1
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Zeid S, Buch G, Velmeden D, Söhne J, Schulz A, Schuch A, Tröbs SO, Heidorn MW, Müller F, Strauch K, Coboeken K, Lackner KJ, Gori T, Münzel T, Prochaska JH, Wild PS. Heart rate variability: reference values and role for clinical profile and mortality in individuals with heart failure. Clin Res Cardiol 2024; 113:1317-1330. [PMID: 37422841 PMCID: PMC11371886 DOI: 10.1007/s00392-023-02248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/19/2023] [Indexed: 07/11/2023]
Abstract
AIMS To establish reference values and clinically relevant determinants for measures of heart rate variability (HRV) and to assess their relevance for clinical outcome prediction in individuals with heart failure. METHODS Data from the MyoVasc study (NCT04064450; N = 3289), a prospective cohort on chronic heart failure with a highly standardized, 5 h examination, and Holter ECG recording were investigated. HRV markers were selected using a systematic literature screen and a data-driven approach. Reference values were determined from a healthy subsample. Clinical determinants of HRV were investigated via multivariable linear regression analyses, while their relationship with mortality was investigated by multivariable Cox regression analyses. RESULTS Holter ECG recordings were available for analysis in 1001 study participants (mean age 64.5 ± 10.5 years; female sex 35.4%). While the most frequently reported HRV markers in literature were from time and frequency domains, the data-driven approach revealed predominantly non-linear HRV measures. Age, sex, dyslipidemia, family history of myocardial infarction or stroke, peripheral artery disease, and heart failure were strongly related to HRV in multivariable models. In a follow-up period of 6.5 years, acceleration capacity [HRperSD 1.53 (95% CI 1.21/1.93), p = 0.0004], deceleration capacity [HRperSD: 0.70 (95% CI 0.55/0.88), p = 0.002], and time lag [HRperSD 1.22 (95% CI 1.03/1.44), p = 0.018] were the strongest predictors of all-cause mortality in individuals with heart failure independently of cardiovascular risk factors, comorbidities, and medication. CONCLUSION HRV markers are associated with the cardiovascular clinical profile and are strong and independent predictors of survival in heart failure. This underscores clinical relevance and interventional potential for individuals with heart failure. CLINICALTRIALS GOV IDENTIFIER NCT04064450.
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Affiliation(s)
- Silav Zeid
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Gregor Buch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - David Velmeden
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Jakob Söhne
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Alexander Schuch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Sven-Oliver Tröbs
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Marc William Heidorn
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Felix Müller
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Konstantin Strauch
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katrin Coboeken
- SPM Methods and Applications, Research and Development, Pharmaceuticals, BAYER AG, Wuppertal, Germany
| | - Karl J Lackner
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tommaso Gori
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Cardiology I, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Cardiology I, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen H Prochaska
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
- Institute of Molecular Biology (IMB), Mainz, Germany.
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Mulla IG, Anjankar A, Pratinidhi S, Agrawal SV, Gundpatil D, Lambe SD. Prediabetes: A Benign Intermediate Stage or a Risk Factor in Itself? Cureus 2024; 16:e63186. [PMID: 39070421 PMCID: PMC11273947 DOI: 10.7759/cureus.63186] [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: 06/09/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Prediabetes is a condition when the blood glucose levels are above the normal range but below the threshold for defining diabetes. Previously considered benign, it is now recognized to be associated with various macrovascular and microvascular complications, with increases in the risk of cardiovascular events, nephropathy neuropathy, and retinopathy. Early identification of prediabetics may help detect the risk for these future complications at an earlier stage. Moreover, therapeutic options for prediabetes are available, which can retard its progression to diabetes and the subsequent development of complications. Hence, we make a case for the early identification of prediabetes through screening methods and appropriate institution of management strategies.
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Affiliation(s)
- Irfan G Mulla
- Biochemistry, Datta Meghe Institute of Higher Education & Research (DMIHER), Wardha, IND
| | | | - Shilpa Pratinidhi
- Biochemistry, Bharatratna Atalbihari Vajpayee Medical College, Pune, Pune, IND
| | - Sarita V Agrawal
- Biochemistry, Bharatratna Atalbihari Vajpayee Medical College, Pune, Pune, IND
| | - Deepak Gundpatil
- Biochemistry, Bharatratna Atalbihari Vajpayee Medical College, Pune, Pune, IND
| | - Sandip D Lambe
- Biochemistry, Smt Mathurabai Bhausaheb Thorat (SMBT) Institute of Medical Sciences and Research Centre, Nashik, IND
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3
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Howell CR, Zhu S, Malla G, Carson G, Cummings D, Uddin J, Levitan EB, Safford M, Cherrington AL, Long DL. Defining diabetes status using medication groups in Medicare data: Trends in prescribing diabetes medications to patients without a diabetes diagnosis over time. Diabetes Obes Metab 2024; 26:1548-1551. [PMID: 38253946 DOI: 10.1111/dom.15450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sha Zhu
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gargya Malla
- Department of Medicine, University of Arizona, Tuscon, AZ, USA
| | - Gargya Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Doyle Cummings
- Departments of Public Health and Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Jalal Uddin
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika Safford
- Department of Medicine, Division of General Internal Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - Andrea L Cherrington
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Dave D, Vyas K, Branan K, McKay S, DeSalvo DJ, Gutierrez-Osuna R, Cote GL, Erraguntla M. Detection of Hypoglycemia and Hyperglycemia Using Noninvasive Wearable Sensors: Electrocardiograms and Accelerometry. J Diabetes Sci Technol 2024; 18:351-362. [PMID: 35927975 PMCID: PMC10973850 DOI: 10.1177/19322968221116393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Monitoring glucose excursions is important in diabetes management. This can be achieved using continuous glucose monitors (CGMs). However, CGMs are expensive and invasive. Thus, alternative low-cost noninvasive wearable sensors capable of predicting glycemic excursions could be a game changer to manage diabetes. METHODS In this article, we explore two noninvasive sensor modalities, electrocardiograms (ECGs) and accelerometers, collected on five healthy participants over two weeks, to predict both hypoglycemic and hyperglycemic excursions. We extract 29 features encompassing heart rate variability features from the ECG, and time- and frequency-domain features from the accelerometer. We evaluated two machine learning approaches to predict glycemic excursions: a classification model and a regression model. RESULTS The best model for both hypoglycemia and hyperglycemia detection was the regression model based on ECG and accelerometer data, yielding 76% sensitivity and specificity for hypoglycemia and 79% sensitivity and specificity for hyperglycemia. This had an improvement of 5% in sensitivity and specificity for both hypoglycemia and hyperglycemia when compared with using ECG data alone. CONCLUSIONS Electrocardiogram is a promising alternative not only to detect hypoglycemia but also to predict hyperglycemia. Supplementing ECG data with contextual information from accelerometer data can improve glucose prediction.
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Affiliation(s)
- Darpit Dave
- Wm Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Kathan Vyas
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, USA
| | - Kimberly Branan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Siripoom McKay
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital Clinical Care Center, Houston, TX, USA
| | - Daniel J. DeSalvo
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital Clinical Care Center, Houston, TX, USA
| | - Ricardo Gutierrez-Osuna
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, USA
| | - Gerard L. Cote
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Madhav Erraguntla
- Wm Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
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Hamaoka T, Leuenberger UA, Drew RC, Murray M, Blaha C, Luck JC, Sinoway LI, Cui J. Glucose metabolism and autonomic function in healthy individuals and patients with type 2 diabetes mellitus at rest and during exercise. Exp Physiol 2024; 109:214-226. [PMID: 38050866 PMCID: PMC10841625 DOI: 10.1113/ep091444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
Autonomic dysfunction is a common complication of type 2 diabetes mellitus (T2DM). However, the character of dysfunction varies in different reports. Differences in measurement methodology and complications might have influenced the inconsistent results. We sought to evaluate comprehensively the relationship between abnormal glucose metabolism and autonomic function at rest and the response to exercise in healthy individuals and T2DM patients. We hypothesized that both sympathetic and parasympathetic indices would decrease with the progression of abnormal glucose metabolism in individuals with few complications related to high sympathetic tone. Twenty healthy individuals and 11 T2DM patients without clinically evident cardiovascular disease other than controlled hypertension were examined. Resting muscle sympathetic nerve activity (MSNA), heart rate variability, spontaneous cardiovagal baroreflex sensitivity (CBRS), sympathetic baroreflex sensitivity and the MSNA response to handgrip exercise were measured. Resting MSNA was lower in patients with T2DM than in healthy control subjects (P = 0.011). Resting MSNA was negatively correlated with haemoglobin A1c in all subjects (R = -0.45, P = 0.024). The parasympathetic components of heart rate variability and CBRS were negatively correlated with glycaemic/insulin indices in all subjects and even in the control group only (all, P < 0.05). In all subjects, the MSNA response to exercise was positively correlated with fasting blood glucose (R = 0.69, P < 0.001). Resting sympathetic activity and parasympathetic modulation of heart rate were decreased in relationship to abnormal glucose metabolism. Meanwhile, the sympathetic responses to handgrip were preserved in diabetics. The responses were correlated with glucose/insulin parameters throughout diabetic and control subjects. These results suggest the importance of a comprehensive assessment of autonomic function in T2DM.
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Affiliation(s)
- Takuto Hamaoka
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineHersheyPennsylvaniaUSA
| | - Urs A. Leuenberger
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineHersheyPennsylvaniaUSA
| | - Rachel C. Drew
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineHersheyPennsylvaniaUSA
- Department of Exercise and Health SciencesUniversity of Massachusetts BostonBostonMassachusettsUSA
| | - Matthew Murray
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineHersheyPennsylvaniaUSA
| | - Cheryl Blaha
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineHersheyPennsylvaniaUSA
| | - Jonathan Carter Luck
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineHersheyPennsylvaniaUSA
| | - Lawrence I. Sinoway
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineHersheyPennsylvaniaUSA
| | - Jian Cui
- Penn State Heart and Vascular InstitutePennsylvania State University College of MedicineHersheyPennsylvaniaUSA
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6
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Körei AE, Békeffy M, Menyhárt A, Osgyán K, Istenes I, Horváth VJ, Kempler P. No clear evidence of neuropathy among patients with high risk for the development of prediabetes/diabetes-a pilot study. Front Endocrinol (Lausanne) 2024; 15:1302013. [PMID: 38352713 PMCID: PMC10863448 DOI: 10.3389/fendo.2024.1302013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Autonomic and sensory neuropathy have been observed in both prediabetes and manifest diabetes mellitus. However, there is a lack of available data regarding whether patients at a moderate or high risk of developing diabetes, yet without a current diagnosis of prediabetes or diabetes, exhibit an increased prevalence of neuropathy. Methods FINDRISC (Finnish Diabetes Risk Score) was used to classify individuals at risk (≥12 points, n = 44; control <12 points, n = 28). HbA1c levels >5.6% served as exclusion criteria, and patients with known medical conditions predisposing to neuropathy were also excluded. Cardiac autonomic function (Ewing tests) and peripheral sensory neuropathy (Neurometer and Q-sense) were assessed by standardized protocols, and their potential association with increased FINDRISC points was analyzed using a regression model. Results Mean age was 46.7 ± 14.3 years in the control and 55.7 ± 14.1 years in the increased risk group. Male/female ratio did not differ. Individuals with increased risk of diabetes were more obese (BMI: 29.9 ± 12.5 kg/m2 vs. 25.9 ± 8.9 kg/m2). Additionally, hypertension was more frequent among them (68.2% vs. 17.9%), and their lipid parameters were also less favorable. Parasympathetic neuropathy was present in both groups (56.8% vs. 32.1%, respectively). Sympathetic neuropathy was not found. Sensory nerve dysfunction was of low prevalence in the high-risk group and did not occur in healthy controls. In multiple logistic regression analysis, HbA1c exhibited an independent association with parasympathetic neuropathy (OR: 5.9; 95% CI: 1.08-32.68; p < 0.041). Discussion An increased risk of developing prediabetes/diabetes does not appear to have a strong correlation with an increased likelihood of developing autonomic or sensory neuropathy. However, the etiology behind the occurrence of parasympathetic autonomic neuropathy in healthy individuals remains unknown.
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Affiliation(s)
| | | | | | | | | | - Viktor J. Horváth
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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7
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Šorli J, Lenasi H. The Effect of Acute Hyperglycaemia Induced by Oral Glucose Load on Heart Rate Variability and Skin Microvascular Reactivity in Young Adults. Life (Basel) 2023; 14:56. [PMID: 38255671 PMCID: PMC10817604 DOI: 10.3390/life14010056] [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: 11/13/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
We aimed to elucidate the effects of acute hyperglycaemia, induced by an oral glucose tolerance test (OGTT), on the autonomic nervous system (ANS) and skin microvascular reactivity at the time point of peak plasma glucose concentration (cglc) in 20 young, healthy participants. We assessed their heart rate variability (HRV) as a measure of the ANS activity and the parameters of post-occlusive reactive hyperaemia (PORH) to estimate skin microvascular reactivity as measured by laser Doppler (LD) fluxmetry. The tests were repeated 30 min after a standard OGTT (75 g glucose dissolved in 250 mL water) and, in a separate control experiment, after drinking the same amount of water. Participants had their cglc and serum insulin measured at three consecutive time-points according to the testing protocol. The low-frequency (LF) spectral power, the LF to high-frequency (LF/HF) ratio, and the diastolic blood pressure increased significantly more after water than after OGTT, and there was a trend of the peak LD flux of PORH decreasing more after OGTT than after water. Significant correlations between some PORH and all the HRV parameters and cglc increase after OGTT were found, implying diminished vascular reactivity evoked by hyperglycaemia in healthy subjects with lower glucose tolerance.
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Affiliation(s)
- Jernej Šorli
- General Hospital Dr. Franc Derganc, 5290 Šempeter pri Gorici, Slovenia
| | - Helena Lenasi
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia
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8
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Ziegler D, Herder C, Papanas N. Neuropathy in prediabetes. Diabetes Metab Res Rev 2023; 39:e3693. [PMID: 37470302 DOI: 10.1002/dmrr.3693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/13/2023] [Accepted: 06/18/2023] [Indexed: 07/21/2023]
Abstract
Diabetic neuropathies are the most frequent complications of diabetes, contributing to high morbidity, excess mortality, reduced quality of life, and increased healthcare costs. Prediabetes is characterised by glucose levels within an intermediate range above normoglycaemia yet below the diagnostic threshold for diabetes. In 2021, 10.6% and 6.2% of adults worldwide were estimated to have impaired glucose tolerance and impaired fasting glucose, respectively, the majority of whom are unaware of having prediabetes. Evidence has accumulated suggesting that prediabetes is a predictor of cardiovascular disease (CVD) and increased mortality. The past 2 decades have witnessed an extensive debate, particularly among diabetologists and neurologists, as to whether prediabetes is associated with peripheral neuropathy. In this review, we elaborate on the current evidence, particularly from population-based studies supporting an increased risk of distal sensorimotor polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN) in people with prediabetes. Moreover, we discuss whether lifestyle interventions showing efficacy in preventing or delaying the transition from prediabetes to diabetes in persons with prediabetes may also exert favourable effects on the development and progression of DSPN and CAN. This review should help in raising the awareness of and translating the current knowledge on neuropathies in people with prediabetes into clinical practice and public health. The current recommendation that adults who are overweight or obese should be screened for prediabetes and referred to or offered preventive interventions should ultimately culminate in preventing not only CVD but also prediabetic neuropathy.
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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, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nikolaos Papanas
- Diabetes Centre, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Shi B, Dhaliwal SS, Soo M, Chan C, Wong J, Lam NWC, Zhou E, Paitimusa V, Loke KY, Chin J, Chua MT, Liaw KCS, Lim AWH, Insyirah FF, Yen SC, Tay A, Ang SB. Assessing Elevated Blood Glucose Levels Through Blood Glucose Evaluation and Monitoring Using Machine Learning and Wearable Photoplethysmography Sensors: Algorithm Development and Validation. JMIR AI 2023; 2:e48340. [PMID: 38875549 PMCID: PMC11041426 DOI: 10.2196/48340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND Diabetes mellitus is the most challenging and fastest-growing global public health concern. Approximately 10.5% of the global adult population is affected by diabetes, and almost half of them are undiagnosed. The growing at-risk population exacerbates the shortage of health resources, with an estimated 10.6% and 6.2% of adults worldwide having impaired glucose tolerance and impaired fasting glycemia, respectively. All current diabetes screening methods are invasive and opportunistic and must be conducted in a hospital or laboratory by trained professionals. At-risk participants might remain undetected for years and miss the precious time window for early intervention to prevent or delay the onset of diabetes and its complications. OBJECTIVE We aimed to develop an artificial intelligence solution to recognize elevated blood glucose levels (≥7.8 mmol/L) noninvasively and evaluate diabetic risk based on repeated measurements. METHODS This study was conducted at KK Women's and Children's Hospital in Singapore, and 500 participants were recruited (mean age 38.73, SD 10.61 years; mean BMI 24.4, SD 5.1 kg/m2). The blood glucose levels for most participants were measured before and after consuming 75 g of sugary drinks using both a conventional glucometer (Accu-Chek Performa) and a wrist-worn wearable. The results obtained from the glucometer were used as ground-truth measurements. We performed extensive feature engineering on photoplethysmography (PPG) sensor data and identified features that were sensitive to glucose changes. These selected features were further analyzed using an explainable artificial intelligence approach to understand their contribution to our predictions. RESULTS Multiple machine learning models were trained and assessed with 10-fold cross-validation, using participant demographic data and critical features extracted from PPG measurements as predictors. A support vector machine with a radial basis function kernel had the best detection performance, with an average accuracy of 84.7%, a sensitivity of 81.05%, a specificity of 88.3%, a precision of 87.51%, a geometric mean of 84.54%, and F score of 84.03%. CONCLUSIONS Our findings suggest that PPG measurements can be used to identify participants with elevated blood glucose measurements and assist in the screening of participants for diabetes risk.
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Affiliation(s)
- Bohan Shi
- Actxa Pte Ltd, Singapore, Singapore
- Activate Interactive Pte Ltd, Singapore, Singapore
| | - Satvinder Singh Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
- Faculty of Health Sciences, Curtin University, Perth, Australia
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | | | - Cheri Chan
- KK Women's and Children's Hospital, Singapore, Singapore
| | | | | | - Entong Zhou
- Activate Interactive Pte Ltd, Singapore, Singapore
| | | | - Kum Yin Loke
- Activate Interactive Pte Ltd, Singapore, Singapore
| | - Joel Chin
- Activate Interactive Pte Ltd, Singapore, Singapore
| | - Mei Tuan Chua
- KK Women's and Children's Hospital, Singapore, Singapore
| | | | | | | | - Shih-Cheng Yen
- Innovation and Design Programme, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Arthur Tay
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Seng Bin Ang
- Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Menopause Unit, KK Women's and Children's Hospital, Singapore, Singapore
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10
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Waataja JJ, Asp AJ, Billington CJ. Combining Celiac and Hepatic Vagus Nerve Neuromodulation Reverses Glucose Intolerance and Improves Glycemic Control in Pre- and Overt-Type 2 Diabetes Mellitus. Biomedicines 2023; 11:2452. [PMID: 37760895 PMCID: PMC10525327 DOI: 10.3390/biomedicines11092452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Neurological disorders and type 2 diabetes mellitus (T2DM) are deeply intertwined. For example, autonomic neuropathy contributes to the development of T2DM and continued unmanaged T2DM causes further progression of nerve damage. Increasing glycemic control has been shown to prevent the onset and progression of diabetic autonomic neuropathies. Neuromodulation consisting of combined stimulation of celiac vagal fibers innervating the pancreas with concurrent electrical blockade of neuronal hepatic vagal fibers innervating the liver has been shown to increase glycemic control in animal models of T2DM. The present study demonstrated that the neuromodulation reversed glucose intolerance in alloxan-treated swine in both pre- and overt stages of T2DM. This was demonstrated by improved performance on oral glucose tolerance tests (OGTTs), as assessed by area under the curve (AUC). In prediabetic swine (fasting plasma glucose (FPG) range: 101-119 mg/dL) the median AUC decreased from 31.9 AUs (IQR = 28.6, 35.5) to 15.9 AUs (IQR = 15.1, 18.3) p = 0.004. In diabetic swine (FPG range: 133-207 mg/dL) the median AUC decreased from 54.2 AUs (IQR = 41.5, 56.6) to 16.0 AUs (IQR = 15.4, 21.5) p = 0.003. This neuromodulation technique may offer a new treatment for T2DM and reverse glycemic dysregulation at multiple states of T2DM involved in diabetic neuropathy including at its development and during progression.
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Affiliation(s)
| | - Anders J. Asp
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55605, USA
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11
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Phillips NE, Collet TH, Naef F. Uncovering personalized glucose responses and circadian rhythms from multiple wearable biosensors with Bayesian dynamical modeling. CELL REPORTS METHODS 2023; 3:100545. [PMID: 37671030 PMCID: PMC10475794 DOI: 10.1016/j.crmeth.2023.100545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/13/2023] [Accepted: 07/06/2023] [Indexed: 09/07/2023]
Abstract
Wearable biosensors and smartphone applications can measure physiological variables over multiple days in free-living conditions. We measure food and drink ingestion, glucose dynamics, physical activity, heart rate (HR), and heart rate variability (HRV) in 25 healthy participants over 14 days. We develop a Bayesian inference framework to learn personal parameters that quantify circadian rhythms and physiological responses to external stressors. Modeling the effects of ingestion events on glucose levels reveals that slower glucose decay kinetics elicit larger postprandial glucose spikes, and we uncover a circadian baseline rhythm for glucose with high amplitudes in some individuals. Physical activity and circadian rhythms explain as much as 40%-65% of the HR variance, whereas the variance explained for HRV is more heterogeneous across individuals. A more complex model incorporating activity, HR, and HRV explains up to 15% of additional glucose variability, highlighting the relevance of integrating multiple biosensors to better predict glucose dynamics.
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Affiliation(s)
- Nicholas E. Phillips
- Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
- Nutrition Unit, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland
| | - Tinh-Hai Collet
- Nutrition Unit, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland
- Diabetes Centre, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Felix Naef
- Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
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Yu L, Yang M, Nie X, Zhou M, Tan Q, Ye Z, Liu W, Liang R, Feng X, Wang B, Chen W. Associations of glucose metabolism and diabetes with heart rate variability: a population-based cohort study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:85569-85577. [PMID: 37391563 DOI: 10.1007/s11356-023-28415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023]
Abstract
The present study aimed to investigate the potential causal pathways and temporal relationships of glucose metabolism and diabetes with heart rate variability (HRV). This cohort study was conducted among a sample of 3858 Chinese adults. At baseline and 6 years follow-up, participants underwent HRV measurement (low frequency [LF], high frequency [HF], total power [TP], standard deviation of all normal-to-normal intervals [SDNN], and square root of the mean squared difference between adjacent normal-to-normal intervals [r-MSSD]) and determination of glucose homeostasis (fasting plasma glucose [FPG] and insulin [FPI], homeostatic model assessment for insulin resistance [HOMA-IR]). The temporal relationships of glucose metabolism and diabetes with HRV were evaluated using cross-lagged panel analysis. FPG, FPI, HOMA-IR, and diabetes were cross-sectionally negatively associated with HRV indices at baseline and follow-up (P < 0.05). Cross-lagged panel analyses demonstrated significant unidirectional paths from baseline FPG to follow-up SDNN (β = -0.06), and baseline diabetes to follow-up low TP group (β = 0.08), low SDNN group (β = 0.05), and low r-MSSD group (β = 0.10) (P < 0.05). No significant path coefficients were observed from baseline HRV to follow-up impaired glucose homeostasis or diabetes. These significant findings persisted even after excluding participants who were taking antidiabetic medication. The results support that elevated FPG and the presence of diabetes may be the causes rather than the consequences of HRV reduction over time.
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Affiliation(s)
- Linling Yu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Meng Yang
- Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430019, Hubei, China
| | - Xiuquan Nie
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Min Zhou
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Qiyou Tan
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Zi Ye
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Wei Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Ruyi Liang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xiaobin Feng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Bin Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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MATERKO W, NEIDE SADALA M, FREIRES FERNANDES D, YAMAGUCHI DA PUREZA D, ADOLFO DUARTE ALBERTO Á, PEREIRA SILVA PENA F. Evaluation on heart rate variability parameters in elderly with type 2 diabetes mellitus using principal component analysis. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2023. [DOI: 10.23736/s0393-3660.22.04782-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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14
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Heart rate variability and the risk of heart failure and its subtypes in post-menopausal women: The Women's Health Initiative study. PLoS One 2022; 17:e0276585. [PMID: 36282885 PMCID: PMC9595519 DOI: 10.1371/journal.pone.0276585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background Low heart rate variability (HRV), a measure of autonomic imbalance, is associated with increased risk of coronary heart disease (CHD) and heart failure (HF). However, its relationship with HF subtypes; heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) has not been studied prior. Methods and findings We conducted a longitudinal study in Women’s Health Initiative study cohort to investigate the association of baseline quartiles of resting heart rate (rHR) and HRV measures; SDNN (SD of normal-to-normal RR interval) and RMSSD (root mean square of successive difference of RR interval) measured by twelve-lead electrocardiogram (ECG) on enrollment, with the risk of hospitalized HF and its subtypes. Total of 28,603 post-menopausal women, predominantly non-Hispanic whites (69%), with a mean (SD) age of 62.6 (7.1) years, free of baseline CHD and HF were included. In a fully adjusted cox-proportional hazards regression model which adjusted for age, race, BMI, alcohol intake, education, physical activity, hyperlipidemia, hypertension, left ventricular hypertrophy, use of beta-blocker, calcium-channel blocker, hormone therapy, and time-varying incident CHD, the hazard ratios of lowest quartile of HRV (Q1) with HF risk were significant (Q1 SDNN compared to Q4 SDNN: 1.22, 95% CI 1.07, 1.39; Q1 RMSSD compared to Q4 RMSSD: 1.17, 95% CI 1.02, 1.33). On subgroup analysis of HF subtypes, low HRV was associated with elevated HFpEF risk (Q1 vs Q4 SDNN: 1.22, 95% CI 1.02, 1.47) but not with HFrEF (Q1 vs Q4 SDNN: 1.19, 95% CI 0.95, 1.50; Q1 RMSSD: 1.13, 95% CI 0.90, 1.43). Conclusion Low HRV is associated with elevated overall hospitalized HF risk and HFpEF risk in post-menopausal women. Whether interventions to increase HRV through healthy lifestyle changes will decrease HF risk warrants further investigation.
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Shell AL, Gonzenbach V, Sawhney M, Crawford CA, Stewart JC. Associations between affective factors and high-frequency heart rate variability in primary care patients with depression. J Psychosom Res 2022; 161:110992. [PMID: 35917659 DOI: 10.1016/j.jpsychores.2022.110992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Depression is a risk factor for cardiovascular disease (CVD), and subgroups of people with depression may be at particularly elevated CVD risk. Lower high-frequency heart rate variability (HF HRV), which reflects diminished parasympathetic activation, is a candidate mechanism underlying the depression-CVD relationship and predicts cardiovascular events. Few studies have examined whether certain depression subgroups - such as those with co-occurring affective factors - exhibit lower HF HRV. The present study sought to assess associations between co-occurring affective factors and HF HRV in people with depression. METHODS Utilizing baseline data from the 216 primary care patients with depression in the eIMPACT trial, we examined cross-sectional associations of depression's co-occurring affective factors (i.e., anxiety symptoms, hostility/anger, and trait positive affect) with HF HRV. HF HRV estimates were derived by spectral analysis from electrocardiographic data obtained during a supine rest period. RESULTS Individual regression models adjusted for demographics and depressive symptoms revealed that anxiety symptoms (standardized regression coefficient β = -0.24, p = .002) were negatively associated with HF HRV; however, hostility/anger (β = 0.02, p = .78) and trait positive affect (β = -0.05, p = .49) were not. In a model further adjusted for hypercholesterolemia, hypertension, diabetes, body mass index, current smoking, CVD prevention medication use, and antidepressant medication use, anxiety symptoms remained negatively associated with HF HRV (β = -0.19, p = .02). CONCLUSION Our findings suggest that, in adults with depression, those with comorbid anxiety symptoms have lower HF HRV than those without. Co-occurring anxiety may indicate a depression subgroup at elevated CVD risk on account of diminished parasympathetic activation.
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Affiliation(s)
- Aubrey L Shell
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Virgilio Gonzenbach
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Manisha Sawhney
- Department of Psychology, Liffrig Family School of Education and Behavioral Sciences, University of Mary, Bismarck, ND, USA
| | - Christopher A Crawford
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA.
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16
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Sailaja AN, Nanda N, Suryanarayana BS, Pal GK. Hypertension attenuates the link of osteoprotegerin to reduced baroreflex sensitivity in type 2 diabetes mellitus patients on oral antidiabetic and antihypertensive therapy - a cross sectional study. BMC Endocr Disord 2022; 22:226. [PMID: 36085061 PMCID: PMC9463832 DOI: 10.1186/s12902-022-01137-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Decreased baroreflex sensitivity (BRS) has been shown to be a marker of cardiovascular (CV) risk. In the present study, the difference in CV risk biomarkers in type 2 diabetes (T2D) patients receiving oral antidiabetic drugs (OAD) with and without hypertension has been assessed. MATERIALS AND METHODS Ninety-two T2D patients on OAD without hypertension (control group) and eighty-eight diabetic patients with hypertension on OAD and antihypertensive drugs (test group) matched for age, gender, body mass index, serum glucose, glycated haemoglobin, and duration of the disease were recruited for the study. Their blood pressure (BP) variability including BRS, heart rate variability (HRV), insulin, lipid profile, osteoprotegerin (OPG), and tumor necrosis factor-α (TNF-α) were estimated. The association of various factors with BRS was assessed by Spearman correlation and multiple regression analysis. RESULTS BRS was decreased (13.90 ± 5.27 vs 6.76 ± 4.58), HRV sympathetic indices [LFnu, LF-HF ratio (1.30 ± 0.49 vs 1.93 ± 0.62)], HOMA-IR, atherogenic index of plasma (AIP), OPG (223.08 ± 103.86 vs 287.60 ± 121.36) and TNF-α were increased, and parasympathetic indices [TP (1012.90 ± 316.18 vs 625.88 ± 229.84), RMSSD, SDNN, NN50, pNN50] were decreased in the test group compared to control group. In control group, parasympathetic indices, AIP, OPG, and TNF-α had a significant correlation and OPG had an independent association (β - 0.344; p 0.004) with BRS. In test group, BP, LF-HF ratio, parasympathetic indices, AIP, OPG, and TNF-α had significant correlation, and TNF-α alone (β - 0.297; p 0.022) had an independent contribution to decreased BRS. CONCLUSION Despite antidiabetic and antihypertensive treatments, T2D patients with hypertension had more cardiometabolic risks in comparison to normotensive T2D patients. Inflammation could be the inciting factor for rise in BP and decrease in BRS (CV risk) in hypertensive T2D patients. Hypertension in diabetes could attenuate the link of OPG to the reduction in BRS. Reduction in BRS could be a physiological marker of CV risk in T2D patients treated with OAD.
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Affiliation(s)
- A Naga Sailaja
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India
| | - Nivedita Nanda
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.
| | - B S Suryanarayana
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - G K Pal
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Handelsman Y, Bunch TJ, Rodbard HW, Steinberg BA, Thind M, Bigot G, Konigsberg L, Wieloch M, Kowey PR. Impact of dronedarone on patients with atrial fibrillation and diabetes: A sub-analysis of the ATHENA and EURIDIS/ADONIS studies. J Diabetes Complications 2022; 36:108227. [PMID: 35717354 DOI: 10.1016/j.jdiacomp.2022.108227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
AIM This post hoc analysis evaluated efficacy and safety of dronedarone in atrial fibrillation (AF) and atrial flutter (AFL) patients with/without diabetes. METHODS Patients were categorized according to baseline diabetes status. Time-to-event analyses were performed using Kaplan-Meier method. Hazard-ratios were assessed using Cox models. RESULTS 945/4628 (dronedarone = 482; placebo = 463) patients in ATHENA and 215/1237 (dronedarone = 148; placebo = 67) patients in EURIDIS/ADONIS studies had diabetes. In ATHENA, there were higher rates of CV hospitalization/death in patients with diabetes (39.5%) than without diabetes (34.7%). Incidence of first CV hospitalization/death was lower in patients with diabetes treated with dronedarone (35.1%) than placebo (44.1%), and time to this event was longer in those treated with dronedarone than placebo (log-rank p = 0.005). Median AF/AFL recurrence time was longer in patients treated with dronedarone than placebo in patients with diabetes (ATHENA: 722 vs 527 days, log-rank p = 0.004; EURIDIS/ADONIS: 100 vs 23 days, log-rank p = 0.15) or without diabetes (ATHENA: 741 vs 492 days, log-rank p < 0.0001; EURIDIS/ADONIS: 120 vs 59 days, log-rank p = 0.0002). Occurrence of any treatment-related adverse events with dronedarone was similar for patients with/without diabetes and was comparable to placebo. CONCLUSIONS Dronedarone reduced incidence of CV hospitalization/death, AF/AFL recurrence and increased time to these events in AF/AFL patients with/without diabetes. TRIAL REGISTRATION Not applicable, as it was a post hoc analysis. This article is based on previously conducted studies (ATHENA: NCT00174785, EURIDIS: NCT00259428, and ADONIS: NCT00259376).
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Affiliation(s)
- Yehuda Handelsman
- Metabolic Institute of America, Tarzana, CA, United States of America.
| | - T Jared Bunch
- School of Medicine, University of Utah, Salt Lake City, UT, United States of America.
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, Rockville, MD, United States of America.
| | - Benjamin A Steinberg
- School of Medicine, University of Utah, Salt Lake City, UT, United States of America.
| | - Munveer Thind
- Lankenau Heart Institute, Lankenau Medical Center, Wynnewood, PA, United States of America.
| | | | | | - Mattias Wieloch
- Sanofi, Paris, France; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Peter R Kowey
- Lankenau Heart Institute, Lankenau Medical Center, Wynnewood, PA, United States of America.
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Gateva A, Kamenov Z. Cardiac Autonomic Neuropathy in Patients with Newly Diagnosed Carbohydrate Disturbances. Horm Metab Res 2022; 54:308-315. [PMID: 35325930 DOI: 10.1055/a-1775-8251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus that can predispose patients to higher risk for cardiovascular death. The aim of the present study was to evaluate the presence of cardiac autonomic neuropathy and sudomotor dysfunction in patients with newly diagnosed carbohydrate disturbances (prediabetes or diabetes) and to assess their relationship to metabolic disturbances and cardiovascular risk. In the present study, we included 160 patients -78 with obesity without carbohydrate disturbances, 52 with prediabetes, and 30 with newly diagnosed diabetes. CAN was diagnosed using cardiovascular reflex tests and sudomotor function was evaluated by SUDOSCAN. Cardiovascular risk was calculated using SCORE and FRMINGHAM risk scores. The prevalence of cardiac autonomic neuropathy was significantly higher in patients with newly diagnosed diabetes. Independently of their glycemic status, the patients who had blood glucose on the 60th-minute of OGTT>8.5 mmol/l had significantly higher prevalence of cardiac autonomic neuropathy (30.2% vs 15.6%, р=0.044). Patients with high cardiovascular risk according to FRAMINGHAM and SCORE had worse heart rate variability scores. Autonomic neuropathy risk assessed by SUDOSCAN was a good predictor for the presence of CAN. In conclusion, CAN has a higher prevalence on patients with newly diagnosed diabetes compared to prediabetic and normoglycemic subjects, while the patients with blood glucose>8.5 mmol/l on the 60th-minute of OGTT have higher prevalence of CAN independently of their glycemic status. SUDOSCAN testing can be used to assess the risk of CAN and to select patients that should undergo further testing.
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Affiliation(s)
- Antoaneta Gateva
- Department of Internal Medicine, Medical University, Sofia, Bulgaria
| | - Zdravko Kamenov
- Department of Internal Medicine, Medical University, Sofia, Bulgaria
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Macdonald DM, Palzer EF, Abbasi A, Baldomero AK, Bhatt SP, Casaburi R, Connett JE, Dransfield MT, Gaeckle NT, Mkorombindo T, Rossiter HB, Stringer WW, Tiller NB, Wendt CH, Zhao D, Kunisaki KM. Chronotropic index during 6-minute walk and acute respiratory events in COPDGene. Respir Med 2022; 194:106775. [PMID: 35203009 PMCID: PMC8932051 DOI: 10.1016/j.rmed.2022.106775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lower heart rate (HR) increases during exercise and slower HR recovery (HRR) after exercise are markers of worse autonomic function that may be associated with risk of acute respiratory events (ARE). METHODS Data from 6-min walk testing (6MWT) in COPDGene were used to calculate the chronotropic index (CI) [(HR immediately post 6MWT - resting HR)/((220 - age) - resting HR)] and HRR at 1 min after 6MWT completion. We used zero-inflated negative binomial regression to test associations of CI and HRR with rates of any ARE (requiring steroids and/or antibiotics) and severe ARE (requiring emergency department visit or hospitalization), among all participants and in spirometry subgroups (normal, chronic obstructive pulmonary disease [COPD], and preserved ratio with impaired spirometry). RESULTS Among 4,484 participants, mean follow-up time was 4.1 years, and 1,966 had COPD. Among all participants, CI-6MWT was not associated with rate of any ARE [adjusted incidence rate ratio (aIRR) 0.98 (0.95-1.01)], but higher CI-6MWT was associated with lower rate of severe ARE [0.95 (0.92-0.99)]. Higher HRR was associated with a lower rate of both any ARE [0.97 (0.95-0.99)] and severe ARE [0.95 (0.92-0.98)]. Results were similar in the COPD spirometry subgroup. CONCLUSION Heart rate measures derived from 6MWT tests may have utility in predicting risk of acute respiratory events and COPD exacerbations.
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Affiliation(s)
- David M Macdonald
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA.
| | - Elise F Palzer
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Asghar Abbasi
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Arianne K Baldomero
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | - Surya P Bhatt
- Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard Casaburi
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - John E Connett
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nathaniel T Gaeckle
- Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | | | - Harry B Rossiter
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - William W Stringer
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nicholas B Tiller
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Chris H Wendt
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | - Dongxing Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China
| | - Ken M Kunisaki
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
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20
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Novel Application of Multiscale Cross-Approximate Entropy for Assessing Early Changes in the Complexity between Systolic Blood Pressure and ECG R-R Intervals in Diabetic Rats. ENTROPY 2022; 24:e24040473. [PMID: 35455136 PMCID: PMC9032476 DOI: 10.3390/e24040473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 02/06/2023]
Abstract
Cardiac autonomic neuropathy (CAN) is a common complication of diabetes mellitus, and can be assessed using heart rate variability (HRV) and the correlations between systolic blood pressure (SBP) and ECG R-R intervals (RRIs), namely baroreflex sensitivity (BRS). In this study, we propose a novel parameter for the nonlinear association between SBP and RRIs based on multiscale cross-approximate entropy (MS-CXApEn). Sixteen male adult Wistar Kyoto rats were equally divided into two groups: streptozotocin-induced diabetes and age-matched controls. RRIs and SBP were acquired in control rats and the diabetic rats at the onset of hyperglycemia and insulin-treated euglycemia to determine HRV by the ratio of low-frequency to high-frequency power (LF/HF) and Poincaré plot as SSR (SD1/SD2), BRS, and MS-CXApEn. SSR and BRS were not significantly different among the three groups. The LF/HF was significantly higher in the hyperglycemic diabetics than those in the controls and euglycemic diabetic rats. MS-CXApEn was higher in the diabetic hyperglycemic rats than the control rats from scales 2 to 10, and approached the values of controls in diabetic euglycemic rats at scales 9 and 10. Conclusions: We propose MS-CXApEn as a novel parameter to quantify the dynamic nonlinear interactions between SBP and RRIs that reveals more apparent changes in early diabetic rats. Furthermore, changes in this parameter were related to correction of hyperglycemia and could be useful for detecting and assessing CAN in early diabetes.
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21
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Rossi A, Mikail N, Bengs S, Haider A, Treyer V, Buechel RR, Wegener S, Rauen K, Tawakol A, Bairey Merz CN, Regitz-Zagrosek V, Gebhard C. Heart-brain interactions in cardiac and brain diseases: why sex matters. Eur Heart J 2022; 43:3971-3980. [PMID: 35194633 PMCID: PMC9794190 DOI: 10.1093/eurheartj/ehac061] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/24/2022] [Accepted: 01/30/2022] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular disease and brain disorders, such as depression and cognitive dysfunction, are highly prevalent conditions and are among the leading causes limiting patient's quality of life. A growing body of evidence has shown an intimate crosstalk between the heart and the brain, resulting from a complex network of several physiological and neurohumoral circuits. From a pathophysiological perspective, both organs share common risk factors, such as hypertension, diabetes, smoking or dyslipidaemia, and are similarly affected by systemic inflammation, atherosclerosis, and dysfunction of the neuroendocrine system. In addition, there is an increasing awareness that physiological interactions between the two organs play important roles in potentiating disease and that sex- and gender-related differences modify those interactions between the heart and the brain over the entire lifespan. The present review summarizes contemporary evidence of the effect of sex on heart-brain interactions and how these influence pathogenesis, clinical manifestation, and treatment responses of specific heart and brain diseases.
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Affiliation(s)
- Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland,Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Ronny Ralf Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric Hospital, Zurich, Switzerland,Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Vera Regitz-Zagrosek
- Charité, Universitätsmedizin Berlin, Berlin, Germany,University of Zurich, Zurich, Switzerland
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22
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Powers A, Mekawi Y, Fickenwirth M, Nugent NR, Dixon HD, Minton S, Kim YJ, Gluck R, Carter S, Fani N, Schwartz AC, Bradley B, Umpierrez GE, Pace TWW, Jovanovic T, Michopoulos V, Gillespie CF. Emotion dysregulation and dissociation contribute to decreased heart rate variability to an acute psychosocial stressor in trauma-exposed Black women. J Psychiatr Res 2021; 142:125-131. [PMID: 34352557 PMCID: PMC8429185 DOI: 10.1016/j.jpsychires.2021.07.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Abstract
Reduced heart rate variability (HRV) in response to stress is a biomarker of emotion dysregulation (ED) and is related to posttraumatic stress disorder (PTSD), yet less is known about its role with dissociation in trauma-exposed adults. The goals of the current study were to examine unique patterns of associations between ED, dissociation, and PTSD with HRV at 15, 30, and 45 min (T1, T2, T3) following an acute psychosocial stressor task in a sample of 49 trauma-exposed, urban-dwelling Black women. Associations with baseline psychophysiology measures were also examined. ED and dissociation were assessed using self-report; PTSD was determined using a semi-structured interview. Heart rate (HR) and HRV, indexed with low frequency/high frequency (LF/HF) ratio and respiratory sinus arrhythmia (RSA), were measured with electrocardiogram recordings. ED and dissociation were positively correlated with LF/HF ratio at T3 (p < .05). There were no significant differences between individuals with PTSD versus those without PTSD in HR or HRV following acute stressor; PTSD diagnosis was related to higher HR at baseline. Latent growth modeling revealed that ED was associated with higher LF/HF ratio directly following acute stressor, while dissociation was associated with increase in LF/HF ratio over time. These findings demonstrate that ED is related to higher sympathetic reactivity for a prolonged period of time following stress exposure, while dissociation shows a delayed association with LF/HF ratio, suggesting a distinct impaired parasympathetic activation pattern exists for dissociation.
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Affiliation(s)
- Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Yara Mekawi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Maximilian Fickenwirth
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - H Drew Dixon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sean Minton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ye Ji Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rachel Gluck
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ann C Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Mental Health Service Line, Atlanta VA Medical Center, USA
| | - Guillermo E Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Thaddeus W W Pace
- College of Nursing, College of Medicine (Psychiatry), & College of Science (Psychology), University of Arizona, Tucson, AZ, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Yerkes National Primate Research Center, Atlanta, GA, USA
| | - Charles F Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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23
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An absolute magnitude deviation of HRV for the prediction of prediabetes with combined artificial neural network and regression tree methods. Artif Intell Rev 2021. [DOI: 10.1007/s10462-021-10040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Larkey L, Kim W, James D, Kishida M, Vizcaino M, Huberty J, Krishnamurthi N. Mind-Body and Psychosocial Interventions May Similarly Affect Heart Rate Variability Patterns in Cancer Recovery: Implications for a Mechanism of Symptom Improvement. Integr Cancer Ther 2021; 19:1534735420949677. [PMID: 32783546 PMCID: PMC7425257 DOI: 10.1177/1534735420949677] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Advancements in early detection and treatment of cancer have led to increased survival rates and greater need to identify effective supportive care options for resolving symptoms of survivorship. Many non-pharmacological approaches to symptom management during and after cancer treatment involve emotional self-regulation as a central strategy for improving well-being. Identifying commonalities among these strategies’ mechanisms of action may facilitate understanding of what might be useful for optimizing intervention effects. Heart rate variability (HRV) parameters are indicative of improved autonomic nervous system (ANS) balance and resiliency and reduced emotional distress and are thus identified as a mechanism to discuss as a marker of potential for intervention efficacy and a target for optimization. Methods: HRV data from 2 studies, 1 examining a mind-body intervention and 1 examining a psychosocial intervention, are presented as a point of discussion about preliminary associations between the interventions, change in HRV, and emotional distress reduction. Results: HRV significantly decreased in sympathetic activity in response to a mind-body intervention (Qigong/Tai Chi), and increased vagal tone in response to a psychosocial (storytelling) intervention. In both, these changes in HRV parameters were associated with improved emotional states. Conclusion: Our preliminary data suggest that HRV may serve as an important marker of underlying changes that mediate emotional regulation; this observation deserves further investigation. If identified as a worthy target, focusing on interventions that improve HRV within the context of interventions for cancer patients may be important to key outcomes and clinical practice.
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Affiliation(s)
- Linda Larkey
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Wonsun Kim
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Dara James
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Moé Kishida
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Jennifer Huberty
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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25
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Ammar A, Boukhris O, Halfpaap N, Labott BK, Langhans C, Herold F, Grässler B, Müller P, Trabelsi K, Chtourou H, Zmijewski P, Driss T, Glenn JM, Müller NG, Hoekelmann A. Four Weeks of Detraining Induced by COVID-19 Reverse Cardiac Improvements from Eight Weeks of Fitness-Dance Training in Older Adults with Mild Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5930. [PMID: 34073051 PMCID: PMC8198940 DOI: 10.3390/ijerph18115930] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/13/2022]
Abstract
Physical training is considered as a low-cost intervention to generate cardioprotective benefits and to promote physical and mental health, while reducing the severity of acute respiratory infection symptoms in older adults. However, lockdown measures during COVID-19 have limited people's opportunity to exercise regularly. The aim of this study was to investigate the effect of eight weeks of Fitness and Dance training, followed by four weeks of COVID-19-induced detraining, on cardiac adaptations and physical performance indicators in older adults with mild cognitive impairment (MCI). Twelve older adults (6 males and 6 females) with MCI (age, 73 ± 4.4 y; body mass, 75.3 ± 6.4 kg; height, 172 ± 8 cm; MMSE score: 24-27) participated in eight weeks of a combined Fitness-Dance training intervention (two sessions/week) followed by four weeks of training cessation induced by COVID-19 lockdowns. Wireless Polar Team Pro and Polar heart rate sensors (H10) were used to monitor covered distance, speed, heart rate (HR min, avg and max), time in HR zone 1 to 5, strenuousness (load score), beat-to-beat interval (max RR and avg RR) and heart rate variability (HRV-RMSSD). One-way ANOVA was used to analyze the data of the three test sessions (T1: first training session, T2: last training session of the eight-week training program, and T3: first training session after the four-week training cessation). Statistical analysis showed that eight weeks of combined Fitness-Dance training induced beneficial cardiac adaptations by decreasing HR (HR min, HR avg and HR max) with p < 0.001, ES = 0.5-0.6 and Δ = -7 to-9 bpm, and increasing HRV related responses (max and avg RR and RMSSD), with p < 0.01 and ES = 0.4. Consequently, participants spent more time in comfortable HR zones (e.g., p < 0.0005; ES = 0.7; Δ = 25% for HR zone 1) and showed reduced strenuousness (p = 0.02, Δ = -15% for load score), despite the higher covered total distance and average speed (p < 0.01; ES = 0.4). However, these changes were reversed after only four weeks of COVID-19 induced detraining, with values of all parameters returning to their baseline levels. In conclusion, eight weeks of combined Fitness-Dance training seems to be an efficient strategy to promote cardioprotective benefits in older adults with MCI. Importantly, to maintain these health benefits, training has to be continued and detraining periods should be reduced. During a pandemic, home-based exercise programs may provide an effective and efficient alternative of physical training.
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Affiliation(s)
- Achraf Ammar
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, 92000 Nanterre, France;
| | - Omar Boukhris
- Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis 1003, Tunisia; (O.B.); (H.C.)
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia;
| | - Nicole Halfpaap
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
| | - Berit Kristin Labott
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
| | - Corinna Langhans
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
| | - Fabian Herold
- German Center for Neurodegenerative Diseases (DZNE), 39104 Magdeburg, Germany; (F.H.); (P.M.); (N.G.M.)
- Department of Neurology, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Bernhard Grässler
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
| | - Patrick Müller
- German Center for Neurodegenerative Diseases (DZNE), 39104 Magdeburg, Germany; (F.H.); (P.M.); (N.G.M.)
- Department of Neurology, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia;
- Research Laboratory, Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax 3000, Tunisia
| | - Hamdi Chtourou
- Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis 1003, Tunisia; (O.B.); (H.C.)
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia;
| | - Piotr Zmijewski
- Jozef Pilsudski University of Physical Education in Warsaw, 00-809 Warsaw, Poland;
| | - Tarak Driss
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, 92000 Nanterre, France;
| | - Jordan M. Glenn
- Exercise Science Research Center, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, USA;
- Neurotrack Technologies, 399 Bradford St, Redwood City, CA 94063, USA
| | - Notger G. Müller
- German Center for Neurodegenerative Diseases (DZNE), 39104 Magdeburg, Germany; (F.H.); (P.M.); (N.G.M.)
- Department of Neurology, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Brenneckestraße 6, 39118 Magdeburg, Germany
| | - Anita Hoekelmann
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
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26
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Heart Rate Variability and Decision-Making: Autonomic Responses in Making Decisions. Brain Sci 2021; 11:brainsci11020243. [PMID: 33672004 PMCID: PMC7919341 DOI: 10.3390/brainsci11020243] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
Decision-making is one of the most crucial cognitive processes in daily life. An adaptable, rapid, and flexible decision requires integration between brain and body. Heart rate variability (HRV) indexes this brain–body connection and appears to be related to cognitive performance. However, its relationship with decision-making is poorly analyzed. This study investigates the relationship between HRV and the decision-making process, assessed through the Iowa Gambling Task (IGT). One hundred and thirty healthy university students (mean age = 23.35 ± 2.50) participated in the study. According to IGT performance, they were divided into high decision-makers (n = 79) and low decision-makers (n = 51). Heart rate variability was measured in the resting, reactivity (i.e., during IGT), and recovery phases. Higher vagally mediated HRV (vmHRV; indexed in frequency domain measures) was evidenced in good decision-makers in the resting, reactivity, and recovery phases. During the task, a higher vagal modulation after a first evaluation was highlighted in good decision-makers. In conclusion, HRV proves to be a valid index of inhibitory circuit functioning in the prefrontal cortex. The relationship with cognitive functions was also confirmed, considering the ability to inhibit disadvantageous responses and make better decisions.
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27
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Eleftheriadou A, Williams S, Nevitt S, Brown E, Roylance R, Wilding JPH, Cuthbertson DJ, Alam U. The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review. Diabetologia 2021; 64:288-303. [PMID: 33164108 PMCID: PMC7801295 DOI: 10.1007/s00125-020-05316-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS Cardiac autonomic neuropathy (CAN) is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Several studies have highlighted the increased prevalence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose). Considering the exponential rise of prediabetes, we aimed to determine the prevalence of CAN through a systematic literature review. METHODS This systematic review was registered with PROSPERO (CRD42019125447). An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, Scopus and Cochrane databases. Published full text, English language articles that provide CAN prevalence data of studies in individuals with prediabetes and aged over 18 years were included. Prevalence data for normal glucose tolerance and diabetes were also extracted from the selected articles, if present. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using a critical appraisal tool. RESULTS Database searches found 4500 articles; subsequently, 199 full text articles were screened, 11 of which fulfilled the inclusion criteria (4431 total participants, 1730 people with prediabetes, 1999 people with normal glucose tolerance [NGT] and 702 people with predominantly type 2 diabetes). Six of the selected studies reported definite CAN prevalence data (9-39%). Only a single large population-based study by Ziegler et al (KORA S4 study, 1332 participants) determined definite CAN based on two or more positive autonomic function tests (AFTs), with a mean prevalence of 9% in all prediabetes groups (isolated impaired glucose tolerance 5.9%; isolated impaired fasting glucose 8.1%; impaired fasting glucose plus impaired glucose tolerance 11.4%), which was higher than NGT (4.5%). This study is most likely to provide a reliable population-specific estimate of CAN in prediabetes. There was a higher than expected prevalence of CAN in prediabetes (9-38%) when compared with normal glucose tolerance (0-18%) within the same studies (n = 8). There was a wide prevalence of possible CAN based on one positive AFT (n = 5). There was heterogeneity between the studies with variations in the definition of CAN, methodology and characteristics of the populations, which likely contributed to the diversity of prevalence estimates. The overall risk of bias was low. CONCLUSIONS/INTERPRETATION There is a higher than expected prevalence of CAN in prediabetes. Early detection of CAN in prediabetes through population screening needs careful consideration in view of the excess morbidity and mortality risk associated with this condition. Graphical abstract.
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Affiliation(s)
- Aikaterini Eleftheriadou
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Scott Williams
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Emily Brown
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Rebecca Roylance
- Edge Hill University Library, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - John P H Wilding
- Obesity and Endocrinology Research, Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Daniel J Cuthbertson
- Obesity and Endocrinology Research, Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Uazman Alam
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester, UK.
- Pain Research Institute and Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
- Department of Diabetes and Endocrinology, Liverpool University Hospital NHS Trust, Liverpool, UK.
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28
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Gao L, Gaba A, Cui L, Yang HW, Saxena R, Scheer FAJL, Akeju O, Rutter MK, Lo MT, Hu K, Li P. Resting Heartbeat Complexity Predicts All-Cause and Cardiorespiratory Mortality in Middle- to Older-Aged Adults From the UK Biobank. J Am Heart Assoc 2021; 10:e018483. [PMID: 33461311 PMCID: PMC7955428 DOI: 10.1161/jaha.120.018483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Spontaneous heart rate fluctuations contain rich information related to health and illness in terms of physiological complexity, an accepted indicator of plasticity and adaptability. However, it is challenging to make inferences on complexity from shorter, more practical epochs of data. Distribution entropy (DistEn) is a recently introduced complexity measure that is designed specifically for shorter duration heartbeat recordings. We hypothesized that reduced DistEn predicted increased mortality in a large population cohort. Method and Results The prognostic value of DistEn was examined in 7631 middle‐older–aged UK Biobank participants who had 2‐minute resting ECGs conducted (mean age, 59.5 years; 60.4% women). During a median follow‐up period of 7.8 years, 451 (5.9%) participants died. In Cox proportional hazards models with adjustment for demographics, lifestyle factors, physical activity, cardiovascular risks, and comorbidities, for each 1‐SD decrease in DistEn, the risk increased by 36%, 56%, and 73% for all‐cause, cardiovascular, and respiratory disease–related mortality, respectively. These effect sizes were equivalent to the risk of death from being >5 years older, having been a former smoker, or having diabetes mellitus. Lower DistEn was most predictive of death in those <55 years with a prior myocardial infarction, representing an additional 56% risk for mortality compared with older participants without prior myocardial infarction. These observations remained after controlling for traditional mortality predictors, resting heart rate, and heart rate variability. Conclusions Resting heartbeat complexity from short, resting ECGs was independently associated with mortality in middle‐ to older‐aged adults. These risks appear most pronounced in middle‐aged participants with prior MI, and may uniquely contribute to mortality risk screening.
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Affiliation(s)
- Lei Gao
- Department of Anesthesia Critical Care and Pain Medicine Massachusetts General HospitalHarvard Medical School Boston MA.,Medical Biodynamics Program Brigham and Women's Hospital Boston MA
| | - Arlen Gaba
- Medical Biodynamics Program Brigham and Women's Hospital Boston MA
| | - Longchang Cui
- Medical Biodynamics Program Brigham and Women's Hospital Boston MA
| | - Hui-Wen Yang
- Medical Biodynamics Program Brigham and Women's Hospital Boston MA
| | - Richa Saxena
- Department of Anesthesia Critical Care and Pain Medicine Massachusetts General HospitalHarvard Medical School Boston MA.,Broad Institute of MIT and Harvard Cambridge MA.,Center for Genomic Medicine Massachusetts General Hospital Boston MA
| | - Frank A J L Scheer
- Broad Institute of MIT and Harvard Cambridge MA.,Division of Sleep Medicine Harvard Medical School Boston MA
| | - Oluwaseun Akeju
- Department of Anesthesia Critical Care and Pain Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Martin K Rutter
- Division of Diabetes Endocrinology & Gastroenterology The University of Manchester Manchester UK
| | - Men-Tzung Lo
- Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering National Central University Taoyuan Taiwan
| | - Kun Hu
- Medical Biodynamics Program Brigham and Women's Hospital Boston MA.,Division of Sleep Medicine Harvard Medical School Boston MA
| | - Peng Li
- Medical Biodynamics Program Brigham and Women's Hospital Boston MA.,Division of Sleep Medicine Harvard Medical School Boston MA
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Aggarwal Y, Das J, Mazumder PM, Kumar R, Sinha RK. Heart rate variability time domain features in automated prediction of diabetes in rat. Phys Eng Sci Med 2020; 44:45-52. [PMID: 33252718 DOI: 10.1007/s13246-020-00950-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
Diabetes is a very common occurring disease, diagnosed by hyperglycemia. The established mode of diagnosis is the analysis of blood glucose level with the help of a hand-held glucometer. Nowadays, it is also known for affecting multi-organ functions, particularly the microvasculature of the cardiovascular system. In this work, an alternative diagnostic system based on the heart rate variability (HRV) analysis and artificial neural network (ANN) and support vector machine (SVM) have been proposed. The experiment and data recording has been performed on male Wister rats of 10-12 week of age and 200 ± 20 gm of weight. The digital lead-I electrocardiogram (ECG) data are recorded from control (n = 5) and Streptozotocin-induced diabetic rats (n = 5). Nine time-domain linear HRV parameters are computed from 60 s of ECG data epochs and used for the training and testing of backpropagation ANN and SVM. Total 526 (334 Control and 192 diabetics) such datasets are computed for the testing of ANN for the identification of the diabetic conditions. The ANN has been optimized for architecture 9:5:1 (Input: hidden: output neurons, respectively) with the optimized learning rate parameter at 0.02. With this network, a very good classification accuracy of 96.2% is achieved. While similar accuracy of 95.2% is attained using SVM. Owing to the successful implementation of HRV parameters based automated classifiers for diabetic conditions, a non-invasive, ECG based online prognostic system can be developed for accurate and non-invasive prediction of the diabetic condition.
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Affiliation(s)
- Yogender Aggarwal
- Department of Bio-Engineering, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| | - Joyani Das
- Department of Pharmaceutical Science and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| | - Papiya Mitra Mazumder
- Department of Pharmaceutical Science and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| | - Rohit Kumar
- Department of Mathematics, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| | - Rakesh Kumar Sinha
- Department of Bio-Engineering, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India.
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Pope ZC, Gabriel KP, Whitaker KM, Chen LY, Schreiner PJ, Jacobs DR, Sternfeld B, Carr JJ, Lloyd-Jones DM, Pereira MA. Association between Objective Activity Intensity and Heart Rate Variability: Cardiovascular Disease Risk Factor Mediation (CARDIA). Med Sci Sports Exerc 2020; 52:1314-1321. [PMID: 32427750 DOI: 10.1249/mss.0000000000002259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE We evaluated the associations between accelerometer-estimated physical activity (PA) intensity and heart rate variability (HRV) and examined mediation of these associations by glycemic control indices and other cardiovascular disease risk factors. METHODS Data were from 1668 participants (X[Combining Overline]age = 45.9 ± 3.5 yr, 58.0% female, 39.9% black) who participated in year 20 (2005-2006) of the Coronary Artery Risk Development in Young Adults Fitness Study. The ActiGraph 7164 estimated participants' mean minutes per day of vigorous-intensity PA (VPA), moderate-intensity PA (MPA), and light-intensity PA (LPA) over 7 d. Three sequential 10-s 12-lead ECG strips were used to derive standard deviation of all normal RR intervals (SDNN) and root mean square of all successive RR intervals (rMSSD) HRV. Mediators representing glycemic control indices included fasting glucose, fasting insulin, and 2-h oral glucose tolerance, with other mediators being traditional cardiovascular disease risk factors. Multiple linear regression assessed independent associations of PA intensity with HRV per 1-SD. Mediation analyses computed the proportion of the PA-HRV association attributable to physiological mediators. RESULTS Participants averaged 2.7 ± 6.2 min·d, 33.0 ± 22.0 min·d, and 360.2 ± 83.8 min·d of VPA, MPA, and LPA, respectively, with mean values for SDNN (32.6 ± 22.4 ms) and rMSSD (34.0 ± 24.8 ms) similar. After adjustment for demographic and lifestyle behaviors, VPA was associated with both HRV metrics (SDNN: std beta = 0.06 [0.03, 0.10]; rMSSD: std beta = 0.08 [0.05, 0.12]) and LPA with rMSSD only (std beta = 0.05 [0.01, 0.08]). Fasting insulin and glucose mediated 11.6% to 20.7% of the association of VPA and LPA with HRV, with triglycerides also potentially mediating these associations (range, 9.6%-13.4%). CONCLUSIONS Accelerometer-estimated VPA was associated with higher (i.e., improved) HRV. Light-intensity PA also demonstrated a positive association. Mediation analyses suggested these associations may be most attributable to glucose-insulin dynamics.
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Affiliation(s)
- Zachary C Pope
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, MN
| | | | - Kara M Whitaker
- Department of Health and Human Physiology and Department of Epidemiology, University of Iowa, Iowa City, IA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, MN
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, MN
| | | | - J Jeffrey Carr
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Mark A Pereira
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, MN
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Shalnova SA, Kutsenko VA, Kapustina AV, Yarovaya EB, Balanova YA, Evstifeeva SE, Imaeva AE, Maksimov SA, Muromtseva GA, Kulakova NV, Kalachikova ON, Chernykh TM, Belova OA, Artamonova GV, Indukaeva EV, Grinshtein YI, Libis RA, Duplyakov DV, Rotar OP, Trubacheva IA, Serebryakova VN, Efanov AY, Konradi AO, Boytsov SA, Drapkina OM. Associations of Blood Pressure and Heart Rate and Their Contribution to the Development of Cardiovascular Complications and All-Cause Mortality in the Russian Population of 25-64 Years. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-10-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To study the relationship of blood pressure (BP) and heart rate (HR) in a sample of men and women 25-64 years old and their predictive value for the development of fatal and non-fatal cardiovascular diseases (CVD) and mortality from all causes.Material and methods. Prospective observation was for cohorts of the population aged 25-64 years from 11 regions of the Russian Federation. 18,251 people were included in the analysis. Each participant gave written informed consent. All surveyed persons were interviewed with a standard questionnaire. BP was measured on the right hand with an automatic tonometer. BP and HR were measured twice with an interval of 2-3 min with the calculation of the average value. The patients were divided into 4 groups: the first group with BP<140/90 ><140/90 mm Hg and HR≤80 beats/min; the second group – BP<140/><140/90 mm Hg and HR>80; the third group – BP≥140/90 mm Hg and HR≤80; the fourth group – BP≥140/90 mm Hg and HR>80 beats/min. Risk factors and cardiovascular history were analyzed as well. Deaths over 6 years of follow-up occurred in 393 people (141 – from CVD). Statistical analysis was performed using the open source R3.6.1 system.Results. A HR>80 beats/min was found in 26.3% of people with BP≥140/90 mm Hg, regardless of medication. Analysis of the associations between HR and BP showed that for every increase in HR by 10 beats/min, systolic BP increases by 3 mm Hg. (p<0.0001). The group with HR>80 beats/min and BP≥140/90 mm Hg had the shortest life expectancy (p<0.001). Adding an increased HR to BP≥140/90 mm Hg significantly><0.001). Adding an increased HR to BP≥140/90 mm Hg significantly worsened the prognosis of patients. Similar results were obtained in the analysis of cardiovascular survival. Elevated BP and elevated HR had the same effect on outcomes, except for the combined endpoint, where the contribution of elevated BP was predominant. However, their combined effect was the largest and highly significant for the development of the studied outcomes, even after adjusting for other predictors. With an increase in HR by every 10 beats/min, the risk of mortality increased statistically significantly by 22%.Conclusion. The prevalence of HR>80 beats/min in people with BP≥140 mm Hg amounted to 26.34%. Every 10 beats/min significantly increases the risk of mortality by 22%. Increased HR with elevated BP leads to increased adverse outcomes.
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Affiliation(s)
- S. A. Shalnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. A. Kutsenko
- National Medical Research Center for Therapy and Preventive Medicine;
Lomonosov Moscow State University
| | - A. V. Kapustina
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. B. Yarovaya
- National Medical Research Center for Therapy and Preventive Medicine;
Lomonosov Moscow State University
| | - Yu. A. Balanova
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. E. Evstifeeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. E. Imaeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. A. Maksimov
- National Medical Research Center for Therapy and Preventive Medicine
| | - G. A. Muromtseva
- National Medical Research Center for Therapy and Preventive Medicine
| | | | | | - T. M. Chernykh
- Voronezh State Medical University named after N. N. Burdenko
| | | | - G. V. Artamonova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - E. V. Indukaeva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - Yu. I. Grinshtein
- Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky
| | | | - D. V. Duplyakov
- Samara State Medical University, Research Institute of Cardiology
| | | | - I. A. Trubacheva
- Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - V. N. Serebryakova
- Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | | | | | | | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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32
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Baranowska-Jurkun A, Matuszewski W, Bandurska-Stankiewicz E. Chronic Microvascular Complications in Prediabetic States-An Overview. J Clin Med 2020; 9:E3289. [PMID: 33066307 PMCID: PMC7602111 DOI: 10.3390/jcm9103289] [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: 08/18/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022] Open
Abstract
A prediabetic state is a major risk factor for the development of diabetes, and, because of an identical pathophysiological background of both conditions, their prevalence increases parallelly and equally fast. Long-term hyperglycemia is the main cause inducing chronic complications of diabetes, yet the range of glucose levels at which they start has not been yet unequivocally determined. The current data show that chronic microvascular complications of diabetes can be observed in patients with abnormal glucose metabolism in whom glycaemia is higher than optimal but below diagnostic criteria for diabetes. Prediabetes is a heterogenous nosological unit in which particular types are differently characterized and show different correlations with particular kinds of complications. Analysis of the latest research results shows the need to continue studies in a larger population and can imply the need to verify the currently employed criteria of diagnosing diabetes and chronic complications of diabetes in people with prediabetes.
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Affiliation(s)
- Angelika Baranowska-Jurkun
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Żołnierska 18, 10-561 Olsztyn, Poland; (W.M.); (E.B.-S.)
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33
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Ikeda A, Steptoe A, Brunner EJ, Maruyama K, Tomooka K, Kato T, Miyoshi N, Nishioka S, Saito I, Tanigawa T. Salivary Alpha-Amylase Activity in Relation to Cardiometabolic Status in Japanese Adults without History of Cardiovascular Disease. J Atheroscler Thromb 2020; 28:852-864. [PMID: 33041312 PMCID: PMC8326169 DOI: 10.5551/jat.53926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims:
Stress is known to be a potential contributor to the development of diabetes and hypertension. However, the biological mechanisms underlying the association between cardiometabolic risk markers and the biological stress response have not yet been determined. Therefore, we examined salivary alpha-amylase and heart rate variability in relation to cardiometabolic status in a sample of healthy Japanese men and women.
Methods:
Participants (473 men and 1,029 women aged 30-84) underwent a 75 g oral glucose tolerance test after a 10-hr fast. The homeostasis model assessment index for insulin resistance was based on fasting and 2-hr postload glucose and insulin concentrations. Sitting blood pressure was measured twice after rest. A saliva sample was collected in the morning and salivary alpha-amylase was assayed. A 5-min heart rate variability recording was evaluated using time-domain indices of standard deviations of normal-to-normal intervals and root mean square of successive differences. Multivariate linear regression models were used to estimate associations between salivary alpha-amylase and each outcome measure.
Results:
Salivary alpha-amylase was associated with fasting glucose (β=0.008; 95% CI=0.002, 0.014), 2-hr postload glucose (β=0.023; 95% CI=0.004, 0.041), homeostasis model assessment index for insulin resistance (β=0.032; 95%CI=0.000, 0.064), systolic (β=1.603; 95% CI=0.479, 2.726) and diastolic (β=0.906; 95% CI=0.212, 1.600) blood pressures among women. These associations remained significant after further adjustment for heart rate variability measures.
Conclusions:
The elevation of salivary alpha-amylase may reflect a dysfunction of the sympathetic nervous system associated with cardiometabolic abnormalities in women.
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Affiliation(s)
- Ai Ikeda
- Department of Public Health, Juntendo University Graduate School of Medicine.,Department of Epidemiology and Public Health, Faculty of Population Health Sciences, University College London
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, Faculty of Population Health Sciences, University College London
| | - Eric J Brunner
- Department of Epidemiology and Public Health, Faculty of Population Health Sciences, University College London
| | - Koutatsu Maruyama
- Laboratory of Community Health and Nutrition, Special Course of Food and Health Science, Department of Bioscience, Graduate School of Agriculture, Ehime University
| | - Kiyohide Tomooka
- Department of Public Health, Juntendo University Graduate School of Medicine
| | - Tadahiro Kato
- Center for Education and Educational Research, Faculty of Education, Ehime University
| | - Noriko Miyoshi
- Department of Public Health, Juntendo University Graduate School of Medicine
| | - Shinji Nishioka
- Laboratory of Community Health and Nutrition, Special Course of Food and Health Science, Department of Bioscience, Graduate School of Agriculture, Ehime University.,Ehime Dental Association
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine
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34
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Zilliox LA, Russell JW. Is there cardiac autonomic neuropathy in prediabetes? Auton Neurosci 2020; 229:102722. [PMID: 33011523 DOI: 10.1016/j.autneu.2020.102722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 06/09/2020] [Accepted: 08/24/2020] [Indexed: 02/09/2023]
Abstract
Although there is considerably more data showing an association between type 2 diabetes mellitus (T2DM) and autonomic neuropathy, accumulating evidence indicates that cardiovascular autonomic neuropathy (CAN) is common in persons with impaired glucose tolerance (IGT). Furthermore, CAN may occur early after a metabolic insult and obesity, especially among mean, and seems to play an important role in the early pathogenesis of CAN. Autonomic symptoms are common in subjects with IGT. In addition to defects in CAN, in subjects with IGT, there is impaired sudomotor function and abnormalities of endothelial peripheral vasoreactivity. At the present time, the only interventions that may be effective in preventing or reversing IGT associated autonomic neuropathy are lifestyle improvement. These include a tailored diet and exercise program. Other approaches that may be beneficial include modulation of oxidative stress and improvement of metabolic regulation in subjects with IGT. Interventions are most likely to be effective early in the course of disease and therefore it is extremely important to have early diagnosis of IGT and autonomic neuropathy.
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Affiliation(s)
- Lindsay A Zilliox
- Department of Neurology, University of Maryland and Maryland VA Healthcare System, Baltimore, MD, United States of America
| | - James W Russell
- Department of Neurology, University of Maryland and Maryland VA Healthcare System, Baltimore, MD, United States of America.
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35
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Aggarwal Y, Das J, Mazumder PM, Kumar R, Sinha RK. Heart rate variability features from nonlinear cardiac dynamics in identification of diabetes using artificial neural network and support vector machine. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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36
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Lee DY, Lee MY, Cho JH, Kwon H, Rhee EJ, Park CY, Oh KW, Lee WY, Park SW, Ryu S, Park SE. Decreased Vagal Activity and Deviation in Sympathetic Activity Precedes Development of Diabetes. Diabetes Care 2020; 43:1336-1343. [PMID: 32300048 DOI: 10.2337/dc19-1384] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 03/21/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to examine whether altered heart rate variability (HRV) could predict the risk of diabetes in Asians. RESEARCH DESIGN AND METHODS A cohort study was conducted in 54,075 adults without diabetes who underwent 3-min HRV measurement during health checkups between 2011 and 2014 at Kangbuk Samsung Hospital. We analyzed the time domain (SD of the normal-to-normal interval [SDNN] and root mean square differences of successive normal-to-normal intervals [RMSSD]) and the frequency domain (total power, normalized low-frequency power [LF], and normalized high-frequency power [HF] and LF/HF ratio). We compared the risk of diabetes until 2017 according to tertiles of heart rate and HRV variables, with tertile 1 serving as the reference group. RESULTS During 243,758.2 person-years, 1,369 subjects were diagnosed with diabetes. Both time and frequency domain variables were lower in the group with diabetes, with the exception of those with normalized LF and LF/HF ratio. In Cox analysis, as SDNN, RMSSD, and normalized HF tertiles increased, the risk of diabetes decreased (hazard ratios [95% CIs] of tertile 3: 0.81 [0.70-0.95], 0.76 [0.65-0.90], and 0.78 [0.67-0.91], respectively), whereas the risk of diabetes increased in the case of heart rate, normalized LF, and LF/HF ratio (hazard ratios [95% CIs] of tertile 3: 1.41 [1.21-1.65], 1.32 [1.13-1.53], and 1.31 [1.13-1.53), respectively) after adjusting for age, sex, BMI, smoking, drinking, systolic blood pressure, lipid level, CRP, and HOMA of insulin resistance. CONCLUSIONS Abnormal HRV, especially decreased vagal activity and deviation in sympathovagal imbalance to sympathetic activity, might precede incident diabetes.
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Affiliation(s)
- Da Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hwan Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyemi Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Won Oh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Woo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Se Eun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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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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Coopmans C, Zhou TL, Henry RMA, Heijman J, Schaper NC, Koster A, Schram MT, van der Kallen CJH, Wesselius A, den Engelsman RJA, Crijns HJGM, Stehouwer CDA. Both Prediabetes and Type 2 Diabetes Are Associated With Lower Heart Rate Variability: The Maastricht Study. Diabetes Care 2020; 43:1126-1133. [PMID: 32161051 DOI: 10.2337/dc19-2367] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/22/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Low heart rate variability (HRV), a marker for cardiac autonomic dysfunction, is a known feature of type 2 diabetes, but it remains incompletely understood whether this also applies to prediabetes or across the whole glycemic spectrum. Therefore, we investigated the association among prediabetes, type 2 diabetes, and measures of glycemia and HRV. RESEARCH DESIGN AND METHODS In the population-based Maastricht Study (n = 2,107; mean ± SD age 59 ± 8 years; 52% men; normal glucose metabolism [n = 1,226], prediabetes [n = 331], and type 2 diabetes [n = 550, oversampled]), we determined 24-h electrocardiogram-derived HRV in time and frequency domains (individual z-scores, based upon seven and six variables, respectively). We used linear regression with adjustments for age, sex, and major cardiovascular risk factors. RESULTS After adjustments, both time and frequency domain HRV were lower in prediabetes and type 2 diabetes as compared with normal glucose metabolism (standardized β [95% CI] for time domain: -0.15 [-0.27; -0.03] and -0.34 [-0.46; -0.22], respectively, P for trend <0.001; for frequency domain: -0.14 [-0.26; -0.02] and -0.31 [-0.43; -0.19], respectively, P for trend <0.001). In addition, 1-SD higher glycated hemoglobin, fasting plasma glucose, and 2-h postload glucose were associated with lower HRV in both domains (time domain: -0.16 [-0.21; -0.12], -0.16 [-0.21; -0.12], and -0.15 [-0.20; -0.10], respectively; frequency domain: -0.14 [-0.19; -0.10], -0.14 [-0.18; -0.09], and -0.13 [-0.18; -0.08], respectively). CONCLUSIONS Both prediabetes and type 2 diabetes were independently associated with lower HRV. This is further substantiated by independent continuous associations between measures of hyperglycemia and lower HRV. These data strongly suggest that cardiac autonomic dysfunction is already present in prediabetes.
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Affiliation(s)
- Charlotte Coopmans
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Tan Lai Zhou
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ronald M A Henry
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Heart+Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jordi Heijman
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Care and Public Health Research Institute School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.,Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Heart+Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Anke Wesselius
- Department of Complex Genetics, Maastricht University, Maastricht, the Netherlands
| | | | - Harry J G M Crijns
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands .,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
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Takahashi N, Takahashi Y, Tabara Y, Matsumoto T, Kawaguchi T, Kuriyama A, Ueshima K, Matsuda F, Chin K, Nakayama T. Correlates of autonomic nervous system function in a general population with special reference to HbA 1c: The Nagahama study. Diabetes Res Clin Pract 2020; 163:108126. [PMID: 32243903 DOI: 10.1016/j.diabres.2020.108126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
AIMS As the glucose tolerance of patients with diabetes worsens, autonomic nervous system (ANS) function decreases. Only a few studies, using plasma glucose, have reported on this relationship in large general populations that include people with wide range of glycemia. This study aimed to examine correlates of ANS function with special reference to HbA1c which is more stable than plasma glucose among community residents. METHODS Spectral analysis was performed to assess heart rate variability (HRV) using 1-minute electrocardiogram RR interval data recordings from 7690 residents aged 35-79 years in Nagahama City, Japan. HRV parameters were log-transformed. Multiple regression analysis was performed using potential correlates. RESULTS lnLF decreased with age (regression coefficient, -0.025; P < 0.001), BMI (-0.010; P = 0.035), and HbA1c (-0.068; P = 0.036). lnHF decreased with age (-0.029; P < 0.001), BMI (-0.032; P < 0.001), and HbA1c (-0.173; P < 0.001). lnLF/HF increased with age (0.003; P = 0.002), BMI (0.023; P < 0.001), and HbA1c (0.105; P < 0.001). Women showed lower lnLF and lnLF/HF than men. Sleep quality assessed by the Pittsburgh Sleep Quality Index, smoking and drinking had almost no relation. CONCLUSIONS Although the associations were weak, age, BMI and HbA1c were inversely correlated with parasympathetic activity, while positively correlated with sympathetic activity among general residents.
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Affiliation(s)
- Naomi Takahashi
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Yoshimitsu Takahashi
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, 53 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takeshi Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, 53 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Akira Kuriyama
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Kenji Ueshima
- Department of EBM Research, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, 53 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
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40
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Liu N, Guo D, Koh ZX, Ho AFW, Xie F, Tagami T, Sakamoto JT, Pek PP, Chakraborty B, Lim SH, Tan JWC, Ong MEH. Heart rate n-variability (HRnV) and its application to risk stratification of chest pain patients in the emergency department. BMC Cardiovasc Disord 2020; 20:168. [PMID: 32276602 PMCID: PMC7149930 DOI: 10.1186/s12872-020-01455-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
Background Chest pain is one of the most common complaints among patients presenting to the emergency department (ED). Causes of chest pain can be benign or life threatening, making accurate risk stratification a critical issue in the ED. In addition to the use of established clinical scores, prior studies have attempted to create predictive models with heart rate variability (HRV). In this study, we proposed heart rate n-variability (HRnV), an alternative representation of beat-to-beat variation in electrocardiogram (ECG), and investigated its association with major adverse cardiac events (MACE) in ED patients with chest pain. Methods We conducted a retrospective analysis of data collected from the ED of a tertiary hospital in Singapore between September 2010 and July 2015. Patients > 20 years old who presented to the ED with chief complaint of chest pain were conveniently recruited. Five to six-minute single-lead ECGs, demographics, medical history, troponin, and other required variables were collected. We developed the HRnV-Calc software to calculate HRnV parameters. The primary outcome was 30-day MACE, which included all-cause death, acute myocardial infarction, and revascularization. Univariable and multivariable logistic regression analyses were conducted to investigate the association between individual risk factors and the outcome. Receiver operating characteristic (ROC) analysis was performed to compare the HRnV model (based on leave-one-out cross-validation) against other clinical scores in predicting 30-day MACE. Results A total of 795 patients were included in the analysis, of which 247 (31%) had MACE within 30 days. The MACE group was older, with a higher proportion being male patients. Twenty-one conventional HRV and 115 HRnV parameters were calculated. In univariable analysis, eleven HRV and 48 HRnV parameters were significantly associated with 30-day MACE. The multivariable stepwise logistic regression identified 16 predictors that were strongly associated with MACE outcome; these predictors consisted of one HRV, seven HRnV parameters, troponin, ST segment changes, and several other factors. The HRnV model outperformed several clinical scores in the ROC analysis. Conclusions The novel HRnV representation demonstrated its value of augmenting HRV and traditional risk factors in designing a robust risk stratification tool for patients with chest pain in the ED.
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Affiliation(s)
- Nan Liu
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore. .,Health Services Research Centre, Singapore Health Services, 20 College Road, Singapore, 169856, Singapore.
| | - Dagang Guo
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore, Singapore
| | - Zhi Xiong Koh
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.,SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Feng Xie
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Tokyo, Japan
| | | | - Pin Pin Pek
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.,Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Bibhas Chakraborty
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Marcus Eng Hock Ong
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.,Health Services Research Centre, Singapore Health Services, 20 College Road, Singapore, 169856, Singapore.,Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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41
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Fabiyi-Edebor TD. Vitamin C ameliorated cardiac autonomic neuropathy in type 2 diabetic rats. World J Diabetes 2020; 11:52-65. [PMID: 32180894 PMCID: PMC7061237 DOI: 10.4239/wjd.v11.i3.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/07/2019] [Accepted: 01/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vitamin C (VC) is a common antioxidant with cell protection potentials. However, its possible protective effect on cardiac autonomic nerves from diabetic induced insults is yet to be explored.
AIM To investigate the effects of VC on diabetic cardiac autonomic neuropathy.
METHODS Thirty male Wistar rats were equally grouped into control, diabetic and diabetic + VC. Type 2 diabetes was induced with fructose diet and alloxan. VC (1 g/kg) was administered for 4 wk via oral canula. Blood pressure and heart rate were measured non-invasively using tail flick blood pressure monitor. Spectral analysis of heart rate variability (HRV) was used to assess cardiac autonomic neuropathy. Blood was collected from the ocular sinus for biochemical analysis. Urethane (1 g/kg-ip) was used for anaesthesia prior to HRV and cervical dislocation to harvest hearts. Intracardiac autonomic nerve was assessed using tyrosine hydroxylase immunohistochemistry on fixed heart sections.
RESULTS Results were analysed using ANOVA at α0.05. Unlike VC and control groups, diabetic rats showed significantly (P < 0.0001) reduced HRV, increased heart-rate and blood pressure, initial increase in cardiac tyrosine hydroxylase activities at week-2 and sparse activity at week-4 of diabetes. Furthermore, apolipoprotein B, Oxidative stress and inflammatory markers were significantly (P < 0.01) reduced in VC treated rats.
CONCLUSION VC possesses cardio-autonomic nerve protective potential and ameliorates the symptoms of cardiac autonomic neuropathy in type 2 diabetes. The possible mechanisms via which VC exert these effects may be via downregulation of oxidative stress, inflammation and apolipoprotein B.
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42
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Sun CK, Liu CC, Liu WM, Wu HT, Huang RM, Liu AB. Compatibility of pulse-pulse intervals with R-R intervals in assessing cardiac autonomic function and its relation to risks of atherosclerosis. Tzu Chi Med J 2020; 32:41-46. [PMID: 32110519 PMCID: PMC7015001 DOI: 10.4103/tcmj.tcmj_68_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 01/12/2018] [Accepted: 02/23/2018] [Indexed: 11/06/2022] Open
Abstract
Objective: Heart rate variability (HRV) analysis using electrocardiographic R–R intervals (RRIs) in either a time or a frequency domain is a useful tool for assessing cardiac autonomic dysfunction in clinical research. For convenience, pulse–pulse intervals (PPIs) acquired by photoplethysmography have been used to assess HRV. However, the compatibility of PPI with RRI is controversial. Materials and Methods: In this study, we investigated the compatibility of PPI with RRI in five groups of participants, including nonoverweight young individuals with a body mass index (BMI) <24 kg/m2 (Group 1, n = 20, aged 18–40 years), overweight young individuals with a BMI ≥24 kg/m2 (Group 2, n = 13, aged 21–38 years), nonoverweight upper middle-aged individuals with a BMI <24 kg/m2 (Group 3, n = 21, aged 45–89 years), overweight upper middle-aged individuals with a BMI ≥24 kg/m2 (Group 4, n = 14, aged 43–74 years), and diabetic patients with a BMI ≥24 kg/m2 (Group 5, n = 19, aged 35–74 years). We then used cross-approximate entropy (CAE) to assess the compatibility between RRI and PPI and analyzed HRV in the time and frequency domains derived from PPR and RRI with traditional methods. Results: The CAE values in Group 1 were significantly lower than those in Group 2 (1.68 ± 0.16 vs. 1.78 ± 0.15, P = 0.041), Group 3 (1.68 ± 0.16 vs. 2.05 ± 0.27, P < 0.001), Group 4 (1.68 ± 0.16 vs. 1.87 ± 0.23, P = 0.023), and Group 5 (1.68 ± 0.16 vs. 2.09 ± 0.23, P < 0.001). There were no significant differences in HRV acquired by PPI and RRI, except for proportion of pairs of adjacent NN intervals differing by more than 50 ms in the entire recording in Group 1. All HRVs derived from PPI were different from those acquired from RRI in the other groups. Conclusion: PPI may be an alternative parameter for effectively assessing cardiac autonomic function in nonoverweight healthy individuals. It should be used carefully in overweight, elderly, or diabetic individuals.
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Affiliation(s)
- Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital and I-Shou University College of Medicine, Kaohsiung, Taiwan
| | - Cyuan-Cin Liu
- Department of Electrical Engineering, National Dong Hwa University, Hualien, Taiwan
| | - Wei-Min Liu
- Department of Computer Science and Information Engineering, National Chung Cheng University, Chiayi, Taiwan
| | - Hsien-Tsai Wu
- Department of Electrical Engineering, National Dong Hwa University, Hualien, Taiwan
| | - Ruay-Ming Huang
- Department of Internal Medicine, Hualien Hospital, Ministry of Health and Welfare, Executive Yuan, Hualien, Taiwan
| | - An-Bang Liu
- Department of Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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43
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Razjouyan J, Lee H, Gilligan B, Lindberg C, Nguyen H, Canada K, Burton A, Sharafkhaneh A, Srinivasan K, Currim F, Ram S, Mehl MR, Goebel N, Lunden M, Bhangar S, Heerwagen J, Kampschroer K, Sternberg EM, Najafi B. Wellbuilt for wellbeing: Controlling relative humidity in the workplace matters for our health. INDOOR AIR 2020; 30:167-179. [PMID: 31663168 PMCID: PMC6973066 DOI: 10.1111/ina.12618] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/16/2019] [Accepted: 10/27/2019] [Indexed: 05/06/2023]
Abstract
This study offers a new perspective on the role of relative humidity in strategies to improve the health and wellbeing of office workers. A lack of studies of sufficient participant size and diversity relating relative humidity (RH) to measured health outcomes has been a driving factor in relaxing thermal comfort standards for RH and removing a lower limit for dry air. We examined the association between RH and objectively measured stress responses, physical activity (PA), and sleep quality. A diverse group of office workers (n = 134) from four well-functioning federal buildings wore chest-mounted heart rate variability monitors for three consecutive days, while at the same time, RH and temperature (T) were measured in their workplaces. Those who spent the majority of their time at the office in conditions of 30%-60% RH experienced 25% less stress at the office than those who spent the majority of their time in drier conditions. Further, a correlational study of our stress response suggests optimal values for RH may exist within an even narrower range around 45%. Finally, we found an indirect effect of objectively measured poorer sleep quality, mediated by stress responses, for those outside this range.
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Affiliation(s)
- Javad Razjouyan
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP)Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTXUSA
- Michael E. DeBakey VA Medical CenterHoustonTXUSA
| | - Hyoki Lee
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP)Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTXUSA
| | | | - Casey Lindberg
- College of Architecture, Planning and Landscape ArchitectureUArizona Institute on Place, Wellbeing & PerformanceUniversity of ArizonaTucsonAZUSA
- HKS, Inc.DallasTXUSA
| | - Hung Nguyen
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP)Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTXUSA
| | | | - Alex Burton
- Department of Biomedical EngineeringUniversity of ArizonaTucsonAZUSA
| | - Amir Sharafkhaneh
- Pulmonary, Critical Medicine and Sleep MedicineDepartment of MedicineBaylor College of MedicineHoustonTXUSA
| | - Karthik Srinivasan
- Center for Business Intelligence and AnalyticsUniversity of ArizonaTucsonAZUSA
| | - Faiz Currim
- Center for Business Intelligence and AnalyticsUniversity of ArizonaTucsonAZUSA
| | - Sudha Ram
- Center for Business Intelligence and AnalyticsUniversity of ArizonaTucsonAZUSA
| | | | | | | | | | | | | | - Esther M. Sternberg
- University of Arizona Institute on Place, Wellbeing & PerformanceAndrew Weil Center for Integrative MedicineUniversity of ArizonaTucsonAZUSA
| | - Bijan Najafi
- Michael E. DeBakey VA Medical CenterHoustonTXUSA
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44
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Williams SM, Eleftheriadou A, Alam U, Cuthbertson DJ, Wilding JPH. Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review. Diabetes Ther 2019; 10:1995-2021. [PMID: 31552598 PMCID: PMC6848658 DOI: 10.1007/s13300-019-00693-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Indexed: 12/19/2022] Open
Abstract
Cardiac autonomic neuropathy (CAN) is a major complication of type 1 and type 2 diabetes mellitus (T1DM and T2DM). The increased morbidity, cardiovascular and all-cause mortality associated with CAN is established from numerous epidemiological studies. However, CAN is increasingly recognised in people with prediabetes (pre-DM) and the metabolic syndrome (MetS) with a reported prevalence up to 11% and 24% respectively. CAN is associated with components of MetS including hypertension and obesity, predating hyperglycaemia. The aetiology of CAN is multifactorial and there is a reciprocal relationship with insulin resistance and MetS. Obstructive sleep apnoea (OSA) is also associated with CAN possibly through MetS and an independent mechanism. An estimated global prevalence of the impaired glucose tolerance (IGT) form of pre-DM of 587 million people by 2045 means CAN will become a major clinical problem. CAN is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Screening for CAN in pre-DM using risk scores with analysis of heart rate variability (HRV) or Sudoscan is important to allow earlier treatment at a reversible stage. The link between obesity and CAN highlights the therapeutic potential of lifestyle interventions including diet and physical activity to reverse MetS and prevent CAN. Weight loss achieved using these dietary and exercise lifestyle interventions improves the sympathetic and parasympathetic HRV indices of cardiac autonomic function. Further research is needed to identify high-risk populations of people with pre-DM or obesity that might benefit from targeted pharmacotherapy including metformin, sodium/glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) analogues. Bariatric surgery also improves HRV through weight loss which might also prevent CAN in severe obesity. This article reviews the literature on CAN in obesity, pre-DM and MetS, to help determine a rationale for screening, early intervention treatment and formulate future research questions in this highly prevalent condition.
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Affiliation(s)
| | | | - Uazman Alam
- Diabetes and Neuropathy Research, Department of Eye and Vision Sciences and Pain Research Institute, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
- Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, UK
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK
| | - Daniel J Cuthbertson
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - John P H Wilding
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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45
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Dennis PA, Neal JM, Travis E, Watkins LL, Calhoun PS, Dennis MF, Beckham JC. Negative Affect-Related Autonomic Arousal Mediates the Association between Baroreflex Dysfunction and Insulin Resistance in Non-Diabetic Young Adults. J PSYCHOPHYSIOL 2019; 33:243-253. [PMID: 31666757 DOI: 10.1027/0269-8803/a000226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Autonomic dysfunction, in particular under-regulation of heart rate (HR) by the baroreflex, is implicated in development of insulin resistance (IR). According to reactivity hypothesis, sympathetic response to stressors may be more sensitive at predicting IR than baroreceptor sensitivity (BRS), a baseline measure of baroreflex functioning. Using ecological momentary assessment (EMA) of negative affect coupled with minute-to-minute HR and heart-rate variability (HRV) monitoring, we examined whether negative affect (NA)-related autonomic arousal mediates the association of BRS with IR. At baseline, BRS was measured, and fasting serum glucose and insulin levels were collected from 178 young adults (18-39 years old), from which homeostasis model assessment of IR (HOMA-IR) and beta-cell functioning (HOMA %B) were derived. Participants subsequently underwent one day of Holter HR and HRV monitoring while reporting negative affect levels via EMA. Multilevel modeling was used to assess the associations of momentary negative affect with HR and low- (LF) and high-frequency (HF) HRV during the 5-minute intervals following each EMA reading. Structural equation modeling was then used to determine whether individual differences in these associations mediated the association of BRS with IR, measured by HOMA-IR, HOMA %B, and insulin levels. As predicted, BRS was negatively associated with the IR (β = -.17, p = .024). However, NA-related autonomic arousal mediated their association, accounting for 56% of the covariance between BRS and IR. Not only do these results provide support for reactivity hypothesis, they reveal a potential point of intervention in the treatment of affective dysregulation.
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Affiliation(s)
- Paul A Dennis
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Julia M Neal
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Emili Travis
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA
| | - Lana L Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA.,Durham Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA
| | - Michelle F Dennis
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Jean C Beckham
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
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46
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Wagner JA, Feinn R, Lampert R, Bermúdez-Millán A, Pérez-Escamilla R. Changes in negative affect and changes in heart rate variability among low-income latinos with type 2 diabetes in a randomized, controlled stress management trial. J Psychosom Res 2019; 124:109774. [PMID: 31443815 DOI: 10.1016/j.jpsychores.2019.109774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Structural equation modeling examined the relationship between change in negative affect (NA) and change in heart rate variability (HRV) among 121 Latinos with type 2 diabetes. METHODS This study leveraged data from the Community Health Workers Assisting Latinos Manage Stress and Diabetes (CALMSD) study which compared diabetes education vs diabetes education plus stress management. Participants completed surveys of NA at baseline and again 8-10 weeks later. They also wore 7‑lead, 3-channel ambulatory ECG monitors for 24 h at both time points. The latent variable NA was modeled by observed scores on symptoms of depression, anxiety, diabetes distress, and wellbeing (reversed). The latent variable HRV was modeled by observed scores in the time domain (the standard deviation of the R-R interval [SDNN] and the root mean square of the successive differences [RMSSD]) and in the frequency domain, i.e., log-transformed ultra-low frequency, very-low frequency, low frequency, and high frequency. RESULTS At baseline, there were strong, negative cross-sectional associations between NA and HRV. Baseline NA predicted change in HRV, whereas baseline HRV did not predict change in NA. Controlling for fasting glucose and treatment assignment did not meaningfully alter the findings. Stress management improved NA but not HRV. At followup, a greater reduction (improvement) in NA was associated with a larger increase (improvement) in HRV, with a small-to-medium negative association that approached statistical significance. CONCLUSIONS Findings indicate a longitudinal relationship between NA and HRV, and suggest that improvement in one may be associated with improvement in the other.
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Affiliation(s)
- Julie A Wagner
- University of Connecticut Schools of Medicine and Dental Medicine, United States of America.
| | - Richard Feinn
- Quinnipiac University School of Medicine, United States of America
| | - Rachel Lampert
- Yale University School of Medicine, United States of America
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47
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Lipponen JA, Tarvainen MP. A robust algorithm for heart rate variability time series artefact correction using novel beat classification. J Med Eng Technol 2019; 43:173-181. [PMID: 31314618 DOI: 10.1080/03091902.2019.1640306] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Purpose: Heart rate variability is a commonly used measurement to evaluate functioning of autonomic nervous system, psychophysiological stress, and exercise intensity and recovery. HRV measurements contain artefacts such as extra, missed or misaligned beat detections, which can produce significant distortion on HRV parameters. In this paper, a robust automatic method for artefact detection from HRV time series is proposed. Methods: The proposed detection method is based on time-varying thresholds estimated from distribution of successive RR-interval differences combined with a novel beat classification scheme. The method is validated using simulated extra, missed and misaligned beat detections as well as real artefacts such as atrial and ventricular ectopic beats. Results: The sensitivity of the algorithm to detect simulated missed/extra beats was 100%. The sensitivity to detect real atrial and ventricular ectopic beats was 96.96%, the corresponding specificity being 99.94%. The mean error in HRV parameters after correction was <2% for missed and extra beats as well as for misaligned beats generated with large displacement factors. Misaligned beats with smallest displacement factor were the most difficult to detect and resulted in largest HRV parameter errors after correction, largest errors being <8%. Conclusions: The HRV artefact correction algorithm presented in this study provided comparable specificity and better sensitivity to detect ectopic beats as compared to state-of-the-art algorithms. The proposed algorithm detects abnormal beats with high accuracy, is relatively easy to implement, and secures reliable HRV analysis by reducing the effect of possible artefacts to tolerable level.
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Affiliation(s)
- Jukka A Lipponen
- a Department of Applied Physics, University of Eastern Finland , Kuopio, Finland
| | - Mika P Tarvainen
- a Department of Applied Physics, University of Eastern Finland , Kuopio, Finland.,b Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital , Kuopio , Finland
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48
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Abstract
As the influence of diet on health may take place over a period of decades, there is a need for biomarkers that help to identify those aspects of nutrition that have either a positive or a negative influence. The evidence is considered that heart-rate variability (HRV) (the time differences between one beat and the next) can be used to indicate the potential health benefits of food items. Reduced HRV is associated with the development of numerous conditions for example, diabetes, cardiovascular disease, inflammation, obesity and psychiatric disorders. Although more systematic research is required, various aspects of diet have been shown to benefit HRV acutely and in the longer term. Examples include a Mediterranean diet, omega-3 fatty acids, B-vitamins, probiotics, polyphenols and weight loss. Aspects of diet that are viewed as undesirable, for example high intakes of saturated or trans-fat and high glycaemic carbohydrates, have been found to reduce HRV. It is argued that the consistent relationship between HRV, health and morbidity supports the view that HRV has the potential to become a widely used biomarker when considering the influence of diet on mental and physical health.
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Jester DJ, Rozek EK, McKelley RA. Heart rate variability biofeedback: implications for cognitive and psychiatric effects in older adults. Aging Ment Health 2019; 23:574-580. [PMID: 29381375 DOI: 10.1080/13607863.2018.1432031] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Two decades of heart rate variability (HRV) biofeedback research have focused on adolescent and adult populations with a variety of symptoms and conditions at the exclusion of older adults. This study explores HRV biofeedback as a novel treatment to decrease psychiatric symptoms and improve cognitive functioning in older adults. METHODS Participants enrolled in a three-week intervention that included six 30-min biofeedback sessions. Neuropsychological and psychiatric measures were administered before and after the intervention. RESULTS Decreases in depression (Cohen's d = 1.02, p < .001), state anxiety (Cohen's d = 0.82, p = .003), and trait anxiety (Cohen's d = 0.84, p = .002) were observed. An increase in attentional skills as measured by the Trail Making Test - Part A was seen (Cohen's d = 1.00, p = .001). Differences in executive skills as measured by the Trial Making Test - Part B and the Stroop Task did not reach statistical significance. CONCLUSION This study suggests that older adults may benefit from HRV biofeedback interventions much like the younger populations that have been studied for decades. Depression, anxiety, and attentional skills were positively affected. Several participants reported improved sleep quality and stress management. Future studies should corroborate these findings.
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Affiliation(s)
- Dylan J Jester
- a Department of Psychology , University of Wisconsin - La Crosse , La Crosse , WI , USA
| | - Ellen K Rozek
- a Department of Psychology , University of Wisconsin - La Crosse , La Crosse , WI , USA
| | - Ryan A McKelley
- a Department of Psychology , University of Wisconsin - La Crosse , La Crosse , WI , USA
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Spallone V. Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet. Diabetes Metab J 2019; 43:3-30. [PMID: 30793549 PMCID: PMC6387879 DOI: 10.4093/dmj.2018.0259] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/01/2019] [Indexed: 12/15/2022] Open
Abstract
The burden of diabetic cardiovascular autonomic neuropathy (CAN) is expected to increase due to the diabetes epidemic and its early and widespread appearance. CAN has a definite prognostic role for mortality and cardiovascular morbidity. Putative mechanisms for this are tachycardia, QT interval prolongation, orthostatic hypotension, reverse dipping, and impaired heart rate variability, while emerging mechanisms like inflammation support the pervasiveness of autonomic dysfunction. Efforts to overcome CAN under-diagnosis are on the table: by promoting screening for symptoms and signs; by simplifying cardiovascular reflex tests; and by selecting the candidates for screening. CAN assessment allows for treatment of its manifestations, cardiovascular risk stratification, and tailoring therapeutic targets. Risk factors for CAN are mainly glycaemic control in type 1 diabetes mellitus (T1DM) and, in addition, hypertension, dyslipidaemia, and obesity in type 2 diabetes mellitus (T2DM), while preliminary data regard glycaemic variability, vitamin B12 and D changes, oxidative stress, inflammation, and genetic biomarkers. Glycaemic control prevents CAN in T1DM, whereas multifactorial intervention might be effective in T2DM. Lifestyle intervention improves autonomic function mostly in pre-diabetes. While there is no conclusive evidence for a disease-modifying therapy, treatment of CAN manifestations is available. The modulation of autonomic function by SGLT2i represents a promising research field with possible clinical relevance.
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Affiliation(s)
- Vincenza Spallone
- Division of Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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