title: Insulin resistance and carotid intima-media thickness mediate the association between resting-state heart rate variability and executive function: A path modelling study.
abstract: Research has linked high-frequency heart rate variability (HF-HRV) to cognitive function. The present study adopts a modern path modelling approach to understand potential causal pathways that may underpin this relationship.
  
  
  
  Here we examine the association between resting-state HF-HRV and executive function in a large sample of civil servants from Brazil (N=8114) recruited for the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). HF-HRV was calculated from 10-min resting-state electrocardiograms. Executive function was assessed using the trail-making test (version B).
  
  
  
  Insulin resistance (a marker of type 2 diabetes mellitus) and carotid intima-media thickness (subclinical atherosclerosis) mediated the relationship between HRV and executive function in seriatim. A limitation of the present study is its cross-sectional design; therefore, conclusions must be confirmed in longitudinal study. Nevertheless, findings support that possibility that HRV provides a 'spark' that initiates a cascade of adverse downstream effects that subsequently leads to cognitive impairment.
authors.affiliation: University Hospital and Faculty of Medicine, University of São Paulo, São Paulo, Brazil; School of Psychology & Discipline of Psychiatry, University of Sydney, Sydney, Australia. Electronic address: a.h.kemp@swansea.ac.uk.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Kemp
authors.affiliation: University Hospital and Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Department of Biology, Universidad Autónoma de Madrid, Spain.
authors.forename: Santiago Rodríguez
authors.initials: SR
authors.lastname: López
authors.affiliation: Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Valeria M A
authors.initials: VMA
authors.lastname: Passos
authors.affiliation: University Hospital and Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Marcio S
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Collegiate of Biological Sciences, Federal University of Vale do São Francisco, Petrolina, Pernambuco, Brazil.
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Dantas
authors.affiliation: Departament of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brasil, Brazil.
authors.forename: José G
authors.initials: JG
authors.lastname: Mill
authors.affiliation: Hospital das Clínicas and Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Antonio L P
authors.initials: ALP
authors.lastname: Ribeiro
authors.affiliation: Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH, 43210, USA.
authors.forename: Julian F
authors.initials: JF
authors.lastname: Thayer
authors.affiliation: University Hospital and Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Bensenor
authors.affiliation: University Hospital and Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
mesh_terms: D000328:Adult; D001938:Brazil; D059168:Carotid Intima-Media Thickness / Q000523:psychology*; D003430:Cross-Sectional Studies; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D008960:Models, Psychological
keywords: Carotid intima-media thickness; Cognition; Executive function; HOMA-IR; HRV; Heart rate variability; Homeostasis model assessment index for insulin resistance; IMT; Mediation analyses; Path modelling; TMT; Trail making test