Sex-based differences in the association between duration of type 2 diabetes and heart rate variability

We examined the association between heart rate variability (HRV) and duration of type 2 diabetes among 155 female and 106 male subjects: mean±SD for duration=49.6±65.6 and 57.3±77.1 months, respectively, p=0.38. Among males, duration of diabetes was independently and inversely associated with vagal-heart rate modulation (high frequency (HF) power, 0.15—0.40 Hz, standardised ß = -0.32, p=0.001; root mean square of successive differences between R-R intervals, ß = -0.26, p=0.006) and total R-R variability (standard deviation of normal R-R intervals, ß = -0.36, p=0.001); but not among females (p≥0.80 for each HRV index). In contrast, HF was inversely associated with age of diabetes diagnosis (ß = -0.16, p=0.04) and 10-year absolute risk for coronary heart disease (ß = -0.16, p=0.04) among female subjects. Longitudinal research is needed to establish whether risk factors for early cardiac autonomic impairment differ among men and women with type 2 diabetes.

[1]  J. P. O’Hare,et al.  The prevalence of autonomic neuropathy in insulin-dependent diabetes mellitus: a controlled study based on heart rate variability. , 1986, The Quarterly journal of medicine.

[2]  Assessment of early stage autonomic nerve dysfunction in diabetic subjects--application of power spectral analysis of heart rate variability. , 1991, Diabetes research.

[3]  J. Fleiss,et al.  The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. , 1993, Circulation.

[4]  M Malik,et al.  Short- and long-term assessment of heart rate variability for risk stratification after acute myocardial infarction. , 1996, The American journal of cardiology.

[5]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[6]  G. Breithardt,et al.  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. , 1996 .

[7]  P. Stein,et al.  Differing effects of age on heart rate variability in men and women. , 1997, The American journal of cardiology.

[8]  D H Singer,et al.  Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. , 1998, Journal of the American College of Cardiology.

[9]  V. Kadirkamanathan.  The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT) , 1998, Diabetologia.

[10]  A Schabmann,et al.  Optimal parameters of short-term heart rate spectrogram for routine evaluation of diabetic cardiovascular autonomic neuropathy. , 1998, Journal of the autonomic nervous system.

[11]  P. Stein,et al.  Insights from the study of heart rate variability. , 1999, Annual review of medicine.

[12]  J. Malacara,et al.  Age at menopause in women with type 2 diabetes mellitus. , 1999, Menopause.

[13]  Philip Greenland,et al.  Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations , 1999 .

[14]  S M Grundy,et al.  Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. , 1999, Circulation.

[15]  T. Orchard,et al.  Cardiovascular autonomic neuropathy (expiration and inspiration ratio) in type 1 diabetes. Incidence and predictors. , 2000, Journal of diabetes and its complications.

[16]  Alessandro Sebastian Podda,et al.  Evidence of a role of endogenous estrogen in the modulation of autonomic nervous system. , 2000, The American journal of cardiology.

[17]  E. Boyko,et al.  Prospective study of autonomic neuropathy as a predictor of mortality in patients with diabetes. , 2002, Diabetes research and clinical practice.

[18]  G. Lanza,et al.  Role of Heart Rate Variability in the Early Diagnosis of Diabetic Autonomic Neuropathy in Children , 2002, Herz.

[19]  Duanping Liao,et al.  Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the atherosclerosis risk in communities (ARIC) study. , 2002, Diabetes.

[20]  E. Migliaro,et al.  Heart Rate Variability: Short‐Term Studies are as Useful as Holter to Differentiate Diabetic Patients from Healthy Subjects , 2003, Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc.

[21]  P. Valensi,et al.  Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications--the French multicenter study. , 2003, Metabolism: clinical and experimental.

[22]  R. Freeman,et al.  Diabetic autonomic neuropathy. , 2003, Diabetes care.

[23]  H. Teede,et al.  Vascular dysfunction and autonomic neuropathy in Type 2 diabetes , 2004, Diabetic medicine : a journal of the British Diabetic Association.

[24]  N. Chaturvedi,et al.  Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus , 2004, Diabetologia.

[25]  Dan Ziegler,et al.  Diabetic neuropathies: a statement by the American Diabetes Association. , 2005, Diabetes care.

[26]  L. Chambless,et al.  Diabetes, glucose, insulin, and heart rate variability: the Atherosclerosis Risk in Communities (ARIC) study. , 2005, Diabetes care.

[27]  E. Disbrow,et al.  Predicting cardiac autonomic neuropathy in type I (insulin-dependent) diabetes mellitus , 1995, Clinical Autonomic Research.

[28]  Y. Aso,et al.  Relationships between Heart Rate Variability and Urinary Albumin Excretion in Patients with Type 2 Diabetes , 2006, The American journal of the medical sciences.

[29]  [Autonomic neuropathy in type-2 diabetes, lessons from Okamoto Diabetes Study]. , 2006, Rinsho shinkeigaku = Clinical neurology.

[30]  M. Szklo,et al.  Diabetic cardiomyopathy and subclinical cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis (MESA). , 2006, Diabetes care.

[31]  T. Moritani,et al.  Body fat and blood lipids in postmenopausal women are related to resting autonomic nervous system activity , 2006, European Journal of Applied Physiology.

[32]  Peter Lindgren,et al.  Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary , 2007 .

[33]  Greet Van den Berghe,et al.  Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text , 2007 .

[34]  T. Simon,et al.  [Management of cardiovascular risk in the peri-menopausal woman--a consensus statement of European cardiologists and gynaecologists]. , 2007, Kardiologia polska.

[35]  A. Vinik,et al.  Diabetic Cardiovascular Autonomic Neuropathy , 2007, Circulation.

[36]  J. Blacher,et al.  Macro and microvasculature in hypertension: therapeutic aspects , 2008, Journal of Human Hypertension.

[37]  Z. Hud,et al.  Gender differences in the onset of diabetic neuropathy. , 2008, Journal of diabetes and its complications.

[38]  T. H. Tanaka,et al.  Effects of drug, biobehavioral and exercise therapies on heart rate variability in coronary artery disease: a systematic review , 2008, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[39]  Eric Boerwinkle,et al.  The Atherosclerosis Risk in Communities (ARIC) Study , 2011 .