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Jorge-Galarza E, Torres-Tamayo M, Martínez-Alvarado MDR, Peña-Aparicio B, González-Salazar C, Reyes-Barrera J, Sierra-Beltrán M, Fajardo-Flores E, Kostin A, González-Hermosillo JA. Cardiovascular autonomic responses during head-up tilt test in newly diagnosed type 2 diabetes. Ir J Med Sci 2021; 191:2077-2084. [PMID: 34750734 DOI: 10.1007/s11845-021-02825-7] [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: 12/07/2020] [Accepted: 10/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Autonomic dysfunction is commonly observed in patients with long-standing type 2 diabetes. Previous studies have confirmed the value of both subjectively assessed symptoms and objective measurements of autonomic nervous system function in diagnosing cardiovascular autonomic neuropathy. However, the head-up tilt test (HUTT) has been rarely used to investigate cardiovascular autonomic responses in subjects with high risk of newly diagnosed type 2 diabetes (nT2D). OBJECTIVE To evaluate autonomic cardiovascular responses through passive orthostatic challenge along the diabetes continuum. METHODS The study population was stratified as normoglycemic (n = 16), prediabetes (n = 20), and nT2D (n = 20). The prevalence of orthostatic intolerance and autonomic cardiovascular responses was evaluated with the Task Force Monitor during a 30-min passive HUTT. Spectral indices of heart rate and blood pressure variability and baroreceptor effectiveness index (BEI) were calculated through the HUTT. BEI was obtained by the sequence method. RESULTS There were no differences in the prevalence of orthostatic intolerance or in the indices of heart rate and blood pressure variability among the three groups of study. The BEI was attenuated in the nT2D group in supine rest and throughout HUTT compared with normoglycemic and prediabetes groups. The multivariable linear regression analysis showed that BEI was associated with fasting glucose (β = - 0.52, p < 0.001) and HbA1c (β = - 0.57, p < 0.001) independently of cardiovascular risk factors. CONCLUSION Cardiovascular autonomic neuropathy, expressed as blunted BEI, is the only abnormal autonomic nervous test detected in nT2D, and it was independently associated with fasting glucose and HbA1c values.
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Affiliation(s)
- Esteban Jorge-Galarza
- Endocrinology Department, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Margarita Torres-Tamayo
- Endocrinology Department, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | | | - Berenice Peña-Aparicio
- Endocrinology Department, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Carmen González-Salazar
- Endocrinology Department, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Juan Reyes-Barrera
- Endocrinology Department, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Manuel Sierra-Beltrán
- Dysautonomic Clinic, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Erika Fajardo-Flores
- Dysautonomic Clinic, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Andrey Kostin
- Dysautonomic Clinic, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - J Antonio González-Hermosillo
- Dysautonomic Clinic, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico. .,, Mexico City, Mexico.
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Poon AK, Whitsel EA, Heiss G, Soliman EZ, Wagenknecht LE, Suzuki T, Loehr L. Insulin resistance and reduced cardiac autonomic function in older adults: the Atherosclerosis Risk in Communities study. BMC Cardiovasc Disord 2020; 20:217. [PMID: 32393179 PMCID: PMC7216367 DOI: 10.1186/s12872-020-01496-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/27/2020] [Indexed: 12/24/2022] Open
Abstract
Background Prior studies have shown insulin resistance is associated with reduced cardiac autonomic function measured at rest, but few studies have determined whether insulin resistance is associated with reduced cardiac autonomic function measured during daily activities. Methods We examined older adults without diabetes with 48-h ambulatory electrocardiography (n = 759) in an ancillary study of the Atherosclerosis Risk in Communities Study. Insulin resistance, the exposure, was defined by quartiles for three indexes: 1) the homeostatic model assessment of insulin resistance (HOMA-IR), 2) the triglyceride and glucose index (TyG), and 3) the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C). Low heart rate variability, the outcome, was defined by <25th percentile for four measures: 1) standard deviation of normal-to-normal R-R intervals (SDNN), a measure of total variability; 2) root mean square of successive differences in normal-to-normal R-R intervals (RMSSD), a measure of vagal activity; 3) low frequency spectral component (LF), a measure of sympathetic and vagal activity; and 4) high frequency spectral component (HF), a measure of vagal activity. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals weighted for sampling/non-response, adjusted for age at ancillary visit, sex, and race/study-site. Insulin resistance quartiles 4, 3, and 2 were compared to quartile 1; high indexes refer to quartile 4 versus quartile 1. Results The average age was 78 years, 66% (n = 497) were women, and 58% (n = 438) were African American. Estimates of association were not robust at all levels of HOMA-IR, TyG, and TG/HDL-C, but suggest that high indexes were associated consistently with indicators of vagal activity. High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low RMSSD (OR: 1.68 (1.00, 2.81), OR: 2.03 (1.21, 3.39), and OR: 1.73 (1.01, 2.91), respectively). High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low HF (OR: 1.90 (1.14, 3.18), OR: 1.98 (1.21, 3.25), and OR: 1.76 (1.07, 2.90), respectively). Conclusions In older adults without diabetes, insulin resistance was associated with reduced cardiac autonomic function – specifically and consistently for indicators of vagal activity – measured during daily activities. Primary prevention of insulin resistance may reduce the related risk of cardiac autonomic dysfunction.
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Affiliation(s)
- Anna K Poon
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric A Whitsel
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elsayed Z Soliman
- Division of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Takeki Suzuki
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laura Loehr
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Ang L, Dillon B, Mizokami-Stout K, Pop-Busui R. Cardiovascular autonomic neuropathy: A silent killer with long reach. Auton Neurosci 2020; 225:102646. [PMID: 32106052 DOI: 10.1016/j.autneu.2020.102646] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
Cardiovascular autonomic neuropathy (CAN) is a common and deadly complication of diabetes mellitus, which is frequently overlooked in clinical practice due to its characteristic subtle presentation earlier in disease. Yet, timely detection of CAN may help implementation of tailored interventions to prevent its progression and mitigate the risk of associated complications, including cardiovascular disease (CVD), cardiac arrhythmias, myocardial dysfunction leading to congestive heart failure and all-cause mortality. This review highlights current CAN epidemiology trends, novel mechanisms linking CAN with other diabetes complications and current recommendations for diagnosis and management of the disease in the clinical setting.
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Affiliation(s)
- Lynn Ang
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States of America
| | - Brendan Dillon
- University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Kara Mizokami-Stout
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States of America
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States of America.
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4
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Cao L, Graham SL, Pilowsky PM. Carbohydrate ingestion induces differential autonomic dysregulation in normal-tension glaucoma and primary open angle glaucoma. PLoS One 2018; 13:e0198432. [PMID: 29879162 PMCID: PMC5991678 DOI: 10.1371/journal.pone.0198432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 05/20/2018] [Indexed: 12/25/2022] Open
Abstract
Background It is reported that glaucoma may be associated with vascular dysregulation. Normal tension glaucoma (NTG) and primary open angle glaucoma (POAG), which feature different intraocular pressure levels, may manifest differential features of systemic autonomic dysregulation. Methods and results We investigated autonomic regulation to carbohydrate ingestion and postural change in 37 glaucoma patients (19 NTG and 18 POAG) and 36 controls. Subjects were age and gender-matched, normotensive, and had normal comparable insulin sensitivity. Continuous finger arterial pressure and ECG was recorded in supine and standing positions before and after carbohydrate ingestion. Low frequency (LF, 0.04–0.15Hz) and high frequency (HF, 0.15–0.4Hz) spectral power of heart rate and systolic blood pressure variability (HRV and SBPV) were calculated to estimate sympathovagal function. Overall comparison glaucoma (N = 37) and controls (N = 36) showed an increased sympathetic excitation, vagal withdrawal and unstable mean arterial pressure after carbohydrate ingestion in glaucoma patients. Glaucoma severity by retinal nerve fibre layer (RNFL) thickness is positively correlated to autonomic responses (HRV LF power and HF power in normalised units (nu), and HRV LF/HF ratio) after carbohydrate ingestion. Early (30 minutes) following carbohydrate ingestion, SBP LF power and HRV parameters remained unchanged in controls; while POAG showed abnormal autonomic responses, with a paradoxical vagal enhancement (increased HRV HF power in nu) and sympathetic inhibition (decreased HRV LF power nu and HRV LF/HF ratio), and associated hypotension. Later (60–120 minutes) following carbohydrate ingestion, HRV parameters remained unaltered in controls; whereas NTG manifested vagal withdrawal (reduced HRV HF power nu) and sympathetic hyper-responsiveness (increased HRV LF power nu and HRV LF/HF ratio), despite increased SBP LF power in both controls and NTG. Both NTG and POAG exhibited attenuated autonomic responses to postural stress. Conclusions NTG and POAG both manifest some systemic autonomic cardiovascular dysregulation. However, the two forms of glaucoma respond differentially to carbohydrate ingestion, irrespective of insulin resistance.
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Affiliation(s)
- Lei Cao
- The Heart Research Institute, The University of Sydney, Newtown, NSW, Australia
| | - Stuart L. Graham
- Australian School of Advanced Medicine, Macquarie University, North Ryde, NSW, Australia
| | - Paul M. Pilowsky
- The Heart Research Institute, The University of Sydney, Newtown, NSW, Australia
- * E-mail:
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5
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Ziegler D, Strom A, Bönhof G, Püttgen S, Bódis K, Burkart V, Müssig K, Szendroedi J, Markgraf DF, Roden M. Differential associations of lower cardiac vagal tone with insulin resistance and insulin secretion in recently diagnosed type 1 and type 2 diabetes. Metabolism 2018; 79:1-9. [PMID: 29113812 DOI: 10.1016/j.metabol.2017.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/15/2017] [Accepted: 10/20/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE It is unclear to which extent altered insulin sensitivity/secretion contribute to the development of diabetic cardiovascular autonomic neuropathy (CAN) characterized by diminished heart rate variability (HRV). We hypothesised that lower HRV is differentially associated with measures of insulin resistance and insulin secretion in recent-onset type 1 and type 2 diabetes. MATERIALS/METHODS This cross-sectional study included participants from the German Diabetes Study with type 1 (n=275) or type 2 diabetes (n=450) with known diabetes duration ≤1year and glucose-tolerant controls (n=81). Four time domain and frequency domain HRV measures each, reflecting vagal and/or sympathetic modulation were determined over 3h during a hyperinsulinaemic-euglycaemic clamp. Insulin sensitivity was calculated as the M-value, while insulin secretion was determined by glucagon-stimulated incremental C-peptide (ΔC-peptide). RESULTS After adjustment for sex, age, BMI, smoking, and HbA1c, both M-value and ΔC-peptide were lower in the diabetes groups compared to controls (P<0.05). In multiple linear regression analyses after Bonferroni correction, vagus-mediated HRV indices were positively associated with M-value in both diabetes types (P<0.05) and inversely associated with ΔC-peptide only in participants with type 1 diabetes (P<0.05). In type 2 diabetes, the low-frequency/high-frequency (LF/HF) power as an indicator of sympathovagal balance was weakly inversely associated with M-value. CONCLUSIONS Insulin resistance may contribute to the development of early cardiovagal suppression rather than sympathetic predominance in both diabetes types, while in type 1 diabetes a lower glucagon-stimulated insulin secretion is linked to a possibly compensatory higher parasympathetic tone. Whether interventions aimed at reducing insulin resistance could also reduce the risk of CAN remains to be established.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Gidon Bönhof
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sonja Püttgen
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kálmán Bódis
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Daniel F Markgraf
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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6
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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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Svensson MK, Lindmark S, Wiklund U, Rask P, Karlsson M, Myrin J, Kullberg J, Johansson L, Eriksson JW. Alterations in heart rate variability during everyday life are linked to insulin resistance. A role of dominating sympathetic over parasympathetic nerve activity? Cardiovasc Diabetol 2016; 15:91. [PMID: 27352833 PMCID: PMC4924321 DOI: 10.1186/s12933-016-0411-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/14/2016] [Indexed: 12/31/2022] Open
Abstract
Aims To evaluate the role of the autonomic nervous system (ANS) in the development of insulin resistance (IR) and assess the relationship between IR and activity of ANS using power spectrum analysis of heart rate variability (HRV). Subjects and methods Twenty-three healthy first-degree relatives of patients with type 2 diabetes (R) and 24 control subjects without family history of diabetes (C) group-matched for age, BMI and sex were included. Insulin sensitivity (M value) was assessed by hyperinsulinemic (56 mU/m2/min) euglycemic clamp. Activity of the ANS was assessed using power spectrum analysis of HRV in long-term recordings, i.e., 24-h ECG monitoring, and in short-term recordings during manoeuvres activating the ANS. Computed tomography was performed to estimate the amount and distribution of abdominal adipose tissue. Results Insulin sensitivity (M value, mg/kg lbm/min) did not differ significantly between the R and C groups. Total spectral power (Ptot) and very low-frequency (PVLF) power was lower in R than C during 24 h ECG-recordings (p = 0.02 and p = 0.03). The best fit multiple variable linear regression model (r2 = 0.37, p < 0.001 for model) indicated that body composition (BMI) and long-term low to high frequency (LF/HF) power ratio (std β = −0.46, p = 0.001 and std β = −0.28, p = 0.003, respectively) were significantly and independently associated with the M value. Conclusion Altered heart rate variability, assessed by power spectrum analysis, during everyday life is linked to insulin resistance. The data suggest that an increased ratio of sympathetic to parasympathetic nerve activity, occurring via both inherited and acquired mechanisms, could potentially contribute to the development of type 2 diabetes. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0411-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria K Svensson
- Department of Medical Sciences, Uppsala University Hospital, 751 85, Uppsala, Sweden.
| | - Stina Lindmark
- Department of Medicine, Umeå University Hospital, Umeå, Sweden
| | - Urban Wiklund
- Department of Biomedical Engineering & Informatics, Umeå University Hospital, Umeå, Sweden
| | - Peter Rask
- Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden
| | - Marcus Karlsson
- Department of Biomedical Engineering & Informatics, Umeå University Hospital, Umeå, Sweden
| | - Jan Myrin
- Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden
| | - Joel Kullberg
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Lars Johansson
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Jan W Eriksson
- Department of Medical Sciences, Uppsala University Hospital, 751 85, Uppsala, Sweden
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8
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Cao L, Graham SL, Pilowsky PM. Carbohydrate ingestion induces sex-specific cardiac vagal inhibition, but not vascular sympathetic modulation, in healthy older women. Am J Physiol Regul Integr Comp Physiol 2016; 311:R49-56. [PMID: 27147618 DOI: 10.1152/ajpregu.00486.2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/29/2016] [Indexed: 11/22/2022]
Abstract
The role of vagal function in cardiovascular risk in older women remains unclear. Autonomic modulation following carbohydrate ingestion (CI) and postural stress (PS) were investigated in 14 healthy men and 21 age-matched postmenopausal women (age: 65.0 ± 2.1 vs. 64.1 ± 1.6 years), with normal and comparable insulin sensitivity. Continuous noninvasive finger arterial pressure and ECG were recorded in the lying and the standing positions before and after ingestion of a carbohydrate-rich meal (600 kcal, carbohydrate 78%, protein 13%, and fat 8%). Low-frequency (LF, 0.04-0.15 Hz) and high-frequency (HF, 0.15-0.4 Hz) components (ms(2)) of heart rate variability (HRV), low-frequency power (mmHg(2)) of systolic blood pressure variability (SBP LF power), and the sequence method for spontaneous baroreflex sensitivity (BRS, ms/mmHg) were used to quantify autonomic modulation. In response to CI and PS, mean arterial pressure maintained stable, and heart rate increased in women and men in the lying and standing positions. Following CI (60, 90, and 120 min postprandially) in the standing position, SBP LF power increased by 40% in men (P = 0.02), with unchanged HRV parameters; in contrast, in women, HRV HF power halved (P = 0.02), with unaltered SBP LF power. During PS before and after CI, similar magnitude of SBP LF power, HRV, and BRS changes was observed in men and women. In conclusion, CI induces sex-specific vascular sympathetic activation in healthy older men, and cardiac vagal inhibition in healthy older women; this CI-mediated efferent vagal inhibition may suggest differential cardiovascular risk factors in women, irrespective of insulin resistance, and impairment of autonomic control.
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Affiliation(s)
- Lei Cao
- The Heart Research Institute and The University of Sydney, New South Wales, Australia; and
| | - Stuart L Graham
- Australian School of Advanced Medicine, Macquarie University, New South Wales, Australia
| | - Paul M Pilowsky
- The Heart Research Institute and The University of Sydney, New South Wales, Australia; and
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9
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Abstract
Diabetes mellitus (DM) has been known for many years to be associated with poor cardiovascular prognosis. Due to the sensitive neuropathy, the coronary artery disease in diabetic patients is frequently asymptomatic. Also twelve leads resting ECG can be within normal limits even in an advanced stage of coronary artery disease. Therefore in addition to the standard ECG other electrocardiographic procedures started to be studied in order to find some typical signs of myocardial damages caused by DM. Repeatedly reported results showed in DM patients without cardiovascular complications the tachycardia, shortening of the QRS and QT intervals, increase of the dispersion of QT interval, decreased amplitudes of depolarization waves, shortened activation time of ventricular myocardium and a flattening of T waves confirmed by the lower value of maximum and minimum in repolarization body surface isopotential maps. Most of these changes are even more pronounced in patients with cardiac autonomic neuropathy. Comparison with similar ECG changes in other diseases suggests that the electrocardiographic changes in DM patients are not specific and that they are particularly caused by an increased tone of the sympathetic nervous system what was indirectly confirmed by the heart rate variability findings in these patients.
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Affiliation(s)
- O. KITTNAR
- Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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10
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Tarvainen MP, Cornforth DJ, Jelinek HF. Principal component analysis of heart rate variability data in assessing cardiac autonomic neuropathy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:6667-70. [PMID: 25571525 DOI: 10.1109/embc.2014.6945157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Heart rate variability (HRV) is recognized to carry early diagnostic value regarding cardiac autonomic neuropathy (CAN). A number of different HRV analysis algorithms have been proposed for the assessment of CAN, each of them providing partly differing information about HRV time series. Instead of confining to a limited set of HRV features, a multi-dimensional approach incorporating a multitude of HRV parameters could be an optimal way of assessing the changes in HRV related to CAN. In this paper, principal component analysis (PCA) is used for analysing multi-dimensional HRV data of 11 patients with definite CAN and 71 subjects without CAN. Using the two most significant principal components, patients with CAN were separated from subjects without CAN with 87% accuracy.
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11
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Saito I, Hitsumoto S, Maruyama K, Nishida W, Eguchi E, Kato T, Kawamura R, Takata Y, Onuma H, Osawa H, Tanigawa T. Heart Rate Variability, Insulin Resistance, and Insulin Sensitivity in Japanese Adults: The Toon Health Study. J Epidemiol 2015; 25:583-91. [PMID: 26277879 PMCID: PMC4549610 DOI: 10.2188/jea.je20140254] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although impaired cardiac autonomic function is associated with an increased risk of type 2 diabetes in Caucasians, evidence in Asian populations with a lower body mass index is limited. METHODS Between 2009-2012, the Toon Health Study recruited 1899 individuals aged 30-79 years who were not taking medication for diabetes. A 75-g oral glucose tolerance test was used to diagnose type 2 diabetes, and fasting and 2-h-postload glucose and insulin concentrations were measured. We assessed the homeostasis model assessment index for insulin resistance (HOMA-IR) and Gutt's insulin sensitivity index (ISI). Pulse was recorded for 5 min, and time-domain heart rate variability (HRV) indices were calculated: the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive difference (RMSSD). Power spectral analysis provided frequency domain measures of HRV: high frequency (HF) power, low frequency (LF) power, and the LF:HF ratio. RESULTS Multivariate-adjusted logistic regression models showed decreased SDNN, RMSSD, and HF, and increased LF:HF ratio were associated significantly with increased HOMA-IR and decreased ISI. When stratified by overweight status, the association of RMSSD, HF, and LF:HF ratio with decreased ISI was also apparent in non-overweight individuals. The interaction between LF:HF ratio and decreased ISI in overweight individuals was significant, with the odds ratio for decreased ISI in the highest quartile of LF:HF ratio in non-overweight individuals being 2.09 (95% confidence interval, 1.41-3.10). CONCLUSIONS Reduced HRV was associated with insulin resistance and lower insulin sensitivity. Decreased ISI was linked with parasympathetic dysfunction, primarily in non-overweight individuals.
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Affiliation(s)
- Isao Saito
- Department of Community Health Systems Nursing, Ehime University Graduate School of Medicine
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12
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Tarvainen MP, Cornforth DJ, Kuoppa P, Lipponen JA, Jelinek HF. Complexity of heart rate variability in type 2 diabetes - effect of hyperglycemia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:5558-61. [PMID: 24110996 DOI: 10.1109/embc.2013.6610809] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Heart rate variability (HRV) is reduced in diabetes mellitus (DM) patients, suggesting dysfunction of cardiac autonomic regulation which has been associated with increased risk for pathological cardiac events. In this paper, we examined changes in HRV complexity in association to blood glucose level (BGL) and duration of diabetes. Resting HRV and BGL measurements of 32 healthy controls and 54 type 2 DM (T2DM) patients were analyzed. HRV complexity was assessed using Shannon entropy, sample entropy (SampEn), multiscale entropy (MSE), and multiscale Renyi entropy. HRV complexity increased with hyperglycemia indicated by increases in Shannon entropy and MSE and decreases in Renyi entropy for negative orders. Diabetes duration was strongly associated with Renyi entropy which increased for positive orders and decreased for negative orders as a function of disease duration. Shannon entropy, SampEn and MSE did not correlate with disease duration.
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13
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ŽÁKOVIČOVÁ E, KITTNAR O, SLAVÍČEK J, MEDOVÁ E, ŠVÁB P, CHARVÁT J. ECG Body Surface Mapping in Patients With Gestational Diabetes Mellitus and Optimal Metabolic Compensation. Physiol Res 2014; 63:S479-87. [DOI: 10.33549/physiolres.932921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Women with gestational diabetes mellitus (GDM) are at increased risk for cardiovascular diseases (CVD) events compared with women without GDM. The aim of the present study was to evaluate 200 parameters of the heart electric field in 35 women with GDM under optimal glycemic compensation compared to 32 healthy pregnant women. All examinations were performed in the 36th week of gestation. The parameters in ECG body surface mapping (BSM) were registered by the diagnostic system Cardiag 112.2. The absolute values of maximum and minimum in depolarization and repolarization isopotential, isointegral and isoarea maps were not significantly different between the groups. These findings correspond to the result of heart rate variability examination. However BSM revealed the significant prolongation of QRS complex (p=0.05), shortening of ventricular myocardial activation time (ICHVAT) (p=0.01), prolongation of mean QT duration (p=0.01) and increase of QT interval dispersion (p=0.01) in women with GDM. Duration of QRS and ICHVAT significantly correlated with interventricular septum and posterior wall thickness in GDM group, QTd interval correlated significantly with HbA1C level. We conclude that despite of optimal metabolic control several significant abnormalities detected by ECG BSM are still present in patients with GDM.
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Affiliation(s)
| | - O. KITTNAR
- Institute of Physiology of the First Faculty of Medicine, Charles University, Prague, Czech Republic
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Wu JM, Yu HJ, Lai HS, Yang PJ, Lin MT, Lai F. Improvement of heart rate variability after decreased insulin resistance after sleeve gastrectomy for morbidly obesity patients. Surg Obes Relat Dis 2014; 11:557-63. [PMID: 25630807 DOI: 10.1016/j.soard.2014.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/11/2014] [Accepted: 09/13/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Morbidly obese patients display both an autonomic nervous imbalance and impaired glucose metabolism, and both of these conditions can be partially reversed after bariatric surgery. The aim of the present study was to investigate changes in heart rate variability (HRV) and glucose metabolism in patients after laparoscopic sleeve gastrectomy (SG). METHODS Eighteen morbidly obese patients who underwent SG were examined before surgery and at 7, 30, 90, and 180 days after surgery. Indices of HRV included time-domain, frequency-domain, and nonlinear parameters. Glucose metabolism was evaluated by the measuring levels of insulin resistance, glycated hemoglobin (HbA(1c)), and gut hormones. RESULTS The study included 9 men and 9 women with a mean age of 34 years. In the HRV study, the average R-R interval, median R-R interval, standard deviation of the R-R intervals, root mean squared successive difference of the R-R intervals (RMSSD), and the number of pairs of successive normal-to-normal beat intervals that differed by>50 ms significantly increased at 180 days after surgery. Regarding the frequency-domain indices, the low frequency (LF)/high frequency (HF) ratio was more balanced at 90 days after SG compared with baseline, and increases in the total power, LF band, and HF band were observed at 180 days. The assessments of insulin resistance, glucose metabolism, and gut hormones revealed not only improvements in the homeostasis model assessment of insulin resistance and HbA1c levels but also increases in the levels of glucagon-like peptide-1 at 90 and 180 days after surgery compared with baseline. A multivariable regression model revealed significantly negative associations between the perioperative changes in HOMA-IR and changes in both the RMSSD and HF band. CONCLUSIONS SG leads to early improvements in insulin resistance and glucose metabolism that are followed by improvements in HRV indices. Improvements in insulin resistance were associated with increases in the RMSSD and HF band index, but the mechanism of these changes require further study.
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Affiliation(s)
- Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Hwan-Jeu Yu
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Jen Yang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
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Lips MA, de Groot GH, De Kam M, Berends FJ, Wiezer R, Van Wagensveld BA, Swank DJ, Luijten A, Pijl H, Burggraaf J. Autonomic nervous system activity in diabetic and healthy obese female subjects and the effect of distinct weight loss strategies. Eur J Endocrinol 2013; 169:383-90. [PMID: 23847327 DOI: 10.1530/eje-13-0506] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Obesity and type 2 diabetes mellitus (T2DM) are reported to be associated with relative overactivity of the sympathetic nervous system (SNS), which is reversible by weight loss. However, direct effects of weight loss by calorie restriction vs Roux-en-Y gastric bypass (RYGB) on SNS overactivity were not studied in parallel. This study compared the effects of RYGB vs restrictive weight loss in obese patients with normal glucose tolerance (NGT) and with T2DM on SNS function as measured by heart rate variability (HRV). DESIGN AND METHODS Lean (n=12), obese NGT (n=27) and T2DM (n=27) subjects were included in this study. Weight reduction in NGT subjects was achieved by gastric banding (GB) or RYGB and in T2DM subjects by RYGB or high-protein very-low-calorie diet (VLCD). HRV analysis was performed and blood samples were taken at baseline, 3 weeks and 3 months after intervention. RESULTS At baseline, T2DM subjects showed SNS overactivity and NGT subjects showed similar, but non-significant, findings when compared with lean controls. Weight loss after 3 weeks was comparable in all treatment groups, whereas after 3 months, weight loss was most in VLCD and RYGB subjects. RYGB and VLCD treatment reduced SNS activity within 3 weeks in T2DM patients. After 3 months, restoration to normal autonomic nervous system activity was evident for all groups, except for the NGT-GB group. CONCLUSION We can conclude that SNS overactivity is more pronounced in obese T2DM subjects when compared with NGT subjects. Reduction of SNS overactivity coincides with weight loss with the time-course of reduction dependent on the type of intervention. Surgery or caloric restriction may transiently induce SNS overactivity but do not prevent a direct restoration of sympathovagal balance.
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Affiliation(s)
- Mirjam A Lips
- Department of Endocrinology and Metabolism, Leiden University Medical Center, C-04-R-83, Albinusdreef 2, PO Box 9600, 2333 ZA Leiden, The Netherlands
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16
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Valensi P, Chiheb S, Fysekidis M. Insulin- and glucagon-like peptide-1-induced changes in heart rate and vagosympathetic activity: why they matter. Diabetologia 2013; 56:1196-200. [PMID: 23584434 DOI: 10.1007/s00125-013-2909-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/07/2013] [Indexed: 12/24/2022]
Abstract
Heart rate (HR) predicts cardiovascular morbidity and mortality in individuals either with or without diabetes. In type 2 diabetic patients, cardiac autonomic neuropathy is a risk marker for cardiac morbidity and mortality. A major pathogenic potential may be attributed to vagal depression and sympathetic predominance. In this issue of Diabetologia, Berkelaar et al (DOI: 10.1007/s00125-013-2848-6 ) examined the effects of euglycaemic, and hyperglycaemic clamp with the addition of glucagon-like-peptide-1 (GLP-1) and arginine, on cardiac vagal control in a large number of healthy subjects. After adjustments for age, BMI and insulin sensitivity, insulin associations with HR remained partially intact while those with vagal control disappeared. This suggested that BMI and insulin sensitivity, but not insulin levels, were the main drivers of cardiac vagal control. GLP-1 infusion during hyperglycaemia increased HR and BP and produced a statistically non-significant decrease in measures of cardiac vagal control compared with values before any manipulation of insulin levels. This commentary summarises how, and to what extent, insulin and GLP-1 affect autonomic nervous system activity, HR and BP. More information is needed on the mechanisms through which acute administration of, and long-term treatment with, GLP-1 may affect haemodynamics and autonomic activity in diabetic and obese patients, since this may influence cardiovascular outcomes.
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Affiliation(s)
- P Valensi
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris-Nord University, CRNH-IdF, Avenue du 14 juillet, 93143 Bondy Cedex, France.
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17
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Borgognoni L, Picciarella A, Di Stefano A, Fontana V, Russo A, Pascucci M, Paris A, Tubani L, Fiorentini A. Correlation between glycemic trends assessed by 24 h continuous monitoring and autonomic activity in patients with recent onset type 2 diabetes. Diabetes Res Clin Pract 2013; 100:e14-6. [PMID: 23497980 DOI: 10.1016/j.diabres.2013.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/31/2012] [Accepted: 01/03/2013] [Indexed: 11/21/2022]
Abstract
We observe, in patients with type 2 diabetes of recent onset, the activity of the autonomic nervous system and glucose metabolic impairment. The data indicate the hyperactivity of the sympathetic and minimal changes in glucose values. The role played by glycemia appeared to be less important than that represented by insulin resistance.
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Affiliation(s)
- Laura Borgognoni
- Department of Clinical Medicine, Policlinico Umberto I, University of Rome Sapienza, Italy
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18
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Chang YW, Lin JD, Chen WL, Yen CF, Loh CH, Fang WH, Wu LW. Metabolic syndrome and short-term heart rate variability in adults with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1701-1707. [PMID: 22684003 DOI: 10.1016/j.ridd.2012.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 04/05/2012] [Indexed: 06/01/2023]
Abstract
Metabolic syndrome (MetS) increases the risk of cardiovascular events. Heart rate variability (HRV) represents autonomic functioning, and reduced HRV significantly increases cardiovascular mortality. The aims of the present paper are to assess the prevalence of MetS in adults with intellectual disabilities (ID), the difference in short-term HRV between the healthy and ID population, and the association of short-term HRV with MetS. In this study, we analyzed 129 ID subjects who participated in routine health check-ups in October 2010. We measured their metabolic components and evaluated the relationships of MetS with short-term HRV indices. The study found that MetS and obesity are common in persons with ID. ID subjects have significantly lower HRV than healthy adults, and persons with ID persons with MetS have significantly lower HRV than ID subjects without MetS. The individual components of MetS are differentially associated with HRV in ID men and women. Metabolic syndrome adversely affects autonomic cardiac control, and reduced autonomic cardiac control could contribute to an increased risk of subsequent cardiovascular events in individuals who exhibit metabolic syndrome. Sex differences in vagal activity and sympathovagal balance may partly explain the greater increase in cardiovascular risk associated with MetS in ID women compared with ID men.
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Affiliation(s)
- Yaw-Wen Chang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Nautiyal M, Shaltout HA, de Lima DC, do Nascimento K, Chappell MC, Diz DI. Central angiotensin-(1-7) improves vagal function independent of blood pressure in hypertensive (mRen2)27 rats. Hypertension 2012; 60:1257-65. [PMID: 23045456 DOI: 10.1161/hypertensionaha.112.196782] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertensive transgenic (mRen2)27 rats with overexpression of the mRen2 gene have impaired baroreflex sensitivity for heart rate control and high nicotinamide adenine dinucleotide phosphate oxidase and kinase-to-phosphatase signaling activity in medullary tissue compared with normotensive Hannover Sprague-Dawley control rats. They also exhibit insulin resistance at a young age. To determine whether blocking angiotensin II actions, supplementing angiotensin-(1-7), or scavenging reactive oxygen species in brain differentially alters mean arterial pressure, baroreflex sensitivity, or metabolic function, while altering medullary signaling pathways in these animals, we compared intracerebroventricular infusions of the angiotensin II type 1 receptor antagonist candesartan (4 μg/5 μL/h), angiotensin-(1-7) (0.1 μg/5 μL/h), a reactive oxygen species scavenger tempol (25 μg/5 μL/h), or artificial cerebrospinal fluid (5 μL/h) for 2 weeks. Mean arterial pressure was reduced in candesartan-treated rats without significantly improving the vagal components of baroreflex function or heart rate variability. In contrast, angiotensin-(1-7) treatment significantly improved the vagal components of baroreflex function and heart rate variability at a dose that did not significantly lower mean arterial pressure. Tempol significantly reduced nicotinamide adenine dinucleotide phosphate oxidase activity in brain dorsal medullary tissue but had no effect on mean arterial pressure or autonomic function. Candesartan tended to reduce fat mass, but none of the treatments significantly altered indices of metabolic function or mitogen-activated protein kinase signaling pathways in dorsal medulla. Although additional dose response studies are necessary to determine the potential maximal effectiveness of each treatment, the current findings demonstrate that blood pressure and baroreflex function can be essentially normalized independently of medullary nicotinamide adenine dinucleotide phosphate oxidase or mitogen-activated protein kinase in hypertensive (mRen2)27 rats.
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Affiliation(s)
- Manisha Nautiyal
- Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1032, USA
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Lindmark S, Lönn L, Wiklund U, Tufvesson M, Olsson T, Eriksson JW. Dysregulation of the Autonomic Nervous System Can Be a Link between Visceral Adiposity and Insulin Resistance. ACTA ACUST UNITED AC 2012; 13:717-28. [PMID: 15897481 DOI: 10.1038/oby.2005.81] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the interplay among abdominal adipose tissue distribution, the cortisol axis, the autonomic nervous system, and insulin resistance. RESEARCH METHODS AND PROCEDURES Two age-, sex-, and BMI-matched groups were studied. Fifteen subjects were first-degree relatives of patients with type 2 diabetes (R), and 15 had no family history of diabetes (controls, C). A hyperinsulinemic euglycemic clamp, cortisol measurements, and analysis of heart rate variability (HRV) were performed. Computed tomography was performed in a subgroup (n = 9 + 9) to determine abdominal adipose tissue distribution. RESULTS R tended to be less insulin-sensitive than C (M value 9.2 +/- 1.0 vs 10.3 +/- 0.7 mg/kg per minute, not significant). Stimulation with tetracosactin or corticotropin releasing hormone yielded lower peak serum cortisol levels in R (p = 0.03 and p = 0.06, respectively). The amount of visceral abdominal fat (VAT) tended to be greater in R. In all subjects, VAT was negatively correlated to insulin sensitivity (r = -0.93, p < 0.001). There was a positive association between VAT and resting heart rate (r = 0.70, p = 0.003) and sympathetic/parasympathetic ratio in HRV assessment after tilt (r = 0.53, p = 0.03). Subcutaneous abdominal tissue was not associated with insulin sensitivity or any of the hormonal or HRV assessments. DISCUSSION Subjects genetically predisposed for type 2 diabetes had a tendency toward a larger amount of VAT and to lower insulin sensitivity compared with control subjects. The amount of visceral fat was strongly associated with insulin resistance and signs of a high ratio of sympathetic vs. parasympathetic reactivity. A large amount of visceral fat may act in concert with sympathetic/parasympathetic imbalance to promote the development of insulin resistance, and this may be partly independent of genetic background.
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Affiliation(s)
- Stina Lindmark
- Department of Medicine, Umeå University Hospital, S-901 85 Umeå, Sweden.
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21
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Enhancing Heart Rate Variability. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tigno XT, Hansen BC, Nawang S, Shamekh R, Albano AM. Vasomotion becomes less random as diabetes progresses in monkeys. Microcirculation 2011; 18:429-39. [PMID: 21435082 PMCID: PMC3148284 DOI: 10.1111/j.1549-8719.2011.00103.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Please cite this paper as: Tigno, Hansen, Nawang, Shamekh, and Albano (2011). Vasomotion Becomes Less Random as Diabetes Progresses in Monkeys. Microcirculation 18(6), 429-439. ABSTRACT OBJECTIVE Changes in vasomotion may precede other global indices of autonomic dysfunction that track the onset and progression of diabetes. Recently, we showed that baseline spectral properties of vasomotion can discriminate among N, PreDM, and T2DM nonhuman primates. In this study, our aims were to: (i) determine the time dependence and complexity of the spectral properties of vasomotion in three metabolic groups of monkeys; (ii) examine the effects of heat-provoked vasodilatation on the power spectrum; and (iii) compare the effects of exogenous insulin on the vasomotion. MATERIALS AND METHODS Laser Doppler flow rates were measured from the foot in 9 N, 11 PreDM, and 7 T2DM monkeys. Baseline flow was measured at 34°C, and under heat stimulation at 44°C. Euglycemic-hyperinsulinemic clamps were performed to produce acute hyperinsulinemia. The Lempel-Ziv complexity, prediction error, and covariance complexity of five-dimensional embeddings were calculated as measures of randomness. RESULTS AND CONCLUSIONS With progression of diabetes, measures of randomness of the vasomotion progressively decreased, suggesting a progressive loss of the homeostatic capacity of the peripheral circulation to respond to environmental changes. Power spectral density among T2DM animals resided mostly in the 0- to 1.45-Hz range, which excluded the cardiac component, suggesting that with progression of the disease, regulation of flow shifts toward local rather than central (autonomic) mechanisms. Heating increased all components of the spectral power in all groups. In N, insulin increased the vasomotion contributed by endothelial, neurogenic, vascular myogenic, and respiratory processes, but diminished that due to heart rate. In contrast, in T2DM, insulin failed to stimulate the vascular myogenic and respiratory activities, but increased the neural/endothelial and heart rate components. Interestingly, acute hyperinsulinemia resulted in no significant vasomotion changes in the chronically hyperinsulinemic PreDM, suggesting yet another form of "insulin resistance" during this stage of the disease.
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Affiliation(s)
- Xenia T Tigno
- Department of Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa, Florida, USA.
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23
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Laitinen T, Lindström J, Eriksson J, Ilanne-Parikka P, Aunola S, Keinänen-Kiukaanniemi S, Tuomilehto J, Uusitupa M. Cardiovascular autonomic dysfunction is associated with central obesity in persons with impaired glucose tolerance. Diabet Med 2011; 28:699-704. [PMID: 21388444 DOI: 10.1111/j.1464-5491.2011.03278.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to investigate the prevalence of cardiovascular autonomic neuropathy in persons with previously diagnosed impaired glucose tolerance and to characterize associations between components of metabolic syndrome and cardiovascular autonomic neuropathy in the Finnish Diabetes Prevention Study cohort. METHODS Two hundred and sixty-eight individuals with impaired glucose tolerance at baseline in the Finnish Diabetes Prevention Study, but not diagnosed with diabetes during follow-up, were studied for cardiovascular autonomic neuropathy. At the second annual follow-up visit after the end of lifestyle intervention, we performed deep-breathing and active orthostatic tests to detect possible parasympathetic and sympathetic dysfunction. To describe metabolic characteristics, anthropometric measurements, an oral glucose tolerance test and assessments for HbA(1c,) serum lipids and blood pressure were carried out. RESULTS Prevalence of parasympathetic dysfunction was 25% and prevalence of sympathetic dysfunction was 6%, with no difference between the former intervention and control group participants or between men and women. Subjects with parasympathetic dysfunction were older, more obese (weight, waist circumference, body mass index) and had higher triglyceride concentration compared with those with normal parasympathetic function (P<0.01 for all). Parasympathetic dysfunction was not significantly associated with other characteristics of metabolic syndrome; for example, high cholesterol, glucose and insulin levels or HbA(1c) . Correlations between the Expiration/Inspiration (E/I) ratio (the longest heart beat duration in expiration divided by the shortest heart beat duration in inspiration) and measures reflecting obesity were statistically significant in the pooled population and in men but not in women. CONCLUSIONS Cardiovascular autonomic neuropathy is common in persons with impaired glucose tolerance. Obesity, especially among men, seems to play an important role in the early pathogenesis of cardiovascular autonomic neuropathy.
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Affiliation(s)
- T Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Puijonlaaksontie2, Kuopio,
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Valensi P, Extramiana F, Lange C, Cailleau M, Haggui A, Maison Blanche P, Tichet J, Balkau B. Influence of blood glucose on heart rate and cardiac autonomic function. The DESIR study. Diabet Med 2011; 28:440-9. [PMID: 21204961 DOI: 10.1111/j.1464-5491.2010.03222.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To evaluate in a general population, the relationships between dysglycaemia, insulin resistance and metabolic variables, and heart rate, heart rate recovery and heart rate variability. METHODS Four hundred and forty-seven participants in the Data from an Epidemiological Study on the Insulin Resistance syndrome (DESIR) study were classified according to glycaemic status over the preceding 9 years. All were free of self-reported cardiac antecedents and were not taking drugs which alter heart rate. During five consecutive periods: rest, deep breathing, recovery, rest and lying to standing, heart rate and heart rate varability were evaluated and compared by ANCOVA and trend tests across glycaemic classes. Spearman correlation coefficients quantified the relations between cardio-metabolic risk factors, heart rate and heart rate varability. RESULTS Heart rate differed between glycaemic groups, except during deep breathing. Between rest and deep-breathing periods, patients with diabetes had a lower increase in heart rate than others (P(trend) < 0.01); between deep breathing and recovery, the heart rate of patients with diabetes continued to increase, for others, heart rate decreased (P(trend) < 0.009). Heart rate was correlated with capillary glucose and triglycerides during the five test periods. Heart rate variability differed according to glycaemic status, especially during the recovery period. After age, sex and BMI adjustment, heart rate variability was correlated with triglycerides at two test periods. Change in heart rate between recovery and deep breathing was negatively correlated with heart rate variability at rest, (r=-0.113, P < 0.05): lower resting heart rate variability was associated with heart rate acceleration. CONCLUSIONS Heart rate, but not heart rate variability, was associated with glycaemic status and capillary glucose. After deep breathing, heart rate recovery was altered in patients with known diabetes and was associated with reduced heart rate variability. Being overweight was a major correlate of heart rate variability.
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Affiliation(s)
- P Valensi
- Department of Endocrinology-Diabetology-Nutrition, Paris-Nord University, Jean Verdier Hospital, Bondy, France
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Yeo S. Prenatal stretching exercise and autonomic responses: preliminary data and a model for reducing preeclampsia. J Nurs Scholarsh 2010; 42:113-21. [PMID: 20618595 DOI: 10.1111/j.1547-5069.2010.01344.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Preeclampsia is a leading cause of perinatal mortality and morbidity, and it increases maternal risk for future cardiovascular disease. The purpose of the study was to explore the relationships among stretching exercise, autonomic cardiac response, and the development of preeclampsia. DESIGN Secondary data analysis. METHODS Heart rate and pulse pressure were longitudinally examined in this secondary data analysis among women who engaged in stretching exercise daily from 18 weeks of gestation to the end of pregnancy compared with women who did walking exercise daily during the same time period. A total of 124 women were randomized to either stretching (n=60) or walking (n=64) in the parent study. FINDINGS Heart rates in the stretching group were consistently lower than those in the walking group. CONCLUSIONS Based on the results of this secondary data analyses, a physiologic framework for possible beneficial effects of stretching exercise by enhancing autonomic responses on reducing risks for preeclampsia is proposed and discussed. CLINICAL RELEVANCE If the protective effect is established, stretching exercise can be translated into nursing intervention for prenatal care.
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Affiliation(s)
- SeonAe Yeo
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA.
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Heiskanen N, Saarelainen H, Kärkkäinen H, Valtonen P, Lyyra-Laitinen T, Laitinen T, Vanninen E, Heinonen S. Gestational diabetic patients with adequate management have normal cardiovascular autonomic regulation during the third trimester of pregnancy and 3 months after delivery. J Diabetes Complications 2010; 24:234-41. [PMID: 19282202 DOI: 10.1016/j.jdiacomp.2008.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 12/22/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the influence of gestational diabetes mellitus (GDM) on hemodynamics and cardiovascular autonomic regulation at rest and their responses to head-up tilt (HUT). RESEARCH DESIGN AND METHODS We prospectively studied 79 pregnant women (51 with GDM, 28 without GDM) during the third trimester of pregnancy and after parturition. The maternal electrocardiogram and arterial blood pressure were noninvasively measured. Heart rate and blood pressure were measured in the supine position and in the upright position. Stroke volume was assessed from noninvasive blood pressure signals, heart rate variability (HRV) was analyzed in frequency domain, and baroreflex sensitivity by the cross-spectral and sequence methods. RESULTS Between the GDM group and control pregnant women there were no significant differences in hemodynamics and cardiovascular autonomic regulation throughout the protocol. Increased normalized low-frequency component and low-frequency to high-frequency ratio suggested a change in sympathovagal balance towards sympathetic predominance during pregnancy in both groups. The response to head-up tilt (HUT) was similar in both GDM and control pregnant women. The pregnancy modulated the response to HUT in systolic and diastolic blood pressure, stroke volume, cardiac index, peripheral resistance, total power of HRV, and its low- and high-frequency components. CONCLUSIONS Our results suggest that pregnancy modulates cardiovascular autonomic regulation and hemodynamics equally in subjects with GDM and without GDM, suggesting that metabolic disorder during pregnancy does not result in cardiovascular dysfunction when GDM is in good balance.
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Affiliation(s)
- Nonna Heiskanen
- Department of Obsteterics and Gynecology, Kuopio University Hospital, University of Kuopio, P.O.B. 1777, 70211 Kuopio, Finland.
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Earnest CP, Poirier P, Carnethon MR, Blair SN, Church TS. Autonomic function and change in insulin for exercising postmenopausal women. Maturitas 2010; 65:284-91. [PMID: 20022188 DOI: 10.1016/j.maturitas.2009.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/18/2009] [Accepted: 11/24/2009] [Indexed: 12/19/2022]
Abstract
PURPOSE Obesity, physical inactivity and altered estrogen metabolism play an integrated role contributing to the disease risk profiles of postmenopausal women. These same risk factors also affect modulation of the autonomic nervous system (ANS). METHODS We examined 332 postmenopausal, overweight, previously sedentary women (mean+/-SD; age, 57.6+/-6.3 years; weight, 84.3+/-11.9kg; BMI, 31.7+/-3.7kg/m(2)) participating in a 6-month, moderate intensity, aerobic exercise training intervention to determine the relationship between heart rate variability (HRV) derived autonomic function and fasting insulin. We analyzed quartiles of change in time and frequency domain indices of ANS activity and changes in insulin for between and within group differences using ANCOVA and Tukey post hoc tests adjusted for age, ethnicity, randomization group, change in fitness, and change in weight. RESULTS We observed at baseline that insulin was positively correlated with body anthropometry (body weight, r(2)=0.34; BMI, r(2)=0.39; waist circumference, r(2)=0.29; all, P<0.001), and inversely associated with rMSSD (r(2)=-0.12) and SDNN (r(2)=-0.18; all, P<0.01). After the intervention, changes in rMSSD (r(2)=-0.21, P<0.002) and SDNN r(2) -0.19, P<0.0001) were inversely correlated to insulin change. Further ANCOVA analysis revealed that rMSSD and SDNN were both significant (P<0.0001); however, only rMSSD exhibited a step-wise pattern of improvement when quartiles of rMSSD were compared to corresponding insulin reductions: Q1 (referent group, 8.41+/-3.2uIU/ml), Q2 (-3.30+/--3.2uIU/ml), Q3 (-5.66+/--3.2uIU/ml; P<0.02), and Q4 (-9.60+/--3.2uIU/ml; P<0.006). CONCLUSION Our study shows that changes in autonomic function are associated with changes in insulin and that exercise training may influence this relationship in postmenopausal women.
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Affiliation(s)
- Conrad P Earnest
- Pennington Biomedical Research Center, Preventive Medicine, 6400 Perkins Road, Baton Rouge, LA, United States.
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Fiorentini A, Perciaccante A, Valente R, Paris A, Serra P, Tubani L. The correlation among QTc interval, hyperglycaemia and the impaired autonomic activity. Auton Neurosci 2009; 154:94-8. [PMID: 19963442 DOI: 10.1016/j.autneu.2009.11.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 07/16/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The QT interval reflects the duration of the intracellular action potential. Little is known on the interval QT duration in non diabetic insulin-resistant subjects. OBJECTIVE The aims of the current study were to evaluate the QTc interval in three groups of non diabetic insulin-resistant subjects and the possible correlation between QTc and the autonomic nervous system's activity. DESIGN 90 subjects were divided in subjects with impaired fasting glycaemia (IFG) and, by the results of OGTT, according to the criteria of ADA, in subjects with normal glucose regulation (NGR) and impaired glucose tolerance (IGT). Insulin resistance was evaluated by the homeostasis model assessment-index (HOMA-I). Heart rate variability and Qtc were calculated. RESULTS QTc interval is correlated with SDNN, LF n.u. and LF/HF. CONCLUSION We have observed that the QTc interval is prolonged in insulin-resistant subjects with associated impaired glucose metabolism, while no difference was reported between insulin-resistant and non insulin-resistant subjects with normal glucose regulation. We hypothesize that hyperglycaemia could play a major role than hyperinsulinemia on the QTc prolongation.
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Cardiac autonomic responses to hyperinsulinemia are associated with skeletal muscle function in healthy human subjects. Auton Neurosci 2009; 152:96-100. [PMID: 19884049 DOI: 10.1016/j.autneu.2009.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 06/17/2009] [Accepted: 09/28/2009] [Indexed: 12/17/2022]
Abstract
Hyperinsulinemia related to obesity may result in activation of the sympathetic nervous system (SNS). Acute autonomic responsiveness to insulin is influenced by body composition, particularly obesity. However, it is unclear whether skeletal muscle mass or function determines autonomic responsiveness to insulin. While muscle function is associated with insulin sensitivity, there are no studies that have assessed if skeletal muscle function modulates autonomic responses to hyperinsulinemia. Fifty healthy men (aged 18-35years) were evaluated for skeletal muscle function (hand grip strength and static and dynamic endurance) and then divided into low and high endurance (LE and HE) groups. Heart rate variability (HRV) in the frequency domain was measured during a hyperinsulinemic euglycemic clamp (HEC). With hyperinsulinemia, the HE group had a higher increment in total power of HRV (1615+/-2536 vs. 97+/-1943, P=0.08) and normalized low frequency (LF) HRV (16.2+/-17.9 vs. -1.3+/-14.8, P=0.008) as compared to the LE group. A significant reduction in the normalized high frequency (HF) HRV was seen in the HE group but not in the LE group (-12.3+/-12.9 vs. 1.7+/-13.9, P=0.009); this translated into an increase in LF/HF ratio for the HE group and but not the LE group (1.21+/-1.8 vs. -0.08+/-0.65, P=0.016). The present study indicates that there are differential cardiac autonomic responses to hyperinsulinemia in healthy human subjects with variable skeletal muscle function.
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30
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Kim MK, Tanaka K, Kim MJ, Matsuo T, Ajisaka R. Exercise Training-Induced Changes in Heart Rate Recovery in Obese Men With Metabolic Syndrome. Metab Syndr Relat Disord 2009; 7:469-76. [DOI: 10.1089/met.2008.0086] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Maeng-Kyu Kim
- Department of Sports Medicine for Health and Disease, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kiyoji Tanaka
- Department of Sports Medicine for Health and Disease, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mi-Ji Kim
- Department of Sports Medicine for Health and Disease, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomoaki Matsuo
- Department of Sports Medicine for Health and Disease, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ryuichi Ajisaka
- Department of Sports Medicine for Health and Disease, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
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31
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Perugini RA, Li Y, Rosenthal L, Gallagher-Dorval K, Kelly JJ, Czerniach DR. Reduced heart rate variability correlates with insulin resistance but not with measures of obesity in population undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2009; 6:237-41. [PMID: 20005785 DOI: 10.1016/j.soard.2009.09.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 09/03/2009] [Accepted: 09/14/2009] [Indexed: 12/23/2022]
Abstract
BACKGROUND Obesity is associated with a pathologic predominance of sympathetic over parasympathetic tone. With respect to the heart, this autonomic dysfunction presents as a decreased heart rate variability (HRV), which has been associated with increased cardiovascular morbidity. Gastric bypass (GB) reduces cardiovascular mortality, and, thus, could beneficially affect the HRV. We sought to identify the factors predictive of HRV in a severely obese population of undergoing GB at a university hospital in the United States. METHODS The data of all patients presenting for GB were included in a prospective database. The homeostatic model of assessment (HOMA) was used to calculate the insulin resistance and glucose disposition index. A 24-hour Holter monitor was used to assess the HRV. Measurements were repeated at 2 weeks and 6 months postoperatively. The correlations between variables were determined using linear mixed models. RESULTS We studied 30 patients undergoing GB. All exhibited some degree of reduced HRV that improved postoperatively. The HOMA-insulin resistance inversely correlated with the HRV, and the HOMA-glucose disposition index directly correlated with the parameters of HRV in our longitudinal models. Weight, body mass index, excess body weight, gender, and age did not correlate with HRV. Improvements in HRV correlated with reductions in the average heart rate, underscoring a postoperative increase in relative vagal tone. CONCLUSION HRV in the severely obese is better predicted by the degree of insulin resistance, than by the degree of obesity, age, or gender. GB led to an improvement in HRV, the magnitude of which correlated with the change in insulin resistance and glucose disposition index, but not with weight loss.
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Affiliation(s)
- Richard A Perugini
- University of Massachusetts Memorial Health Care, Worcester, Massachusetts, USA.
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Faria CA, Moraes RS, Sobral-Filho DC, Rego AG, Baracho MF, Egito ES, Brandão-Neto J. Autonomic modulation in patients with congenital generalized lipodystrophy (Berardinelli-Seip syndrome). ACTA ACUST UNITED AC 2009; 11:763-9. [DOI: 10.1093/europace/eup095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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33
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Straznicky NE, Lambert GW, Masuo K, Dawood T, Eikelis N, Nestel PJ, McGrane MT, Mariani JA, Socratous F, Chopra R, Esler MD, Schlaich MP, Lambert EA. Blunted sympathetic neural response to oral glucose in obese subjects with the insulin-resistant metabolic syndrome. Am J Clin Nutr 2009; 89:27-36. [PMID: 19056585 DOI: 10.3945/ajcn.2008.26299] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glucose ingestion stimulates sympathetic nervous system (SNS) activity in lean subjects, whereas blunted responses have been reported in the obese. OBJECTIVE The objective was to investigate the impact of insulin resistance on the SNS response to oral glucose. DESIGN Nineteen insulin-resistant (IR) and 12 insulin-sensitive (IS) obese subjects with the metabolic syndrome and matched for age, sex, and blood pressure participated. Simultaneous measurements of muscle sympathetic nerve activity (MSNA) by microneurography, whole-body norepinephrine spillover rate, cardiac baroreflex sensitivity (BRS), calf blood flow, and arterial blood pressure were made at baseline and 30, 60, 90, and 120 min after a 75-g glucose load. RESULTS IR subjects had a higher insulin area under the curve from 0 to 120 min (AUC(0-120): 13,468 +/- 677 compared with 6399 +/- 612 mU/L . min; P < 0.001), glucose AUC(0-120) (P < 0.05), and resting MSNA (41 +/- 3 compared with 31 +/- 3 bursts/min; P = 0.03) than did IS subjects. MSNA and the norepinephrine spillover rate increased from baseline (by 29 +/- 7% and 40 +/- 13%, respectively; P < or = 0.001 for both) in IS subjects after the glucose load. In contrast, there was a blunted and delayed sympathetic response in IR subjects. Cardiac BRS and diastolic blood pressure decreased, whereas calf blood flow increased after the glucose load and by a similar magnitude in both groups (P < 0.01). Body mass index, abdominal fat, and insulin AUC(0-120) were independent (inverse) predictors of the SNS response. CONCLUSIONS IR subjects with the metabolic syndrome have a blunted SNS response to oral glucose compared with IS subjects with the metabolic syndrome, which is related to central adiposity and the insulin response but not to differences in skeletal muscle vasodilation or BRS.
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Affiliation(s)
- Nora E Straznicky
- Human Neurotransmitters and Heart Failure Division, Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia.
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Ethnic differences in heart rate: can these be explained by conventional cardiovascular risk factors? Clin Auton Res 2008; 18:90-5. [PMID: 18414771 DOI: 10.1007/s10286-008-0463-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 03/13/2008] [Indexed: 12/19/2022]
Abstract
OBJECTIVES South Asians worldwide have an elevated risk of coronary heart disease (CHD), only partly explicable by a higher prevalence of diabetes. Diabetes and dysglycaemia are associated with increased heart rates and abnormal cardiac sympathovagal balance, and are predictive of increased coronary mortality. This study investigated ethnic differences in heart rate, sympathovagal balance, and baroreflex sensitivity (BRS) to establish if they were explained by dysglycaemia/insulin resistance. METHODS 84 South Asian and 83 European men (age 45-85 yrs), half with established CHD and half without proven CHD, underwent metabolic profiling and assessment of mean RR interval, heart rate variablility (HRV) and BRS. RESULTS Mean resting RR interval was greater in Europeans than South Asians (1014 (149) ms vs. 936 (158) ms respectively, means (SD); P = 0.005). This corresponded to resting heart rates of 59.1 bpm for Europeans and 64.1 bpm for South Asians. No ethnic differences were detected in HRV or BRS. Insulin resistance, assessed by the homeostasis model of assessment of insulin resistance (HOMA-IR), correlated with mean RR interval (beta coefficient = -0.189, P = 0.04) and BRS (beta coefficient = -0.246, P = 0.006) and similar correlations were seen with fasting serum glucose. However, ethnic differences in mean RR interval persisted after adjustment for age, systolic BP, beta blocker use, and HOMA-IR. INTERPRETATION South Asian men have higher heart rates compared with European men. This difference was not explained by measures of insulin resistance or other risk factors. This may be indicative of altered sympathovagal balance, and contribute to the greater coronary disease risk in people of South Asian ethnicity.
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Perciaccante A. Cardiovascular Autonomic Dysfunction as a Link Between Insulin Resistance and Nocturnal Blood Pressure Elevation. Hypertension 2008; 51:e30; author reply e31. [DOI: 10.1161/hypertensionaha.108.110361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Antonio Perciaccante
- Internal Medicine, “San Giovanni Decollato-Andosilla” Hospital, Civita Castellana, Italy
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Neves FJ, Bousquet-Santos K, Silva BM, Soares PPS, Nóbrega ACL. Preserved heart rate variability in first-degree relatives of subjects with Type 2 diabetes mellitus without metabolic disorders. Diabet Med 2008; 25:355-9. [PMID: 18215170 DOI: 10.1111/j.1464-5491.2007.02364.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the influence of a family history of Type 2 diabetes mellitus (T2DM) on resting heart rate variability in the absence of concomitant metabolic disorders. METHODS We studied 55 first-degree relatives (FDRs) of subjects with T2DM and 36 control subjects without any known family history of diabetes. FDRs were recruited from a University Hospital out-patient diabetes clinic. The protocol included: oral glucose tolerance test (30, 60, 90 and 120 min after ingestion of 75 g glucose) blood glucose, plasma insulin, cholesterol and subfractions, triglycerides, leptin and C-reactive protein. Heart rate variability (HRV) at rest was determined by spectral analysis of interbeat intervals recorded during 10 min in the supine position. RESULTS HRV was lower in FDRs compared with control subjects (P < 0.05). Multiple regression analysis identified cholesterol (P = 0.014) and triglycerides (P = 0.014) as significant independent predictors (model r = 0.40; P < 0.001) of HRV. Since FDRs had higher values for anthropometric and metabolic variables known to alter HRV, we performed an ancova adjusted for cholesterol and triglycerides and also another analysis in which the groups were comparable for anthropometric and metabolic characteristics. Comparison of FDRs and comparable control subjects revealed no significant difference in HRV (P > 0.05). CONCLUSIONS A family history of T2DM, in the absence of concomitant metabolic disorders, does not impair heart rate variability.
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Affiliation(s)
- F J Neves
- Department of Physiology and Pharmacology & Postgraduate Programme in Cardiovascular Sciences, Federal Fluminense University, Niterói, Rio de Janeiro, RJ, Brazil
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38
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Impaired circadian rhythm of cardiac autonomic activity as possible link between insulin resistance and nocturnal nondipping. Blood Press Monit 2008; 13:63; author reply 63-4. [DOI: 10.1097/mbp.0b013e3282f13ece] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Eriksson JW. Metabolic stress in insulin's target cells leads to ROS accumulation - A hypothetical common pathway causing insulin resistance. FEBS Lett 2007; 581:3734-42. [PMID: 17628546 DOI: 10.1016/j.febslet.2007.06.044] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 06/16/2007] [Accepted: 06/18/2007] [Indexed: 01/04/2023]
Abstract
The metabolic syndrome is a cluster of cardiovascular risk factors, and visceral adiposity is a central component that is also strongly associated with insulin resistance. Both visceral obesity and insulin resistance are important risk factors for the development of type 2 diabetes. It is likely that adipose tissue, particularly in the intra-abdominal depot, is part of a complex interplay involving several tissues and that dysregulated hormonal, metabolic and neural signalling within and between organs can trigger development of metabolic disease. One attractive hypothesis is that many factors leading to insulin resistance are mediated via the generation of abnormal amounts of reactive oxygen species (ROS). There is much evidence supporting that detrimental effects of glucose, fatty acids, hormones and cytokines leading to insulin resistance can be exerted via such a common pathway. This review paper mainly focuses on metabolic and other 'stress' factors that affect insulin's target cells, in particular adipocytes, and it will highlight oxidative stress as a potential unifying mechanism by which these stress factors promote insulin resistance and the development and progression of type 2 diabetes.
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Affiliation(s)
- Jan W Eriksson
- The Lundberg Laboratory for Diabetes Research, Institute of Medicine, Sahlgrenska University Hospital, SE 41345 Gothenburg, Sweden.
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40
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Abraham NG, Brunner EJ, Eriksson JW, Robertson RP. Metabolic syndrome: psychosocial, neuroendocrine, and classical risk factors in type 2 diabetes. Ann N Y Acad Sci 2007; 1113:256-75. [PMID: 17513461 DOI: 10.1196/annals.1391.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article summarizes some aspects of stress in the metabolic syndrome at the psychosocial, tissue, and cellular levels. The metabolic syndrome is a valuable research concept for studying population health and social-biological translation. The cluster of cardiovascular risk factors labeled the metabolic syndrome is linked with low socioeconomic status. Systematic differences in diet and physical activity contribute to social patterning of the syndrome. In addition, psychosocial factors including chronic work stress are linked with its development. Psychosocial factors could lead to metabolic perturbations and increase cardiovascular risk via activation of neuroendocrine responses, for example, in the autonomic nervous system and in several hormonal pathways. High glucocorticoid levels will promote lipid storage in visceral rather than subcutaneous adipose tissue. Adipocytes secrete several proinflammatory cytokines, which considered major contributors to increase in oxidants and cell injury. Upregulation of heme oxygenase 1 (HO-1) and peroxidase in the early development of diabetes produces a decrease in oxidative-mediated injury. Increased HO activity is associated with a significant decrease in superoxide, endothelial cell shedding and blood pressure. Finally, it is proposed that overexpression of glutathione peroxidase in beta cells may protect beta cell deterioration from oxidative stress during development of diabetes and hyperglycemia and this may result in attenuation of beta cell failure. If this proves to be the case, then the scene will be set to develop glutathione peroxidase mimetics for use in preclinical and clinical trials.
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Affiliation(s)
- N G Abraham
- New York Medical College, Department of Pharmacology, Valhalla, NY 10595. USA.
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41
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Enhancing Heart Rate Variability. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50100-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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42
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Urbancic-Rovan V, Meglic B, Stefanovska A, Bernjak A, Azman-Juvan K, Kocijancic A. Incipient cardiovascular autonomic imbalance revealed by wavelet analysis of heart rate variability in Type 2 diabetic patients. Diabet Med 2007; 24:18-26. [PMID: 17227320 DOI: 10.1111/j.1464-5491.2007.02019.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Incipient cardiovascular autonomic imbalance is not readily diagnosed by conventional methods. Spectral analysis of heart rate variability (HRV) by wavelet transform (WT) was used to measure cardiovascular autonomic function in patients with Type 2 diabetes. METHODS Thirty-two diabetic patients without (D), 26 with cardiovascular autonomic neuropathy (DAN) and 72 control subjects (C) participated. A 30-min HRV time series was analysed by wavelet transformation and four characteristic frequency intervals were defined: I (0.0095-0.021 Hz), II (0.021-0.052 Hz), III (0.052-0.145 Hz) and IV (0.145-0.6 Hz). RESULTS When compared with C, in both D and DAN the normalized power and amplitude of interval II were increased and of interval IV decreased, resulting in a significantly higher II/IV ratio. Furthermore, in DAN the normalized power and amplitude of interval I were increased and of interval III decreased when compared with the D and C groups. The diabetic patients were divided in two equal subgroups according to HbA(1c) < 8.0% and >or= 8.0%. In the subgroup with HbA(1c) >or= 8.0%, normalized power in interval II was significantly higher and in interval IV significantly lower than in the subgroup with HbA(1c) < 8.0%. In D, but not in DAN patients prescribed ACE inhibitors, the absolute amplitude and power of oscillations were significantly higher than in patients not taking ACE inhibitor therapy. CONCLUSIONS Patients with diabetes have increased sympathetic and decreased parasympathetic cardiac activity regardless of the presence of autonomic neuropathy. Glycaemic control and treatment with ACE inhibitors may favourably influence HRV in diabetic patients without autonomic neuropathy.
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Affiliation(s)
- V Urbancic-Rovan
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, University of Ljubljana, Ljubljana, Slovenia.
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Brinkworth GD, Noakes M, Buckley JD, Clifton PM. Weight loss improves heart rate recovery in overweight and obese men with features of the metabolic syndrome. Am Heart J 2006; 152:693.e1-6. [PMID: 16996838 DOI: 10.1016/j.ahj.2006.07.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 07/27/2006] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart rate recovery (HRR) is an independent risk factor for cardiovascular disease (CVD) and mortality, but whether it is modifiable and can improve with weight loss is unclear. We sought to determine the effects of weight loss on HRR and its association with traditional CVD risk markers. METHODS Heart rate recovery (defined as the decrease in heart rate from peak heart rate to that measured 1 minute after a standardized graded treadmill test) and a range of established cardiovascular risk factors were measured in 42 overweight and obese men (body mass index 33.8 +/- 0.6 kg/m2, mean age 46.5 +/- 1.3 years) who had no symptoms of CVD but had components of the metabolic syndrome before and after 12 weeks of weight loss. RESULTS There was a 9% weight reduction (P < .001), with losses of 6.3 +/- 0.6 kg of fat mass (P < .001) and 3.1 +/- 0.6 kg of non-bone fat-free mass (P < .001). There were significant reductions in waist circumference, blood pressure, plasma triglycerides, total cholesterol, low-density lipoprotein cholesterol, triglyceride/high-density lipoprotein ratio, C-reactive protein, plasma insulin, glucose, and insulin resistance (P < .05). Although peak heart rate remained unchanged, HRR at 1 minute improved from 33.1 +/- 1.4 to 36.9 +/- 1.3 beats/min (P < .001) after weight loss. There was no change in cardiorespiratory fitness (P = .30); neither was there any change in physical activity levels (P = .67). The improvement in HRR was significantly correlated with decreases in body weight, body mass index, waist circumference, plasma glucose, serum triglycerides, and triglyceride/high-density lipoprotein ratio; however, it was only independently associated with changes in weight and plasma glucose concentrations. CONCLUSION In addition to improving a range of well-accepted cardiovascular and metabolic risk factors, weight loss also improves HRR after exercise, a less recognized risk factor.
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Affiliation(s)
- Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organization-Human Nutrition, Adelaide, South Australia, Australia.
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Iellamo F, Tesauro M, Rizza S, Aquilani S, Cardillo C, Iantorno M, Turriziani M, Lauro R. Concomitant Impairment in Endothelial Function and Neural Cardiovascular Regulation in Offspring of Type 2 Diabetic Subjects. Hypertension 2006; 48:418-23. [PMID: 16864746 DOI: 10.1161/01.hyp.0000234648.62994.ab] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endothelial function is impaired in first-degree relatives (FDRs) of patients with type 2 diabetes. Many states characterized by endothelial dysfunction are associated with increased cardiovascular sympathetic outflow. In this study, we investigated endothelial and autonomic nervous system (ANS) functioning in FDRs and tested the hypothesis that in basal condition, impaired endothelial function is associated with impaired cardiovascular ANS regulation. Flow-mediated endothelium-dependent and -independent vasodilation of the brachial artery was measured with high-resolution ultrasound in 27 otherwise healthy FDRs (14 men and 13 women; mean age 32 years) with normal oral glucose tolerance and in 15 age- and gender-matched control subjects. Cardiovascular ANS regulation was investigated by means of spectral analysis of heart rate and systolic blood pressure (SBP) variability. Baroreflex sensitivity was assessed by the spontaneous baroreflex sequences technique. Flow-mediated endothelium-dependent vasodilation was 9.4+/-1.0% in FDRs and 17.0+/-2.3% in control subjects (P=0.001). Low-frequency oscillations in SBP variability were 8.6+/-2.8 and 2.8+/-0.6 mm Hg in FDRs and controls, respectively (P=0.04). Baroreflex sensitivity was significantly less in FDRs than controls (22.8+/-2.7 versus 37.0+/-5.8, respectively; P=0.01). Change in vessel diameter was inversely correlated with the low-frequency component of SBP variability (r=-0.40; P=0.014). In healthy FDRs of diabetic patients there is a concomitant, possibly related, impairment in endothelial and ANS functioning, which manifests, indirectly, with increase in vascular sympathetic outflow and a depressed baroreflex, vagal, control of heart rate.
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Affiliation(s)
- Ferdinando Iellamo
- Dipartimento Medicina Interna, Università di Roma Tor Vergata, Rome, Italy.
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Abstract
Heart rate (HR) recovery after exercise is a function of vagal reactivation, and its impairment is a predictor of overall mortality and adverse cardiovascular events. While metabolic syndrome is associated with sympathetic overactivity, little is known about the relationship between metabolic syndrome and HR recovery. A symptom-limited exercise stress test in healthy subjects (n=1, 434) was used to evaluate HR recovery. Metabolic syndrome was defined according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) criteria. Seventeen percent of subjects had > or =3 criteria for metabolic syndrome. HR recovery was lower in men than women and in smokers than nonsmokers. The subject with metabolic syndrome (vs. without) showed lower HR recovery (10.3+/-11.6 vs. 13.6+/-9.7 per minute) and higher resting HR (64.3+/-10.3 vs. 61.6+/-9.1 per minute). HR recovery correlated inversely to age (r=-0.25, p<0.0001), but not to resting HR or maximal oxygen uptake. Delayed HR recovery was associated with metabolic syndrome after an adjustment for age, sex, resting HR and smoking (p<0.01). Metabolic syn-drome is associated with impaired vagal reactivation. Adverse cardiovascular out-comes associated with metabolic syndrome may be mediated by the failure of vagal reactivation in addition to sympathetic overactivity.
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Affiliation(s)
- Jidong Sung
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Ho Choi
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Bae Park
- Department of Medicine/Cardiology, Cheil General Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Perciaccante A, Fiorentini A, Paris A, Serra P, Tubani L. Circadian rhythm of the autonomic nervous system in insulin resistant subjects with normoglycemia, impaired fasting glycemia, impaired glucose tolerance, type 2 diabetes mellitus. BMC Cardiovasc Disord 2006; 6:19. [PMID: 16670002 PMCID: PMC1525196 DOI: 10.1186/1471-2261-6-19] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 05/02/2006] [Indexed: 11/23/2022] Open
Abstract
Background In type 2 diabetes mellitus both insulin resistance and hyperglycemia are considered responsible for autonomic dysfunction. The relation between the autonomic activity, impaired fasting glycemia and impaired glucose tolerance is, however, unclear. The purpose of this study was to evaluate and compare the circadian autonomic activity expressed as heart rate variability (HRV) measured by 24-hours ECG recording in insulin resistant subjects (IR) with characteristics as follow: IR subjects with normal oral glucose tolerance test results, IR subjects with impaired fasting glucose, IR subjects with impaired glucose tolerance and subjects with type 2 diabetes mellitus. Methods Eighty Caucasian insulin resistant subjects (IR) and twenty five control subjects were recruited for the study. IR subjects were divided into four groups according to the outcoming results of oral glucose tests (OGTTs): IR subjects with normal glucose regulation (NGR), IR subjects with impaired fasting glycemia (IFG), IR subjects with impaired glucose tolerance (IGT) and subjects with type 2 diabetes mellitus (DM). Autonomic nervous activity was studied by 24-hours ECG recording. Heart rate variability analysis was performed in time and frequency domains: SDNN, RMS-SD, low frequency (LF) and high frequency (HF) were calculated. Results The total SDNN showed statistically significant reduction in all four groups with insulin resistant subjects (IR) when compared to the control group (p <0,001). During night LF normalized units (n.u.) were found to be higher in all four groups including IR subjects than in the control group (all p < 0,001) and subjects with normal glucose regulation (NGR), with impaired fasting glycemia (IFG) and with impaired glucose tolerance (IGT) were found to have higher LF n.u. than those in the type 2 diabetes mellitus group. The linear regression model demonstrated direct association between LF values and the homeostasis model assessment-index (HOMA-I), in the insulin resistant group (r = 0,715, p <0,0001). Conclusion The results of our study suggest that insulin resistance might cause global autonomic dysfunction which increases along with worsening glucose metabolic impairment. The analysis of sympathetic and parasympathetic components and the sympathovagal balance demonstrated an association between insulin resistance and sympathetic over-activity, especially during night. The results indicated that the sympathetic over-activity is directly correlated to the grade of insulin resistance calculated according to the HOMA-I. Since increased sympathetic activity is related to major cardiovascular accidents, early diagnosis of all insulin resistant patients should be contemplated.
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Affiliation(s)
- Antonio Perciaccante
- III Clinica Medica, Department of Clinical Medicine, University "La Sapienza", Rome, Italy
| | - Alessandra Fiorentini
- III Clinica Medica, Department of Clinical Medicine, University "La Sapienza", Rome, Italy
| | - Alberto Paris
- III Clinica Medica, Department of Clinical Medicine, University "La Sapienza", Rome, Italy
| | - Pietro Serra
- III Clinica Medica, Department of Clinical Medicine, University "La Sapienza", Rome, Italy
| | - Luigi Tubani
- Medicina Interna E, Department of Clinical Medicine, University "La Sapienza", Rome, Italy
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Chemla D, Young J, Badilini F, Maison-Blanche P, Affres H, Lecarpentier Y, Chanson P. Comparison of fast Fourier transform and autoregressive spectral analysis for the study of heart rate variability in diabetic patients. Int J Cardiol 2006; 104:307-13. [PMID: 16186061 DOI: 10.1016/j.ijcard.2004.12.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Revised: 09/13/2004] [Accepted: 12/07/2004] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Impaired heart rate variability (HRV) is associated with poor outcome in diabetic patients. The present prospective study compared spectral components of HRV obtained by either fast Fourier transform (FFT) or autoregressive (AR) analyses in diabetic patients. METHODS Thirty patients (49+/-12 years; 11 F/19 M; 60% with insulin-dependent type 1 diabetes) underwent 24-h ambulatory electrocardiographic recordings which comprised a 10-min resting period at the onset (n=30) and end (n=12) of the monitoring. Spectral analysis was applied to 5-min sequences at rest, and the total power and power spectra integrated over the very low (VLF), low (LF), and high (HF) frequency bands were obtained. RESULTS Fifteen patients had moderately depressed HRV and two patients had highly depressed HRV (standard deviation of the RR intervals over 24-h<100 ms and <50 ms, respectively). Both raw data and ln-transformed data were significantly different between FFT and AR. All spectra component were obtained in each patient using FFT. Using AR, the LF/HF ratio could not be estimated or was zero in 4 and 11 patients, respectively. The AR results were more sensitive than FFT results to minor changes (+/-5%) in the timing of the onset of analysis. The day-to-day reproducibility of FFT was better than that of AR. Finally, using FFT, the LF/HF ratio, LFnu, and HFnu were essentially redundant (nu=normalized units). CONCLUSIONS The spectral components of short-term HRV calculated by using the FFT and AR methods were not interchangeable and FFT analysis must be preferred in diabetic patients.
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Affiliation(s)
- Denis Chemla
- Service de Physiologie Cardio-Respiratoire and Service d'Endocrinologie, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hopitaux de Paris, Université Paris Sud 11, 94 275 Le Kremlin Bicêtre, France.
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Gazzaruso C, Solerte SB, De Amici E, Mancini M, Pujia A, Fratino P, Giustina A, Garzaniti A. Association of the metabolic syndrome and insulin resistance with silent myocardial ischemia in patients with type 2 diabetes mellitus. Am J Cardiol 2006; 97:236-9. [PMID: 16442369 DOI: 10.1016/j.amjcard.2005.07.133] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 07/28/2005] [Accepted: 07/28/2005] [Indexed: 12/13/2022]
Abstract
Metabolic syndrome is associated with elevated morbidity and mortality for overt coronary artery disease (CAD). In diabetic patients, CAD is often silent. The relation between metabolic syndrome and silent CAD has never been studied. We investigated whether metabolic syndrome is associated with silent CAD in patients with type 2 diabetes mellitus. We evaluated the prevalence of metabolic syndrome in 169 patients with uncomplicated diabetes and angiographically verified silent CAD and in 158 diabetic patients without myocardial ischemia on exercise electrocardiography, 48-hours ambulatory electrocardiography, and stress echocardiography. The groups were comparable for gender, age, glycemic control, and diabetes duration. Metabolic syndrome was defined according to the National Cholesterol Education Program criteria. To estimate insulin resistance in patients treated with diet alone or oral agents (122 patients with CAD and 115 patients without CAD), the Homeostasis Model Insulin-Resistance Assessment (HOMA) was used. The prevalence of metabolic syndrome (59.8% vs 44.3%, p = 0.005) and HOMA (5.4 +/- 2.1 vs 4.9 +/- 2.8, p = 0.044) were significantly higher in those with CAD than in those without CAD. Multiple logistic regression analysis showed that the metabolic syndrome was associated with silent CAD (odds ratio 2.44, 95% confidence interval 1.19 to 5.02, p = 0.015). Among patients on diet alone or oral agents, the HOMA was the strongest predictor of silent CAD (odds ratio 10.16, 95% confidence interval 2.60 to 39.63, p < 0.001). In conclusion, our data have shown an independent association of metabolic syndrome and insulin resistance with silent CAD in patients with type 2 diabetes mellitus. Other studies are needed to establish whether metabolic syndrome and HOMA are reliable markers to identify diabetic patients for additional screening for silent CAD.
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Frontoni S, Bracaglia D, Gigli F. Relationship between autonomic dysfunction, insulin resistance and hypertension, in diabetes. Nutr Metab Cardiovasc Dis 2005; 15:441-449. [PMID: 16314230 DOI: 10.1016/j.numecd.2005.06.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 06/15/2005] [Accepted: 06/21/2005] [Indexed: 11/23/2022]
Abstract
Sympathovagal imbalance and insulin resistance are the common underlying disorders linking hypertension and diabetes. The role of hyperinsulinemia, however, on sympathovagal balance and blood pressure has never been clearly dissected from that of hyperglycemia. Nevertheless, the study of animal models of hypertension showed that hypertension does not invariably result in the onset of insulin resistance. This suggests that insulin resistance precedes the onset of hypertension and (possibly) contributes to its pathogenesis, mainly through sympathetic activation. To examine this hypothesis, recent studies investigated the relationship between insulin sensitivity and sympathetic activity in subjects with insulin resistance but free of overt hyperglycemia and obesity, i.e., insulin-resistant offspring of type 2 diabetic patients, demonstrating a prevalence of sympathetic over vagal activity. Therefore insulin resistance and sympathovagal imbalance come before hypertension, but a clear causative role cannot be demonstrated since other mechanisms, including an inappropriate lifestyle, must be taken into account to determine clinical hypertension. Finally, several experiments in human healthy volunteers suggest that the modulation of autonomic regulation at the forearm level can regulate insulin sensitivity, tempting us to speculate that it is the primary autonomic imbalance, through vasoconstriction, that results in both insulin resistance and hypertension. In conclusion, the close relationship between autonomic imbalance, insulin resistance and hypertension is unquestionable; although logical hypothesis can be constructed, which of the three is the earliest event is still not understood, and further research is required.
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Affiliation(s)
- Simona Frontoni
- Diabetes Center, Department of Internal Medicine, University of Rome Tor Vergata, Viale Duilio Cambellotti 11, I-00133 Rome, Italy.
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Burén J, Eriksson JW. Is insulin resistance caused by defects in insulin's target cells or by a stressed mind? Diabetes Metab Res Rev 2005; 21:487-94. [PMID: 15977304 DOI: 10.1002/dmrr.567] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The importance of understanding insulin action is emphasized by the increasing prevalence of insulin resistance in various populations and by the fact that it plays an important pathophysiological role in many common disorders, for example, diabetes, obesity, hypertension and dyslipidemia. The primary factors responsible for the development of insulin resistance are so far unknown, although both genetic and environmental factors are involved. The genetic defects responsible for the common forms of insulin resistance, for example, in type 2 diabetes, are largely unidentified. Some studies from our group as well as by other investigators suggest that cellular insulin resistance is reversible and that it may be secondary to factors in the in vivo environment. These may include insulin-antagonistic action of hormones like catecholamines, glucocorticoids, sex steroids and adipokines as well as dysregulation of autonomic nervous activity and they could contribute to the early development of insulin resistance. Some of these factors can directly impair glucose uptake capacity and this might be due to alterations in key proteins involved in insulin's intracellular signaling pathways. This article briefly summarizes proposed mechanisms behind cellular and whole-body insulin resistance. In particular, we question the role of intrinsic defects in insulin's target cells as primary mechanisms in the development of insulin resistance in type 2 diabetes and we suggest that metabolic and neurohormonal factors instead are the main culprits.
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Affiliation(s)
- Jonas Burén
- Department of Public Health and Clinical Medicine, Medicine, Umeå University Hospital, Umeå, Sweden.
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