Related Experiment Video
Updated: May 14, 2026
Calculating Heart Rate Variability from ECG Data from Youth with Cerebral Palsy During Active Video Game Sessions
Published on: June 5, 2019
Heart rate variability and first cardiovascular event in populations without known cardiovascular disease:
Stefanie Hillebrand1, Karin B Gast, Renée de Mutsert
1Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands.
Insights
Low heart rate variability (HRV) increases the risk of a first cardiovascular event by 32-45% in individuals without prior cardiovascular disease (CVD). Higher HRV, specifically SDNN, is linked to a reduced risk of fatal or non-fatal CVD.
Area of Science:
- Cardiology
- Preventive Medicine
- Biostatistics
Background:
- Heart rate variability (HRV) is a known predictor of cardiovascular disease (CVD) in patients with established CVD.
- The association between HRV and the risk of a first cardiovascular event in the general population is less understood.
Purpose of the Study:
- To conduct a meta-analysis investigating the relationship between HRV and incident cardiovascular events in individuals without pre-existing CVD.
- To quantify the risk associated with different levels of HRV in predicting first-time cardiovascular events.
Main Methods:
- A comprehensive meta-analysis and dose-response meta-regression were performed.
- Searched major scientific databases (PubMed, Embase, Web of Science, Cochrane, ScienceDirect, CINAHL) up to December 2011.
- Included eight studies with 21,988 participants, analyzing standard deviation of the normalized N-N interval (SDNN), low-frequency (LF), and high-frequency (HF) components of HRV.
Main Results:
- Low HRV, specifically low SDNN, was associated with a 32-45% increased risk of a first cardiovascular event (RR 1.35 for lowest vs. highest SDNN).
- Low LF HRV also showed an increased risk (RR 1.45), while HF HRV approached significance (RR 1.32).
- Meta-regression indicated that the 10th percentile of SDNN predicted a 50% higher risk of incident CVD compared to the 50th percentile.
Conclusions:
- Reduced heart rate variability is a significant risk factor for first-time cardiovascular events in individuals without known CVD.
- A 1% increase in SDNN is associated with an approximately 1% reduction in the risk of fatal or non-fatal CVD.
- HRV metrics, particularly SDNN, can aid in identifying individuals at higher risk for primary cardiovascular events.
Aims:
Heart rate variability (HRV) is associated with cardiovascular disease (CVD) in individuals with known CVD. It is less clear whether HRV is associated with a first cardiovascular event. Therefore, we performed a meta-analysis to study the association between HRV and incident cardiovascular events in populations without known CVD.
Methods And Results:
We performed a meta-analysis and dose-response meta-regression of studies assessing the association between HRV and CVD. We searched Pubmed, Embase, Web of Science, Cochrane library, ScienceDirect, and CINAHL up to December 2011 for eligible studies. We selected studies that used the standard deviation of the normalized N-N interval (SDNN), low-frequency (LF) or high-frequency (HF) spectral component as a measure of HRV. Primary outcomes were (non)fatal cardiovascular events. Eight studies with a total number of 21 988 participants were included. The pooled relative risk (RR) comparing the lowest level to the highest level of SDNN was 1.35 (95% CI 1.10, 1.67). The pooled RRs for LF and HF were 1.45 (95% CI 1.12, 1.87) and 1.32 (95% CI 0.96, 1.81), respectively. In a meta-regression, the predicted RR of incident CVD of the 10th and 90th HRV (SDNN) percentiles compared with the 50th percentile were 1.50 (95% CI 1.22, 1.83) and 0.67 (95% CI 0.41, 1.09).
Conclusion:
In conclusion, low HRV is associated with a 32-45% increased risk of a first cardiovascular event in populations without known CVD. An increase in SDNN of 1% results in an ∼1% lower risk of fatal or non-fatal CVD.
Related Concept Videos
01:30Factors Influencing Heart Rate
Let us explore the significant factors affecting heart rate, including age, body temperature, posture, acute pain, chemical influences,...
01:31Regulation of Heart Rates
The SNS increases heart rate through the release of norepinephrine and epinephrine, which act on beta-1 adrenergic receptors in the heart. This action increases the rate of depolarization in the sinoatrial (SA) node, the heart's...
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
01:19Cardiac Output I:Effect of Heart Rate on Cardiac Output
Cardiac output (CO) refers to the total amount of blood ejected by one of the ventricles in liters per minute (L/min). In a resting adult, CO ranges from 5 to 6 L/min, adjusting according to the body's metabolic requirements.
Effect of Heart Rate on Cardiac Output
Cardiac output adapts to metabolic demands during stress, physical activity, or illness. The autonomic nervous system regulates heart rate via the sinoatrial node. The parasympathetic nervous system decreases heart rate...
01:29Pathophysiology of Cardiac Performance