Multiple Metabolic Syndrome Is Associated With Lower Heart Rate Variability: The Atherosclerosis Risk in Communities Study
Abstract
OBJECTIVE: To test at the population level whether people with multiple metabolic syndrome (MMS) disorders have reduced cardiac autonomic activity (CAA). RESEARCH DESIGN AND METHODS: We examined the association between the level of CAA and MMS disorders, at the degree of clustering and the segregate combination levels, using a random sample of 2,359 men and women aged 45–64 years from the biracial, population-based Atherosclerosis Risk in Communities (AR1C) Study. Supine resting 2-min beat-to-beat heart rate data were collected. High-frequency (HF) (0.15–0.35 Hz) and low-frequency (LF) (0.025–0.15 Hz) spectral powers, the ratio of LF to HF, and the SD of all normal R-R intervals (SDNN) were used as the conventional indices of heart rate variability (HRV) to measure CAA. The MMS disorders included hypertension, type 2 diabetes, and dyslipidemia. RESULTS: HRV indices were significantly lower in individuals with MMS disorders. The multivariable adjusted mean HF was 0.85 (beat/min)2 in subjects with all three MMS disorders, in contrast to 1.31 beat/min)2 in subjects without any MMS disorder. At the segregated combination level, the multivariable adjusted means ± SEM of HF were 1.34 ± 0.05, 1.16 ± 0.05, 1.01 ± 0.17, and 1.34 ± 0.05 (beat/min)2, respectively, for subjects without any MMS disorder, with hypertension only, with diabetes only, and with dyslipidemia only, and the means ± SEM of HF were 0.93 ± 0.04,0.70 ± 0.15, and 1.20 ± 0.05 eat/min)2, respectively, for subjects with diabetes and hypertension, diabetes and dyslipidemia, and hypertension and dyslipidemia. An increase in fasting insulin of 1 SD was associated with 88% higher odds of having a lower HF The pattern of associations was similar for LF and SDNN. CONCLUSIONS: These findings suggest that MMS disorders adversely affect cardiac autonomic control and a reduced cardiac autonomic control may contribute to the increased risk of subsequent cardiovascular events in individuals who exhibit MMS disorders.
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Indices such as heart rate variability and urinary normetanephrine have suggested an increased sympathetic drive and its effects in MS patients.
“For instance, indices such as heart rate variability 27,28 and urinary normetanephrine 28 have suggested an increased sympathetic drive and its effects in MS patients.”
From Sympathetic Neural Activation in Nondiabetic Metabolic Syndrome and Its Further Augmentation by Hypertension (2004) · cites this paper as [28]
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ResultHeart rate variability analysis
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“Participants in this study were accrued through the National Institute on Aging (NIA) P01 AG023028 Early Determinants of Adult Health (EDAH; 2003–2008) (described in Susser et al.,56 this issue) and NIMH-NHLBI RO1 MH074679 (Goldstein, principal investigator (P.I.)) on Shared Fetal Antecedents to Major Depression and R…”
BackgroundResultInfluentialSelf-citationChyun, D. A., Wackers, F. J. T., Inzucchi, S. E., Jose, P. O., Weiss, C. H., Davey, J. A., Heller, G. V., Iskandrian, A. E., Young, L. H., & for the DIAD Investigators (2015) · SAGE Open Medicine · doi:10.1177/2050312114568476 · Cited by 31 · see citing works
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“…diabetes, hypertension, levels of fasting glucose and insulin among non-diabetes, using HRV indices calculated from 100 Hz sampling rate from 2 min beat-to-beat ECG data (Dekker et al., 2000; Liao et al., 1996, 1997, 1998, 2002, 2004; Carnethon et al., 2002, 2003; Schroeder et al., 2003, 2005).”
BackgroundMethodSelf-citationLi, X., Yu, S., Chen, H., Lu, C. H., Zhang, K., & Li, F. (2014) · Journal of Diabetes Investigation · doi:10.1111/jdi.12270 · Cited by 31 · see citing works
Takahashi, N., Anan, F., Nakagawa, M., Yufu, K., Shinohara, T., Tsubone, T., Goto, K., Masaki, T., Katsuragi, I., Tanaka, K., et al. (2007) · Metabolism · doi:10.1016/j.metabol.2007.02.005 · Cited by 31 · see citing works
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“Dyslipidemia was defined as fasting triglyceride levels of at least 200 mg/dL or high-density lipoprotein cholesterol (HDL-C) concentration less than 45 mg/dL for women and less than 35 mg/dL for men [14].”
BackgroundHeart rate variability is severely impaired among type 2 diabetic patients with hypertension
Istenes, I., Körei, A. E., Putz, Z., Németh, N., Martos, T., Keresztes, K., Kempler, M., Vági, O. E., Vargha, P., & Kempler, P. (2013) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2496 · Cited by 29 · see citing works
“Our data are consistent with the results of the Atherosclerosis Risk in Communities study, in which lower HRV was independently associated with hypertension and diabetes, and hypertension clusteredwith diabetes had additive, negative effects on HRV [22].”
ResultBerkelaar, M., Eekhoff, E. M. W., Simonis-Bik, A. M. C., Boomsma, D. I., Diamant, M., IJzerman, R. G., Dekker, J. M., Hart, L. M. ‘., & de Geus, E. J. C. (2013) · Diabetologia · doi:10.1007/s00125-013-2848-6 · Cited by 28 · see citing works
“People with obesity and insulin resistance are characterised by decreased heart rate (HR) variability (HRV) compared with healthy controls [1–4].”
BackgroundChildhood Obesity and Autonomic Dysfunction: Risk for Cardiac Morbidity and Mortality
Liao, D., Rodriguez-Colon, S. M., He, F., & Bixler, E. O. (2014) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-014-0342-1 · Cited by 29 · see citing works
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“Dyslipidemia was defined as fasting triglycerides levels ≥200 mg/dl or HDL-C concentration b45 mg/dl for women and b35 mg/dl for men (Liao et al., 1998).”
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Insulin resistance and circadian rhythm of cardiac autonomic modulation
Rodriguez-Colon, S. M., Li, X., Shaffer, M. L., He, F., Bixler, E. O., Vgontzas, A. N., Cai, J., & Liao, D. (2010) · Cardiovascular Diabetology · doi:10.1186/1475-2840-9-85 · Cited by 28 · see citing works
Self-citationEffect of atorvastatin and fenofibrate on autonomic tone in subjects with combined hyperlipidemia
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Correlations between homocysteine levels and atherosclerosis in Japanese type 2 diabetic patients
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Regulation of QT indices mediated by autonomic nervous function in patients with type 2 diabetes
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Central adiposity and decreased heart rate variability in postmenopause: a cross-sectional study
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Associations between heart rate variability, metabolic syndrome risk factors, and insulin resistance
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The Contribution of Autonomic Imbalance to the Development of Metabolic Syndrome
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“In a report from theAtherosclerosis Risk in Communities Study, Liao and colleagues (16) found an association between lowHRVand multiple metabolic disorders, namely, hypertension, dyslipidemia, and Type 2 diabetes.”
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Heart Rate Variability in Healthy Populations: Correlates and Consequences
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- Authors
- Liao, D., Sloan, R. P., Cascio, W. E., Folsom, A. R., Liese, A. D., Evans, G. W., Cai, J., & Sharrett, A. R.
- Affiliations
- Pennsylvania State University (US)
- University of Minnesota (US)
- University of North Carolina at Chapel Hill (US)
- National Institutes of Health (US)
- University of Münster (DE)
- Wake Forest University Health Sciences (US)
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 1998-12-01
- Volume
- 21
- Issue
- 12
- Pages
- 2116-2122
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W1987379871
- Cited by
- 223
- References
- 0
- Citations by year
- 2025: 2 · 2024: 5 · 2023: 6 · 2022: 6 · 2021: 5 · 2020: 4 · 2019: 8 · 2018: 11 · 2017: 3 · 2016: 3 · 2015: 15 · 2014: 9 · 2013: 17 · 2012: 12
- FWCI
- 1.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc55016-37-0-0, 5r01hl055669-04, n01hc55015-48-0-1)
- National Heart, Lung, and Blood Institute (N01-HC55016, N01‐HC‐55015, 5R01 HL 55669)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- heart rate variability, cardiac autonomic control, hypertension, type 2 diabetes, dyslipidemia, fasting insulin, spectral power, cardiovascular risk
- MeSH terms
- Arteriosclerosis, Blood Pressure, Diabetes Mellitus, Type 2, Female, Heart Rate, Humans, Hyperlipidemias, Hypertension, Longitudinal Studies, Male, Middle Aged, Risk Factors, Syndrome, United States, Cohort Studies
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