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Ethnic differences in resting heart rate variability: a systematic review and meta-analysis
LaBarron K Hill1, Dixie D Hu, Julian Koenig
1From the Center for the Study of Aging and Human Development (L.K.H.) and Department of Psychiatry (L.K.H.), Duke University Medical Center, Durham, North Carolina; Department of Psychology (D.D.H., J.K., J.F.T.), The Ohio State University, Columbus, Ohio; Department of Psychological Medicine (J.J.S.), The University of Auckland, Auckland, New Zealand; Georgia Prevention Institute (G.K., X.W., H.S.), Georgia Health Sciences University, Augusta, Georgia; Unit of Genetic Epidemiology and Bioinformatics, Department of Epidemiology (H.S.), University of Groningen-University Medical Center, Groningen, the Netherlands.
Insights
African Americans (AAs) exhibit greater heart rate variability (HRV) than European Americans, suggesting reduced parasympathetic cardiac modulation does not explain ethnic disparities in cardiovascular disease (CVD) risk.
Area of Science:
- Cardiology
- Physiology
- Health Disparities
Background:
- Ethnic disparities in cardiovascular disease (CVD) morbidity and mortality are well-documented.
- Decreased parasympathetic cardiac modulation is linked to CVD and stroke risk factors.
- African Americans (AAs) face disproportionate CVD risk, prompting investigation into cardiac autonomic function.
Purpose of the Study:
- To systematically review and meta-analyze evidence on ethnic differences in vagally mediated heart rate variability (HRV).
- To determine if reduced HRV in AAs contributes to CVD health disparities.
Main Methods:
- Systematic literature search for studies comparing HRV in AAs and European Americans.
- Meta-analysis using a mixed-effects model with restricted maximum likelihood estimation.
- Calculation of adjusted standardized effect sizes (Hedges g) for 17 studies.
Main Results:
- AAs demonstrated significantly greater HRV than European Americans (Hedges g = 0.93).
- This finding persisted after adjusting for covariates like health status, medication use, sex, and age.
Conclusions:
- Decreased vagally mediated heart rate variability is unlikely to explain ethnic disparities in CVD risk and burden among AAs.
- Continued research is needed to understand the biobehavioral mechanisms underlying socioethnic cardiovascular differences.
Background:
Ethnic disparities in cardiovascular morbidity and mortality are widely documented in the literature. Recently, research has shown that decreased parasympathetic cardiac modulation is associated with the established and emerging risk factors for cardiovascular disease (CVD) and stroke. In consideration of the disproportionate CVD risk and disease profile of African Americans (AAs), it is plausible that decreased cardiac parasympathetic functioning may partially explain these disparities. In the present systematic review and meta-analysis, we assess the available evidence for a reliable ethnic difference in tonic vagally mediated heart rate variability (HRV), an indicator of parasympathetic cardiac modulation.
Methods:
A systematic literature search was conducted yielding studies comparing tonic HRV in AAs and European Americans. Adjusted standardized effect sizes (Hedges g) were calculated using a mixed-effects model, with restricted maximum likelihood estimation for 17 studies containing appropriate measures of vagally mediated HRV.
Results:
Meta-analysis results suggest that AAs have greater HRV than do European Americans (Hedges g = 0.93, 95% confidence interval = 0.25-1.62), even after consideration of several covariates including health status, medication use, and subgroup stratification by sex and age.
Conclusions:
These findings suggest that decreased vagally mediated HRV is not likely to account for the persistent health disparities experienced by AAs with respect to CVD risk and burden. These disparities underscore the need for continued research addressing socioethnic cardiovascular differences and the biobehavioral mechanisms involved.
