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© 2005 by the American Diabetes Association, Inc.
Pathophysiology/Complications |
Diabetes, Glucose, Insulin, and Heart Rate Variability
The Atherosclerosis Risk in Communities (ARIC) study
1 Duke University School of Medicine, Duke University, Durham, North Carolina
2 Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
3 Department of Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
4 Department of Public Health Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
5 Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Address correspondence and reprint requests to Gerardo Heiss, MD, PhD, 137 E. Franklin St., Suite 306, Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514. E-mail: gerardo_heiss{at}unc.edu
OBJECTIVE—To describe the progression of autonomic impairment among individuals with diabetes and pre-diabetic metabolic impairments.
RESEARCH DESIGN AND METHODS—We investigated the consequence of diabetes and pre-diabetic metabolic impairments on the 9-year change in heart rate variability (HRV) in a population-based cohort of 6,245 individuals aged 45–64 years at baseline and cross-sectional associations among 9,940 individuals.
RESULTS—Diabetic subjects had a more rapid temporal decrease in HRV conditional on baseline HRV than nondiabetic subjects. Adjusted mean annual changes (95% CI) (ms/year) in the SD of all normal-to-normal R-R intervals were –0.65 (–0.69 to –0.61) for those with normal fasting glucose vs. –0.95 (–1.09 to –0.81) for diabetic subjects, in root mean square of successive differences in normal-to-normal R-R intervals –0.35 (–0.39 to –0.30) vs. –0.66 (–0.82 to –0.51), and in R-R interval 6.70 (6.37–7.04) vs. 3.89 (2.72–5.05). While we found cross-sectional associations between decreased HRV and diabetes and nondiabetic hyperinsulinemia and a weak inverse association with fasting glucose, neither impaired fasting glucose nor nondiabetic hyperinsulimenia was associated with a measurably more rapid decline in HRV than normal.
CONCLUSIONS—Cardiac autonomic impairment appears to be present at early stages of diabetic metabolic impairment, and progressive worsening of autonomic cardiac function over 9 years was observed in diabetic subjects. The degree to which pre-diabetic metabolic impairments in insulin and glucose metabolism contribute to decreases in cardiac autonomic function remains to be determined.
Abbreviations: ARIC, Atherosclerosis Risk in Communities • HF, high-frequency power • HRV, heart rate variability • IFG, impaired fasting glucose • LF, low-frequency power • NFG, normal fasting glucose • rMSSD, root mean square of successive differences in normal-to-normal R-R intervals • SDNN, SD of all normal-to-normal R-R intervals
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