Association between Carotid Intima Media Thickness and Heart Rate Variability in Adults at Increased Cardiovascular Risk

Abstract

Background: Atherosclerotic carotid intima-media thickness (IMT) may be associated with alterations in the sensitivity of carotid baroreceptors. The aim of this study was to investigate the association between carotid IMT and the autonomic modulation of heart rate variability (HRV).Methods: A total of 101 subjects were enrolled in this prospective observational study. The carotid IMT was determined by duplex ultrasonography. The cardiac autonomic function was determined through HRV measures during the Deep Breathing Test. Linear regression models, adjusted for demographics, comorbidities, body mass index, waist-hip-ratio, and left ventricular ejection fraction were used to evaluate the association between HRV parameters and carotid IMT.Results: Participants had a mean age of 60.4 ± 13.4 years and an estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk score (using the Pooled Cohort Equations) of 16.4 ± 17. The mean carotid media thickness was highest (0.90 ± 0.19 mm) in the first quartile of the standard deviation of all RR intervals (SDNN) (19.7 ± 5.1 ms) and progressively declined in each subsequent quartile to 0.82 ± 0.21 mm, 0.81 ± 0.16 mm, and 0.68 ± 0.19 in quartiles 2 (36.5 ± 5.9 ms), 3 (57.7 ± 6.2 ms) and 4 (100.9 ± 22.2 ms), respectively. In multivariable adjusted models, there was a statistical significant association between SDNN and carotid IMT (OR −0.002; 95%CI −0.003 to −0.001, p = 0.005). The same significant association was found between carotid IMT and other measures of HRV, including coefficient of variation of RR intervals (CV) and dispersion of points along the line of identity (SD2).Conclusions: In a cohort of individuals at increased cardiovascular risk, carotid IMT as a marker of subclinical atherosclerosis was associated with alterations of HRV indicating an impaired cardiac autonomic control, independently of other cardiovascular risk factors.

Relationship between heart rate variability and carotid intima‐media thickness in the Brazilian Longitudinal Study of Adult Health – ELSA‐Brasil

“…Then, this work sought to investigate whether there is an independent relationship between cIMT and HRV. Agreeing with this, Pereira et al (2017) reported higher cIMT in the lowest quartile of SDNN and a progressive decline in the subsequent quartiles in adults at increased cardiovascular risk during a deep breath test. This lack of association may suggest that besides dependents on several factors, these measures assess different and complementary domains of cardiovascular risk, providing important, useful and non-redundant information for clinical and scientific purposes.…”

“…Atherosclerosis is the main underlying cause of cardiovascular diseases and is characterized by the presence of atheromatous plaques in the arterial wall and increased intima-media (Huikuri et al, 1999;Stein et al, 2008;Pereira et al, 2017;Ulleryd et al, 2017). Carotid intima-media thickness (cIMT) is a an important marker for subclinical vascular disease and an indicator of systemic inflammation, considered a surrogate outcome for atherosclerotic disease (Stein et al, 2008;Santos et al, 2014;Generoso et al, 2018;Sena et al, 2018;Holwerda et al, 2019b).…”

DSM-5 Criteria and Depression Severity: Implications for Clinical Practice

“…Depression has been closely associated with autonomic nervous system dysfunction, with reduced parasympathetic and/or increased sympathetic activity leading to increased cardiovascular risk in depressed patients ( 32 – 34 ). In line with these findings, increased inter-lead QT interval differences on 12-lead electrocardiography (QT dispersion) or reduced heart rate variability (HRV) has been reported in depressed patients ( 19 , 35 – 41 ).…”

“…Decreasing serotonin may cause a decrease in parasympathetic activity ( 58 ), and emotional response capabilities are marked peripherally by vagal efference to the heart ( 40 , 59 ). Specifically, high parasympathetic tone helps to maintain heart stability and protect against possible adverse cardiac events ( 32 , 34 ). Conversely, increased sympathetic tone increases the risk of malignant arrhythmias and sudden cardiac death ( 60 ).…”

Intrapartum Fetal Heart Rate: A Possible Predictor of Neonatal Acidemia and APGAR Score

“…The FHR variability was determined using coefficient of variation (CV), which equals the standard deviation divided by the mean ( Pereira et al, 2017 ). The characteristics of study participants were depicted using standard descriptive statistics, overall and stratified by quartiles of the mean of FHR.…”