Clinical InvestigationCoronary Artery DiseaseDecreased heart rate variability is associated with higher levels of inflammation in middle-aged men
Section snippets
Subjects
Twins included in THS were selected from the Vietnam Era Twin Registry, which includes 7,369 middle-aged male-male twin pairs, both of whom served in the United States military during the Vietnam War.24 The THS included 180 monozygotic and dizygotic twin pairs (360 twins), all born between 1946 and 1956. The methods of construction of this sample have been described previously.4, 25 Briefly, the twins were free of a self-reported previous diagnosis of cardiovascular disease based on survey data
Study population
Of the 325 twins free of cardiovascular disease, 264 had ambulatory electrocardiogram data adequate for analysis. Two subjects and their co-twins were excluded due to IL-6 levels above the outlier threshold. The remaining 260 subjects comprise the study population. The mean age was 54 years (range, 47-60). Eight percent had diabetes, 44% hypertension, and 17% were current smokers. Subject characteristics are listed in Table I.
Associations between HRV, inflammatory markers, and clinical factors
Bivariate correlations between HRV, inflammatory markers, and
Discussion
In middle-aged men free of cardiovascular disease, autonomic dysfunction, as demonstrated by decreased HRV, was associated with higher levels of the inflammatory biomarkers CRP and IL-6. Decreased long-term HRV (ULF and VLF) remained an independent predictor of plasma concentration of CRP after adjustment for CAD risk factors associated with both autonomic dysfunction and inflammation.
Conclusions
Markers of inflammation are associated with decreased HRV, even after controlling for clinical CAD risk factors. Autonomic dysregulation leading to inflammation may represent one pathway through which traditional risk factors promote the development of CAD.
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This study received financial support from the National Institutes of Health (Bethesda, MD) (K24HL077506, R01 HL68630, and R01 AG026255), Emory General Clinical Research Center (Atlanta, GA) (MO1-RR00039), and American Heart Association (Dallas, TX) (0245115N). United States Department of Veterans Affairs (Washington, DC) has supported the development and maintenance of the Vietnam Era Twin Registry. Invaluable assistance provided by VA Cooperative Study Program (Washington, DC); Department of Defense (Washington, DC); National Personnel Records Center (Overland, MO), National Archives, and Records Administration (College Park, MD); the Internal Revenue Service (Washington, DC); NIH (Bethesda, MD); National Opinion Research Center (Chicago, IL); National Research Council (Washington, DC), National Academy of Sciences (Washington, DC); and Institute for Survey Research (Washington, DC), Temple University (Philadelphia, PA).
Ambulatory electrocardiogram analysis software is provided by GE Medical, Milwaukee, WI.