Cardiovascular autonomic dysfunction precedes cardiovascular disease and all-cause mortality: 11-year follow-up in...

Area of Science:

• Cardiology
• Diabetology
• Autonomic Nervous System Research

Background:

• Individuals at high risk for diabetes often exhibit cardiovascular autonomic dysfunction.
• Heart rate variability (HRV) is a non-invasive measure reflecting autonomic nervous system activity.
• Multiday HRV assessment provides a comprehensive view of cardiac autonomic function over time.

Purpose of the Study:

• To investigate the association between multiday heart rate variability (HRV) and the risk of major adverse cardiovascular events (MACE), heart failure, and all-cause mortality.
• To identify specific time frames during the day where HRV measurements are most predictive of cardiovascular outcomes.
• To evaluate the impact of HRV on mortality in a high-risk diabetic population.

Main Methods:

• 1627 participants from the ADDITION-PRO study provided multiday HRV and mean heart rate (mHR) data between 2009-2011.
• A proxy for standard deviation of normal heartbeat (SDNN) was calculated weekly, daily, and hourly as a measure of HRV.
• Poisson regression analysis was used to determine incidence rate ratios (IRR) for MACE, heart failure, and all-cause mortality, with data linkage to Danish patient registers until 2021.

Main Results:

• Multiday HRV index SDNN demonstrated significant associations: IRR of 0.82 for MACE, 0.76 for heart failure, and 0.79 for all-cause mortality per standard deviation increase.
• SDNN measurements between 6:00 AM and 7:00 AM showed the strongest link to MACE risk.
• Lower SDNN was consistently associated with increased all-cause mortality throughout the day, irrespective of time.

Conclusions:

• Multiday HRV, reflecting cardiovascular autonomic dysfunction, is significantly linked to MACE, heart failure, and all-cause mortality in individuals at high risk for diabetes.
• Specific diurnal patterns of HRV and heart rate under free-living conditions can indicate heightened cardiovascular disease risk.
• These findings underscore the importance of continuous HRV monitoring for risk stratification and management in prediabetic and diabetic populations.