Association may boost risk for cardiovascular disease in those with type 1 diabetes
WEDNESDAY, April 3 (HealthDay News) — Cardiac autonomic dysfunction as measured by lower heart rate variability (HRV) is associated with increases in both central and vascular vascular stiffness among youths with type 1 diabetes regardless of underlying cardiovascular disease (CVD) risk factors, according to research published online Feb. 22 in Diabetes Care.
Mamta Jaiswal, M.B.B.S, Ph.D., of the Colorado School of Public Health in Aurora, and colleagues conducted a sub-study to the SEARCH for Diabetes in Youth Study to explore the associations between reduced HRV and increased arterial stiffness (AS) in 344 youth with type 1 diabetes and 171 youth without.
According to the researchers, in youths with type 1 diabetes, lower HRV, as measured by SD of normal R-R interval (SDNN), was associated with lower brachial distensibility (BrachD), a marker of peripheral AS (P = 0.01), and higher pulse wave velocity in the carotid to femoral segment (PWV-trunk) (P = 0.0001), as well as a higher augmentation index adjusted for heart rate of 75 beats per min (AIx75), (P = 0.007), markers for central AS. Adjustment for CVD risk factors attenuated these associations, except for BrachD and PWV-trunk. Although a similar association was observed between HRV and BrachD in youth controls, lower HRV was not associated with higher PWV-trunk and AIx75.
”We found a strong association between cardiac autonomic dysfunction and both central and peripheral AS in youth with type 1 diabetes, independent of traditional CVD risk factors,” the authors write. ”While lower HRV was also associated with increased peripheral stiffness in non-diabetic control youth, the association with central stiffness may be unique to individuals with type 1 diabetes. This association may contribute to the increased and premature cardiovascular disease burden in people with type 1 diabetes.”
Abstract
Reduced Heart Rate Variability Is Associated With Increased Arterial Stiffness in Youth With Type 1 Diabetes
The SEARCH Cardiovascular Disease Study
Mamta Jaiswal, MBBS, PHD1, Elaine M. Urbina, MD, MS2, R. Paul Wadwa, MD3, Jennifer W. Talton, MS4, Ralph B. D’Agostino Jr, PHD4, Richard F. Hamman, MD, DRPH1, Tasha E. Fingerlin, PHD1, Stephen R. Daniels, MD, PHD5, Santica M. Marcovina, MD6, Lawrence M. Dolan, MD2 and Dana Dabelea, MD, PHD1⇓
+ Author Affiliations
1Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
2Department of Pediatrics, Cincinnati Children’s Hospital and the University of Cincinnati, Cincinnati, Ohio
3Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado
4Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
5Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
6Department of Medicine, University of Washington, Seattle, Washington
Corresponding author: Dana Dabelea, dana.dabelea@ucdenver.edu.
Abstract
OBJECTIVE Reduced heart rate variability (HRV) and increased arterial stiffness (AS) are both present in youth with type 1 diabetes. However, it is unclear whether they are associated and whether their association is independent of cardiovascular disease (CVD) risk factors.
RESEARCH DESIGN AND METHODS The SEARCH Cardiovascular Disease Study explored the cross-sectional relationships between HRV and several measures of AS in youth with (n = 344) and without (n = 171) type 1 diabetes. The SphygmoCor device (AtCor Medical, Sydney, Australia) was used to measure HRV using SD of normal R-R interval (SDNN), as well as AS, using pulse wave velocity in the carotid to femoral segment (PWV-trunk) and augmentation index adjusted to a heart rate of 75 bpm (AIx75). Brachial distensibility (BrachD), another index of AS, was measured with a DynaPulse instrument (Pulse Metric, San Diego, CA). Multiple linear regression analyses explored the associations between HRV and each of the three AS measures, after adjusting for demographic characteristics and traditional CVD risk factors (blood pressure, lipids, obesity, microalbuminuria, and smoking) separately, for youth with and without type 1 diabetes.
RESULTS Among youth with type 1 diabetes, lower SDNN was associated with peripheral AS (lower BrachD, P = 0.01; r2 = 0.30) and central AS (higher PVW-trunk, P < 0.0001; r2 = 0.37; and higher AIx75, P = 0.007; r2 = 0.08). These associations were attenuated with adjustment for CVD risk factors, but remained statistically significant for BrachD and PWV-trunk. While a similar association between HRV and BrachD was present in control youth, lower HRV was not associated with increased central AS or with AIx75.
CONCLUSIONS Longitudinal studies are needed to understand the pathways responsible for these associations.
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