Resting heart rate and measures of effort-related cardiac autonomic dysfunction predict cardiovascular events in asymptomatic type 2 diabetes

Zafrir, Barak; Azencot, Mali; Dobrecky‐Mery, Idit; Lewis, Basil S.; Flugelman, Moshe Y.; Halon, David A.

doi:10.1177/2047487315624747

Cited by 30 publications

(28 citation statements)

References 41 publications

(50 reference statements)

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“…The autonomic nervous system, combined with the sympathetic and parasympathetic nerves, largely acts unconsciously and regulates various bodily functions such as heart rate, digestion, respiratory rate, and pupillary response. In recent times, the concept of autonomic nervous modulation has been applied to healthcare management in various fields other than medical treatment (Lucini et al, 1997; Singh et al, 2004; Sakuragi and Sugiyama, 2006; Mizuno et al, 2011; Tanaka et al, 2011) and to the risk management of diseases such as arrhythmia and cardiovascular disease (Zimmerman et al, 1988; Barutcu et al, 2014; Zafrir et al, 2016). Autonomic nervous activation in a large range of emotions was previously reported.…”

Section: Introductionmentioning

confidence: 99%

Music Improves Subjective Feelings Leading to Cardiac Autonomic Nervous Modulation: A Pilot Study

et al. 2017

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It is widely accepted that listening to music improves subjective feelings and reduces fatigue sensations, and different kinds of music lead to different activations of these feelings. Recently, cardiac autonomic nervous modulation has been proposed as a useful objective indicator of fatigue. However, scientific considerations of the relation between feelings of fatigue and cardiac autonomic nervous modulation while listening to music are still lacking. In this study, we examined which subjective feelings of fatigue are related to participants' cardiac autonomic nervous function while they listen to music. We used an album of comfortable and relaxing environmental music, with blended sounds from a piano and violin as well as natural sound sources. We performed a crossover trial of environmental music and silent sessions for 20 healthy subjects, 12 females, and 8 males, after their daily work shift. We measured changes in eight types of subjective feelings, including healing, fatigue, sleepiness, relaxation, and refreshment, using the KOKORO scale, a subjective mood measurement system for self-reported feelings. Further, we obtained measures of cardiac autonomic nervous function on the basis of heart rate variability before and after the sessions. During the music session, subjective feelings significantly shifted toward healing and a secure/relaxed feeling and these changes were greater than those in the silent session. Heart rates (ΔHR) in the music session significantly decreased compared with those in the silent session. Other cardiac autonomic parameters such as high-frequency (HF) component and the ratio of low-frequency (LF) and HF components (LF/HF) were similar in the two sessions. In the linear regression analysis of the feelings with ΔHR and changes in LF/HF (ΔLF/HF), increases and decreases in ΔHR were correlated to the feeling axes of Fatigue-Healing and Anxiety/Tension–Security/Relaxation, whereas those in ΔLF/HF were related to the feeling axes of Sleepiness–Wakefulness and Gloomy–Refreshed. This indicated that listening to music improved the participants' feelings of fatigue and decreased their heart rates. However, it did not reduce the cardiac LF/HF, suggesting that cardiac LF/HF might show a delayed response to fatigue. Thus, we demonstrated changes in cardiac autonomic nervous functions based on feelings of fatigue.

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Section: Introductionmentioning

confidence: 99%

Music Improves Subjective Feelings Leading to Cardiac Autonomic Nervous Modulation: A Pilot Study

et al. 2017

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“…The authors hypothesized that in the presence of diabetes, the relationship between obesity and mortality may not be independent. In particular, diabetes is characterized by autonomic dysfunction with sympathetic activation, which is associated with increased morbidity and mortality . Thus, the positive impact of an attenuated sympathetic activation in obese patients with HF could be blunted by the presence of the metabolic disorder.…”

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confidence: 99%

Obesity in heart failure: is it time to rethink the paradox?

Piepoli

2017

European J of Heart Fail

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“…In this Framingham Heart Study offspring cohort these measures, in addition to smoking, age, and gender, were shown to be significant predictors for developing CVD, DM, and early mortality within 12 years. Zafrir et al (2016) also showed that resting tachycardia (HR > 100 beats/minute), chronotropic incompetence (inability of the heart to increase its rate commensurate with increased activity or demand), and reduced HR recovery after treadmill exercise were independently correlated with stroke, MI, and overall mortality in T2DM patients (hazard ratios of 1.97, 1.89, and 1.77, respectively), regardless of established coronary heart disease. In addition, the EURODIAB Prospective Cohort Study (Soedamah-Muthu et al, 2008) revealed that CAN was the most distinctive predictor for mortality in a large group of patients with T1DM, and increased mortality risk with deteriorating CAN was shown in a meta-analysis of several trials (Maser et al, 2003).…”

Section: Cardiac Autonomic Neuropathy and Risk Of Cardiovascular Evenmentioning

confidence: 95%

Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events

et al. 2018

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Autonomic nervous system (ANS) imbalance manifesting as cardiac autonomic neuropathy in the diabetic population is an important predictor of cardiovascular events. Symptoms and signs of ANS dysfunction, such as resting heart rate elevations, diminished blood pressure responses to standing, and altered time and frequency domain measures of heart rate variability in response to deep breathing, standing, and the Valsalva maneuver, should be elicited from all patients with diabetes and prediabetes. With the recognition of the presence of ANS imbalance or for its prevention, a rigorous regime should be implemented with lifestyle modification, physical activity, and cautious use of medications that lower blood glucose. Rather than intensifying diabetes control, a regimen tailored to the individual risk of autonomic imbalance should be implemented. New agents that may improve autonomic function, such as SGLT2 inhibitors, should be considered and the use of incretins monitored. One of the central mechanisms of dysfunction is disturbance of the hypothalamic cardiac clock, a consequence of dopamine deficiency that leads to sympathetic dominance, insulin resistance, and features of the metabolic syndrome. An improvement in ANS balance may be critical to reducing cardiovascular events, cardiac failure, and early mortality in the diabetic population.

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Resting heart rate and measures of effort-related cardiac autonomic dysfunction predict cardiovascular events in asymptomatic type 2 diabetes

Abstract: Chronotropic incompetence, resting tachycardia and reduced heart rate recovery are independently and additively associated with long-term mortality, myocardial infarction or stroke in type 2 diabetes without known coronary heart disease.

Cited by 30 publications

References 41 publications

Music Improves Subjective Feelings Leading to Cardiac Autonomic Nervous Modulation: A Pilot Study

Music Improves Subjective Feelings Leading to Cardiac Autonomic Nervous Modulation: A Pilot Study

Obesity in heart failure: is it time to rethink the paradox?

Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events

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