title: The Contribution of Autonomic Imbalance to the Development of Metabolic Syndrome.
abstract: Obesity, diabetes, and heart disease-the most costly epidemics of our time-share a common but rarely treated mechanism: autonomic imbalance. We examined the contribution of autonomic imbalance, relative to selected demographic and biobehavioral risk factors, to the development of metabolic syndrome in a community sample for 12 years.
  
  
  
  We identified offspring cohort participants from the Framingham Heart Study who did not have metabolic syndrome at Examination 3 (1983-1987, baseline for this analysis) and whose metabolic syndrome status was assessed at the 4-, 8-, and 12-year follow-ups. We created logistic regression models, using baseline resting heart rate (RHR) and heart rate variability (HRV), to predict the odds of developing metabolic syndrome within 12 years, adjusting for age, sex, depressive symptoms, and smoking. HRV indices (standard deviation of the beat-to-beat interval [SDNN] and root mean square of the standard deviation) were calculated from 2-hour Holter monitor data.
  
  
  
  Our sample consisted of 1143 participants (mean [SD] age = 46.6 (9.9) years, 57% female). One standard deviation of a decrease in SDNN increased the odds of developing metabolic syndrome within 12 years by 43% (95% confidence interval = 1.302-1.572, p < .001). Without HRV in the model, each increase in RHR of 10 beats/min increased the odds of developing metabolic syndrome by 24% (95% confidence interval = 1.094-1.426, p < .001).
  
  
  
  In this community sample, low HRV by both measures (SDNN and root mean square of the standard deviation), high RHR, increased age, cigarette smoking, and being male significantly increased the odds of developing metabolic syndrome within 12 years of baseline.
authors.affiliation: From the Cincinnati VA Medical Center (Perry, Wulsin) and University of Cincinnati College of Medicine (Wulsin), Cincinnati, Ohio; Cincinnati VA Medical Center and University of Cincinnati (Horn), Cincinnati, Ohio; Department of Biostatistics, Boston University School of Public Health (Massaro), Boston, Massachusetts; and Department of Mathematics and Statistics, Boston University (D'Agostino), Boston, Massachusetts.
authors.forename: Lawson R
authors.initials: LR
authors.lastname: Wulsin
authors.forename: Paul S
authors.initials: PS
authors.lastname: Horn
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Perry
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.forename: Ralph B
authors.initials: RB
authors.lastname: DʼAgostino
mesh_terms: D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000209:etiology*; D008875:Middle Aged