Autonomic function and prothrombotic activity in women after an acute coronary event.
BACKGROUND
The link between decreased heart rate variability (HRV) and atherosclerosis progression is elusive. We hypothesized that reduced HRV relates to increased levels of prothrombotic factors previously shown to predict coronary risk.


METHODS
We studied 257 women (aged 56 +/- 7 years) between 3 and 6 months after an acute coronary event and obtained very low frequency (VLF), low frequency (LF), and high frequency (HF) power, and LF/HF ratio from 24-hour ambulatory ECG recordings. Plasma levels of activated clotting factor VII (FVIIa), fibrinogen, von Willebrand factor antigen (VWF:Ag), and plasminogen activator inhibitor-1 (PAI-1) activity were determined, and their levels were aggregated into a standardized composite index of prothrombotic activity.


RESULTS
In bivariate analyses, all HRV indices were inversely correlated with the prothrombotic index explaining between 6% and 14% of the variance (p < 0.001). After controlling for sociodemographic factors, index event, menopausal status, cardiac medication, lifestyle factors, self-rated health, metabolic variables, and heart rate, VLF power, LF power, and HF power explained 2%, 5%, and 3%, respectively, of the variance in the prothrombotic index (p < 0.012). There were also independent relationships between VLF power and PAI-1 activity, between LF power and fibrinogen, VWF:Ag, and PAI-1 activity, between HF power and FVIIa and fibrinogen, and between the LF/HF power ratio and PAI-1 activity, explaining between 2% and 3% of the respective variances (p < 0.05).


CONCLUSIONS
Decreased HRV was associated with prothrombotic changes partially independent of covariates. Alteration in autonomic function might contribute to prothrombotic activity in women with coronary artery disease (CAD).
von Känel
Roland
R
Department of General Internal Medicine,University Hospital, Inselspital, CH-3010 Bern, Switzerland. roland.vonkaenel@insel.ch
Orth-Gomér
Kristina
K
D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001779:Blood Coagulation Factors / Q000032:analysis*; D003324:Coronary Artery Disease / Q000097:blood / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006487:Hemostasis; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000503:physiopathology*; D011516:Prothrombin / Q000032:analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013548:Sweden
D001779:Blood Coagulation Factors; D011516:Prothrombin
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