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Insulin resistance and reduced cardiac autonomic function in older adults: the Atherosclerosis Risk in Communities study.
BMC Cardiovasc Disord. 2020 05 11; 20(1):217.BC

Abstract

BACKGROUND

Prior studies have shown insulin resistance is associated with reduced cardiac autonomic function measured at rest, but few studies have determined whether insulin resistance is associated with reduced cardiac autonomic function measured during daily activities.

METHODS

We examined older adults without diabetes with 48-h ambulatory electrocardiography (n = 759) in an ancillary study of the Atherosclerosis Risk in Communities Study. Insulin resistance, the exposure, was defined by quartiles for three indexes: 1) the homeostatic model assessment of insulin resistance (HOMA-IR), 2) the triglyceride and glucose index (TyG), and 3) the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C). Low heart rate variability, the outcome, was defined by <25th percentile for four measures: 1) standard deviation of normal-to-normal R-R intervals (SDNN), a measure of total variability; 2) root mean square of successive differences in normal-to-normal R-R intervals (RMSSD), a measure of vagal activity; 3) low frequency spectral component (LF), a measure of sympathetic and vagal activity; and 4) high frequency spectral component (HF), a measure of vagal activity. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals weighted for sampling/non-response, adjusted for age at ancillary visit, sex, and race/study-site. Insulin resistance quartiles 4, 3, and 2 were compared to quartile 1; high indexes refer to quartile 4 versus quartile 1.

RESULTS

The average age was 78 years, 66% (n = 497) were women, and 58% (n = 438) were African American. Estimates of association were not robust at all levels of HOMA-IR, TyG, and TG/HDL-C, but suggest that high indexes were associated consistently with indicators of vagal activity. High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low RMSSD (OR: 1.68 (1.00, 2.81), OR: 2.03 (1.21, 3.39), and OR: 1.73 (1.01, 2.91), respectively). High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low HF (OR: 1.90 (1.14, 3.18), OR: 1.98 (1.21, 3.25), and OR: 1.76 (1.07, 2.90), respectively).

CONCLUSIONS

In older adults without diabetes, insulin resistance was associated with reduced cardiac autonomic function - specifically and consistently for indicators of vagal activity - measured during daily activities. Primary prevention of insulin resistance may reduce the related risk of cardiac autonomic dysfunction.

Authors+Show Affiliations

Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.Division of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. loehr@unc.edu.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32393179

Citation

Poon, Anna K., et al. "Insulin Resistance and Reduced Cardiac Autonomic Function in Older Adults: the Atherosclerosis Risk in Communities Study." BMC Cardiovascular Disorders, vol. 20, no. 1, 2020, p. 217.
Poon AK, Whitsel EA, Heiss G, et al. Insulin resistance and reduced cardiac autonomic function in older adults: the Atherosclerosis Risk in Communities study. BMC Cardiovasc Disord. 2020;20(1):217.
Poon, A. K., Whitsel, E. A., Heiss, G., Soliman, E. Z., Wagenknecht, L. E., Suzuki, T., & Loehr, L. (2020). Insulin resistance and reduced cardiac autonomic function in older adults: the Atherosclerosis Risk in Communities study. BMC Cardiovascular Disorders, 20(1), 217. https://doi.org/10.1186/s12872-020-01496-z
Poon AK, et al. Insulin Resistance and Reduced Cardiac Autonomic Function in Older Adults: the Atherosclerosis Risk in Communities Study. BMC Cardiovasc Disord. 2020 05 11;20(1):217. PubMed PMID: 32393179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insulin resistance and reduced cardiac autonomic function in older adults: the Atherosclerosis Risk in Communities study. AU - Poon,Anna K, AU - Whitsel,Eric A, AU - Heiss,Gerardo, AU - Soliman,Elsayed Z, AU - Wagenknecht,Lynne E, AU - Suzuki,Takeki, AU - Loehr,Laura, Y1 - 2020/05/11/ PY - 2020/01/10/received PY - 2020/04/27/accepted PY - 2020/5/13/entrez PY - 2020/5/13/pubmed PY - 2020/11/25/medline KW - Ambulatory electrocardiograms KW - Cardiac autonomic function KW - Heart rate variability KW - Homeostatic model assessment of insulin resistance KW - Insulin resistance SP - 217 EP - 217 JF - BMC cardiovascular disorders JO - BMC Cardiovasc Disord VL - 20 IS - 1 N2 - BACKGROUND: Prior studies have shown insulin resistance is associated with reduced cardiac autonomic function measured at rest, but few studies have determined whether insulin resistance is associated with reduced cardiac autonomic function measured during daily activities. METHODS: We examined older adults without diabetes with 48-h ambulatory electrocardiography (n = 759) in an ancillary study of the Atherosclerosis Risk in Communities Study. Insulin resistance, the exposure, was defined by quartiles for three indexes: 1) the homeostatic model assessment of insulin resistance (HOMA-IR), 2) the triglyceride and glucose index (TyG), and 3) the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C). Low heart rate variability, the outcome, was defined by <25th percentile for four measures: 1) standard deviation of normal-to-normal R-R intervals (SDNN), a measure of total variability; 2) root mean square of successive differences in normal-to-normal R-R intervals (RMSSD), a measure of vagal activity; 3) low frequency spectral component (LF), a measure of sympathetic and vagal activity; and 4) high frequency spectral component (HF), a measure of vagal activity. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals weighted for sampling/non-response, adjusted for age at ancillary visit, sex, and race/study-site. Insulin resistance quartiles 4, 3, and 2 were compared to quartile 1; high indexes refer to quartile 4 versus quartile 1. RESULTS: The average age was 78 years, 66% (n = 497) were women, and 58% (n = 438) were African American. Estimates of association were not robust at all levels of HOMA-IR, TyG, and TG/HDL-C, but suggest that high indexes were associated consistently with indicators of vagal activity. High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low RMSSD (OR: 1.68 (1.00, 2.81), OR: 2.03 (1.21, 3.39), and OR: 1.73 (1.01, 2.91), respectively). High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low HF (OR: 1.90 (1.14, 3.18), OR: 1.98 (1.21, 3.25), and OR: 1.76 (1.07, 2.90), respectively). CONCLUSIONS: In older adults without diabetes, insulin resistance was associated with reduced cardiac autonomic function - specifically and consistently for indicators of vagal activity - measured during daily activities. Primary prevention of insulin resistance may reduce the related risk of cardiac autonomic dysfunction. SN - 1471-2261 UR - https://www.unboundmedicine.com/medline/citation/32393179/Insulin_resistance_and_reduced_cardiac_autonomic_function_in_older_adults:_the_Atherosclerosis_Risk_in_Communities_study_ L2 - https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-020-01496-z DB - PRIME DP - Unbound Medicine ER -