title: Association of glucose homeostasis measures with heart rate variability among Hispanic/Latino adults without diabetes: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
abstract: BACKGROUND
  Reduced heart rate variability (HRV), a measure of cardiac autonomic function, is associated with an increased risk of cardiovascular disease (CVD) and mortality. Glucose homeostasis measures are associated with reduced cardiac autonomic function among those with diabetes, but inconsistent associations have been reported among those without diabetes. This study aimed to examine the association of glucose homeostasis measures with cardiac autonomic function among diverse Hispanic/Latino adults without diabetes.
  
  
  METHODS
  The Hispanic community Health Study/Study of Latinos (HCHS/SOL; 2008-2011) used two-stage area probability sampling of households to enroll 16,415 self-identified Hispanics/Latinos aged 18-74 years from four USA communities. Resting, standard 12-lead electrocardiogram recordings were used to estimate the following ultrashort-term measures of HRV: RR interval (RR), standard deviation of all normal to normal RR (SDNN) and root mean square of successive differences in RR intervals (RMSSD). Multivariable regression analysis was used to estimate associations between glucose homeostasis measures with HRV using data from 11,994 adults without diabetes (mean age 39 years; 52 % women).
  
  
  RESULTS
  Higher fasting glucose was associated with lower RR, SDNN, and RMSSD. Fasting insulin and the homeostasis model assessment of insulin resistance was negatively associated with RR, SDNN, and RMSSD, and the association was stronger among men compared with women. RMSSD was, on average, 26 % lower in men with higher fasting insulin and 29 % lower in men with lower insulin resistance; for women, the corresponding estimates were smaller at 4 and 9 %, respectively. Higher glycated hemoglobin was associated with lower RR, SDNN, and RMSSD in those with abdominal adiposity, defined by sex-specific cut-points for waist circumference, after adjusting for demographics and medication use. There were no associations between glycated hemoglobin and HRV measures among those without abdominal adiposity.
  
  
  CONCLUSIONS
  Impairment in glucose homeostasis was associated with lower HRV in Hispanic/Latino adults without diabetes, most prominently in men and individuals with abdominal adiposity. These results suggest that reduced cardiac autonomic function is associated with metabolic impairments before onset of overt diabetes in certain subgroups, offering clues for the pathophysiologic processes involved as well as opportunity for identification of those at high risk before autonomic control is manifestly impaired.
authors.affiliation: University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC, 27514, USA. mlmeyer@unc.edu.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Meyer
authors.affiliation: University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC, 27514, USA.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Gotman
authors.affiliation: Wake Forest School of Medicine, Winston Salem, NC, USA.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC, 27514, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Whitsel
authors.affiliation: Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Raanan
authors.initials: R
authors.lastname: Arens
authors.affiliation: University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC, 27514, USA.
authors.forename: Jianwen
authors.initials: J
authors.lastname: Cai
authors.affiliation: University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.affiliation: Northwestern University, Chicago, IL, USA.
authors.forename: Pablo
authors.initials: P
authors.lastname: Denes
authors.affiliation: Michigan State University, East Lansing, MI, USA.
authors.forename: Hector M
authors.initials: HM
authors.lastname: González
authors.affiliation: University of Miami, Coral Gables, FL, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Moreiras
authors.affiliation: San Diego State University, San Diego, CA, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Talavera
authors.affiliation: University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC, 27514, USA.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D005215:Fasting / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006304:Health Status; D006321:Heart / Q000294:innervation*; D006339:Heart Rate; D006630:Hispanic or Latino; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000208:ethnology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056128:Obesity, Abdominal / Q000097:blood / Q000208:ethnology / Q000503:physiopathology; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Autonomic function; Cohort study; Insulin resistance; Parasympathetic and sympathetic nervous system; Type 2 diabetes mellitus