Fyfe-Johnson Amber L, Muller Clemma J, Alonso Alvaro, Folsom Aaron R, Gottesman Rebecca F, Rosamond Wayne D, Whitsel Eric A, Agarwal Sunil K, MacLehose Richard F
From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
Stroke. 2016 Jun;47(6):1452-8. doi: 10.1161/STROKEAHA.116.012662. Epub 2016 May 5.
Low heart rate variability (HRV), a marker of cardiac autonomic dysfunction, has been associated with increased all-cause and cardiovascular mortality. We examined the association between reduced HRV and incident stroke in a community-based cohort.
The Atherosclerosis Risk in Communities (ARIC) study measured HRV using 2-minute ECG readings in 12 550 middle-aged adults at baseline (1987-1989). HRV indices were calculated using the SD of RR intervals (SDNN), the mean of all normal RR intervals (meanNN), the root mean square of successive differences of successive RR intervals (RMSSD), low (LF) and high (HF) frequency power, and the LF/HF ratio. All HRV measures were categorized into quintiles. Incident stroke was adjudicated through 2011. Cox regression was used to estimate hazard ratios (HRs) with the lowest HRV quintile as the reference, with and without stratification by prevalent diabetes mellitus.
Over a median follow-up of 22 years, 816 (6.5%) participants experienced incident stroke. After covariate adjustment, there was no strong evidence of association between HRV and stroke risk. In stratified analyses, the lowest HRV quintile was associated with higher stroke risk compared with the highest quintile for SDNN (HR, 2.0, 95% confidence interval, 1.1-4.0), RMSSD (HR, 1.7; 95% confidence interval, 0.9-3.2), LF (HR, 1.5; 95% confidence interval, 0.8-3.0), and HF (HR, 1.7; 95% confidence interval, 0.9-3.0) only among people with diabetes mellitus.
Lower HRV was associated with higher risk of incident stroke among middle-aged adults with prevalent diabetes mellitus but not among people without diabetes mellitus.
低心率变异性（HRV）是心脏自主神经功能障碍的一个指标，与全因死亡率和心血管死亡率增加有关。我们在一个基于社区的队列中研究了HRV降低与卒中事件之间的关联。
社区动脉粥样硬化风险（ARIC）研究在基线时（1987 - 1989年）对12550名中年成年人进行了2分钟心电图读数测量HRV。使用RR间期标准差（SDNN）、所有正常RR间期的平均值（meanNN）、连续RR间期连续差值的均方根（RMSSD）、低频（LF）和高频（HF）功率以及LF/HF比值计算HRV指标。所有HRV测量值均分为五分位数。通过2011年判定卒中事件。采用Cox回归估计风险比（HRs），以最低HRV五分位数作为参照，有或无糖尿病患病率分层。
在中位随访22年期间，816名（6.5%）参与者发生了卒中事件。在进行协变量调整后，没有强有力的证据表明HRV与卒中风险之间存在关联。在分层分析中，仅在糖尿病患者中，与最高五分位数相比，最低HRV五分位数与更高的卒中风险相关，对于SDNN（HR，2.0；95%置信区间，1.1 - 4.0）、RMSSD（HR，1.7；95%置信区间，0.9 - 3.2）、LF（HR，1.5；95%置信区间，0.8 - 3.0）和HF（HR，1.7；95%置信区间，0.9 - 3.0）而言。
在患有糖尿病的中年成年人中，较低的HRV与较高的卒中事件风险相关，但在无糖尿病的人群中并非如此。
