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Association Between Heart Rate and Subclinical Cerebrovascular Disease in the Elderly
Koki Nakanishi1, Zhezhen Jin1, Shunichi Homma1
1From the Department of Medicine (K.N., S.H., S.C.L., A.T., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., C.B.W., R.L.S.), Department of Public Health Sciences (T.R., C.B.W., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; Department of Neurology, Hokuriku National Hospital, Nanto, Japan (M.Y.); and Department of Neurology, University of California at Davis (C.D.).
Insights
Elevated nighttime heart rate (HR) is linked to white matter hyperintensity volume in older adults. This finding suggests a potential role for nighttime HR in subclinical cerebrovascular disease development.
Area of Science:
- Cardiology
- Neurology
- Gerontology
Background:
- Increased heart rate (HR) is a known predictor of cardiovascular events and mortality.
- Subclinical cerebrovascular disease is common in the elderly population.
- The association between HR and subclinical cerebrovascular disease has not been previously evaluated.
Purpose of the Study:
- To investigate the association of daytime, nighttime, 24-hour HR, and HR variability with subclinical cerebrovascular disease.
- To analyze these associations in an elderly cohort without a history of stroke.
Main Methods:
- The study included 680 elderly participants (mean age 73 years) in sinus rhythm.
- 24-hour ambulatory blood pressure and HR monitoring, echocardiography, and brain MRI were performed.
- Subclinical cerebrovascular disease was defined as silent brain infarcts and white matter hyperintensity volume (WMHV).
Main Results:
- Nighttime HR was significantly associated with the upper quartile of white matter hyperintensity volume (log WMHV4) (OR, 1.29 per 10 bpm; P=0.026).
- This association remained significant after adjusting for cardiovascular risk factors and echocardiographic parameters.
- No significant association was found between daytime HR, HR variability, and silent brain infarcts.
Conclusions:
- Elevated nighttime heart rate is independently associated with white matter hyperintensity volume in an elderly cohort.
- This suggests a potential role for nighttime heart rate in the development of subclinical cerebrovascular disease.
- Further research is warranted to explore the underlying mechanisms.
Background And Purpose:
Although increased heart rate (HR) is a predictor of cardiovascular events and mortality, its possible association with subclinical cerebrovascular disease, which is prevalent in the elderly, has not been evaluated. This study aimed to investigate the association of daytime, nighttime, 24-hour HR, and HR variability with subclinical cerebrovascular disease in an elderly cohort without history of stroke.
Methods:
The study cohort consisted of 680 participants (mean age, 73±7 years; 42% men) in sinus rhythm who underwent 24-hour ambulatory blood pressure and HR monitoring, 2-dimensional echocardiography, and brain magnetic resonance imaging as part of the CABL study (Cardiac Abnormalities and Brain Lesion). Subclinical cerebrovascular disease was defined as silent brain infarcts and white matter hyperintensity volume (WMHV). The relationship of HR measures with the presence of silent brain infarct and upper quartile of log WMHV (log WMHV4) was analyzed.
Results:
Presence of silent brain infarct was detected in 93 participants (13.7%); mean log WMHV was -0.92±0.93 (median, -1.05; min, -5.88; max, 1.74). Multivariate analysis showed that only nighttime HR (adjusted odds ratio, 1.29 per 10 bpm; 95% confidence interval, 1.03-1.61; P=0.026) was significantly associated with log WMHV4, independent of traditional cardiovascular risk factors, ambulatory systolic blood pressure, and echocardiographic parameters. No similar association was observed for daytime HR and HR variability. There was no significant association between all HR measures and silent brain infarct.
Conclusions:
In a predominantly elderly cohort, elevated nighttime HR was associated with WMHV, suggesting an independent role of HR in subclinical cerebrovascular disease.
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