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Autonomic function and prothrombotic activity in women after an acute coronary event
Roland von Känel1, Kristina Orth-Gomér
1Department of General Internal Medicine,University Hospital, Inselspital, CH-3010 Bern, Switzerland. roland.vonkaenel@insel.ch
Insights
Reduced heart rate variability (HRV) is linked to increased prothrombotic factors in women post-coronary event. Autonomic function may influence clot formation, impacting coronary artery disease (CAD) progression.
Area of Science:
- Cardiovascular Research
- Autonomic Nervous System Function
- Hemostasis and Thrombosis
Background:
- The relationship between diminished heart rate variability (HRV) and the progression of atherosclerosis remains unclear.
- This study investigates the hypothesis that reduced HRV is associated with elevated levels of prothrombotic factors, known predictors of coronary risk.
Purpose of the Study:
- To examine the association between heart rate variability (HRV) indices and a composite index of prothrombotic activity in women following an acute coronary event.
- To determine if HRV is an independent predictor of prothrombotic state in this patient population.
Main Methods:
- 257 women (mean age 56 years) were studied 3-6 months after an acute coronary event.
- 24-hour ambulatory ECG recordings were used to calculate very low frequency (VLF), low frequency (LF), and high frequency (HF) power, and the LF/HF ratio.
- Plasma levels of activated clotting factor VII (FVIIa), fibrinogen, von Willebrand factor antigen (VWF:Ag), and plasminogen activator inhibitor-1 (PAI-1) activity were measured and combined into a prothrombotic index.
Main Results:
- Bivariate analyses revealed inverse correlations between all HRV indices and the prothrombotic index (6-14% variance explained, p < 0.001).
- After adjusting for multiple covariates, VLF, LF, and HF power independently explained 2%, 5%, and 3% of the variance in the prothrombotic index, respectively (p < 0.012).
- Specific independent associations were found between VLF power and PAI-1, LF power and fibrinogen/VWF:Ag/PAI-1, HF power and FVIIa/fibrinogen, and LF/HF ratio and PAI-1 (2-3% variance explained, p < 0.05).
Conclusions:
- Decreased HRV is associated with prothrombotic changes in women with coronary artery disease (CAD), even after accounting for various covariates.
- Autonomic dysfunction may play a role in promoting prothrombotic activity in women with established CAD.
Background:
The link between decreased heart rate variability (HRV) and atherosclerosis progression is elusive. We hypothesized that reduced HRV relates to increased levels of prothrombotic factors previously shown to predict coronary risk.
Methods:
We studied 257 women (aged 56 +/- 7 years) between 3 and 6 months after an acute coronary event and obtained very low frequency (VLF), low frequency (LF), and high frequency (HF) power, and LF/HF ratio from 24-hour ambulatory ECG recordings. Plasma levels of activated clotting factor VII (FVIIa), fibrinogen, von Willebrand factor antigen (VWF:Ag), and plasminogen activator inhibitor-1 (PAI-1) activity were determined, and their levels were aggregated into a standardized composite index of prothrombotic activity.
Results:
In bivariate analyses, all HRV indices were inversely correlated with the prothrombotic index explaining between 6% and 14% of the variance (p < 0.001). After controlling for sociodemographic factors, index event, menopausal status, cardiac medication, lifestyle factors, self-rated health, metabolic variables, and heart rate, VLF power, LF power, and HF power explained 2%, 5%, and 3%, respectively, of the variance in the prothrombotic index (p < 0.012). There were also independent relationships between VLF power and PAI-1 activity, between LF power and fibrinogen, VWF:Ag, and PAI-1 activity, between HF power and FVIIa and fibrinogen, and between the LF/HF power ratio and PAI-1 activity, explaining between 2% and 3% of the respective variances (p < 0.05).
Conclusions:
Decreased HRV was associated with prothrombotic changes partially independent of covariates. Alteration in autonomic function might contribute to prothrombotic activity in women with coronary artery disease (CAD).
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