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01-03-2009 | Cardiovascular Disease

Cardiovascular diseases, risk factors and short-term heart rate variability in an elderly general population: the CARLA study 2002–2006

Authors: Karin Halina Greiser, Alexander Kluttig, Barbara Schumann, Cees A. Swenne, Jan A. Kors, Oliver Kuss, Johannes Haerting, Hendrik Schmidt, Joachim Thiery, Karl Werdan

Published in: European Journal of Epidemiology | Issue 3/2009

Abstract

Background: A reduced heart rate variability (HRV) is associated with worse prognosis, increased incidence of cardiovascular disease (CVD) and mortality. There are conflicting results and a lack of population-based data regarding the association of HRV with CVD risk factors and its potential role as independent cause or mediator of CVD risk. Methods: Cross-sectional data of a population-based cohort including 1,779 women and men aged 45–83 years were used to analyse associations of time and frequency domain measures of HRV (derived from 5-min ECG segments) with age, behavioural and biomedical risk factors and disease in the whole sample and in a “healthy” subgroup. Results: Age was inversely associated with all measures of HRV (mean standard deviation of normal intervals across 10-year age-groups 32.1, 26.9, 27.1 and 24.8 ms in women, 29.3, 25.9, 23.8 and 25.7 ms in men). There was no association of physical activity, current smoking or alcohol with HRV. In age-adjusted models, triglycerides, glucose, waist-to-hip ratio and diabetes were inversely associated with HRV in men and women, and low/high density cholesterol and hypertension in men only (up to 43% difference across risk factor quartiles). Multivariable adjustment and restriction to the “healthy” subgroup attenuated the associations. Conclusions: We found only weak and inconsistent associations of HRV with cardiovascular risk factors. However, these results as well as those from previous studies are still compatible with the hypothesis that short-term HRV may be a marker of ill health or a mediator of the effect of selected biomedical risk factors on CVD.

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National Institutes of Health NHLaBI. NHLBI fact book fiscal year 2006. http://www.nhlbi.nih.gov/about/factpdf.htm (2007). 23 Nov 2007.

Bursi F, Weston SA, Redfield MM, Jacobsen SJ, Pakhomov S, Nkomo VT, et al. Systolic and diastolic heart failure in the community. JAMA. 2006;296(18):2209–16. doi:10.1001/jama.296.18.2209.PubMed

Cowie MR, Wood DA, Coats AJ, Thompson SG, Poole-Wilson PA, Suresh V, et al. Incidence and aetiology of heart failure; a population-based study. Eur Heart J. 1999;20(6):421–8. doi:10.1053/euhj.1998.1280.PubMed

Kannel WB. Vital epidemiologic clues in heart failure. J Clin Epidemiol. 2000;53(3):229–35. doi:10.1016/S0895-4356(99)00135-3.PubMed

O’Connell JB. The economic burden of heart failure. Clin Cardiol. 2000;23(3 Suppl):III6–10.PubMed

Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003;289(2):194–202. doi:10.1001/jama.289.2.194.PubMed

Shammas RL, Khan NU, Nekkanti R, Movahed A. Diastolic heart failure and left ventricular diastolic dysfunction: what we know, and what we don’t know! Int J Cardiol. 2007;115(3):284–92. doi:10.1016/j.ijcard.2006.03.027.PubMed

Bigger JT, Fleiss JL, Rolnitzky LM, Steinman RC. The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation. 1993;88(3):927–34.PubMed

Huikuri HV, Jokinen V, Syvanne M, Nieminen MS, Airaksinen KE, Ikaheimo MJ, et al. Heart rate variability and progression of coronary atherosclerosis. Arterioscler Thromb Vasc Biol. 1999;19(8):1979–85.PubMed

10.

Janszky I, Ericson M, Mittleman MA, Wamala S, Al Khalili F, Schenck-Gustafsson K, et al. Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease: the Stockholm female coronary risk study. J Intern Med. 2004;255(1):13–21. doi:10.1046/j.0954-6820.2003.01250.x.PubMed

11.

Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, et al. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation. 1998;98(15):1510–6.PubMed

12.

Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59(4):256–62. doi:10.1016/0002-9149(87)90795-8.PubMed

13.

Zuanetti G, Neilson JM, Latini R, Santoro E, Maggioni AP, Ewing DJ. Prognostic significance of heart rate variability in post-myocardial infarction patients in the fibrinolytic era. The GISSI-2 results. Gruppo Italiano per lo Studio della Sopravvivenza nell’ Infarto Miocardico. Circulation. 1996;94(3):432–6.PubMed

14.

Hohnloser SH, Klingenheben T, Zabel M, Li YG. Heart rate variability used as an arrhythmia risk stratifier after myocardial infarction. Pacing Clin Electrophysiol. 1997;20(10 Pt 2):2594–601. doi:10.1111/j.1540-8159.1997.tb06109.x.PubMed

15.

La Rovere MT, Pinna GD, Hohnloser SH, Marcus FI, Mortara A, Nohara R, et al. Baroreflex sensitivity and heart rate variability in the identification of patients at risk for life-threatening arrhythmias: implications for clinical trials. Circulation. 2001;103(16):2072–7.PubMed

16.

Kearney MT, Fox KA, Lee AJ, Prescott RJ, Shah AM, Batin PD, et al. Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure. J Am Coll Cardiol. 2002;40(10):1801–8. doi:10.1016/S0735-1097(02)02490-7.PubMed

17.

La Rovere MT, Pinna GD, Maestri R, Mortara A, Capomolla S, Febo O, et al. Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation. 2003;107(4):565–70. doi:10.1161/01.CIR.0000047275.25795.17.PubMed

18.

Hadase M, Azuma A, Zen K, Asada S, Kawasaki T, Kamitani T, et al. Very low frequency power of heart rate variability is a powerful predictor of clinical prognosis in patients with congestive heart failure. Circ J. 2004;68(4):343–7. doi:10.1253/circj.68.343.PubMed

19.

Guzzetti S, La Rovere MT, Pinna GD, Maestri R, Borroni E, Porta A, et al. Different spectral components of 24 h heart rate variability are related to different modes of death in chronic heart failure. Eur Heart J. 2005;26(4):357–62. doi:10.1093/eurheartj/ehi067.PubMed

20.

Stein PK, Domitrovich PP, Huikuri HV, Kleiger RE. Traditional and nonlinear heart rate variability are each independently associated with mortality after myocardial infarction. J Cardiovasc Electrophysiol. 2005;16(1):13–20. doi:10.1046/j.1540-8167.2005.04358.x.PubMed

21.

Moore RK, Groves DG, Barlow PE, Fox KA, Shah A, Nolan J, et al. Heart rate turbulence and death due to cardiac decompensation in patients with chronic heart failure. Eur J Heart Fail. 2006;8(6):585–90. doi:10.1016/j.ejheart.2005.11.012.PubMed

22.

de Bruyne MC, Kors JA, Hoes AW, Klootwijk P, Dekker JM, Hofman A, et al. Both decreased and increased heart rate variability on the standard 10-second electrocardiogram predict cardiac mortality in the elderly: the Rotterdam study. Am J Epidemiol. 1999;150(12):1282–8.PubMed

23.

Dekker JM, Schouten EG, Klootwijk P, Pool J, Swenne CA, Kromhout D. Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men. The Zutphen study. Am J Epidemiol. 1997;145(10):899–908.PubMed

24.

Dekker JM, Crow RS, Folsom AR, Hannan PJ, Liao D, Swenne CA, et al. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC study. Atherosclerosis Risk in Communities. Circulation. 2000;102(11):1239–44.PubMed

25.

Liao D, Cai J, Rosamond WD, Barnes RW, Hutchinson RG, Whitsel EA, et al. Cardiac autonomic function and incident coronary heart disease: a population-based case-cohort study. The ARIC study. Atherosclerosis Risk in Communities study. Am J Epidemiol. 1997;145(8):696–706.PubMed

26.

Liao D, Carnethon M, Evans GW, Cascio WE, Heiss G. Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the Atherosclerosis Risk in Communities (ARIC) study. Diabetes. 2002;51(12):3524–31. doi:10.2337/diabetes.51.12.3524.PubMed

27.

Tsuji H, Venditti FJ Jr, Manders ES, Evans JC, Larson MG, Feldman CL, et al. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham heart study. Circulation. 1994;90(2):878–83.PubMed

28.

Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, Feldman CL, et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham heart study. Circulation. 1996;94(11):2850–5.PubMed

29.

Britton A, Hemingway H. Heart rate variability in healthy populations: correlates and consequences. In: Malik M, Camm A, editors. Dynamic electrocardiography. New York: Futura/Blackwell; 2004. p. 90–111.

30.

Fagard RH, Pardaens K, Staessen JA. Influence of demographic, anthropometric and lifestyle characteristics on heart rate and its variability in the population. J Hypertens. 1999;17(11):1589–99. doi:10.1097/00004872-199917110-00013.PubMed

31.

Felber Dietrich D, Schindler C, Schwartz J, Barthelemy JC, Tschopp JM, Roche F, et al. Heart rate variability in an ageing population and its association with lifestyle and cardiovascular risk factors: results of the SAPALDIA study. Europace. 2006;8(7):521–9. doi:10.1093/europace/eul063.PubMed

32.

Felber Dietrich D, Schwartz J, Schindler C, Gaspoz JM, Barthelemy JC, Tschopp JM, et al. Effects of passive smoking on heart rate variability, heart rate and blood pressure: an observational study. Int J Epidemiol. 2007;36(4):834–40. doi:10.1093/ije/dym031.PubMed

33.

Hemingway H, Shipley M, Brunner E, Britton A, Malik M, Marmot M. Does autonomic function link social position to coronary risk? The Whitehall II study. Circulation. 2005;111(23):3071–7. doi:10.1161/CIRCULATIONAHA.104.497347.PubMed

34.

Kuch B, Hense HW, Sinnreich R, Kark JD, von Eckardstein A, Sapoznikov D, et al. Determinants of short-period heart rate variability in the general population. Cardiology. 2001;95(3):131–8. doi:10.1159/000047359.PubMed

35.

Stolarz K, Staessen JA, Kuznetsova T, Tikhonoff V, State D, Babeanu S, et al. Host and environmental determinants of heart rate and heart rate variability in four European populations. J Hypertens. 2003;21(3):525–35. doi:10.1097/00004872-200303000-00018.PubMed

36.

Stein PK, Barzilay JI, Domitrovich PP, Chaves PM, Gottdiener JS, Heckbert SR, et al. The relationship of heart rate and heart rate variability to non-diabetic fasting glucose levels and the metabolic syndrome: the cardiovascular health study. Diabet Med. 2007;24(8):855–63. doi:10.1111/j.1464-5491.2007.02163.x.PubMed

37.

Carney RM, Blumenthal JA, Freedland KE, Stein PK, Howells WB, Berkman LF, et al. Low heart rate variability and the effect of depression on post-myocardial infarction mortality. Arch Intern Med. 2005;165(13):1486–91. doi:10.1001/archinte.165.13.1486.PubMed

38.

Sloan RP, Bagiella E, Shapiro PA, Kuhl JP, Chernikhova D, Berg J, et al. Hostility, gender, and cardiac autonomic control. Psychosom Med. 2001;63(3):434–40.PubMed

39.

van der Kooy KG, van Hout HP, van Marwijk HW, de Haan M, Stehouwer CD, Beekman AT. Differences in heart rate variability between depressed and non-depressed elderly. Int J Geriatr Psychiatry. 2006;21(2):147–50. doi:10.1002/gps.1439.PubMed

40.

Vrijkotte TG, Van Doornen LJ, De Geus EJ. Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability. Hypertension. 2000;35(4):880–6.PubMed

41.

Collins SM, Karasek RA, Costas K. Job strain and autonomic indices of cardiovascular disease risk. Am J Ind Med. 2005;48(3):182–93. doi:10.1002/ajim.20204.PubMed

42.

Martens EJ, Nyklicek I, Szabo BM, Kupper N. Depression and anxiety as predictors of heart rate variability after myocardial infarction. Psychol Med. 2008;38(3):375–83.PubMed

43.

Ziegler D, Zentai CP, Perz S, Rathmann W, Haastert B, Doring A, et al. Prediction of mortality using measures of cardiac autonomic dysfunction in the diabetic and nondiabetic population: the MONICA/KORA Augsburg cohort study. Diabetes Care. 2008;31(3):556–61. doi:10.2337/dc07-1615.PubMed

44.

Stein PK, Ehsani AA, Domitrovich PP, Kleiger RE, Rottman JN. Effect of exercise training on heart rate variability in healthy older adults. Am Heart J. 1999;138(3 Pt 1):567–76. doi:10.1016/S0002-8703(99)70162-6.PubMed

45.

Rennie KL, Hemingway H, Kumari M, Brunner E, Malik M, Marmot M. Effects of moderate and vigorous physical activity on heart rate variability in a British study of civil servants. Am J Epidemiol. 2003;158(2):135–43. doi:10.1093/aje/kwg120.PubMed

46.

De Meersman RE, Stein PK. Vagal modulation and aging. Biol Psychol. 2007;74(2):165–73. doi:10.1016/j.biopsycho.2006.04.008.PubMed

47.

Gademan MG, Swenne CA, Verwey HF, van der Laarse A, Maan AC, Van de Vooren H, et al. Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure. J Card Fail. 2007;13(4):294–303. doi:10.1016/j.cardfail.2006.12.006.PubMed

48.

Dreifus LS, Agarwal JB, Botvinick EH, Ferdinand KC, Fisch C, Fisher CD, et al. Heart rate variability for risk stratification of life-threatening arrhythmias. American College of Cardiology Cardiovascular Technology Assessment Committee. J Am Coll Cardiol. 1993;22(3):948–50.

49.

Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task force of the European society of cardiology and the North American society of pacing and electrophysiology. Eur Heart J. 1996;17(3):354–81.

50.

Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Schneider WJ, Stein PK. RR variability in healthy, middle-aged persons compared with patients with chronic coronary heart disease or recent acute myocardial infarction. Circulation. 1995;91(7):1936–43.PubMed

51.

Huikuri HV, Makikallio T, Airaksinen KE, Mitrani R, Castellanos A, Myerburg RJ. Measurement of heart rate variability: a clinical tool or a research toy? J Am Coll Cardiol. 1999;34(7):1878–83. doi:10.1016/S0735-1097(99)00468-4.PubMed

52.

Kleiger R, Stein P. Heart rate variability in ischaemic disease. In: Malik M, Camm A, editors. Dynamic electrocardiography. New York: Futura/Blackwell; 2004.

53.

Faber TS, Staunton A, Hnatkova K, Camm AJ, Malik M. Stepwise strategy of using short- and long-term heart rate variability for risk stratification after myocardial infarction. Pacing Clin Electrophysiol. 1996;19(11 Pt 2):1845–51. doi:10.1111/j.1540-8159.1996.tb03238.x.PubMed

54.

Kornitzer M. Predictive value of electrocardiographic markers for autonomic nervous system dysfunction in healthy populations: more studies needed. Eur Heart J. 2001;22(2):109–12. doi:10.1053/euhj.2000.2375.PubMed

55.

Lombardi F. Physiological understanding of HRV components. In: Malik M, Camm A, editors. Dynamic electrocardiography. New York: Futura/Blackwell; 2004. p. 40–7.

56.

Greiser KH, Kluttig A, Schumann B, Kors JA, Swenne CA, Kuss O, et al. Cardiovascular disease, risk factors and heart rate variability in the elderly general population: design and objectives of the cardiovascular disease, living and ageing in Halle (CARLA) study. BMC Cardiovasc Disord. 2005;5:33. doi:10.1186/1471-2261-5-33.PubMed

57.

Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36(5):936–42.PubMed

58.

Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9 Suppl):S498–504. doi:10.1097/00005768-200009001-00009.PubMed

59.

Lee IM, Paffenbarger RS Jr. Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard alumni health study. Am J Epidemiol. 2000;151(3):293–9.PubMed

60.

UNESCO. International standard classification of education. ISCED 1997. Paris: UNESCO; 1997.

61.

Leichtle A, Teupser D, Thiery J. Alpha-tocopherol distribution in lipoproteins and anti-inflammatory effects differ between CHD-patients and healthy subjects. J Am Coll Nutr. 2006;25(5):420–8.PubMed

62.

Kannel WB. The Framingham study: ITS 50-year legacy and future promise. J Atheroscler Thromb. 2000;6(2):60–6.PubMed

63.

van Bemmel JH, Kors JA, van Herpen G. Methodology of the modular ECG analysis system MEANS. Methods Inf Med. 1990;29(4):346–53.PubMed

64.

Prineas RJ, Crow RS, Blackburn H. The Minnesota code manual of electrocardiographic findings. Standard procedures for measurement and classification. Boston: John Wright PSB; 1982.

65.

Dekker JM, De Vries EL, Lengton RR, Maan AC, Schouten EG, Swenne CA, et al. Reproducibility and comparability of short- and long-term heart rate variability measures in healthy young men. Ann Noninvasive Electrocardiol. 1996;1:287–92. doi:10.1111/j.1542-474X.1996.tb00281.x.

66.

Bootsma M, Swenne CA, Van Bolhuis HH, Chang PC, Cats VM, Bruschke AV. Heart rate and heart rate variability as indexes of sympathovagal balance. Am J Physiol. 1994;266(4 Pt 2):H1565–71.PubMed

67.

Pluim BM, Swenne CA, Zwinderman AH, Maan AC, van der Laarse A, Doornbos J, et al. Correlation of heart rate variability with cardiac functional and metabolic variables in cyclists with training induced left ventricular hypertrophy. Heart. 1999;81(6):612–7.PubMed

68.

Bootsma M, Swenne CA, Janssen MJA, Cats VM, Schalij MJ. Heart rate variability and sympathovagal balance: pharmacological validation. Neth Heart J. 2003;11(6):250–9.

69.

National Heart Lung and Blood Institute of the National Institutes of Health. ARIC manuals of operation. Manual 5 electrocardiography. Chapel Hill: ARIC Coordinating Center, School of Public Health, University of North Carolina; 1987. p. 5.

70.

Meisinger C, Heier M, Doering A, Thorand B, Loewel H. Prevalence of known diabetes and antidiabetic therapy between 1984/1985 and 1999/2001 in southern Germany. Diabetes Care. 2004;27(12):2985–7. doi:10.2337/diacare.27.12.2985.PubMed

71.

Ziegler D, Zentai C, Perz S, Rathmann W, Haastert B, Meisinger C, et al. Selective contribution of diabetes and other cardiovascular risk factors to cardiac autonomic dysfunction in the general population. Exp Clin Endocrinol Diabetes. 2006;114(4):153–9. doi:10.1055/s-2006-924083.PubMed

72.

Fay MP, Feuer EJ. Confidence intervals for directly standardized rates: a method based on the gamma distribution. Stat Med. 1997;16(7):791–801. doi:10.1002/(SICI)1097-0258(19970415)16:7<791::AID-SIM500>3.0.CO;2-#.PubMed

73.

Dragano N, Verde PE, Moebus S, Stang A, Schmermund A, Roggenbuck U, et al. Subclinical coronary atherosclerosis is more pronounced in men and women with lower socio-economic status: associations in a population-based study. Coronary atherosclerosis and social status. Eur J Cardiovasc Prev Rehabil. 2007;14(4):568–74. doi:10.1097/HJR.0b013e32804955c4.PubMed

74.

Meisinger C, Heier M, Volzke H, Lowel H, Mitusch R, Hense HW, et al. Regional disparities of hypertension prevalence and management within Germany. J Hypertens. 2006;24(2):293–9. doi:10.1097/01.hjh.0000200508.10324.8e.PubMed

75.

Völzke H, Neuhauser H, Moebus S, Baumert J, Berger K, Stang A, et al. Regional disparities in smoking among adults in Germany. Dtsch Arztebl. 2006;103(42):A2784–90.

76.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285(19):2486–97. doi:10.1001/jama.285.19.2486.

77.

NCEP Expert Panel. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143–421.

78.

Bansal S, Buring JE, Rifai N, Mora S, Sacks FM, Ridker PM. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA. 2007;298(3):309–16. doi:10.1001/jama.298.3.309.PubMed

79.

Nordestgaard BG, Benn M, Schnohr P, Tybjaerg-Hansen A. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA. 2007;298(3):299–308. doi:10.1001/jama.298.3.299.PubMed

80.

Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc. 1993;25(1):81–91. doi:10.1249/00005768-199301000-00012.PubMed

81.

Pols MA, Peeters PH, Bueno-De-Mesquita HB, Ocke MC, Wentink CA, Kemper HC, et al. Validity and repeatability of a modified Baecke questionnaire on physical activity. Int J Epidemiol. 1995;24(2):381–8. doi:10.1093/ije/24.2.381.PubMed

82.

Pols MA, Peeters PH, Kemper HC, Collette HJ. Repeatability and relative validity of two physical activity questionnaires in elderly women. Med Sci Sports Exerc. 1996;28(8):1020–5. doi:10.1097/00005768-199608000-00012.PubMed

83.

Voorrips LE, Ravelli AC, Dongelmans PC, Deurenberg P, van Staveren WA. A physical activity questionnaire for the elderly. Med Sci Sports Exerc. 1991;23(8):974–9. doi:10.1249/00005768-199108000-00015.PubMed

84.

Port SC, Boyle NG, Hsueh WA, Quinones MJ, Jennrich RI, Goodarzi MO. The predictive role of blood glucose for mortality in subjects with cardiovascular disease. Am J Epidemiol. 2006;163(4):342–51. doi:10.1093/aje/kwj027.PubMed

85.

Kuss O, Schumann B, Kluttig A, Greiser KH, Haerting J. Time domain parameters can be estimated with less statistical error than frequency domain parameters in the analysis of heart rate variability. J Electrocardiol. 2008;41(4):287–91.PubMed

86.

Pinna GD, Maestri R, Torunski A, Danilowicz-Szymanowicz L, Szwoch M, La Rovere MT, et al. Heart rate variability measures: a fresh look at reliability. Clin Sci (Lond). 2007;113(3):131–40. doi:10.1042/CS20070055.CrossRef

87.

Eckberg DL. Sympathovagal balance: a critical appraisal. Circulation. 1997;96(9):3224–32.PubMed

88.

Tulppo M, Huikuri HV. Origin and significance of heart rate variability. J Am Coll Cardiol. 2004;43(12):2278–80. doi:10.1016/j.jacc.2004.03.034.PubMed

89.

Stein PK, Domitrovich PP, Hui N, Rautaharju P, Gottdiener J. Sometimes higher heart rate variability is not better heart rate variability: results of graphical and nonlinear analyses. J Cardiovasc Electrophysiol. 2005;16(9):954–9. doi:10.1111/j.1540-8167.2005.40788.x.PubMed

90.

Labarthe DR. Stroke. In: Labarthe DR, editor. Epidemiology and prevention of cardiovascular diseases. A global challenge. Gaithersburg: Aspen; 1998. p. 73–90.

91.

Löwel H, Janku D, Lewis M, Hörmann A, Gostomzyk J, Keil U, et al. MONICA-projekt region Augsburg, data-book coronary event register 1990. Neuherberg: GSF-Forschungszentrum für Umwelt und Gesundheit; 1993.

92.

Gerritsen J, Dekker JM, TenVoorde BJ, Bertelsmann FW, Kostense PJ, Stehouwer CD, et al. Glucose tolerance and other determinants of cardiovascular autonomic function: the Hoorn study. Diabetologia. 2000;43(5):561–70. doi:10.1007/s001250051344.PubMed

93.

Liao D, Barnes RW, Chambless LE, Simpson RJ Jr, Sorlie P, Heiss G. Age, race, and sex differences in autonomic cardiac function measured by spectral analysis of heart rate variability—the ARIC study, Atherosclerosis Risk in Communities. Am J Cardiol. 1995;76(12):906–12. doi:10.1016/S0002-9149(99)80260-4.PubMed

94.

Antelmi I, de Paula RS, Shinzato AR, Peres CA, Mansur AJ, Grupi CJ. Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease. Am J Cardiol. 2004;93(3):381–5. doi:10.1016/j.amjcard.2003.09.065.PubMed

95.

Buchheit M, Simon C, Charloux A, Doutreleau S, Piquard F, Brandenberger G. Heart rate variability and intensity of habitual physical activity in middle-aged persons. Med Sci Sports Exerc. 2005;37(9):1530–4. doi:10.1249/01.mss.0000177556.05081.77.PubMed

96.

Reland S, Ville NS, Wong S, Senhadji L, Carre F. Does the level of chronic physical activity alter heart rate variability in healthy older women? Clin Sci (Lond). 2004;107(1):29–35. doi:10.1042/CS20030405.

97.

Sajadieh A, Nielsen OW, Rasmussen V, Hein HO, Abedini S, Hansen JF. Increased heart rate and reduced heart-rate variability are associated with subclinical inflammation in middle-aged and elderly subjects with no apparent heart disease. Eur Heart J. 2004;25(5):363–70. doi:10.1016/j.ehj.2003.12.003.PubMed

98.

Sandercock GR, Bromley PD, Brodie DA. Effects of exercise on heart rate variability: inferences from meta-analysis. Med Sci Sports Exerc. 2005;37(3):433–9. doi:10.1249/01.MSS.0000155388.39002.9D.PubMed

99.

Schuit AJ, van Amelsvoort LG, Verheij TC, Rijneke RD, Maan AC, Swenne CA, et al. Exercise training and heart rate variability in older people. Med Sci Sports Exerc. 1999;31(6):816–21. doi:10.1097/00005768-199906000-00009.PubMed

100.

Boutcher SH, Stein P. Association between heart rate variability and training response in sedentary middle-aged men. Eur J Appl Physiol Occup Physiol. 1995;70(1):75–80. doi:10.1007/BF00601812.PubMed

101.

Carnethon MR, Liao D, Evans GW, Cascio WE, Chambless LE, Heiss G. Correlates of the shift in heart rate variability with an active postural change in a healthy population sample: The Atherosclerosis Risk in Communities study. Am Heart J. 2002;143(5):808–13. doi:10.1067/mhj.2002.121928.PubMed

102.

Loimaala A, Huikuri H, Oja P, Pasanen M, Vuori I. Controlled 5-mo aerobic training improves heart rate but not heart rate variability or baroreflex sensitivity. J Appl Physiol. 2000;89(5):1825–9.PubMed

103.

Uusitalo AL, Laitinen T, Vaisanen SB, Lansimies E, Rauramaa R. Physical training and heart rate and blood pressure variability: a 5-yr randomized trial. Am J Physiol Heart Circ Physiol. 2004;286(5):H1821–6. doi:10.1152/ajpheart.00600.2003.PubMed

104.

Verheyden B, Eijnde BO, Beckers F, Vanhees L, Aubert AE. Low-dose exercise training does not influence cardiac autonomic control in healthy sedentary men aged 55–75 years. J Sports Sci. 2006;24(11):1137–47. doi:10.1080/02640410500497634.PubMed

105.

Roach D, Wilson W, Ritchie D, Sheldon R. Dissection of long-range heart rate variability: controlled induction of prognostic measures by activity in the laboratory. J Am Coll Cardiol. 2004;43(12):2271–7. doi:10.1016/j.jacc.2004.01.050.PubMed

106.

Serrador JM, Finlayson HC, Hughson RL. Physical activity is a major contributor to the ultra low frequency components of heart rate variability. Heart. 1999;82(6):e9.PubMed

107.

Eryonucu B, Bilge M, Guler N, Uzun K, Gencer M. Effects of cigarette smoking on the circadian rhythm of heart rate variability. Acta Cardiol. 2000;55(5):301–5. doi:10.2143/AC.55.5.2005757.PubMed

108.

Horsten M, Ericson M, Perski A, Wamala SP, Schenck-Gustafsson K, Orth-Gomer K. Psychosocial factors and heart rate variability in healthy women. Psychosom Med. 1999;61(1):49–57.PubMed

109.

Kupari M, Virolainen J, Koskinen P, Tikkanen MJ. Short-term heart rate variability and factors modifying the risk of coronary artery disease in a population sample. Am J Cardiol. 1993;72(12):897–903. doi:10.1016/0002-9149(93)91103-O.PubMed

110.

Tsuji H, Venditti FJ Jr, Manders ES, Evans JC, Larson MG, Feldman CL, et al. Determinants of heart rate variability. J Am Coll Cardiol. 1996;28(6):1539–46. doi:10.1016/S0735-1097(96)00342-7.PubMed

111.

Janszky I, Ericson M, Blom M, Georgiades A, Magnusson JO, Alinagizadeh H, et al. Wine drinking is associated with increased heart rate variability in women with coronary heart disease. Heart. 2005;91(3):314–8. doi:10.1136/hrt.2004.035105.PubMed

112.

Christensen JH, Skou HA, Fog L, Hansen V, Vesterlund T, Dyerberg J, et al. Marine n-3 fatty acids, wine intake, and heart rate variability in patients referred for coronary angiography. Circulation. 2001;103(5):651–7.PubMed

113.

Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al. Obesity and the risk of myocardial infarction in 27, 000 participants from 52 countries: a case-control study. Lancet. 2005;366(9497):1640–9. doi:10.1016/S0140-6736(05)67663-5.PubMed

114.

Carnethon MR, Golden SH, Folsom AR, Haskell W, Liao D. Prospective investigation of autonomic nervous system function and the development of type 2 diabetes: the Atherosclerosis Risk in Communities study, 1987–1998. Circulation. 2003;107(17):2190–5. doi:10.1161/01.CIR.0000066324.74807.95.PubMed

115.

Schroeder EB, Chambless LE, Liao D, Prineas RJ, Evans GW, Rosamond WD, et al. Diabetes, glucose, insulin, and heart rate variability: the Atherosclerosis Risk in Communities (ARIC) study. Diabetes Care. 2005;28(3):668–74. doi:10.2337/diacare.28.3.668.PubMed

116.

Singh JP, Larson MG, O’Donnell CJ, Wilson PF, Tsuji H, Lloyd-Jones DM, et al. Association of hyperglycemia with reduced heart rate variability (the Framingham heart study). Am J Cardiol. 2000;86(3):309–12. doi:10.1016/S0002-9149(00)00920-6.PubMed

117.

Perciaccante A, Fiorentini A, Paris A, Serra P, Tubani L. Circadian rhythm of the autonomic nervous system in insulin resistant subjects with normoglycemia, impaired fasting glycemia, impaired glucose tolerance, type 2 diabetes mellitus. BMC Cardiovasc Disord. 2006;6:19. doi:10.1186/1471-2261-6-19.PubMed

118.

Schroeder EB, Liao D, Chambless LE, Prineas RJ, Evans GW, Heiss G. Hypertension, blood pressure, and heart rate variability: the Atherosclerosis Risk in Communities (ARIC) study. Hypertension. 2003;42(6):1106–11. doi:10.1161/01.HYP.0000100444.71069.73.PubMed

119.

Singh JP, Larson MG, Tsuji H, Evans JC, O’Donnell CJ, Levy D. Reduced heart rate variability and new-onset hypertension: insights into pathogenesis of hypertension: the Framingham heart study. Hypertension. 1998;32(2):293–7.PubMed

120.

Copie X, Le Heuzey JY. Effects of drugs. In: Malik M, Camm A, editors. Dynamic electrocardiography. New York: Futura/Blackwell; 2004. p. 83–9.

Title: Cardiovascular diseases, risk factors and short-term heart rate variability in an elderly general population: the CARLA study 2002–2006
Authors: Karin Halina Greiser
Alexander Kluttig
Barbara Schumann
Cees A. Swenne
Jan A. Kors
Oliver Kuss
Johannes Haerting
Hendrik Schmidt
Joachim Thiery
Karl Werdan
Publication date: 01-03-2009
Publisher: Springer Netherlands
Published in: European Journal of Epidemiology / Issue 3/2009
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-009-9317-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cardiovascular diseases, risk factors and short-term heart rate variability in an elderly general population: the CARLA study 2002–2006

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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