Heart rate variability and the risk of Parkinson disease: The Atherosclerosis Risk in Communities study

Abstract

Objectives Autonomic dysfunction frequently occurs in the context of Parkinson’s disease (PD) and may precede onset of motor symptoms. Limited data exist on the prospective association of heart rate variability (HRV), a marker of autonomic function, with PD risk. Methods We included 12,162 participants of the Atherosclerosis Risk in Communities (ARIC) study, a community-based cohort, without a diagnosis of PD at baseline (1987-89) and with available HRV data (mean age 54, 57% women). A 2-minute electrocardiogram was used to measure HRV. Incident PD was identified through 2008 from multiple sources, and adjudicated. Multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of PD by quartiles of HRV measurements. Results During a mean follow-up of 18 years, we identified 78 incident PD cases. Lower values of the root mean square of successive differences in normal-to-normal R-R intervals (rMSSD) and standard deviation of normal-to-normal R-R intervals (SDNN), markers of parasympathetic activity and total variability respectively, were associated with higher PD risk during follow-up. In multivariable models, the HR (95%CI) of PD in the bottom quartiles of rMSSD and SDNN compared to the top quartiles were 2.1 (1.0-4.3) and 2.9 (1.4-6.1), respectively. Other measures of cardiac autonomic function, including mean RR interval and frequency-domain measurements, were not associated with PD risk. Interpretation In this prospective cohort, decreased HRV was associated with an increased risk of PD. Assessment of cardiac autonomic function may help identify individuals at risk for PD.

Heart rate variability to differentiate essential tremor from early-stage tremor-dominant Parkinson's disease

“…ACCEPTED MANUSCRIPT 8 HRV is also associated with RBD [11,12], a well-known precursor of LBD, and can predict conversion to PD in elderly [17,18], suggesting that cardiac autonomic dysfunction occurs during the premotor stage of PD. Further, HRV is reported to correlate with other known LB markers, such as changes in olfaction and cardiac MIBG findings [11,[25][26][27].…”

“…Heart rate variability (HRV), as determined by electrocardiography (ECG), is a simple and non-invasive method used to investigate cardiac autonomic abnormalities [10]. HRV is reduced in PD, DLB or RBD [11][12][13][14][15][16], and predictive of PD development in elderly [17,18], suggesting the utility of HRV as an early diagnostic tool in LBD. However, HRV has not been compared between ET and TDPD.…”

Pilomotor function is impaired in patients with Parkinson's disease: A study of the adrenergic axon-reflex response and autonomic functions

“…However, the literature on the course of HRV decline related to PD is not entirely consistent. In fact, a recent cohort study found an increased risk of PD in subjects with low HRV indicating HRV impairment in prodromal disease stages [13]. This discrepancy among studies highlights our still limited understanding of cardiac autonomic dysfunction in PD.…”

Can natural ways to stimulate the vagus nerve improve seizure control?

“…In the prospective Atherosclerosis Risk in Communities study, which included 12,162 participants, one of the outcomes showed that a low HRV was associated with an increased risk of Parkinson disease [21]. Using HRV as a measure of VN activity, a number of studies have shown a relationship between poor VN activity and inflammatory conditions such as rheumatoid arthritis [22], atherosclerosis [23] and Crohn's disease [24].…”