Heart Rate Variability and Incident Stroke: The Atherosclerosis Risk in Communities Study

Amber L Fyfe-Johnson, Clemma J Muller, Alvaro Alonso, Aaron R Folsom, Rebecca F Gottesman, Wayne D Rosamond, Eric A Whitsel, Sunil K Agarwal, Richard F MacLehose, Amber L Fyfe-Johnson, Clemma J Muller, Alvaro Alonso, Aaron R Folsom, Rebecca F Gottesman, Wayne D Rosamond, Eric A Whitsel, Sunil K Agarwal, Richard F MacLehose

Abstract

Background and purpose: Low heart rate variability (HRV), a marker of cardiac autonomic dysfunction, has been associated with increased all-cause and cardiovascular mortality. We examined the association between reduced HRV and incident stroke in a community-based cohort.

Methods: The Atherosclerosis Risk in Communities (ARIC) study measured HRV using 2-minute ECG readings in 12 550 middle-aged adults at baseline (1987-1989). HRV indices were calculated using the SD of RR intervals (SDNN), the mean of all normal RR intervals (meanNN), the root mean square of successive differences of successive RR intervals (RMSSD), low (LF) and high (HF) frequency power, and the LF/HF ratio. All HRV measures were categorized into quintiles. Incident stroke was adjudicated through 2011. Cox regression was used to estimate hazard ratios (HRs) with the lowest HRV quintile as the reference, with and without stratification by prevalent diabetes mellitus.

Results: Over a median follow-up of 22 years, 816 (6.5%) participants experienced incident stroke. After covariate adjustment, there was no strong evidence of association between HRV and stroke risk. In stratified analyses, the lowest HRV quintile was associated with higher stroke risk compared with the highest quintile for SDNN (HR, 2.0, 95% confidence interval, 1.1-4.0), RMSSD (HR, 1.7; 95% confidence interval, 0.9-3.2), LF (HR, 1.5; 95% confidence interval, 0.8-3.0), and HF (HR, 1.7; 95% confidence interval, 0.9-3.0) only among people with diabetes mellitus.

Conclusions: Lower HRV was associated with higher risk of incident stroke among middle-aged adults with prevalent diabetes mellitus but not among people without diabetes mellitus.

Keywords: autonomic nervous system; diabetes mellitus; follow-up studies; heart rate; stroke.

© 2016 American Heart Association, Inc.

References

    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart Disease and Stroke Statistics-2015 Update: A Report From the American Heart Association. Circulation. 2014;131:e29–322.
    1. Centers for Disease Control and Prevention (CDC) Prevalence of stroke--United States, 2006-2010. MMWR. Morb. Mortal. Wkly. Rep. 2012;61:379–82.
    1. Ohira T, Shahar E, Chambless LE, Rosamond WD, Mosley TH, Folsom AR. Risk factors for ischemic stroke subtypes: the Atherosclerosis Risk in Communities study. Stroke. 2006;37:2493–8.
    1. McLaren A, Kerr S, Allan L, Steen IN, Ballard C, Allen J, et al. Autonomic function is impaired in elderly stroke survivors. Stroke. 2005;36:1026–30.
    1. Hamner JW, Tan CO, Lee K, Cohen MA, Taylor JA. Sympathetic control of the cerebral vasculature in humans. Stroke. 2010;41:102–9.
    1. Zhang R, Zuckerman JH, Iwasaki K, Wilson TE, Crandall CG, Levine BD. Autonomic neural control of dynamic cerebral autoregulation in humans. Circulation. 2002;106:1814–20.
    1. Esler M. The sympathetic system and hypertension. Am. J. Hypertens. 2000;13:99S–105S.
    1. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation. 1996;93:1043–65.
    1. Bigger JT, Fleiss JL, Rolnitzky LM, Steinman RC. The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation. 1993;88:927–34.
    1. Dekker JM, Crow RS, Folsom AR, Hannan PJ, Liao D, Swenne CA, et al. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis Risk In Communities. Circulation. 2000;102:1239–44.
    1. Liao D, Carnethon M, Evans GW, Cascio WE, Heiss G. Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the atherosclerosis risk in communities (ARIC) study. Diabetes. 2002;51:3524–31.
    1. Mäkikallio AM, Mäkikallio TH, Korpelainen JT, Sotaniemi KA, Huikuri HV, Myllylä VV. Heart rate dynamics predict poststroke mortality. Neurology. 2004;62:1822–6.
    1. Binici Z, Mouridsen MR, Køber L, Sajadieh A. Decreased nighttime heart rate variability is associated with increased stroke risk. Stroke. 2011;42:3196–201.
    1. Sykora M, Diedler J, Turcani P, Hacke W, Steiner T. Baroreflex: a new therapeutic target in human stroke? Stroke. 2009;40:e678–82.
    1. The ARIC investigators The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. Am. J. Epidemiol. 1989;129:687–702.
    1. Cygankiewicz I, Zareba W. Heart rate variability. Handb. Clin. Neurol. 2013;117:379–93.
    1. Liao D, Barnes RW, Chambless LE, Heiss G. A computer algorithm to impute interrupted heart rate data for the spectral analysis of heart rate variability--the ARIC study. Comput. Biomed. Res. 1996;29:140–51.
    1. Liao D, Cai J, Brancati FL, Folsom A, Barnes RW, Tyroler HA, et al. Association of vagal tone with serum insulin, glucose, and diabetes mellitus--The ARIC Study. Diabetes Res. Clin. Pract. 1995;30:211–21.
    1. Rosamond WD, Folsom AR, Chambless LE, Wang CH, McGovern PG, Howard G, et al. Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke. 1999;30:736–43.
    1. Robins M, Weinfeld FD. The National Survey of Stroke. Study design and methodology. Stroke. 1981;12:I7–11.
    1. White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat. Med. 2011;30:377–99.
    1. StataCorp. Stata Statistical Software: Release 14. StataCorp LP; College Station, TX: 2015.
    1. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing; Austria, Vienna: 2015.
    1. Folsom AR, Szklo M, Stevens J, Liao F, Smith R, Eckfeldt JH. A prospective study of coronary heart disease in relation to fasting insulin, glucose, and diabetes. The Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care. 1997;20:935–42.
    1. Goadsby PJ. Autonomic nervous system control of the cerebral circulation. Handb. Clin. Neurol. 2013;117:193–201.
    1. Guyenet PG. The sympathetic control of blood pressure. Nat. Rev. Neurosci. 2006;7:335–46.
    1. Cressman MD, Gifford RW. Hypertension and stroke. J. Am. Coll. Cardiol. 1983;1:521–7.
    1. Palatini P, Julius S. The role of cardiac autonomic function in hypertension and cardiovascular disease. Curr. Hypertens. Rep. 2009;11:199–205.
    1. Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, Pop-Busui R, et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes. Metab. Res. Rev. 2011;27:639–53.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit