title: Heart Rate Variability and Incident Stroke: The Atherosclerosis Risk in Communities Study.
abstract: Low heart rate variability (HRV), a marker of cardiac autonomic dysfunction, has been associated with increased all-cause and cardiovascular mortality. We examined the association between reduced HRV and incident stroke in a community-based cohort.
  
  
  
  The Atherosclerosis Risk in Communities (ARIC) study measured HRV using 2-minute ECG readings in 12 550 middle-aged adults at baseline (1987-1989). HRV indices were calculated using the SD of RR intervals (SDNN), the mean of all normal RR intervals (meanNN), the root mean square of successive differences of successive RR intervals (RMSSD), low (LF) and high (HF) frequency power, and the LF/HF ratio. All HRV measures were categorized into quintiles. Incident stroke was adjudicated through 2011. Cox regression was used to estimate hazard ratios (HRs) with the lowest HRV quintile as the reference, with and without stratification by prevalent diabetes mellitus.
  
  
  
  Over a median follow-up of 22 years, 816 (6.5%) participants experienced incident stroke. After covariate adjustment, there was no strong evidence of association between HRV and stroke risk. In stratified analyses, the lowest HRV quintile was associated with higher stroke risk compared with the highest quintile for SDNN (HR, 2.0, 95% confidence interval, 1.1-4.0), RMSSD (HR, 1.7; 95% confidence interval, 0.9-3.2), LF (HR, 1.5; 95% confidence interval, 0.8-3.0), and HF (HR, 1.7; 95% confidence interval, 0.9-3.0) only among people with diabetes mellitus.
  
  
  
  Lower HRV was associated with higher risk of incident stroke among middle-aged adults with prevalent diabetes mellitus but not among people without diabetes mellitus.
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.). fyfej004@umn.edu.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Fyfe-Johnson
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
authors.forename: Clemma J
authors.initials: CJ
authors.lastname: Muller
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
authors.forename: Eric A
authors.initials: EA
authors.lastname: Whitsel
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.L.F.-J., C.J.M., A.A., A.R.F., R.F.M.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Epidemiology, Gillings School of Global Public Health (W.D.R., E.A.W.) and Department of Medicine, School of Medicine (E.A.W.), University of North Carolina, Chapel Hill; and Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.A.).
authors.forename: Richard F
authors.initials: RF
authors.lastname: MacLehose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012111:Residence Characteristics; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology*
keywords: autonomic nervous system; diabetes mellitus; follow-up studies; heart rate; stroke