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Published on: September 21, 2018
Inflammatory markers and heart rate variability in women with coronary heart disease
I Janszky1, M Ericson, M Lekander
1Department of Preventive Medicine, Public Health Sciences, Karolinska Institutet, and Center of Public Health, Stockholm County Council, Stockholm, Sweden.
Insights
In women with coronary heart disease (CHD), higher levels of interleukin-6 (IL-6) were independently linked to lower heart rate variability (HRV). This suggests inflammation may worsen CHD prognosis by reducing HRV.
Area of Science:
- Cardiology
- Immunology
- Biomedical Engineering
Background:
- Heart rate variability (HRV) and inflammatory markers are crucial prognostic indicators in coronary heart disease (CHD).
- The relationship between HRV and specific inflammatory markers in CHD patients remains under-explored.
Purpose of the Study:
- To investigate the association between HRV and inflammatory activity in women with CHD.
- To assess the correlation between HRV parameters and levels of interleukin-6 (IL-6), IL-1 receptor antagonist (IL-1ra), and C-reactive protein (CRP).
Main Methods:
- Ambulatory 24-hour ECG recordings were analyzed for HRV parameters (SDNN, total power, VLF, LF, HF) in women 1 year post-myocardial infarction or revascularization.
- Serum levels of high-sensitivity CRP, IL-6, and IL-1ra were quantified using nephelometry and enzyme immunoassay.
Main Results:
- Interleukin-6 (IL-6) demonstrated a significant inverse association with multiple HRV measures, even after adjusting for confounding factors.
- The correlation between IL-6 and HRV was stronger than that observed for CRP or IL-1ra.
- No significant inverse relationship was found between HRV and CRP or IL-1ra levels.
Conclusions:
- Elevated IL-6 concentrations are independently associated with reduced HRV in women with CHD.
- Increased inflammatory activity, indicated by IL-6, may be an auxiliary mechanism contributing to the link between decreased HRV and poor CHD prognosis.
Purpose:
Both heart rate variability (HRV) and inflammatory markers are carrying prognostic information in coronary heart disease (CHD), however, we know of no studies examining their relation in CHD. The aim of this study, therefore, was to assess the association between HRV and inflammatory activity, as reflected by the levels of interleukin-6 (IL-6), IL-1 receptor antagonist (IL-1ra) and C-reactive protein (CRP).
Subjects And Methods:
Consecutive women patients who survived hospitalization for acute myocardial infarction, and/or underwent a percutaneous transluminal coronary angioplasty or a coronary artery bypass grafting were included and evaluated in a stable condition 1 year after the index events. An ambulatory 24-h ECG was recorded during normal activities. SDNN index (mean of the standard deviations of all normal to normal intervals for all 5-min segments of the entire recording) and the following frequency domain parameters were assessed: total power, high frequency (HF) power, low frequency (LF) power and very low frequency (VLF) power. Levels of high-sensitivity CRP were measured by nephelometry, IL-6 and IL-1ra concentrations were determined by enzyme immunoassay.
Results:
Levels of IL-6 showed an inverse relation with HRV measures even after controlling for potential confounding factors. The P-values were 0.02, 0.04, 0.01, 0.03, 0.18 for the multivariate association with SDDN index, total power, VLF power, LF power and HF power respectively. In contrast, the inverse relationship between HRV measures and CRP or IL-1ra levels were weak and nonsignificant. Correlation coefficients for the relationship between IL-6 and HRV measures were both uni- and multivariately higher than for the relationship between HRV measures and any other factors evaluated in this study.
Conclusion:
Concentration of IL-6 showed a negative, independent association with HRV in women with CHD. Thus, increased inflammatory activity, as reflected by IL-6 levels, may represent a new auxiliary mechanism linking decreased HRV to poor prognosis in CHD.
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