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Oliveira CM, Novelli FI, Alves-Santos ÉT, Queiroz MG, Ghezzi AC, Cambri LT. Physical activity influences heart rate variability in young adults, regardless of dextrose ingestion. Blood Press Monit 2022; 27:220-226. [PMID: 35258021 DOI: 10.1097/mbp.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cardiac autonomic modulation can be altered by carbohydrate ingestion. On the other hand, some of the protective effects of physical activity may be due to its impact on the autonomic nervous system. PURPOSE This cross-sectional study was conducted to evaluate whether physical activity level influences heart rate variability (HRV) under fasting and mainly, after dextrose ingestion. METHODS Healthy adults aged 18-40 years ( n = 92; 54.35 % women) were separated into nonactive ( n = 47) and active groups ( n = 45), based on the physical activity level determined by International Physical Activity Questionnaire (IPAQ) and then compared. RESULTS There were no significant differences ( P > 0.05) for age, body mass, BMI, abdominal circumference, blood pressure, fasting glucose and blood glucose at 60 min after dextrose ingestion between groups. Body fat (%) was lower in the active group ( P = 0.02). The time-domain indices (RMSSD, SDNN and pNN50) were higher in the physically active group compared to the nonactive group (main effect of group, P < 0.01). The SDNN index was higher at 60 min after dextrose ingestion compared to fasting (main effect of time, P ≤ 0.01). However, no HRV indices showed significantly interaction effect (group x time; P > 0.05). CONCLUSION The magnitude of HRV responses to glucose was not influenced by physical activity status. Young adults who met at least the minimum physical activity recommendations showed a higher cardiac autonomic modulation, regardless of dextrose ingestion.
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Affiliation(s)
| | - Fabiula Isoton Novelli
- Physical Education Department, Graduate Program in Physical Education, Federal University of Mato Grosso, Cuiabá
- Medicine Department, Graduate Program in Sciences, University of São Paulo, São Paulo
| | | | - Marilene Gonçalves Queiroz
- Physical Education Department, Graduate Program in Health Sciences, Federal University of Mato Grosso, Cuiabá
| | | | - Lucieli Teresa Cambri
- Nutrition Department, Graduate Program in Nutrition, Foods and Metabolism
- Physical Education Department, Graduate Program in Physical Education, Federal University of Mato Grosso, Cuiabá
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Martins DF, Viseux FJF, Salm DC, Ribeiro ACA, da Silva HKL, Seim LA, Bittencourt EB, Bianco G, Moré AOO, Reed WR, Mazzardo-Martins L. The role of the vagus nerve in fibromyalgia syndrome. Neurosci Biobehav Rev 2021; 131:1136-1149. [PMID: 34710514 DOI: 10.1016/j.neubiorev.2021.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 08/08/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022]
Abstract
Fibromyalgia (FM) syndrome is a common illness characterized by chronic widespread pain, sleep problems, fatigue, and cognitive difficulties. Dysfunctional neurotransmitter systems that influence the body's endogenous stress response systems are thought to underlie many of the major FM-related symptoms. A model of FM pathogenesis suggests biological and psychosocial variables interact to influence the genetic predisposition, but the precise mechanisms remain unclear. The Polyvagal Theory provides a theoretical framework from which to investigate potential biological mechanisms. The vagus nerve (VN) has anti-inflammatory properties via its afferent and efferent fibers. A low vagal tone (as assessed by low heart rate variability), has been observed in painful and inflammatory diseases, including FM, while the ventral branch of the VN is linked to emotional expression and social engagement. These anti-inflammatory and psychological (limbic system) properties of the VN may possess therapeutic potential in treating FM. This review paper summarizes the scientific literature regarding the potential role of the VN in transducing and/or therapeutically managing FM signs and symptoms.
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Affiliation(s)
- Daniel F Martins
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, SC, Brazil.
| | - Frederic J F Viseux
- Laboratoire d'Automatique, de Mécanique et d'Informatique industrielle et Humaine (LAMIH), UMR CNRS 8201, Université Polytechnique des Hauts-de-France, Valenciennes, France; Centre d'Evaluation et de Traitement de la Douleur (CETD), Hôpital Jean Bernard, Centre Hospitalier de Valenciennes, F-59322 Valenciennes, France
| | - Daiana C Salm
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, SC, Brazil
| | - Anny Caroline Avelino Ribeiro
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil
| | - Helen Kassiana Lopes da Silva
- Experimental Neuroscience Laboratory (LaNEx), Physiotherapy Graduate Course, University of Southern Santa Catarina, Palhoça, SC, Brazil
| | - Lynsey A Seim
- Hospital Internal Medicine, 4500 San Pablo Road, Mayo Clinic, Jacksonville, FL, USA
| | | | - Gianluca Bianco
- Research Laboratory of Posturology and Neuromodulation RELPON, Department of Human Neuroscience, Sapienza University, Rome, Italy; Istituto di Formazione in Agopuntura e Neuromodulazione IFAN, Rome, Italy
| | - Ari Ojeda Ocampo Moré
- Integrative Medicine and Acupuncture Service, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - William R Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leidiane Mazzardo-Martins
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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da Silva Santos PM, Novelli FI, Araújo JA, Tamanho S, Cambri LT. Aerobic fitness influences cardiac autonomic modulation in police officers regardless of specific duties. Blood Press Monit 2021; 26:200-206. [PMID: 33491996 DOI: 10.1097/mbp.0000000000000518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study assesses whether the specific duties of a police officer or aerobic fitness influences blood pressure (BP) and cardiac autonomic modulation. METHOD Police officers (n = 161) were divided into administrative and operational (34.72 ± 5.98 vs. 33.95 ± 5.61 years old) groups, and subsequently divided into lower and higher aerobic fitness (35.49 ± 4.32 vs. 45.39 ± 13.10 mL·kg-1·min-1). RESULTS Higher SBP (125 ± 10 vs. 121 ± 10 mmHg; P = 0.02) and aerobic fitness (42.10 ± 5.57 vs. 38.51 ± 6.67 mL·kg-1·min-1; P < 0.01) were observed in the operational group. On the other hand, lower obesity indicators and higher heart rate variability (HRV) indices (SD1: 26.67 ± 14.19 vs. 20.98 ± 9.12; SD2: 54.04 ± 19.81 vs. 47.32 ± 18.85; RMSSD: 36.50 ± 18.78 vs. 29.90 ± 12.51; SDNN: 42.80 ± 16.05 vs. 36.85 ± 14.23 ms; pNN50: 17.32 ± 17.54 vs. 10.60 ± 10.77 %) were observed in the higher aerobic fitness group (P ≤ 0.05). CONCLUSION In summary, although the operational occupation had shown a negative influence on SBP, the HRV was not impaired in police officers. Additionally, aerobic fitness was related to differences in obesity indicators and HRV regardless of police duties. Our findings encourage the inclusion of BP and HRV measurements in routine health checks to screen for early hypertension and autonomic dysfunction.
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Affiliation(s)
- Patrícia Marina da Silva Santos
- Physical Education Department, Graduate Program on Physical Education, Federal University of Mato Grosso (UFMT), Cuiabá, Montana, Brazil
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Abstract
INTRODUCTION Both inflammation and cardiorespiratory fitness (CRF) are associated with the risk of respiratory infections. To clarify the hypothesis that CRF attenuates the incident risk of pneumonia due to inflammation, we conducted a prospective study examining the independent and joint associations of inflammation and CRF on the risk of pneumonia in a population sample of 2041 middle-aged men. METHODS Cardiorespiratory fitness was directly measured as peak oxygen uptake (V˙o2peak) during progressive exercise testing to volitional fatigue, and categorized into tertiles. Inflammation was defined by high-sensitivity C-reactive protein (hsCRP). Pneumonia cases were identified by internal medicine physicians using the International Classification of Diseases codes in clinical practice. RESULTS During a median follow-up of 27 yr, 432 pneumonia cases were recorded. High hsCRP and CRF were associated with a higher risk (HR = 1.38; 95% CI, 1.02-1.88) and a lower risk of pneumonia (HR = 0.55; CI, 0.39-0.76) after adjusting for potential confounders, respectively. Compared with normal hsCRP-Fit, moderate to high hsCRP-Unfit had an increased risk of pneumonia (HR = 1.63; CI, 1.21-2.20), but moderate to high hsCRP-Fit was not associated with an increased risk of pneumonia (HR = 1.25; CI, 0.93-1.68). CONCLUSIONS High CRF attenuates the increased risk of pneumonia due to inflammation. These findings have potential implications for the prevention of respiratory infection characterized by systemic inflammation, such as coronavirus disease-2019 (COVID-19).
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Corres P, Maldonado-Martín S, Gorostegi-Anduaga I, Fryer SM, Jurio-Iriarte B, MartínezAguirre-Betolaza A, Arratibel-Imaz I, Francisco-Terreros S, Pérez-Asenjo J. Is cardiorespiratory fitness independently associated with the biochemical profile in overweight/obese adults with primary hypertension? The EXERDIET-HTA study. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:613-620. [PMID: 30474427 DOI: 10.1080/00365513.2018.1531297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cardiorespiratory fitness (CRF) is positively associated with enhanced cardiovascular health. This cross-sectional study aimed to determine associations between CRF and the biochemical profile of overweight/obese adults diagnosed with primary hypertension (HTN). Does cardiorespiratory fitness (exposure) positively affect the biochemical profile (outcome) in overweight/obese individuals suffering from HTN? Assessment with anthropometric, ambulatory blood pressure monitoring (24 h), CRF (peak oxygen uptake, V̇O2peak) and biochemical analysis was performed on 214 participants (138 men, 76 women). A series of linear and logistic regression analyses were conducted. Participants were divided into CRF tertiles (classified as low, moderate and high CRF). The CRF was independently and inversely associated with aspartate aminotransferase (AST; β = -0.328, p < .05) and alanine aminotransferase (ALT; β = -0.376, p < .01) concentrations. C-reactive protein, AST/ALT ratio, gamma-glutamyl transpeptidase, total cholesterol/high-density lipoprotein cholesterol ratio, glucose, insulin and insulin resistance index (HOMA-IR), were all associated, but not independently, with CRF in linear and/or unadjusted logistic regression models. However, independently, logistic regression revealed that glucose was associated with the moderate CRF group. Findings suggest that a lower CRF is associated with an unhealthy biochemical profile in non-physically active and overweight/obese individuals with HTN. As such, this population should look to increase physical activity in order to improve their CRF and biochemical profile.
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Affiliation(s)
- Pablo Corres
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Sara Maldonado-Martín
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Ilargi Gorostegi-Anduaga
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Simon M Fryer
- b School of Sport and Exercise , University of Gloucestershire , Gloucester , UK
| | - Borja Jurio-Iriarte
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Aitor MartínezAguirre-Betolaza
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Iñaki Arratibel-Imaz
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | | | - Javier Pérez-Asenjo
- d Cardiology Unit , Igualatorio Médico Quirúrgico (IMQ-Amárica) , Vitoria-Gasteiz , Spain
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Kuyumcu MS, Ozeke O, Cay S, Ozcan F, Bayraktar MF, Kara M, Vicdan M, Acar B, Aydogdu S, Topaloglu S, Aras D. The short-term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1193-1199. [PMID: 28850690 DOI: 10.1111/pace.13179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/01/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The autonomic nervous system (ANS) is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation (AF), whereas the presence of AF can activate and alter the ANS. The catheter ablation of AF (AFCA) may cause the cardiac ANS dysfunction, whereas restoration of sinus rhythm or sympathovagal imbalance by AFCA can reverse this process. Our principal goal was to investigate the short-term effect of AFCA on ANS functions evaluated by noninvasive chronotropic (CI), resting heart rate (RHR), and heart rate recovery (HRR) indices. METHOD A total of 45 patients were enrolled with symptomatic, drug refractory paroxysmal AF undergoing first cryoballoon (CB) pulmonary vein antrum isolation (PVAI) with one 28-mm CB using single 3-minute freeze techniques without bonus applications. All patients underwent symptom-limited exercise treadmill testing to evaluate noninvasive parameters of ANS before PVAI. For those patients who remained in sinus rhythm, an additional exercise test was repeated after 1 and 3 months after discharge. RESULTS The autonomic CI and RHR/HRR indices were impaired after PVAI and persisted post-PVAI 3 months. However, these parameters were not different in patients with and without recurrence. CONCLUSION This study demonstrated that the successful AFCA might concurrently impair the ANS parameters. The autonomic imbalance between the sympathetic and parasympathetic activity after AFCA could either become antiarrhythmic and/or proarrhythmic based on which of the two components was going to prevail after successful AFCA. The impaired ANS balance after PVAI might also be another hypothetical mechanism for AF recurrence particularly in the absence of PV reconnection.
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Affiliation(s)
- Mevlut Serdar Kuyumcu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Fırat Ozcan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Muhammed Fatih Bayraktar
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Meryem Kara
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Murat Vicdan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Burak Acar
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Sinan Aydogdu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
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Orri JC, Hughes EM, Mistry DG, Scala AH. Is Vigorous Exercise Training Superior to Moderate for CVD Risk after Menopause? Sports Med Int Open 2017; 1:E166-E171. [PMID: 30539103 PMCID: PMC6226081 DOI: 10.1055/s-0043-118094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/10/2017] [Accepted: 07/21/2017] [Indexed: 01/24/2023] Open
Abstract
Postmenopausal women have an increased risk for cardiovascular disease through many factors, such as a sedentary lifestyle and reduced heart rate variability (HRV). Endurance training improves coronary risk but the role of exercise intensity is unclear. The purpose of this observational study was to evaluate the effects of moderate versus vigorous exercise on cardiovascular disease risk in postmenopausal women. Thirty-six postmenopausal women who self-reported training at moderate (3-5.9 METS; n=18; age 58.9±4.4yr) or vigorous intensities (>6 METS; n=18; age 59.7±5.2yr) participated. C-reactive protein (CRP), HRV, VO 2 max, and stress (Perceived Stress Survey, Menopause Rating Scale) were measured. Groups were compared using independent samples t- tests, and associations of exercise intensities with CRP and HRV were assessed using multiple regression. CRP, HRV, and VO 2 max were similar ( p >0.05). Vigorous exercise had lower stress subscale scores ( p <0.01) and higher counter-stress subscale scores compared to moderate ( p <0.05). There was a positive association between time spent in vigorous exercise and HRV ( p <0.05).Vigorous exercise may not confer additional benefits in CRP and HRV over moderate, except for stress reduction. However, more time spent in vigorous exercise was associated with higher HRV. Therefore, increased parasympathetic tone may provide cardioprotection after menopause.
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Affiliation(s)
| | | | - Deepa G Mistry
- Kinesiology, University of San Francisco, San Francisco, United States
| | - Antone H Scala
- Kinesiology, University of San Francisco, San Francisco, United States
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Hwang J, Castelli DM, Gonzalez-Lima F. The positive cognitive impact of aerobic fitness is associated with peripheral inflammatory and brain-derived neurotrophic biomarkers in young adults. Physiol Behav 2017; 179:75-89. [PMID: 28501557 DOI: 10.1016/j.physbeh.2017.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/17/2017] [Accepted: 05/08/2017] [Indexed: 12/24/2022]
Abstract
There is ample evidence for supporting the positive impact of aerobic fitness on cognitive function, but little is known about the physiological mechanisms. The objective of this study was to investigate whether the positive cognitive impact of aerobic fitness is associated with inflammatory and neurotrophic peripheral biomarkers in young adults aged 18 to 29years (n=87). For the objective assessment of aerobic fitness, we measured maximal oxygen uptake (VO2max) as a parametric measure of cardiorespiratory capacity. We demonstrated that young adults with the higher levels of VO2max performed better on computerized cognitive tasks assessing sustained attention and working memory. This positive VO2max-cognitive performance association existed independently of confounders (e.g., years of education, intelligence scores) but was significantly dependent on resting peripheral blood levels of inflammatory (C-reactive protein, CRP) and neurotrophic (brain-derived neurotrophic factor, BDNF) biomarkers. Statistical models showed that CRP was a mediator of the effect of VO2max on working memory. Further, BDNF was a moderator of the effect of VO2max on working memory. These mediating and moderating effects occurred in individuals with higher levels of aerobic fitness. The results suggest that higher aerobic fitness, as measured by VO2max, is associated with enhanced cognitive functioning and favorable resting peripheral levels of inflammatory and brain-derived neurotrophic biomarkers in young adults.
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Affiliation(s)
- Jungyun Hwang
- Bouvé College of Health Sciences and College of Arts, Media and Design, Northeastern University, Boston, MA 02115, USA.
| | - Darla M Castelli
- Department of Kinesiology and Health Education, University of Texas at Austin, TX 78712, USA.
| | - F Gonzalez-Lima
- Department of Psychology, Institute for Neuroscience, University of Texas at Austin, TX 78712, USA
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Aeschbacher S, Schoen T, Dörig L, Kreuzmann R, Neuhauser C, Schmidt-Trucksäss A, Probst-Hensch NM, Risch M, Risch L, Conen D. Heart rate, heart rate variability and inflammatory biomarkers among young and healthy adults. Ann Med 2017; 49:32-41. [PMID: 27534940 DOI: 10.1080/07853890.2016.1226512] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Heart rate (HR), heart rate variability (HRV), and inflammation are all associated with cardiovascular morbidity and mortality. The aim of this study was to assess potential interrelationships between these parameters in a young and healthy population. METHODS Healthy individuals aged 25-41 years were included in a prospective population-based study. All participants underwent 24-h electrocardiography using a validated device. The standard deviation of all normal RR intervals (SDNN) was pre-defined as the main HRV outcome variable. High-sensitivity C-reactive protein (hs-CRP), total leukocyte (LC) count and LC subtypes were obtained from venous blood samples. RESULTS A total of 2064 participants (47% men, 37 years) were included in this analysis. In multivariable linear regression analyses using SDNN as the outcome variable, β-coefficients (95% confidence intervals) per 1 standard deviation (SD) increase on the log-scale were -0.11 (-0.16; -0.07), p < .0001 for hs-CRP, -0.13 (-0.17; -0.09), p < .0001 for total LC count, -0.12 (-0.16; -0.08), p < .0001 for neutrophils, -0.04 (-0.09; 0.00), p = .05 for lymphocytes and -0.08 (-0.09; -0.02), p = .005 for monocytes. There were positive relationships between resting and ambulatory HR and inflammatory biomarkers, except for lymphocytes. CONCLUSION In this large cohort of young and healthy adults, inflammatory parameters were strongly associated with increased HR and decreased HRV, suggesting an important interaction between inflammatory pathways and the autonomic nervous system. Key message Inflammatory biomarkers, such as high-sensitivity C-reactive protein and leukocyte cell count with its subtypes were inversely associated with HRV and positively associated with HR. Our findings suggest important interrelationships between inflammatory pathways and the ANS.
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Affiliation(s)
- Stefanie Aeschbacher
- a Division of Internal Medicine, Department of Medicine , University Hospital Basel , Basel , Switzerland.,b Cardiovascular Research Institute Basel (CRIB), University Hospital Basel , Basel , Switzerland
| | - Tobias Schoen
- b Cardiovascular Research Institute Basel (CRIB), University Hospital Basel , Basel , Switzerland.,c Cardiology Division, University Hospital Basel , Basel , Switzerland
| | - Laura Dörig
- a Division of Internal Medicine, Department of Medicine , University Hospital Basel , Basel , Switzerland.,b Cardiovascular Research Institute Basel (CRIB), University Hospital Basel , Basel , Switzerland
| | - Rahel Kreuzmann
- a Division of Internal Medicine, Department of Medicine , University Hospital Basel , Basel , Switzerland.,b Cardiovascular Research Institute Basel (CRIB), University Hospital Basel , Basel , Switzerland
| | - Charlotte Neuhauser
- b Cardiovascular Research Institute Basel (CRIB), University Hospital Basel , Basel , Switzerland
| | - Arno Schmidt-Trucksäss
- d Department of Sport, Exercise and Health, Division Sports and Exercise Medicine , University of Basel , Basel , Switzerland
| | - Nicole M Probst-Hensch
- e Swiss Tropical and Public Health Institute , Basel , Switzerland.,f Epidemiology and Public Health, University Basel , Basel , Switzerland
| | - Martin Risch
- g Labormedizinisches Zentrum Dr Risch, Schaan, Principality of Liechtenstein.,h Division of Laboratory Medicine , Kantonsspital Graubünden , Chur , Switzerland
| | - Lorenz Risch
- g Labormedizinisches Zentrum Dr Risch, Schaan, Principality of Liechtenstein.,i Division of Clinical Biochemistry , Medical University , Innsbruck , Austria.,j Private University , Triesen , Principality of Liechtenstein
| | - David Conen
- a Division of Internal Medicine, Department of Medicine , University Hospital Basel , Basel , Switzerland.,b Cardiovascular Research Institute Basel (CRIB), University Hospital Basel , Basel , Switzerland
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Tofler GH, Massaro J, Levy DA, Sutherland PA, Buckley T, D’Agostino RB. Increased heart rate is associated with a prothrombotic state: The Framingham Heart Study. Eur J Prev Cardiol 2016; 24:382-388. [DOI: 10.1177/2047487316679902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Geoffrey H Tofler
- Royal North Shore Hospital, Australia
- University of Sydney, Australia
| | | | - Daniel A Levy
- The Framingham Heart Study of the National Heart Lung and Blood Institute of the National Institutes of Health, USA
- Boston University School of Medicine, USA
| | - Patrice A Sutherland
- The Framingham Heart Study of the National Heart Lung and Blood Institute of the National Institutes of Health, USA
- Boston University School of Medicine, USA
| | - Thomas Buckley
- Royal North Shore Hospital, Australia
- University of Sydney, Australia
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Osailan A, Metsios GS, Rouse PC, Ntoumanis N, Duda JL, Kitas GD, Veldhuijzen van Zanten JJCS. Factors associated with parasympathetic activation following exercise in patients with rheumatoid arthritis: a cross-sectional study. BMC Cardiovasc Disord 2016; 16:86. [PMID: 27165730 PMCID: PMC4862092 DOI: 10.1186/s12872-016-0264-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 04/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) with poor parasympathetic function being implicated as an underlying factor. Factors related to parasympathetic function, commonly assessed by heart rate recovery (HRR) following maximal exercise, are currently not known in RA. We aimed to explore the association between HRR with CVD risk factors, inflammatory markers, and wellbeing in patients with RA. METHODS Ninety-six RA patients (54.4 ± 12.6 years, 68 % women) completed a treadmill exercise test, during which heart rate (HR) was monitored. HRR1 and HRR2 were defined as the absolute change from HR peak to HRR 1 min post HR peak and 2 min post HR peak, respectively. Cardiorespiratory fitness, CVD risk factors, and serological markers of inflammation were measured in all patients. The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD events, and wellbeing was assessed by questionnaires. RESULTS Mean HRR1 and HRR2 were 29.1 ± 13.2 bpm and 46.4 ± 15.3 bpm, respectively. CVD risk factors as well as most inflammatory markers and measures of wellbeing were inversely correlated with HRR1 and HRR2. Multivariate regression analyses revealed that 27.9 % of the variance in HRR1 and 37.9 % of the variance in HRR2 was explained collectively by CVD risk factors, measures of inflammation, and wellbeing (p = 0.009, p = 0.001 respectively), however no individual measure was independently associated with HRR1 or HRR2. CONCLUSION Parasympathetic activation was associated with overall CVD risk, arthritis-related burden and wellbeing in patients with RA. TRIAL REGISTRATION [Exercise, cardiovascular disease and rheumatoid arthritis, ISRCTN04121489 ].
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Affiliation(s)
- Ahmad Osailan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK.
| | - George S Metsios
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
- Department of Physical Activity Exercise and Health, University of Wolverhampton, Walsall, West Midlands, UK
| | - Peter C Rouse
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
- Department for Health, University of Bath, Bath, UK
| | - Nikos Ntoumanis
- School of Psychology & Speech Pathology, Curtin University, Perth, Australia
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
- Department of Physical Activity Exercise and Health, University of Wolverhampton, Walsall, West Midlands, UK
| | - Jet J C S Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
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12
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Bonaz B, Sinniger V, Pellissier S. Anti-inflammatory properties of the vagus nerve: potential therapeutic implications of vagus nerve stimulation. J Physiol 2016; 594:5781-5790. [PMID: 27059884 DOI: 10.1113/jp271539] [Citation(s) in RCA: 315] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/24/2016] [Indexed: 12/30/2022] Open
Abstract
Brain and viscera interplay within the autonomic nervous system where the vagus nerve (VN), containing approximately 80% afferent and 20% efferent fibres, plays multiple key roles in the homeostatic regulations of visceral functions. Recent data have suggested the anti-inflammatory role of the VN. This vagal function is mediated through several pathways, some of them still debated. The first one is the anti-inflammatory hypothalamic-pituitary-adrenal axis which is stimulated by vagal afferent fibres and leads to the release of cortisol by the adrenal glands. The second one, called the cholinergic anti-inflammatory pathway, is mediated through vagal efferent fibres that synapse onto enteric neurons which release acetylcholine (ACh) at the synaptic junction with macrophages. ACh binds to α-7-nicotinic ACh receptors of those macrophages to inhibit the release of tumour necrosis (TNF)α, a pro-inflammatory cytokine. The last pathway is the splenic sympathetic anti-inflammatory pathway, where the VN stimulates the splenic sympathetic nerve. Norepinephrine (noradrenaline) released at the distal end of the splenic nerve links to the β2 adrenergic receptor of splenic lymphocytes that release ACh. Finally, ACh inhibits the release of TNFα by spleen macrophages through α-7-nicotinic ACh receptors. Understanding of these pathways is interesting from a therapeutic point of view, since they could be targeted in various ways to stimulate anti-inflammatory regulation in TNFα-related diseases such as inflammatory bowel disease and rheumatoid arthritis. Among others, VN stimulation, either as an invasive or non-invasive procedure, is becoming increasingly frequent and several clinical trials are ongoing to evaluate the potential effectiveness of this therapy to alleviate chronic inflammation.
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Affiliation(s)
- Bruno Bonaz
- University Clinic of Hepato-Gastroenterology, University Hospital, F-38000, Grenoble, France. .,Université Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Inserm, U1216, F-38000, Grenoble, France.
| | - Valérie Sinniger
- University Clinic of Hepato-Gastroenterology, University Hospital, F-38000, Grenoble, France.,Université Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Inserm, U1216, F-38000, Grenoble, France
| | - Sonia Pellissier
- University Clinic of Hepato-Gastroenterology, University Hospital, F-38000, Grenoble, France.,Department of Psychology, Université Savoie Mont-Blanc, F-73011, Chambéry, France
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Carreira MAMDQ, Nogueira AB, Pena FM, Kiuchi MG, Rodrigues RC, Rodrigues RDR, Matos JPSD, Lugon JR. Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients. Arq Bras Cardiol 2015; 104:493-500. [PMID: 26131705 PMCID: PMC4484682 DOI: 10.5935/abc.20150039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/19/2015] [Indexed: 11/20/2022] Open
Abstract
Background Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and
has been implicated in their increased risk of cardiovascular mortality. Objective To correlate heart rate variability (HRV) during exercise treadmill test (ETT)
with the values obtained when measuring functional aerobic impairment (FAI) in HD
patients and controls. Methods Cross-sectional study involving HD patients and a control group. Clinical
examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT
were performed. A symptom-limited ramp treadmill protocol with active recovery was
employed. Heart rate variability was evaluated in time domain at exercise and
recovery periods. Results Forty-one HD patients and 41 controls concluded the study. HD patients had higher
FAI and lower HRV than controls (p<0.001 for both). A correlation was found
between exercise HRV (SDNN) and FAI in both groups. This association was
independent of age, sex, smoking, body mass index, diabetes, and clonidine or
beta-blocker use, but not of hemoglobin levels. Conclusion No association was found between FAI and HRV on 24-hour Holter or at the recovery
period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD
patients and controls.
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Affiliation(s)
| | - André Barros Nogueira
- Department of Cardiology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Felipe Montes Pena
- Department of Cardiology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Marcio Galindo Kiuchi
- Department of Cardiology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Jocemir Ronaldo Lugon
- Department of Nephrology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
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Carreira MAMQ, Nogueira AB, Pena FM, Kiuchi MG, Rodrigues RC, Rodrigues RR, Matos JPS, Lugon JR. Detection of autonomic dysfunction in hemodialysis patients using the exercise treadmill test: the role of the chronotropic index, heart rate recovery, and R-R variability. PLoS One 2015; 10:e0128123. [PMID: 26042678 PMCID: PMC4456158 DOI: 10.1371/journal.pone.0128123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 04/22/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the ability of different parameters of exercise treadmill test to detect autonomic dysfunction in hemodialysis patients. METHODS Cross-sectional study involving hemodialysis patients and a control group. Clinical examination, blood sampling, echocardiogram, 24-hour Holter, and exercise treadmill test were performed. A ramp treadmill protocol symptom-limited with active recovery was employed. RESULTS Forty-one hemodialysis patients and 41 controls concluded the study. There was significant difference between hemodialysis patients and controls in autonomic function parameters in 24h-Holter and exercise treadmill test. Probability of having autonomic dysfunction in hemodialysis patients compared to controls was 29.7 at the exercise treadmill test and 13.0 in the 24-hour Holter. Chronotropic index, heart rate recovery at the 1st min, and SDNN at exercise were used to develop an autonomic dysfunction score to grade autonomic dysfunction, in which, 83% of hemodialysis patients reached a scoring ≥2 in contrast to 20% of controls. Hemodialysis was independently associated with either altered chronotropic index or autonomic dysfunction scoring ≥2 in every tested model (OR=50.1, P=0.003; and OR=270.9, P=0.002, respectively, model 5). CONCLUSION The exercise treadmill test was feasible and useful to diagnose of the autonomic dysfunction in hemodialysis patients. Chronotropic index and autonomic dysfunction scoring ≥2 were the most effective parameters to differentiate between hemodialysis patients and controls suggesting that these variables portrays the best ability to detect autonomic dysfunction in this setting.
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Affiliation(s)
- Maria Angela M. Q. Carreira
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - André B. Nogueira
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Felipe M. Pena
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Marcio G. Kiuchi
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Ronaldo C. Rodrigues
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Rodrigo R. Rodrigues
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Jorge P. S. Matos
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Jocemir R. Lugon
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
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15
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Whelton SP, Narla V, Blaha MJ, Nasir K, Blumenthal RS, Jenny NS, Al-Mallah MH, Michos ED. Association between resting heart rate and inflammatory biomarkers (high-sensitivity C-reactive protein, interleukin-6, and fibrinogen) (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol 2014; 113:644-9. [PMID: 24393259 DOI: 10.1016/j.amjcard.2013.11.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 01/14/2023]
Abstract
Heart rate (HR) at rest is associated with adverse cardiovascular events; however, the biologic mechanism for the relation is unclear. We hypothesized a strong association between HR at rest and subclinical inflammation, given their common interrelation with the autonomic nervous system. HR at rest was recorded at baseline in the Multi-Ethnic Study of Atherosclerosis, a cohort of 4 racial or ethnic groups without cardiovascular disease at baseline and then divided into quintiles. Subclinical inflammation was measured using high-sensitivity C-reactive protein, interleukin-6, and fibrinogen. We used progressively adjusted regression models with terms for physical activity and atrioventricular nodal blocking agents in the fully adjusted models. We examined inflammatory markers as both continuous and categorical variables using the clinical cut point of ≥3 mg/L for high-sensitivity C-reactive protein and the upper quartiles of fibrinogen (≥389 mg/dl) and interleukin-6 (≥1.89 pg/ml). Participants had a mean age of 62 years (SD 9.7), mean resting heart rate of 63 beats/min (SD 9.6) and were 47% men. Increased HR at rest was significantly associated with higher levels of all 3 inflammatory markers in both continuous (p for trend <0.001) and categorical (p for trend <0.001) models. Results were similar among all 3 inflammatory markers, and there was no significant difference in the association among the 4 racial or ethnic groups. In conclusion, an increased HR at rest was associated with a higher level of inflammation among an ethnically diverse group of subjects without known cardiovascular disease.
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Affiliation(s)
- Seamus P Whelton
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
| | - Venkata Narla
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Center for Prevention and Wellness, Baptist Health South Florida, Miami, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Nancy S Jenny
- Department of Pathology, University of Vermont College of Medicine, Colchester, Vermont
| | - Mouaz H Al-Mallah
- King Abdul-Aziz Cardiac Center, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
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Syamsunder AN, Pal GK, Pal P, Kamalanathan CS, Parija SC, Nanda N. Association of sympathovagal imbalance with cardiovascular risks in overt hypothyroidism. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:554-61. [PMID: 24251274 PMCID: PMC3818829 DOI: 10.4103/1947-2714.118921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Cardiovascular morbidities have been reported in hypothyroidism. Aims: The objective of this study is to investigate the link of sympathovagal imbalance (SVI) to cardiovascular risks (CVRs) and the plausible mechanisms of CVR in hypothyroidism. Materials and Methods: Age-matched 104 females (50 controls, 54 hypothyroids) were recruited and their body mass index (BMI), cardiovascular parameters, autonomic function tests by spectral analysis of heart rate variability (HRV), heart rate response to standing, deep breathing and blood pressure response to isometric handgrip were studied. Thyroid profile, lipid profile, immunological and inflammatory markers were estimated and their association with low-frequency to the high-frequency ratio (LF-HF) of HRV, the marker of SVI was assessed by multivariate regression. Results: Increased diastolic pressure, decreased HRV, increased LF-HF, dyslipidemia and increased high-sensitive C-reactive protein (hsCRP) were observed in hypothyroid patients and all these parameters had significant correlation with LF-HF. BMI had no significant association with LF-HF. Atherogenic index (β 1.144, P = 0.001) and hsCRP (b 0.578, P = 0.009) had independent contribution to LF-HF. LF-HF could significantly predict hypertension status (odds ratio 2.05, confidence interval 1.110-5.352, P = 0.008) in hypothyroid subjects. Conclusions: SVI due to sympathetic activation and vagal withdrawal occurs in hypothyroidism. Dyslipidemia and low-grade inflammation, but not obesity contribute to SVI and SVI contributes to cardiovascular risks.
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Affiliation(s)
- Avupati Naga Syamsunder
- Department of Physiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India
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Bonaz B, Picq C, Sinniger V, Mayol JF, Clarençon D. Vagus nerve stimulation: from epilepsy to the cholinergic anti-inflammatory pathway. Neurogastroenterol Motil 2013; 25:208-21. [PMID: 23360102 DOI: 10.1111/nmo.12076] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The brain and the gut communicate bidirectionally through the autonomic nervous system (ANS). The vagus nerve (VN), a major component of the ANS, plays a key role in the neuro-endocrine-immune axis to maintain homeostasia through its afferents (through the activation of the hypothalamic pituitary adrenal axis and the central ANS) and through its efferents (i.e. the cholinergic anti-inflammatory pathway; CAP). The CAP has an anti-TNF effect both through the release of acetylcholine at the distal VN acting on macrophages and through the connection of the VN with the spleen through the splenic sympathetic nerve. Vagus nerve stimulation (VNS) of vagal afferents at high frequency (20-30 Hz) is used for the treatment of drug-resistant epilepsy and depression. Low-frequency (5 Hz) VNS of vagal efferents activates the CAP for an anti-inflammatory effect that is as an anti-TNF therapy in inflammatory diseases were TNF is a key cytokine as represented by experimental sepsis, postoperative ileus, burn-induced intestinal barrier injury, colitis. However, both vagal afferents and efferents are activated by VNS. PURPOSE The objective of this review was to explore the following: (i) the supporting evidence for the importance of VNS in epilepsy (and depression) and its mechanisms of action, (ii) the anti-inflammatory characteristics of the VN, (iii) the experimental evidence that VNS impact on inflammatory disorders focusing on the digestive tract, and (iv) how VNS could potentially be harnessed therapeutically in human inflammatory disorders such as inflammatory bowel diseases, irritable bowel syndrome, postoperative ileus, rheumatoid arthritis as an anti-inflammatory therapy.
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Affiliation(s)
- B Bonaz
- Clinique Universitaire d'Hépato-Gastroentérologie, CHU de Grenoble, Grenoble Cedex, France.
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Leib C, Katus HA, Kaya Z. Cholinergic control of inflammation in cardiovascular diseases. Trends Cardiovasc Med 2012; 23:46-51. [PMID: 23266154 DOI: 10.1016/j.tcm.2012.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/14/2012] [Accepted: 08/14/2012] [Indexed: 11/18/2022]
Abstract
A neuroimmunological reflexive signaling pathway with potent anti-inflammatory capacity has been discovered recently. Within this so called cholinergic anti-inflammatory pathway the vagus nerve plays a central role in both signal integration and signal output, by measuring and influencing levels of circulating pro-inflammatory cytokines. Our group has recently shown that parasympathomimetic stimulation of the vagus nerve has the potential to inhibit inflammatory processes in experimental autoimmune myocarditis. Although vagus nerve stimulation has been shown to be protective in several inflammatory diseases, its potential as a therapeutic strategy has not been studied extensively in clinical settings. In this review we will discuss general molecular mechanisms of the cholinergic anti-inflammatory pathway with emphasis on autoimmune myocarditis. Furthermore, clinical and experimental studies that investigate the role of vagus nerve stimulation in cardiovascular diseases will be discussed.
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Affiliation(s)
- Christoph Leib
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
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Carroll S, Marshall P, Ingle L, Borkoles E. Cardiorespiratory fitness and heart rate recovery in obese premenopausal women. Scand J Med Sci Sports 2012; 22:e133-9. [PMID: 22998554 DOI: 10.1111/j.1600-0838.2012.01522.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 11/30/2022]
Abstract
Post-exercise heart rate recovery (HRR) has been proposed as a measure of cardiac autonomic dysfunction in apparently healthy adults. We aimed to determine the effects of a lifestyle intervention on HRR among clinically obese premenopausal women. A randomized controlled trial was conducted to investigate the effects of a 3-month non-dieting lifestyle intervention program on cardiorespiratory fitness (CRF) and HRR among healthy clinically obese premenopausal women. Thirty-one were randomly assigned to 3-month intensive lifestyle intervention and 31 served as controls. Sixty-one participants performed a maximal treadmill walking test with metabolic gas exchange. Baseline anthropometric measures were closely related to HRR at 1 min, which may indicate reduced parasympathetic reactivation. Post-exercise HRR at 60 s (HRR60) increased from 21.3 ± 6.2 to 27.8 ± 10.2 bpm in the intervention group compared with a smaller reduction (26.8 ± 12.3 to 24.5 ± 9.9 bpm) in controls (test for interaction P = 0.0001). HRR120 showed a significant effect of time (P = 0.0002) with no significant interaction with lifestyle intervention. A significant increase in VO2 peak was evident in the lifestyle group (21.6 to 23.6 mL/kg/min) compared with a modest reduction in the controls (22.6 to 21.6 mL/kg/min; test for interaction, P = 0.001). Clinically obese healthy premenopausal women achieved significant improvements in HRR60 and VO peak following a 3-month intensive lifestyle intervention.
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Affiliation(s)
- S Carroll
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK.
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Acetylcholine and an acetylcholinesterase inhibitor neostigmine can aggravate tularemia progress in BALB/c mice. Interdiscip Toxicol 2012; 5:21-4. [PMID: 22783145 PMCID: PMC3389505 DOI: 10.2478/v10102-012-0004-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 02/02/2012] [Accepted: 02/10/2012] [Indexed: 02/07/2023] Open
Abstract
The present experiment was aimed at assessing the application of neostigmine, an acetylcholinesterase (AChE) pseudo-irreversible inhibitor with poor penetration through the hematoencephalitic barrier, and the neurotransmitter acetylcholine (ACh). The experiment was done to evaluate their ability to modulate an infectious disease: tularemia. Mice infected with Franciselle tularensis and exposed to either ACh or neostigmine had a higher mortality and spleen bacterial burden when compared to infected mice exposed to saline solution only. The activated cholinergic anti-inflammatory pathway suppressed pathways necessary for tularemia resolution. Administration of AChE inhibitors to the individuals suffering from tularemia is contra-indicatory. Drugs based on AChE inhibition should be restricted when tularemia or disease with a similar pathogenesis is suspected.
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Abstract
The mammalian immune system and the nervous system coevolved under the influence of infection and sterile injury. Knowledge of homeostatic mechanisms by which the nervous system controls organ function was originally applied to the cardiovascular, gastrointestinal, musculoskeletal, and other body systems. Development of advanced neurophysiological and immunological techniques recently enabled the study of reflex neural circuits that maintain immunological homeostasis, and are essential for health in mammals. Such reflexes are evolutionarily ancient, dating back to invertebrate nematode worms that possess primitive immune and nervous systems. Failure of these reflex mechanisms in mammals contributes to nonresolving inflammation and disease. It is also possible to target these neural pathways using electrical nerve stimulators and pharmacological agents to hasten the resolution of inflammation and provide therapeutic benefit.
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Affiliation(s)
- Ulf Andersson
- Department of Women’s and Children’s Health, Karolinska University Hospital, Karolinska Institutet, S-171 76 Stockholm, Sweden
| | - Kevin J. Tracey
- Feinstein Institute for Medical Research, Manhasset, New York 11030
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Hellard P, Guimaraes F, Avalos M, Houel N, Hausswirth C, Toussaint JF. Modeling the association between HR variability and illness in elite swimmers. Med Sci Sports Exerc 2011; 43:1063-70. [PMID: 21085039 DOI: 10.1249/mss.0b013e318204de1c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine whether HR variability (HRV), an indirect measure of autonomic control, is associated with upper respiratory tract and pulmonary infections, muscular affections, and all-type pathologies in elite swimmers. METHODS For this study, 7 elite international and 11 national swimmers were observed weekly for 2 yr. The indexes of cardiac autonomic regulation in supine and orthostatic position were assessed as explanatory variables by time domain (SD1, SD2) and spectral analyses (high frequency [HF] = 0.15-0.40 Hz, low frequency [LF] = 0.04-0.15 Hz, and HF/LF ratio) of HRV. Logistic mixed models described the relationship between the explanatory variables and the risk of upper respiratory tract and pulmonary infections, muscular affections, and all-type pathologies. RESULTS The risk of all-type pathologies was higher for national swimmers and in winter (P < 0.01). An increase in the parasympathetic indexes (HF, SD1) in the supine position assessed 1 wk earlier was linked to a higher risk of upper respiratory tract and pulmonary infections (P < 0.05) and to a higher risk of muscular affections (increase in HF, P < 0.05). Multivariate analyses showed (1) a higher all-type pathologies risk in winter and for an increase in the total power of HRV associated with a decline SD1 in supine position, (2) a higher all-type pathologies risk in winter associated with a decline in HF assessed 1 wk earlier in orthostatic position, and (3) a higher risk of muscular affections in winter associated with a decrease SD1 and an increase LF in orthostatic position. CONCLUSIONS Swimmers' health maintenance requires particular attention when autonomic balance shows a sudden increase in parasympathetic indices in the supine position assessed 1 wk earlier evolving toward sympathetic predominance in supine and orthostatic positions.
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Chien MY, Lee P, Tsai YF, Yang PC, Wu YT. C-reactive protein and heart rate recovery in middle-aged men with severe obstructive sleep apnea. Sleep Breath 2011; 16:629-37. [PMID: 21706288 DOI: 10.1007/s11325-011-0549-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 03/30/2011] [Accepted: 06/16/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study aimed to evaluate whether the inflammatory marker "high-sensitivity C-reactive protein (hsCRP)" level was associated with impaired heart rate recovery at 1 min after exercise termination (HRR-1) in middle-aged patients with severe obstructive sleep apnea (OSA). METHODS Thirty middle-aged male patients (40-64 years old) with severe OSA (apnea-hypopnea index [AHI] ≥ 30 h(-1)) and 30 subjects without OSA (AHI < 5 h(-1)), matched with age and body mass index (BMI), were recruited. All subjects underwent an overnight polysomnography and completed a symptom-limited maximal exercise test. Cardiopulmonary parameters included peak oxygen consumption (VO(2peak)) and heart rate response during and immediately after exercise. Fasting blood samples were drawn for hsCRP analysis. RESULT Patients with severe OSA had significantly higher hsCRP levels (0.18 vs. 0.07 mg/dl, P < 0.01), lower reduced HRR-1, peak heart rate, and VO(2peak) values than those in the controls. The hsCRP levels significantly correlated with HRR-1 in the OSA group (r = -0.69, P < 0.01) after adjustment for VO(2peak) (r = -0.66, P < 0.01). Furthermore, stepwise multiple regression analysis showed that HRR-1 and AHI were significant predictors of hsCRP levels in all participants (adjusted R(2) = 0.53, P < 0.01). CONCLUSIONS Blunted HRR was shown in middle-aged men with severe OSA, and it was associated with high hsCRP levels significantly.
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Affiliation(s)
- Meng-Yueh Chien
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Jensen MT, Marott JL, Allin KH, Nordestgaard BG, Jensen GB. Resting heart rate is associated with cardiovascular and all-cause mortality after adjusting for inflammatory markers: the Copenhagen City Heart Study. Eur J Prev Cardiol 2011; 19:102-8. [PMID: 21525123 DOI: 10.1177/1741826710394274] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the association between resting heart rate (RHR) and markers of chronic low-grade inflammation. Also, to examine whether elevated resting heart rate is independently associated with cardiovascular and all-cause mortality in the general population, or whether elevated RHR is merely a marker of chronic low-grade inflammation. METHODS AND RESULTS A group of 6518 healthy subjects from the the Danish general population were followed for 18 years during which 1924 deaths occurred. Subjects underwent assessment of baseline RHR, conventional cardiovascular risk factors, high-sensitivity C-reactive protein (hsCRP), and fibrinogen. RHR was associated with hsCRP and fibrinogen in uni- and multivariate models (p < 0.0001). A 10 beats per minute increase in RHR was associated with increased cardiovascular and all-cause mortality in univariate models - HR (95%CI) (1.21 (1.14-1.29) and 1.15 (1.11-1.19); multivariate models adjusted for conventional risk factors - 1.16 (1.09-1.24) and 1.10 (1.06-1.14); multivariate models including hsCRP - 1.14 (1.07-1.22) and 1.09 (1.05-1.14); fibrinogen - 1.15 (1.07-1.22) and 1.09 (1.05-1.14); and both hsCRP and fibrinogen - 1.14 (1.07-1.22) and 1.09 (1.05-1.14). CONCLUSION RHR was associated with markers of chronic low-grade inflammation. However, RHR remained associated with both cardiovascular and all-cause mortality after adjusting for markers of chronic low-grade inflammation. This suggests that RHR is an independent risk factor for cardiovascular and all-cause mortality, and not merely a marker of chronic low-grade inflammation.
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Affiliation(s)
- Magnus T Jensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
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The use of pupillometry in the assessment of cardiac autonomic function in elite different type trained athletes. Eur J Appl Physiol 2011; 111:2079-87. [DOI: 10.1007/s00421-011-1836-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 01/07/2011] [Indexed: 11/26/2022]
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Belalcazar LM, Reboussin DM, Haffner SM, Hoogeveen RC, Kriska AM, Schwenke DC, Tracy RP, Pi-Sunyer FX, Ballantyne CM. A 1-year lifestyle intervention for weight loss in individuals with type 2 diabetes reduces high C-reactive protein levels and identifies metabolic predictors of change: from the Look AHEAD (Action for Health in Diabetes) study. Diabetes Care 2010; 33:2297-303. [PMID: 20682679 PMCID: PMC2963483 DOI: 10.2337/dc10-0728] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined whether a 1-year intensive lifestyle intervention (ILI) for weight loss reduced elevated high-sensitivity C-reactive protein (hs-CRP) levels in obese individuals with diabetes and identified metabolic and fitness predictors of hs-CRP change. RESEARCH DESIGN AND METHODS Look AHEAD (Action for Health in Diabetes) is an ongoing multicenter clinical trial examining the effects of weight loss achieved through ILI on cardiovascular events and overall mortality in obese/overweight adults with type 2 diabetes. We report on 1,759 Look AHEAD participants who had hs-CRP and fitness data at baseline and 1 year. Subjects were randomly assigned to ILI or to usual care (diabetes support and education [DSE]). ILI involved frequent counseling to increase moderate-intensity exercise to 175 min/week, reduce caloric and saturated fat intake, and change macronutrient composition to improve glycemic control. RESULTS ILI reduced median hs-CRP by 43.6% from baseline to 1 year, compared with a 16.7% reduction with DSE (P<0.001). ILI decreased weight (8.8%), A1C (0.7%), and triglycerides (17%) and increased fitness (19%) and HDL cholesterol (7.5%) (P<0.0001 vs. changes with DSE). Changes in adiposity and glucose control with ILI remained independent predictors of hs-CRP change at 1 year (P<0.0001 for each) after adjustment for demographics, smoking, cardiovascular history, statin and thiazolidinedione use, and changes in fitness and lipid control. Neither statin nor insulin therapy modified the association between ILI and hs-CRP. CONCLUSIONS A 1-year lifestyle intervention for weight loss in obese individuals with diabetes was associated with substantial reductions in hs-CRP. Improved glycemic control and reduced adiposity had comparable effects on hs-CRP change.
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Affiliation(s)
- L Maria Belalcazar
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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