Manuck
- Department of Psychology, University of Pittsburgh, PA, United States
| | - Peter J. Gianaros
- Department of Psychology, University of Pittsburgh, PA, United States
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Benichou T, Pereira B, Mermillod M, Tauveron I, Pfabigan D, Maqdasy S, Dutheil F. Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLoS One 2018; 13:e0195166. [PMID: 29608603 PMCID: PMC5880391 DOI: 10.1371/journal.pone.0195166] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/16/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cardiac autonomic neuropathy in type 2 dibetes mellitus (T2DM) patients is frequent and associated with high cardiovascular mortality. Heart rate variability (HRV) is the gold standard to measure cardiac autonomic neuropathy. We aimed to conduct a systematic review and meta-analysis to evaluate the impact of T2DM on HRV parameters. METHODS The PubMed, Cochrane Library, Embase and Science Direct databases were searched on 1st October 2017 using the keywords "diabetes" AND ("heart rate variability" OR "HRV"). Included articles had to report HRV parameters in T2DM patients and healthy controls measured during 24 hours with a Holter-electrocardiogram. Measurements of HRV retieved were: RR-intervals (or Normal to Normal intervals-NN), standard deviation of RR intervals (SDNN), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50), square root of the mean squared difference of successive RR intervals (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio, as per Task Force recommendations. RESULTS We included twenty-five case-control studies with 2,932 patients: 1,356 with T2DM and 1,576 healthy controls. T2DM patients had significantly (P<0.01) lower RR-intervals (effect size = -0.61; 95%CI -1.21 to -0.01), lower SDNN (-0.65; -0.83 to -0.47), lower RMSSD (-0.92; -1.37 to -0.47), lower pNN50 (-0.46; -0.84 to -0.09), lower total power (-1.52; -2.13 to -0.91), lower LF (-1.08; -1.46 to -0.69]), and lower HF (-0.79; -1.09 to -0.50). LF/HF did not differ between groups. Levels of blood glucose and HbA1c were associated with several HRV parameters, as well as Time from diagnosis of T2DM. CONCLUSIONS T2DM was associated with an overall decrease in the HRV of T2DM patients. Both sympathetic and parasympathetic activity were decreased, which can be explained by the deleterious effects of altered glucose metabolism on HRV, leading to cardiac autonomic neuropathy.
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Affiliation(s)
- Thomas Benichou
- University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Bruno Pereira
- University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Clinical Research Direction, Clermont–Ferrand, France
| | - Martial Mermillod
- Univ. Grenoble Alpes, LPNC & CNRS, LPNC, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Igor Tauveron
- Université Clermont Auvergne, CNRS, GReD, Inserm, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Daniela Pfabigan
- Peking University, Culture and Social Cognitive Neuroscience Laboratory, School of Psychological and Cognitive Sciences, Beijing, China
| | - Salwan Maqdasy
- Université Clermont Auvergne, CNRS, GReD, Inserm, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Preventive and Occupational Medicine, WittyFit, Clermont–Ferrand, France
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria, Australia
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Guan L, Collet JP, Mazowita G, Claydon VE. Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability. Front Neurol 2018; 9:90. [PMID: 29556209 PMCID: PMC5844932 DOI: 10.3389/fneur.2018.00090] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/08/2018] [Indexed: 12/20/2022] Open
Abstract
Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye’s fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or “stressors,” respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke.
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Affiliation(s)
- Ling Guan
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Jean-Paul Collet
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Garey Mazowita
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada.,Department of Family and Community Medicine, Providence Healthcare, Vancouver, BC, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
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28
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Utzinger ML. Enhancing Heart Rate Variability. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00096-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kang SJ, Ha GC, Ko KJ. Association between resting heart rate, metabolic syndrome and cardiorespiratory fitness in Korean male adults. J Exerc Sci Fit 2017; 15:27-31. [PMID: 29541128 PMCID: PMC5812868 DOI: 10.1016/j.jesf.2017.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/OBJECTIVE The present study aimed to investigate the association between metabolic syndrome and cardiorespiratory fitness according to resting heart rate of Korean male adults. METHODS A total of 11,876 male adults aged 20-65 years who underwent health examinations from 2010 to 2015 at a National Fitness Centre in South Korea were included. Subjects' resting heart rate, cardiorespiratory fitness (VO2max), and metabolic syndrome parameters were collected. The subjects were divided into 5 categories (<60 bpm, 60-69 bpm, 70-79 bpm, 80-89 bpm, and ≥90 bpm) of resting heart rate for further analysis. RESULTS We found that elevated resting heart rate was positively associated with body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, and fasting blood glucose levels (p < 0.001, respectively); in contrast, elevated resting heart rate was inversely associated with VO2max (p < 0.001). When resting heart rate of subjects was categorized into quintiles and analysed, the results showed that the relative risk of metabolic syndrome was 1.53-fold higher (95% CI, 1.34 to 1.82) in the range of 60-69 beats per minute (bpm), 2.08-fold higher (95% CI, 1.77 to 2.45) in the range of 70-79 bpm, 2.28-fold higher (95% CI, 1.73 to 3.00) in the range of 80-89 bpm, and 2.61-fold higher (95% CI, 1.62 to 4.20) in the range of ≥90 bpm, compared to those <60 bpm; this indicated that as resting heart rate increased, the relative risk of metabolic syndrome also increased. CONCLUSION Resting heart rate of male adults was found to be associated with cardiorespiratory fitness; the risk factors for metabolic syndrome and relative risk of metabolic syndrome increased as resting heart rate increased.
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Affiliation(s)
- Seol-Jung Kang
- Department of Physical Education, Changwon National University, Republic of Korea
| | - Gi-Chul Ha
- Department of Sports Medicine, National Health Fitness Center, Republic of Korea
| | - Kwang-Jun Ko
- Department of Sports Medicine, National Health Fitness Center, Republic of Korea
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30
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Tuck NL, Adams KS, Consedine NS. Does the ability to express different emotions predict different indices of physical health? A skill-based study of physical symptoms and heart rate variability. Br J Health Psychol 2017; 22:502-523. [PMID: 28452399 DOI: 10.1111/bjhp.12242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/30/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The outward expression of emotion has been frequently associated with better health outcomes, whereas suppressing emotion is thought to contribute to worse physical health. However, work has typically focused on trait expressive tendencies and the possibility that individual differences in the ability to express specific emotions may also be associated with health has not been widely tested. DESIGN A cross-sectional study of community dwelling adults. METHODS One hundred and twenty-eight participants aged 18-88 years completed questionnaires assessing demographics and health status, before attending a testing session in which resting heart rate variability (HRV) was assessed. Participants then completed a performance-based test of expressive regulatory skill in which they were instructed to enhance and suppress their emotional expressions while they watched film clips validated to elicit amusement, sadness, and anger. Participants rated subjective emotional experience before and after each clip, and their degree of expressivity was scored using FACS-based Noldus FaceReader. RESULTS Missing data resulted in a final sample size of 117. Linear regressions controlling for age, sex, diagnoses, and trait emotion revealed that greater ability to enhance sad expressions was associated with higher HRV while the ability to enhance expressions of joy was associated with lower symptom interference. In parallel models, the ability to flexibly regulate (both enhance and suppress) expressions of joy and sadness was also associated with lower symptom interference. CONCLUSIONS Findings suggest that the ability to regulate expressions of both sadness and joy is associated with health indices even when controlling for trait affect and potential confounds. The present findings offer early evidence that individual differences in the ability to regulate the outward expression of emotion may be relevant to health and suggest that expressive regulatory skills offer a novel avenue for research and intervention. Statement of contribution What is already known on this subject The tendency to outwardly express felt emotion generally predicts better health, whereas expressive suppression typically predicts worse health outcomes. Most work has been based on trait assessments; however, the ability to regulate the expression of felt emotion can be objectively assessed using performance-based tests. Prior work in mental health suggests that the ability to flexibly up- and downregulate the expression of emotion predicts better outcomes. What does this study add The first evidence that the ability to flexibly regulate expressions predicts indices of health. Skill in both expressing and suppressing facial expressions predicts better reported health. Skills with different emotions differentially predict symptom interference and cardiac vagal tone.
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Affiliation(s)
- Natalie L Tuck
- Department of Psychological Medicine, University of Auckland, New Zealand
| | | | - Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, New Zealand
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Hu MX, Lamers F, Hiles SA, Penninx BWJH, de Geus EJC. Basal autonomic activity, stress reactivity, and increases in metabolic syndrome components over time. Psychoneuroendocrinology 2016; 71:119-26. [PMID: 27262344 DOI: 10.1016/j.psyneuen.2016.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/29/2016] [Accepted: 05/18/2016] [Indexed: 12/31/2022]
Abstract
CONTEXT Basal autonomic nervous system (ANS) functioning has been linked to the metabolic syndrome (MetS), but the role of ANS reactivity in response to stress remains unclear. OBJECTIVE To examine cross-sectionally and longitudinally to what extent ANS basal level and stress reactivity are related to MetS. DESIGN 2-year and 6-year data from a prospective cohort: the Netherlands Study of Depression and Anxiety. SETTING Participants were recruited from the general community, primary care, and mental health care organizations. PARTICIPANTS 1922 respondents (mean age=43.7years). MAIN OUTCOME MEASURES Indicators of ANS functioning were heart rate (HR), respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP). ANS stress reactivity was measured during a cognitively challenging stressor and a personal-emotional stressor. MetS components included triglycerides, high-density lipoprotein cholesterol, blood pressure, glucose and waist circumference. RESULTS Cross-sectional analyses indicated that higher basal HR, lower basal values of RSA and PEP, and higher RSA reactivity during cognitive challenge were related to less favorable values of almost all individual MetS components. Longitudinal analyses showed that higher basal HR and shorter basal PEP predicted 4-year increase in many MetS abnormalities. Higher RSA stress reactivity during cognitive challenge predicted 4-year increase in number of MetS components. CONCLUSION Higher basal sympathetic, lower basal parasympathetic activity, and increased parasympathetic withdrawal during stress are associated with multiple MetS components, and higher basal sympathetic activity predicts an increase in metabolic abnormalities over time. These findings support a role for ANS dysregulation in the risk for MetS and, consequently, the development of cardiovascular disease.
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Affiliation(s)
- Mandy X Hu
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, AJ Ernststraat 1187, 1081 HL Amsterdam, The Netherlands.
| | - Femke Lamers
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, AJ Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Sarah A Hiles
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, AJ Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, AJ Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Eco J C de Geus
- Department of Biological Psychology and EMGO Institute for Health and Care Research, VU University, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
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Stuckey MI, Kiviniemi A, Gill DP, Shoemaker JK, Petrella RJ. Associations between heart rate variability, metabolic syndrome risk factors, and insulin resistance. Appl Physiol Nutr Metab 2016; 40:734-40. [PMID: 26140416 DOI: 10.1139/apnm-2014-0528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to examine differences in heart rate variability (HRV) in metabolic syndrome (MetS) and to determine associations between HRV parameters, MetS risk factors, and insulin resistance (homeostasis model assessment for insulin resistance (HOMA-IR)). Participants (n = 220; aged 23-70 years) were assessed for MetS risk factors (waist circumference, blood pressure, fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol) and 5-min supine HRV (time and frequency domain and nonlinear). HRV was compared between those with 3 or more (MetS+) and those with 2 or fewer MetS risk factors (MetS-). Multiple linear regression models were built for each HRV parameter to investigate associations with MetS risk factors and HOMA-IR. Data with normal distribution are presented as means ± SD and those without as median [interquartile range]. In women, standard deviation of R-R intervals 38.0 [27.0] ms, 44.5 [29.3] ms; p = 0.020), low-frequency power (5.73 ± 1.06 ln ms(2), 6.13 ± 1.05 ln ms(2); p = 0.022), and the standard deviation of the length of the Poincaré plot (46.8 [31.6] ms, 58.4 [29.9] ms; p = 0.014) were lower and heart rate was higher (68 [13] beats/min, 64 [12] beats/min; p = 0. 018) in MetS+ compared with MetS-, with no differences in men. Waist circumference was most commonly associated with HRV, especially frequency domain parameters. HOMA-IR was associated with heart rate. In conclusion, MetS+ women had a less favourable HRV profile than MetS- women, but there were no differences in men. HOMA-IR was associated with heart rate, not HRV.
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Affiliation(s)
- Melanie I Stuckey
- a Lawson Health Research Institute, Aging Rehabilitation and Geriatric Care Research Centre, 801 Commissioners Road East, London, ON N6C 5J1, Canada.,b School of Kinesiology, University of Western Ontario, London, ON, Canada
| | - Antti Kiviniemi
- c Verve Research, Department of Exercise and Medical Physiology, Kasarmintie 13, PO Box 404, FI-90101 Oulu, Finland
| | - Dawn P Gill
- a Lawson Health Research Institute, Aging Rehabilitation and Geriatric Care Research Centre, 801 Commissioners Road East, London, ON N6C 5J1, Canada.,d Faculty of Health Sciences, Western Centre for Public Health and Family Medicine, University of Western Ontario, London, ON N6A 3K7, Canada.,e School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - J Kevin Shoemaker
- g School of Kinesiology, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Robert J Petrella
- a Lawson Health Research Institute, Aging Rehabilitation and Geriatric Care Research Centre, 801 Commissioners Road East, London, ON N6C 5J1, Canada.,b School of Kinesiology, University of Western Ontario, London, ON, Canada.,f Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5B9, Canada
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Abstract
OBJECTIVES Obesity, diabetes, and heart disease-the most costly epidemics of our time-share a common but rarely treated mechanism: autonomic imbalance. We examined the contribution of autonomic imbalance, relative to selected demographic and biobehavioral risk factors, to the development of metabolic syndrome in a community sample for 12 years. METHODS We identified offspring cohort participants from the Framingham Heart Study who did not have metabolic syndrome at Examination 3 (1983-1987, baseline for this analysis) and whose metabolic syndrome status was assessed at the 4-, 8-, and 12-year follow-ups. We created logistic regression models, using baseline resting heart rate (RHR) and heart rate variability (HRV), to predict the odds of developing metabolic syndrome within 12 years, adjusting for age, sex, depressive symptoms, and smoking. HRV indices (standard deviation of the beat-to-beat interval [SDNN] and root mean square of the standard deviation) were calculated from 2-hour Holter monitor data. RESULTS Our sample consisted of 1143 participants (mean [SD] age = 46.6 (9.9) years, 57% female). One standard deviation of a decrease in SDNN increased the odds of developing metabolic syndrome within 12 years by 43% (95% confidence interval = 1.302-1.572, p < .001). Without HRV in the model, each increase in RHR of 10 beats/min increased the odds of developing metabolic syndrome by 24% (95% confidence interval = 1.094-1.426, p < .001). CONCLUSIONS In this community sample, low HRV by both measures (SDNN and root mean square of the standard deviation), high RHR, increased age, cigarette smoking, and being male significantly increased the odds of developing metabolic syndrome within 12 years of baseline.
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Kubičková A, Kozumplík J, Nováková Z, Plachý M, Jurák P, Lipoldová J. Heart rate variability analysed by Poincaré plot in patients with metabolic syndrome. J Electrocardiol 2016; 49:23-8. [DOI: 10.1016/j.jelectrocard.2015.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Indexed: 11/28/2022]
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Balcioğlu AS, Akinci S, Çiçek D, Eldem HO, Çoner A, Bal UA, Müderrisoğlu H. Which is responsible for cardiac autonomic dysfunction in non-diabetic patients with metabolic syndrome: Prediabetes or the syndrome itself? Diabetes Metab Syndr 2016; 10:S13-S20. [PMID: 26610403 DOI: 10.1016/j.dsx.2015.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/27/2015] [Indexed: 01/28/2023]
Abstract
AIMS Cardiac autonomic dysfunction (CAD) is associated with both prediabetes and metabolic syndrome (MS). Heart rate variability (HRV) and heart rate turbulence (HRT) are reliable 24-h Holter-ECG findings of cardiac autonomic function. This study aimed to investigate the relation between MS and its components and CAD using HRV and HRT. MATERIALS AND METHODS The study included 80 non-diabetic patients with MS and 70 control subjects. All study population and the patients with MS were further analyzed for each diagnostic component of MS to investigate which criteria impaired HRV and HRT. RESULTS HRV and HRT parameters were disturbed in patients in the MS group. While impairment in HRV and HRT was significantly related to the presence of the fasting plasma glucose (FPG) criterion, there were no differences between groups in terms of the other 4 MS criteria. Moreover, FPG level was significantly correlated with SDNN (r=-0.352, p<0.001), SDNN index (r=-0.423, p<0.001), SDANN (r=-0.301, p<0.001), RMSSD (r=-0.237, p<0.001), pNN50 (r=-0.237, p<0.001), turbulence onset (TO) (r=0.365, p<0.001) and turbulence slope (TS) (r=-0.365, p<0.001). Among the MS diagnostic criteria, only FPG level was an independent determinant of all HRV and HRT parameters. CONCLUSIONS This study confirms the relation between MS and CAD. Increased FPG alone appears to be responsible for the mentioned findings among the 5 diagnostic criteria. Accordingly, CAD may be the result of prediabetes, not MS in patients with MS.
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Affiliation(s)
- Akif Serhat Balcioğlu
- Başkent University, Medical and Research Center of Alanya, Department of Cardiology, Alanya, Antalya, Turkey.
| | - Sinan Akinci
- Başkent University, Medical and Research Center of Alanya, Department of Cardiology, Alanya, Antalya, Turkey
| | - Davran Çiçek
- Başkent University, Medical and Research Center of Alanya, Department of Cardiology, Alanya, Antalya, Turkey
| | - Halil Olcay Eldem
- Başkent University, Medical and Research Center of Alanya, Department of Cardiology, Alanya, Antalya, Turkey
| | - Ali Çoner
- Başkent University, Medical and Research Center of Alanya, Department of Cardiology, Alanya, Antalya, Turkey
| | - Uğur Abbas Bal
- Başkent University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Haldun Müderrisoğlu
- Başkent University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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Vrachimis A, Hadjicharalambous M, Tyler C. The Effect of Circuit Training on Resting Heart Rate Variability, Cardiovascular Disease Risk Factors and Physical Fitness in Healthy Untrained Adults. Health (London) 2016. [DOI: 10.4236/health.2016.82017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Huang SC, Fang WH, Wang CC, Chen WL, Kao TW, Hwang LL, Chu CM, Chang YW. Alteration of Heart Rate Variability in People With Bowel Preparation Before Colonoscopy. Medicine (Baltimore) 2015; 94:e1926. [PMID: 26554795 PMCID: PMC4915896 DOI: 10.1097/md.0000000000001926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/24/2015] [Accepted: 10/06/2015] [Indexed: 12/27/2022] Open
Abstract
In current health examination setting, people frequently undergo heart rate variability (HRV) analysis and colonoscopy on the same day. However, it remains unclear whether the bowel preparation before colonoscopy affects HRV. This study aimed to evaluate the association between HRV and bowel preparation.We conducted a cross-sectional observational study of 1755 people from January 2012 to December 2013 in Taipei, Taiwan. The participants, aged 45 to 65 years, received health examinations that included a physical examination, blood tests, and an HRV analysis. Among these people, 1099 additionally received a colonoscopy on the same day and underwent bowel preparation 1 day before the colonoscopy. The association between HRV and bowel preparation was derived by a multivariable linear regression with adjusted confounding factors.Bowel preparation was associated with a lower standard deviation of the normal-to-normal intervals (SDNN), the root mean square of the successive differences (RMSSD), low-frequency power (LF), and high-frequency power (HF) (all P < 0.0001). After adjusting confounding factors, bowel preparation remained correlated with lower SDNN, RMSSD, LF, and HF (all P < 0.0001). Higher serum phosphorus and lower serum potassium levels were noted in the bowel preparation group (P < 0.0001), and an association between lower HRV and higher serum phosphorus and lower serum potassium levels was only noted in the bowel preparation group.Bowel preparation was significantly associated with lower HRV. The underlying mechanism may be related to an electrolyte imbalance. Cautions may be needed when interpreting HRV reports for people receiving bowel preparations before colonoscopy.
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Affiliation(s)
- Shang-Cheng Huang
- From the Department of Family Medicine and Community Health, Tri-Service General Hospital, National Defense Medical Center (SCH, WHF, CCW, WLC, TWK, YWC); Department of Graduate Institute of Medical Sciences College of Medicine, Taipei Medical University (SCH); Department of Physiology College of Medicine, Taipei Medical University (LLH); and School of Public Health, National Defense Medical Center, Taipei, Taiwan (CMC)
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Lee SH, Lee DH, Ha DH, Oh YJ. Dynamics of heart rate variability in patients with type 2 diabetes mellitus during spinal anaesthesia: prospective observational study. BMC Anesthesiol 2015; 15:141. [PMID: 26450424 PMCID: PMC4599650 DOI: 10.1186/s12871-015-0125-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/03/2015] [Indexed: 01/26/2023] Open
Abstract
Background Little is known about the changes in autonomic function during spinal anaesthesia in type 2 diabetic patients. The purpose of the study was to assess the influence of spinal anaesthesia on the heart rate variability in type 2 diabetic patients according to the glycated hemoglobin (HbA1c) level. Methods Sixty-six patients who were scheduled for elective orthostatic lower limb surgery were assigned to three groups (n = 22, each) according to HbA1c; controlled diabetes mellitus (HbA1c < 7 %), uncontrolled diabetes mellitus (HbA1c > 7 %) and the control group. The heart rate variability was measured 10 min before (T0), and at10 min (T1), 20 min (T2) and 30 min (T3) after spinal anaesthesia. Results Before spinal anaesthesia, total, low-and high-frequency power were significantly lower in the uncontrolled diabetec group than in other group (p < 0.05). During spinal anaesthesia, total, low- and high-frequency powers were did not change in the uncontrolled diabetec group while the low-frequency power in the controlled diabetec group was significantly depressed (p < 0.05). The ratio of low-to high-frequency was comparable among the groups, while it was reduced at T1-2 than at T0 in all the groups. The blood pressures were higher in the uncontrolled diabetec group than in the other groups. Conclusions Spinal anaesthesia had an influence on the cardiac autonomic modulation in controlled diabetec patients, but not in uncontrolled diabetec patients. There were no differences in all haemodynamic variables during an adequate level of spinal anaesthesia in controlled and uncontrolled type 2 DM. Trial registration ClinicalTrials.gov NCT02137057 Electronic supplementary material The online version of this article (doi:10.1186/s12871-015-0125-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Su Hyun Lee
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
| | - Dong Hoon Lee
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
| | - Dong Hoon Ha
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
| | - Young Jun Oh
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
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[Relationship between blood pressure, heart rate and cardiac autonomic dysfunction in non-diabetic obese patients]. Ann Cardiol Angeiol (Paris) 2015; 64:139-44. [PMID: 26047878 DOI: 10.1016/j.ancard.2015.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 11/23/2022]
Abstract
RATIONALE Some studies suggest that a high heart rate (HR) would be predictive of the incidence of an elevated blood pressure (BP). Cardiac autonomic dysfunction (CAD) affects a high proportion of obese patients. CAD could be involved in BP increase. Our aim was to examine the relationship between CAD, HR and BP in obese patients without known diabetes. PATIENTS AND METHODS We included 428 overweight or obese patients. CAD was assessed by analyzing HR variations during three standard tests (Valsalva, deep breathing, lying-to-standing), which are mostly dependent on vagal control. An oral load in glucose was performed and the Matsuda index was calculated. RESULTS The population was separated in 4 groups according to the grade of CAD (no or only one abnormal test, 2 or 3 abnormal tests) and HR (< or ≥ 75 bpm). Age was similar in the four groups. Systolic (P=0.05), diastolic (P<0.005) and mean BP (P<0.001) differed significantly between the 4 groups, and was the highest in the group of patients who had 2 or 3 abnormal tests and HR ≥ 75 bpm. Matsuda index differed across the groups (P=0.018) and was the lowest in this group. CONCLUSION These data indicate that among overweight or obese patients with a defect in cardiac vagal activity BP is elevated only in those with a high heart rate, which is indicative of a more marked insulin resistance and probably an excess in sympathetic activity.
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Rodríguez-Colón SM, He F, Bixler EO, Fernandez-Mendoza J, Vgontzas AN, Calhoun S, Zheng ZJ, Liao D. Metabolic syndrome burden in apparently healthy adolescents is adversely associated with cardiac autonomic modulation--Penn State Children Cohort. Metabolism 2015; 64:626-32. [PMID: 25684658 PMCID: PMC4372460 DOI: 10.1016/j.metabol.2015.01.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/22/2015] [Accepted: 01/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reduced cardiac autonomic modulation (CAM) has been associated with metabolic syndrome (MetS) in adults. However, the association between MetS component cluster and CAM has not been examined in adolescents. METHODS We conducted a cross-sectional analysis using data from the Penn State Child Cohort follow-up examination. CAM was assessed by heart rate variability (HRV) analysis of 39-h RR intervals, including frequency (high frequency, HF; low frequency, LF; and LF/HF ratio) and time (SDNN, standard deviation of all RR intervals; RMSSD, square root of the mean of the sum of the squares of differences between adjacent RR intervals; and HR, heart rate) domain variables. To assess the MetS burden, we used continuous MetS score (cMetS)--sum of the age and sex-adjusted standardized residual (Z-score) of five established MetS components. Linear mixed-effect models were used to analyze the association between cMetS and CAM in the entire population and stratified by gender. RESULTS After adjusting for age, sex, and race, cMetS was significantly associated with reduced HRV and higher HR. With 1 standard deviation increase in cMetS, there was a significant decrease in HF (-0.10 (SE = 0.02)), LF (-0.07 (SE = 0.01)), SDNN (-1.97 (SE = 0.50)), and RMSSD (-1.70 (SE = 0.72)), and increase in LF/HF (0.08 (SE = 0.02)) and HR (1.40 (SE = 0.26)). All cMetS components, with the exception of high-density lipoprotein (HDL), were associated with significantly decreased HRV and increased HR. High blood pressure (MAP) and triglyceride (TG) levels were also associated with an increase in LF/HF and decrease in RMSSD. An increase in high-density lipoprotein was only associated with higher LF and SDNN. Moreover, cMetS and HRV associations were more pronounced in males than in females. The associations between HRV and. MAP, TG, and HDL were more pronounced in females. CONCLUSIONS cMetS score is associated with lower HRV, suggesting an adverse impact on CAM, even in apparently healthy adolescents.
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Affiliation(s)
- Sol M Rodríguez-Colón
- Department of Public Health Sciences Penn State University College of Medicine, Hershey, PA, 17033.
| | - Fan He
- Department of Public Health Sciences Penn State University College of Medicine, Hershey, PA, 17033.
| | - Edward O Bixler
- Sleep Research &Treatment Center, Department of Psychiatry, Penn State University College of Medicine, Hershey, PA, 17033.
| | - Julio Fernandez-Mendoza
- Sleep Research &Treatment Center, Department of Psychiatry, Penn State University College of Medicine, Hershey, PA, 17033.
| | - Alexandros N Vgontzas
- Sleep Research &Treatment Center, Department of Psychiatry, Penn State University College of Medicine, Hershey, PA, 17033.
| | - Susan Calhoun
- Sleep Research &Treatment Center, Department of Psychiatry, Penn State University College of Medicine, Hershey, PA, 17033.
| | - Zhi-Jie Zheng
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
| | - Duanping Liao
- Department of Public Health Sciences Penn State University College of Medicine, Hershey, PA, 17033.
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Chyun DA, Wackers FJT, Inzucchi SE, Jose P, Weiss C, Davey JA, Heller GV, Iskandrian AE, Young LH. Autonomic dysfunction independently predicts poor cardiovascular outcomes in asymptomatic individuals with type 2 diabetes in the DIAD study. SAGE Open Med 2015; 3:2050312114568476. [PMID: 26770763 PMCID: PMC4679226 DOI: 10.1177/2050312114568476] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 12/17/2014] [Indexed: 12/19/2022] Open
Abstract
Objective: The primary aim of this secondary analysis was to determine whether cardiac autonomic neuropathy independently predicted adverse cardiac outcomes in asymptomatic individuals with type 2 diabetes. Additional aims include the determination of the correlation of standard autonomic testing measures and power spectral analysis of heart rate variability, and the association of diabetes-related and cardiac risk factors with cardiac autonomic neuropathy measures. Methods: Cardiac autonomic neuropathy was assessed at the study entry into the Detection of Ischemia in Asymptomatic Diabetics study, using autonomic heart rate and blood pressure testing, and power spectral analysis of heart rate variability. All participants were prospectively followed for the composite clinical outcome of cardiac death, acute coronary syndromes, heart failure, or coronary revascularization. Results: Over 5 years of follow-up, 94 of 1119 (8.4%) subjects developed symptomatic cardiac disease. In unadjusted bivariate analyses, abnormalities in several cardiac autonomic neuropathy tests, including lower Valsalva and Standing Heart Rate Ratios, higher resting Heart Rate, greater systolic blood pressure decrease on standing, and lower low-frequency power, were predictive of symptomatic disease. Independent predictors of poor cardiac outcome were a lower Valsalva Heart Rate Ratio, non-Black ethnicity, longer diabetes duration, higher glycated hemoglobin (HbA1c), insulin use, reported numbness in the extremities, higher pulse pressure, family history of coronary artery disease, and higher waist-to-hip ratio. Clinical factors independently associated with a lower Valsalva Heart Rate Ratio were insulin use, clinical proteinuria, higher pulse pressure, use of angiotensin-converting enzyme inhibitor and non-Black ethnicity. Conclusion: Cardiac autonomic neuropathy predicted adverse cardiac outcomes in asymptomatic type 2 diabetes without known cardiac disease. Clinical variables may help to identify patients who might have cardiac autonomic neuropathy and warrant consideration for autonomic testing.
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Affiliation(s)
| | - Frans J Th Wackers
- Section of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Silvio E Inzucchi
- Section of Endocrinology, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Powell Jose
- Sutter Medical Group, Cardiology, Sacramento, CA, USA
| | - Curtis Weiss
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Janice A Davey
- Section of Endocrinology, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Gary V Heller
- Division of Cardiology, Morristown Medical Center, Morristown, NJ, USA
| | - Ami E Iskandrian
- Division of Cardiovascular Diseases, University of Alabama, Birmingham, AL, USA
| | - Lawrence H Young
- Section of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
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Modeling of performance and ANS activity for predicting future responses to training. Eur J Appl Physiol 2014; 115:589-96. [PMID: 25359446 DOI: 10.1007/s00421-014-3035-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Our aim was to assess whether we can predict satisfactorily performance in swimming and high frequency power (HF power) of heart rate variability from the responses to previous training. We have tested predictions using the model of Banister and the variable dose-response model. METHODS Data came from ten swimmers followed during 30 weeks of training with performance and HF power measured each week. The first 15-week training period was used to estimate the parameters of each model for both performance and HF power. Both were then predicted in response to the training done during the second 15-week training period. The bias and precision were estimated from the mean and SD of the difference between prediction and actual value expressed as a percentage of performance or HF power at the first week. RESULTS With the variable-dose response model, the bias for performance prediction was -0.24 ± 0.06 and the precision 0.69 ± 0.24% (mean ± between-subject SD). For HF power, the bias was 0 ± 21 and the precision 22 ± 8%. When HF power was transformed into performance using a quadratic relation in each swimmer established from the first 15-week period, the bias was 0.18 ± 0.74 and the precision 0.80 ± 0.30%. No clear trend in the error was observed during the second period. CONCLUSIONS This study showed that the modeling of training effects on performance allowed accurate performance prediction supporting its relevance to control and predict week after week the responses to future training.
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The circadian pattern of cardiac autonomic modulation and obesity in adolescents. Clin Auton Res 2014; 24:265-73. [PMID: 25358502 DOI: 10.1007/s10286-014-0257-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the impact of obesity and population attributes on the circadian pattern of cardiac autonomic modulation (CAM) in a population-based sample of adolescents. METHODS We used data from 421 adolescents who completed the follow-up exam in the Penn State Children Cohort study. CAM was assessed by heart rate variability (HRV) analysis of beat-to-beat, normal R-R intervals from a 24-hour ECG, on a 30-minute basis. The HRV indices included frequency-domain (HF, LF, and LF/HF ratio) and time-domain (SDNN, RMSSD, and HR) variables. Nonlinear mixed-effect models were used to calculate a cosine periodic curve, each having three parameters quantifying its circadian period: M (mean levels of the HRV variables), Â (amplitude of the oscillation), and θ (the time of the highest oscillation). RESULTS The mean (SD) age was 16.9 (2.2) years, with 54 % male and 77 % white. The mean BMI percentile was 66, with 16 % obese (BMI percentile ≥ 95). Overall, HF (a marker of parasympathetic modulation) gradually increased from the late afternoon, reached peak amplitude around 3 a.m., and then decreased throughout the daytime until late afternoon. In contrast, obesity had adverse effects on all circadian parameters. The age, sex and race showed varying differences on the CAM circadian parameters. The adjusted means (95 %Cls) of M, Â, and θ for HF were 5.99 (5.79-6.19), 0.77 (0.66-0.89), 3:15 (2:15-4:15) a.m., and 6.21 (6.13-6.29), 0.66 (0.61-0.70), 2:45 (2:30-3:15) a.m. for obese and non-obese subjects, respectively. CONCLUSION The circadian pattern of CAM can be quantified by the three cosine parameters. Obesity is associated with lower HRV even in young individuals like children/adolescents.
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Li X, Yu S, Chen H, Lu C, Zhang K, Li F. Cardiovascular autonomic function analysis using approximate entropy from 24-h heart rate variability and its frequency components in patients with type 2 diabetes. J Diabetes Investig 2014; 6:227-35. [PMID: 25802731 PMCID: PMC4364858 DOI: 10.1111/jdi.12270] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 01/08/2023] Open
Abstract
Aims/Introduction The principal aim of the present study was to investigate the cardiovascular autonomic system status of diabetes patients using approximate entropy (ApEn) extracted from 24-h heart rate variability (HRV) and its frequency components. Materials and Methods A total of 29 healthy controls and 63 type 2 diabetes patients were included. Participants’ 24-h HRV signals were recorded, and decomposed and reconstructed into four frequency components: high, low, very low and ultra low. The total 24-h HRV and its four components were divided into 24 1-h segments. ApEn values were extracted and statistically analyzed. Four traditional HRV indices, namely standard deviation of the RR intervals, root mean square of successive differences, coefficient of variance of RR intervals and ratio of low to high power of HRV, were also calculated. Results The low-frequency component contained the most abundant non-linear information, so was potentially most suitable for studying the cardiovascular system status with non-linear methods. ApEn values extracted from low- and high-frequency components of healthy controls were higher than those of diabetes patients. Except for root mean square of successive differences, standard deviation of the RR intervals, low to high power of HRV and coefficient of variance of RR intervals of healthy controls were all higher than those of diabetes patients. Conclusions The results showed that ApEn contained information on disorders of autonomic system function of diabetes patients as traditional HRV indices in time and frequency domains. ApEn and three traditional indices showed accordance to some degree. Non-linear information in subcomponents of HRV was shown, which is potentially more effective for distinguishing healthy individuals and diabetes patients than that extracted from the total HRV. Compared with diabetes patients, the cardiovascular system of healthy controls showed information of higher complexity, and better regulation function in response to changes of environment.
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Affiliation(s)
- Xia Li
- School of Biomedical Engineering, Capital Medical University Beijing, China ; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University Beijing, China
| | - Shuo Yu
- School of Biomedical Engineering, Capital Medical University Beijing, China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University Beijing, China ; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University Beijing, China
| | - Cheng Lu
- School of Biomedical Engineering, Capital Medical University Beijing, China
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University Beijing, China ; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University Beijing, China
| | - Fangjie Li
- Wangjing Hospital of China Academy of Traditional Chinese Medicine Beijing, China
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Ozveren O, Dogdu O, Sengul C, Cinar V, Eroglu E, Kucukdurmaz Z, Degertekin M. Deterioration of heart rate recovery index in patients with non-alcoholic fatty liver disease (NAFLD). Med Sci Monit 2014; 20:1539-43. [PMID: 25168159 PMCID: PMC4159245 DOI: 10.12659/msm.890741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) has been considered as a benign disease often associated with central obesity and insulin resistance and, in general, with factors of the metabolic syndrome. Heart rate recovery after exercise is a function of vagal reactivation, and its impairment is an independent prognostic indicator for cardiovascular and all-cause mortality. The aim of our study was to evaluate the heart rate recovery index in patients with NAFLD. Material/Methods The study population included 59 patients with NAFLD (mean age=42.3±9.3 years) and 22 healthy subjects as controls (mean age=40.7±6.5 years). Basal electrocardiography, echocardiography, and treadmill exercise testing were performed on all patients and controls. The heart rate recovery index was defined as the reduction in the heart rate from the rate at peak exercise to the rate at the 1st minute (HRR1), 2nd minute (HRR2), 3rd minute (HRR3), and 5th minute (HRR5) after stopping exercise stress testing. Results There were significant differences in HRR1 and HRR2 indices between patients with ED and the control group (19.9±8.2 vs. 34.1±9.6; p<0.001 and 24.3±5.4 vs. 40.5±9.1; p=0.006, respectively). Similarly, HRR indices after the 3rd and 5th minutes of the recovery period were significantly lower in patients with NAFLD compared with those indices in the control group (32.3±8.5 vs. 58.4±6.5; p=0.001 and 58±18.2 vs. 75.1±15.8; p<0.001). Effort capacity was markedly lower (11±1.9 vs. 12.5±1.5 METs; p=0.001) among the patients with NAFLD. Conclusions The heart rate recovery index is deteriorated in patients with NAFLD. When the prognostic significance of the heart rate recovery index is considered, these results may help explain the increased occurrence of cardiac death. It points to the importance of the heart rate recovery index in the identification of high-risk patients.
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Affiliation(s)
- Olcay Ozveren
- Department of Cardiology, Yeditepe University, Medical School, Istanbul, Turkey
| | - Orhan Dogdu
- Department of Cardiology, Firat University, Medical School, Elazig, Turkey
| | - Cihan Sengul
- Department of Cardiology, Kosuyolu Educational and Research Hospital, Istanbul, Turkey
| | - Veysel Cinar
- Department of Cardiology, Yeditepe University, Medical School, Istanbul, Turkey
| | - Elif Eroglu
- Department of Cardiology, Yeditepe University, Medical School, Istanbul, Turkey
| | | | - Muzaffer Degertekin
- Department of Cardiology, Yeditepe University, Medical School, Istanbul, Turkey
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Sex-specific impact of maternal-fetal risk factors on depression and cardiovascular risk 40 years later. J Dev Orig Health Dis 2014; 2:353-64. [PMID: 23378891 DOI: 10.1017/s2040174411000651] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Major depressive disorder (MDD) and cardiovascular disease (CVD) represent leading causes of morbidity and mortality worldwide. We tested the hypothesis that growth restriction and preeclampsia (referred to as fetal risk) are significant predictors of these conditions, with women at higher risk in adulthood. Adult offspring exposed to fetal risk factors and their discordant siblings were from two prenatal cohorts, whose mothers were followed through pregnancy and whom we recruited as adults 40 years later (n = 538; 250 males and 288 females). Subjects were psychiatrically diagnosed and underwent a stress challenge during which parasympathetic regulation was assessed by electrocardiogram, operationalized as high-frequency R-R interval variability (HF-RRV). Linear mixed models and generalized estimating equations were used to examine the relationship of fetal risk on HF-RRV, MDD and comorbidity of low HF-RRV (lowest 25th percentile) and MDD, including interactions with sex and socioeconomic status (SES). Fetal risk was significantly associated with low HF-RRV response (F = 3.64, P = 0.05), particularly among low SES (interaction: F = 4.31, P < 0.04). When stratified by MDD, the fetal risk impact was three times greater among MDD compared with non-MDD subjects (effect size: 0.21 v. 0.06). Females had a significantly higher risk for the comorbidity of MDD and low HF-RRV than males (relative risk (RR) = 1.36, 95% CI: 1.07-1.73), an association only seen among those exposed to fetal risk (RR = 1.38, 95% CI: 1.04-1.83). Findings suggest that these are shared fetal antecedents to the comorbidity of MDD and CVD risk 40 years later, an association stronger in females than in males.
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Liao D, Rodríguez-Colón SM, He F, Bixler EO. Childhood obesity and autonomic dysfunction: risk for cardiac morbidity and mortality. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:342. [PMID: 25143120 DOI: 10.1007/s11936-014-0342-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OPINION STATEMENT The epidemic of childhood obesity is becoming a major predictor for risk of cardiovascular diseases (CVD) and mortality during adulthood. Alterations in the morphology of the heart due to obesity could be a predictor for the dysfunction of cardiac autonomic modulation (CAM). A number of epidemiologic studies have evaluated the effect of obesity and CAM in children, finding that obesity impaired the balance of CAM toward a sympathetic overflow and reduced parasympathetic modulation, a significant predictor of CVD morbidity and mortality in adults. Lifestyle modifications, for example long-term exercise programs, have been shown to improve CAM in the obese. This review discusses the recent evidence on childhood and adolescent obesity and its impact on CAM, as well as how early lifestyle changes could help improve CAM, which may in turn reduce the burden of CVD in adults.
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Affiliation(s)
- Duanping Liao
- Department of Public Health Sciences, Penn State University College of Medicine, 90 Hope Drive, Suite 2000/A210, PO Box 855, Hershey, PA, 17033, USA,
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Istenes I, Körei AE, Putz Z, Németh N, Martos T, Keresztes K, Kempler MS, Erzsébet VO, Vargha P, Kempler P. Heart rate variability is severely impaired among type 2 diabetic patients with hypertension. Diabetes Metab Res Rev 2014; 30:305-12. [PMID: 24829967 DOI: 10.1002/dmrr.2496] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The aim of our study was to evaluate the relative effect of diabetes and hypertension on heart rate variability. RESEARCH DESIGN AND METHODS Four age-matched groups including type 2 diabetic patients with and without hypertension, non-diabetic patients with essential hypertension and healthy control subjects were studied. Autonomic function was evaluated by the standard cardiovascular reflex tests and 24-hour heart rate variability measurement. Heart rate variability was characterized by the triangular index value and by the spectral components of the frequency domain analysis. RESULTS According to the two-way analysis of variance on ranks, all parameters were influenced negatively by diabetes (heart rate variability triangular index: p < 0.001; low-frequency component: p < 0.0001; high-frequency component: p < 0.001; and total power: p < 0.0001), whereas hypertension had a negative effect only on the low-frequency component (p < 0.05). The interaction between hypertension and diabetes was not significant, indicating that their effects on the heart rate variability parameters are additive. Beat-to-beat variation upon deep breathing, the most sensitive cardiovascular reflex test was also negatively influenced by both diabetes (p < 0.001) and hypertension, (p < 0.05), and their effects were additive. CONCLUSIONS Diabetes appears to have a greater effect on autonomic dysfunction compared with hypertension. Patients suffering from both diabetes and hypertension are at the highest risk of reduced heart rate variability. Early assessment of the autonomic nerve function is suggested in diabetic patients with hypertension.
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Véber O, Lendvai Z, Ronai KZ, Dunai A, Zoller R, Lindner AV, Turányi CZ, Szocs JL, Keresztes K, Tabák AG, Novak M, Molnar MZ, Mucsi I. Obstructive Sleep Apnea and Heart Rate Variability in Male Patients with Metabolic Syndrome: Cross-Sectional Study. Metab Syndr Relat Disord 2014; 12:117-24. [DOI: 10.1089/met.2013.0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Orsolya Véber
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Institute of Pathophysiology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Zsofia Lendvai
- First Department of Pediatrics,Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Katalin Zsuzsanna Ronai
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Andrea Dunai
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Rezso Zoller
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
- First Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Anett Virag Lindner
- Department of Neurology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Csilla Zita Turányi
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Julia Luca Szocs
- Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Adam Gyula Tabák
- First Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Marta Novak
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Miklos Z. Molnar
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Institute of Pathophysiology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Medicine, Division of Nephrology, McGill University Health Centre, Montreal, Quebec, Canada
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Yufu K, Okada N, Ebata Y, Murozono Y, Shinohara T, Nakagawa M, Takahashi N. Plasma norepinephrine is an independent predictor of adverse cerebral and cardiovascular events in type 2 diabetic patients without structural heart disease. J Cardiol 2014; 64:225-30. [PMID: 24529506 DOI: 10.1016/j.jjcc.2013.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/09/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Resting plasma norepinephrine (NE) level was reportedly related to high mortality in patients with heart failure. The current study investigated whether resting NE could predict long-term major adverse cerebral and cardiovascular events (MACCEs) in Japanese type 2 diabetic patients without heart disease. METHODS AND SUBJECTS We evaluated resting NE in 95 patients with type 2 diabetes who did not have severe complications. Based on the ROC curves, high NE was defined as ≥333pg/ml. Accurate follow-up information during a mean of 3.6±1.9 years was obtained in 27 high NE patients (13 female, mean age 64±12 years) and 68 low NE patients (29 female, 60±12 years). ESSENTIAL RESULTS The Kaplan-Meier curves revealed that MACCE-free ratio was significantly lower in the high NE patients than in the low NE patients (log-rank 10.3, p=0.0013). Cox proportional hazards regression analysis revealed that female gender (hazard ratio 7.75), low baroreflex sensitivity (hazard ratio 6.66), and high NE (hazard ratio 5.40) were independently associated with the incidence of MACCE. PRINCIPAL CONCLUSIONS Our results suggest that resting NE is comparably useful to identify the high-risk patients for MACCE to baroreflex sensitivity in type 2 diabetic patients. The results also suggest that pathogenic sympathetic activation leading to MACCE may be identified by the assessment of resting NE, more easily and less expensively compared to cardiac iodine 123 metaiodobenzylguanidine scintigraphy in this population.
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Affiliation(s)
- Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
| | - Norihiro Okada
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Yuki Ebata
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Yukichi Murozono
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Mikiko Nakagawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan
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