American Journal of Epidemiology Vol. 155, No. 1 : 48-56
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Does the Cardiac Autonomic Response to Postural Change Predict Incident Coronary Heart Disease and Mortality?
The Atherosclerosis Risk in Communities Study
1 Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, CA.
2 Department of Health Evaluation Sciences, Pennsylvania State Medical College, Hershey,PA.
3 Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC.
4 Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
5 Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC.
6 Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
This study evaluated whether small shifts in cardiac autonomic balance with standing, as measured by heart rate variability (HRV), were prospectively associated with incident coronary heart disease (CHD) and mortality. Both Black and White men and women aged 45–64 years from the Atherosclerosis Risk in Communities Study (n = 9,267) were followed from 1987 to 1997 for myocardial infarction (n = 296), fatal CHD (n = 63), and non-CHD mortality (n = 533). HRV indices and mean R-R interval length (inverse of heart rate) were measured in the supine and standing positions for 2 minutes each; HRV shift was calculated as the difference between positions. After adjustment for demographic characteristics and medication use, HRV in each position was significantly inversely related to events in Cox proportional hazards models. With the exception of R-R interval length shift and myocardial infarction (hazard ratio = 1.42, 95% confidence interval: 1.02, 1.98 for the smallest vs. the largest quartile), there was no association between HRV shift and the other events. Despite clinical research suggesting that HRV shift with standing is a more sensitive measure of autonomic balance than is HRV in one position, simple measures such as heart rate change and supine and standing HRV were better predictors of events.
coronary disease; heart rate; mortality; nervous system, autonomic; risk factors
Abbreviations: ARIC, Atherosclerosis Risk in Communities Study; CHD, coronary heart disease; HF, high-frequency power; HRV, heart rate variability; MI, myocardial infarction; SDNN, standard deviation of normal R-R intervals
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