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Autonomic imbalance may predict multiple poor metabolic outcomes
Resting heart rate and heart rate variability may serve as predictors for certain metabolic risk outcomes and diabetes, according to research in The Journal of Clinical Endocrinology & Metabolism.
Data suggested that both resting heart rate (RHR) and heart rate variability (HRV), two measures of autonomic imbalance, significantly predicted two of the five metabolic risk factors — hyperglycemia and high blood pressure — and diabetes diagnosis within 12 years, and also predicted cardiovascular disease and early mortality for most patients studied. Links between autonomic imbalance and the other three factors — BMI, HDL and triglycerides — were not statistically as strong, according to researchers.
“It is not yet clear why these autonomic imbalance measures better predicted these two outcomes, compared to BMI, HDL and triglycerides,” the researchers wrote. “It is possible that in our sample lipids were more influenced by insulin resistance or some other factor than by autonomic activity.”
Lawson R. Wulsin, MD, of the Cincinnati VA Medical Center and University of Cincinnati College of Medicine, and colleagues at other institutions analyzed prospective data from 1,882 Offspring Cohort participants in the Framington Heart Study, first examined between 1971 and 1975 and approximately every subsequent 4 to 8 years. The baseline RHR was 65.2 ± 10.6 beats per minute, and the baseline HRV was .094 ± .028 milliseconds.
Lawson R. Wulsin
Researchers measured whether autonomic imbalance, measured by both RHR and HRV, was an independent predictor of each of the five components of metabolic syndrome: hyperglycemia, high blood pressure, high triglycerides, low HDL and high BMI, as well as CVD, diabetes and early mortality. Researchers used baseline RHR, HRV, age, sex and smoking status to predict the odds of developing a specific metabolic risk, conducting a logistic regression model with backward elimination.
In addition to predicting high blood pressure and hyperglycemia within 12 years, HRV, along with various combinations of sex, age and smoking status, predicted CVD and death for men, while RHR predicted CVD in the younger half of the sample and death for both sexes. HRV and RHR also predicted incident diabetes (for HRV, OR = 0.549; 95% CI, 0.429-0.701; for RHR, OR = 1.638; 95% CI, 1.364 – 1.966).
The study is the first to measure the effect of RHR and HRV on the development of metabolic factors, CVD, diabetes and early mortality, according to researchers. Future studies are needed to address several questions, including the relationship between autonomic imbalance and insulin resistance during the development of metabolic risk, according to researchers.
“If these findings are supporeted by confirmations in other populations, clinicians may assess measures of autonomic imbalance, such as resting heart rate and heart rate variability, to target high-risk groups for prevention interventions,” Wulsin told Endocrine Today. “Comprehensive treatment planning to reduce sympathetic activity or increase parasympathetic activity by medications, exercise, meditation, sleep management and stress management programs could reduce metabolic risks and improve outcomes.”
Wulsin added that replicating and refuting these findings in other population should be the focus of future research.
Subsequently, it will be important to test in clinical trials which treatments most effectively reduce autonomic imbalance and metabolic risks in these high risk groups,” Wulsin said. – by Regican Schaffer
For more information:
Lawson R. Wulsin, MD, can be reached at 260 Stetson Ave., Ste 3200, Cincinnati, OH 45219; email: lawsun.wulsin@va.gov.
Disclosure: The researchers report no relevant financial disclosures.