Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.
Julius Global Health, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
J Clin Endocrinol Metab. 2023 Sep 18;108(10):2510-2516. doi: 10.1210/clinem/dgad200.
Hyperglycemia and autonomic dysfunction are bidirectionally related.
We investigated the association of longitudinal evolution of heart rate variability (HRV) with incident type 2 diabetes (T2D) among the general population.
We included 7630 participants (mean age 63.7 years, 58% women) from the population-based Rotterdam Study who had no history of T2D and atrial fibrillation at baseline and had repeated HRV assessments at baseline and during follow-up. We used joint models to assess the association between longitudinal evolution of heart rate and different HRV metrics (including the heart rate-corrected SD of the normal-to-normal RR intervals [SDNNc], and root mean square of successive RR-interval differences [RMSSDc]) with incident T2D. Models were adjusted for cardiovascular risk factors. Bidirectional Mendelian randomization (MR) using summary-level data was also performed.
During a median follow-up of 8.6 years, 871 individuals developed incident T2D. One SD increase in heart rate (hazard ratio [HR] 1.20; 95% CI, 1.09-1.33), and log(RMSSDc) (HR 1.16; 95% CI, 1.01-1.33) were independently associated with incident T2D. The HRs were 1.54 (95% CI, 1.08-2.06) for participants younger than 62 years and 1.15 (95% CI, 1.01-1.31) for those older than 62 years for heart rate (P for interaction <.001). Results from bidirectional MR analyses suggested that HRV and T2D were not significantly related to each other.
Autonomic dysfunction precedes development of T2D, especially among younger individuals, while MR analysis suggests no causal relationship. More studies are needed to further validate our findings.
高血糖与自主神经功能障碍呈双向相关。
我们调查了一般人群中心率变异性（HRV）的纵向变化与 2 型糖尿病（T2D）发病的相关性。
我们纳入了来自人群基础的鹿特丹研究中的 7630 名参与者（平均年龄 63.7 岁，58%为女性），他们在基线时没有 T2D 和心房颤动的病史，并且在基线和随访期间有重复的 HRV 评估。我们使用联合模型评估了心率和不同 HRV 指标（包括心率校正的正常到正常 RR 间期的标准差[SDNNc]和连续 RR 间期差异的均方根[RMSSDc]）的纵向变化与 T2D 发病的相关性。模型调整了心血管危险因素。还使用汇总水平数据进行了双向孟德尔随机化（MR）。
在中位数为 8.6 年的随访期间，871 名参与者发生了 T2D 事件。心率每增加 1 个标准差（风险比[HR]1.20；95%可信区间[CI]，1.09-1.33）和 log(RMSSDc)（HR 1.16；95%CI，1.01-1.33）与 T2D 发病独立相关。对于年龄小于 62 岁的参与者，HR 为 1.54（95%CI，1.08-2.06），对于年龄大于 62 岁的参与者，HR 为 1.15（95%CI，1.01-1.31）（心率交互作用 P<0.001）。双向 MR 分析的结果表明，HRV 和 T2D 彼此之间没有显著的关系。
自主神经功能障碍先于 T2D 的发生，尤其是在年轻人群中，而 MR 分析表明两者之间没有因果关系。需要更多的研究来进一步验证我们的发现。
