Relationship between reduced heart rate variability and increased arterial stiffness evaluated by the cardio-ankle vascular index in people with type 2 diabetes

Masato Kase; Toshie Iijima; Takafumi Niitani; Masaaki Sagara; Shintaro Sakurai; Takuya Tomaru; Teruo Jojima; Isao Usui; Yoshimasa Aso

doi:10.1007/s13340-022-00604-y

Relationship between reduced heart rate variability and increased arterial stiffness evaluated by the cardio-ankle vascular index in people with type 2 diabetes

Diabetol Int. 2022 Sep 29;14(1):94-102. doi: 10.1007/s13340-022-00604-y. eCollection 2023 Jan.

Authors

Masato Kase¹, Toshie Iijima¹, Takafumi Niitani¹, Masaaki Sagara¹, Shintaro Sakurai¹, Takuya Tomaru¹, Teruo Jojima¹, Isao Usui¹, Yoshimasa Aso¹

Affiliation

¹ Department of Endocrinology and Metabolism, Dokkyo Medical University, Mibu, Tochigi Japan.

Abstract

Objective: Cardiac autonomic neuropathy (CAN) is an independent risk factor for cardiovascular mortality and also is associated with a high risk of lethal arrhythmias and sudden death in people with type 1 or 2 diabetes. Heart rate variability (HRV) is an index of cardiac autonomic function. To investigate the relationship between HRV and arterial stiffness evaluated by the cardio-ankle vascular index (CAVI), a relatively new marker for arterial stiffness and a predictor of cardiovascular disease, in patients with type 2 diabetes.

Materials and methods: We studied consecutive 313 patients with type 2 diabetes in a cross-sectional design. HRV was estimated by the coefficient of variation of 100 R-R intervals (CVR-R) at rest and during deep breathing (DB). The difference in CVR-R was defined as CVR-R during DB minus CVR-R at rest. Arterial stiffness was evaluated by CAVI, which is independent of blood pressure (BP). A CAVI greater than or equal to 9.0 was defined as significant arterial stiffening.

Results: Linear regression analysis showed that CAVI correlated positively with age, duration of diabetes, urinary albumin creatinine ratio (UACR), CVR-R during DB, and the difference in CVR-R and negatively with body mass index (BMI), estimated glomerular filtration rate, and sensory nerve conduction velocity and action potential of the sural nerve. Multivariate analysis found that age, BMI, systolic blood pressure, UACR, and CVR-R during DB were independently associated with arterial stiffness determined by CAVI. The CVR-R at rest and during deep breathing was significantly lower in the patients with arterial stiffness than in those without it.

Conclusion: Low HRV estimated by CVR-R during DB is closely associated with arterial stiffness measured by CAVI in people with type 2 diabetes, suggesting that arterial stiffness associated with CAN may be an independent risk factor for cardiovascular disease in people with type 2 diabetes.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-022-00604-y.

Keywords: Arterial stiffness; Cardiac autonomic neuropathy; Cardio-ankle vascular index; Cardiovascular disease; Heart rate variation; Pulse wave velocity.

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