Huang Yiquan, Xie Peihan, Zhang Shaozhao, Liu Menghui, Xiong Zhenyu, Huang Rihua, Huang Zhuoshan, Zhong Xiangbin, Chen Zhuohui, Zhou Ziwei, Zhang Wenjing, Guo Yue, Yang Daya, Zhuang Xiaodong, Liao Xinxue
Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China.
NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), China; Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, China.
Diabetes Metab Syndr. 2024 Jan;18(1):102930. doi: 10.1016/j.dsx.2023.102930. Epub 2023 Dec 20.
Heart rate variability (HRV) and resting heart rate (RHR) are usually analyzed and interpreted separately. We aimed to assess the interplay of HRV and RHR on mortality in type 2 diabetes.
The study included 7,529 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. HRV metrics included standard deviation of all normal-to-normal intervals (SDNN) and root mean square of successive differences between normal-to-normal intervals (rMSSD). Abnormal values were defined based on <25th percentile for HRV and >75th percentile for RHR. Interactions of HRV status and RHR status were tested on multiplicative and additive scales. Results were validated in a subset of patients with type 2 diabetes (n = 745) from the Multi-Ethnic Study of Atherosclerosis.
Low SDNN was associated with increased all-cause mortality in the high RHR group (HR 1.60; 95% CI 1.29-1.97), but not in the normal RHR group. Compared with those who had neither low SDNN nor high RHR, the presence of either low SDNN or high RHR was not significantly associated with an increased risk of all-cause mortality. In contrast, the combination of low SDNN and high RHR was associated with a significantly increased risk of all-cause mortality (HR 1.68; 95% CI 1.43-1.97). Significant multiplicative and additive interactions were found between HRV status and RHR status on risk of all-cause mortality (all P < 0.05). Similar findings were observed for cardiovascular mortality, in analyses using rMSSD, and in the Multi-Ethnic Study of Atherosclerosis.
The association between HRV and mortality risk is modified by RHR levels. Furthermore, low HRV and high RHR have interdependent and synergistic associations with mortality risk.
心率变异性（HRV）和静息心率（RHR）通常是分别进行分析和解读的。我们旨在评估HRV和RHR在2型糖尿病患者死亡率方面的相互作用。
该研究纳入了糖尿病心血管风险控制行动（ACCORD）试验中的7529名参与者。HRV指标包括全部正常心动周期间期的标准差（SDNN）和相邻正常心动周期间期差值的均方根（rMSSD）。异常值根据HRV低于第25百分位数和RHR高于第75百分位数来定义。在乘法和加法尺度上测试HRV状态和RHR状态的相互作用。结果在动脉粥样硬化多族裔研究中2型糖尿病患者的一个亚组（n = 745）中得到验证。
在高RHR组中，低SDNN与全因死亡率增加相关（风险比1.60；95%置信区间1.29 - 1.97），而在正常RHR组中则不然。与既没有低SDNN也没有高RHR的人相比，单独存在低SDNN或高RHR与全因死亡率增加的风险没有显著关联。相比之下，低SDNN和高RHR同时存在与全因死亡率显著增加的风险相关（风险比1.68；95%置信区间1.43 - 1.97）。在全因死亡率风险方面，HRV状态和RHR状态之间存在显著的乘法和加法相互作用（所有P < 0.05）。在使用rMSSD进行的分析以及动脉粥样硬化多族裔研究中，心血管死亡率也观察到了类似的结果。
RHR水平会改变HRV与死亡风险之间的关联。此外，低HRV和高RHR与死亡风险存在相互依存和协同的关联。
