© 1999 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Heart Rate Variability and Progression of Coronary Atherosclerosis
From the Division of Cardiology, Department of Medicine and Biocenter of Oulu, University of Oulu (H.V.H., V.J., K.E.J.A., M.J.I., J.M.K., H.K., A.Y.K.); Department of Medicine, University of Helsinki (M.S., M.S.N., M.H.F.); and Department of Medicine, University of Tampere, Finland (S.M., K.O.N.).
Correspondence to Heikki V Huikuri, MD, Division of Cardiology, Department of Medicine, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland. E-mail HEIKKI.HUIKURI{at}oulu.fi
Abstract—Low heart rate (HR) variability is associated with increased risk of cardiovascular morbidity and mortality, but the causes and mechanisms of this association are not well known. This prospective study was designed to test the hypothesis that reduced HR variability is related to progression of coronary atherosclerosis. Average HR and HR variability were analyzed in 12-hour ambulatory ECG recordings from 265 qualified patients participating in a multicenter study to evaluate the angiographic progression of coronary artery disease in patients with prior coronary artery bypass surgery and low high-density lipoprotein cholesterol concentrations (<1.1 mmol/L). Participants were randomized to receive a placebo or gemfibrozil therapy. The progression of coronary atherosclerosis was estimated by quantitative, computer-assisted analysis of coronary artery stenoses from the baseline angiograms and from repeated angiograms performed an average of 32 months later. The progression of focal coronary atherosclerosis of the patients randomized to placebo therapy was more marked in the tertile with the lowest standard deviation of all normal to normal R-R intervals (SDNN, 74±13 ms; mean decrease in the per-patient minimum luminal diameter -0.17 mm; 95% confidence interval [CI], -0.23 to -0.12 mm) than in the middle tertile (SDNN, 107±7 ms; mean decrease -0.05 mm; 95% CI, -0.08 to -0.01 mm) or highest tertile (SDNN, 145±25 ms; mean change 0.01 mm; 95% CI, -0.04 to 0.02 mm) (P<0.001 between the tertiles). This association was abolished by gemfibrozil. SDNN was lower (P<0.001) and minimum HR was faster (P<0.01) in the patients with marked progression than in those with regression of focal coronary atherosclerosis. In multiple regression analysis including HR variability, minimum HR, demographic and clinical variables, smoking, blood pressure, glucose, lipid measurements and lipid-modifying therapy, progression of focal coronary atherosclerosis was independently predicted by the SDNN (ß=0.24; P=0.0001). Low HR variability analyzed from ambulatory ECG predicts rapid progression of coronary artery disease. HR variability provided information on progression of focal coronary atherosclerosis beyond that obtained by traditional risk markers of atherosclerosis.
Key Words: coronary artery disease • lipids • heart period • angiography
This article has been cited by other articles:
 |
|
 |
|
  R. P. Sloan, P. A. Shapiro, R. E. DeMeersman, E. Bagiella, E. N. Brondolo, P. S. McKinley, I. Slavov, Y. Fang, and M. M. Myers The Effect of Aerobic Training and Cardiac Autonomic Regulation in Young Adults Am J Public Health, May 1, 2009; 99(5): 921 - 928. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Bhattacharyya, D. L. Whitehead, R. Rakhit, and A. Steptoe Depressed Mood, Positive Affect, and Heart Rate Variability in Patients With Suspected Coronary Artery Disease Psychosom Med, November 1, 2008; 70(9): 1020 - 1027. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Pizzi, L. Manzoli, S. Mancini, and G. M. Costa Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function Eur. Heart J., May 1, 2008; 29(9): 1110 - 1117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Bleil, P. J. Gianaros, J. R. Jennings, J. D. Flory, and S. B. Manuck Trait Negative Affect: Toward an Integrated Model of Understanding Psychological Risk for Impairment in Cardiac Autonomic Function Psychosom Med, April 1, 2008; 70(3): 328 - 337. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Ohira, A. V. D. Roux, R. J. Prineas, M. A. Kizilbash, M. R. Carnethon, and A. R. Folsom Associations of Psychosocial Factors With Heart Rate and Its Short-Term Variability: Multi-Ethnic Study of Atherosclerosis Psychosom Med, February 1, 2008; 70(2): 141 - 146. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Fox, J. S. Borer, A. J. Camm, N. Danchin, R. Ferrari, J. L. Lopez Sendon, P. G. Steg, J.-C. Tardif, L. Tavazzi, M. Tendera, et al. Resting Heart Rate in Cardiovascular Disease J. Am. Coll. Cardiol., August 28, 2007; 50(9): 823 - 830. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Schubiner, B. Hassunizadeh, and R. Kaczynski A controlled study of autonomic nervous system function in adults with attention-deficit/hyperactivity disorder treated with stimulant medications: results of a pilot study. J Atten Disord, November 1, 2006; 10(2): 205 - 211. [Abstract] [PDF]
|
|
|
|
 |
|
 F. Iellamo, A. Galante, J. M. Legramante, M. E. Lippi, C. Condoluci, G. Albertini, and M. Volterrani Altered autonomic cardiac regulation in individuals with Down syndrome Am J Physiol Heart Circ Physiol, December 1, 2005; 289(6): H2387 - H2391. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Falcone, M. P. Buzzi, C. Klersy, and P. J. Schwartz Rapid Heart Rate Increase at Onset of Exercise Predicts Adverse Cardiac Events in Patients With Coronary Artery Disease Circulation, September 27, 2005; 112(13): 1959 - 1964. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Gianaros, K. Salomon, F. Zhou, J. F. Owens, D. Edmundowicz, L. H. Kuller, and K. A. Matthews A Greater Reduction in High-Frequency Heart Rate Variability to a Psychological Stressor is Associated With Subclinical Coronary and Aortic Calcification in Postmenopausal Women Psychosom Med, July 1, 2005; 67(4): 553 - 560. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. K. Kim, S. P. McGorray, B. A. Bartholomew, M. Marsh, T. Dicken, S. Wassertheil-Smoller, J. D. Curb, A. Oberman, J. Hsia, J. Gardin, et al. Depressive Symptoms and Heart Rate Variability in Postmenopausal Women Arch Intern Med, June 13, 2005; 165(11): 1239 - 1244. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Abuissa, J. H. O'Keefe Jr, W. Harris, and C. J. Lavie Autonomic Function, Omega-3, and Cardiovascular Risk Chest, April 1, 2005; 127(4): 1088 - 1091. [Full Text] [PDF]
|
|
|
|
|
|
A. Sajadieh, O. W. Nielsen, V. Rasmussen, H. O. Hein, S. Abedini, and J. F. Hansen 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., March 1, 2004; 25(5): 363 - 370. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Pelat, C. Dessy, P. Massion, J.-P. Desager, O. Feron, and J.-L. Balligand Rosuvastatin Decreases Caveolin-1 and Improves Nitric Oxide-Dependent Heart Rate and Blood Pressure Variability in Apolipoprotein E-/- Mice In Vivo Circulation, May 20, 2003; 107(19): 2480 - 2486. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. M. Curtis and J. H. O'Keefe Jr Autonomic Tone as a Cardiovascular Risk Factor: The Dangers of Chronic Fight or Flight Mayo Clin. Proc., January 1, 2002; 77(1): 45 - 54. [Abstract] [PDF]
|
|