Heart Rate Variability and Cardiac Autonomic Dysfunction: Prevalence, Risk Factors, and Relationship to Arterial Stiffness in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study
Year: 2019
Type: article
Abstract: OBJECTIVE To determine whether prior type 2 diabetes (T2D) treatment or glycemic control over time are independently associated with heart rate variability (HRV) and whether the presence of cardiac autonomic dysfunction is associated with arterial stiffness in young adults with youth-onset T2D enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. RESEARCH DESIGN AND METHODS Heartbeats over 10 min were measured to derive the normal R-Rs (NN intervals). Outcomes included the standard deviation of the NN intervals (SDNN), the root mean square differences of successive NN intervals (RMSSD), percent of NN beats that differ by more than 50 ms (PNN50), and the low-frequency (LF) power domain, high-frequency (HF) power domain, and their ratio (LF:HF). Autonomic dysfunction was defined as ≥3 of 5 abnormal HRV indices compared with obese controls from a separate study. RESULTS A total of 397 TODAY participants were evaluated 7 years after randomization. TODAY participants had reduced HRV (SDNN 58.1 ± 29.6 ms vs. controls 67.1 ± 25.4 ms; P < 0.0001) with parasympathetic loss (RMSSD 53.2 ± 36.7 ms vs. controls 67.9 ± 35.2 ms; P < 0.0001) with sympathetic overdrive (LF:HF ratio 1.4 ± 1.7 vs. controls 1.0 ± 1.1; P < 0.0001). Cardiac autonomic dysfunction was present in 8% of TODAY participants, and these participants had greater pulse wave velocity compared with those without dysfunction (P = 0.0001). HRV did not differ by randomized treatment, but higher hemoglobin A1c (HbA1c) over time was independently associated with lower SDNN and RMSSD and higher LF:HF ratio after adjustment for age, race-ethnicity, sex, and BMI. CONCLUSIONS Young adults with youth-onset T2D show evidence of cardiac autonomic dysfunction with both parasympathetic and sympathetic impairments that are associated with higher HbA1c.
Source: Diabetes Care
DOI: 10.2337/dc19-0993
Institutions: Cincinnati Children's Hospital Medical Center, University of Cincinnati, George Washington University, Children's Hospital of Philadelphia, Baylor College of Medicine, Texas Children's Hospital, Case Western Reserve University, FH Foundation, University of Oklahoma Health Sciences Center, Washington University in St. Louis
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G130883262, Management of Pediatric Type 2 Diabetes Mellitus, Multi-Center Study of the Treatment of T2DM in Youth, G1650331929, G1711233980, G1789861183, G1824217007, G2078309758, G2244966566, Case Western Reserve University/Cleveland Clinic CTSA (UL1), G2824222223, G299222429, Harvard Clinical and Translational Science Center (UL1), General Clinical Research Center, University of Pittsburgh Clinical and Translational Science Institute, Type 2 Diabetes in Youth: Beta Cell Preservation, G413336477, G426894015, Treatment Alternatives in Pediatric Type 2 Diabetes, G475936976, TODAY2 Phase 2 (T2P2): Long-Term Post-Intervention Follow-Up, Career Development Program in Pediatric Diabetes Research (K12) at CHOP, Institutional Clinical and Translational Science Award, G554783770, General Clinical Research Center, General Clinical Research Center, Washington University Institute of Clinical and Translational Sciences (UL1), Yale University Clinical and Translational Science Award Program, Clinical and Translational Science Collaborative of Cleveland, G903953877, Colorado Clinical and Translational Science Institute (UL1)
OpenAlex ID: W2972495656