Low Heart Rate Variability in a 2 Minute Rhythm Strip Predicts Risk of Coronary Heart Disease and Mortality From Several Causes

The ARIC Study, Jacqueline M. Dekker, PhD; Richard S. Crow, MD; Aaron R. Folsom, MD, MPH; Peter J. Hannan, MStat; Duanping Liao, MD, PhD; Cees A. Swenne, PhD; Evert G. Schouten, MD, PhD

From the Division of Human Nutrition and Epidemiology (J.D., E.S.), Wageningen Agricultural University, Wageningen, the Netherlands; Institute for Research in Extramural Medicine (J.D.), Vrije Universiteit Amsterdam (the Netherlands); Division of Epidemiology (R.C., A.F., P.H.), School of Public Health, University of Minnesota, Minn; Department of Epidemiology (D.L.), School of Public Health, University of North Carolina (Chapel Hill); and Department of Cardiology (C.S.), University Hospital, Leiden, the Netherlands.

Background—Low heart rate variability is associated with a higher risk of death in patients with heart disease and in elderly subjects and with a higher incidence of coronary heart diseasein the general population.

Methods and Results—We studied the predictive value of heart rate variability for coronary heart disease and death from several causes in a population study of 14 672 men and women without coronary heart disease, aged 45 to 65, by using the case-cohort design. At baseline, in 1987 to 1989, 2-minute rhythm strips were recorded. Time-domain measures of heart rate variability were determined in a random sample of 900 subjects, for all subjects with incident coronary heart disease (395 subjects), and for all deaths (443 subjects) that occurred through 1993. Relative rates of incident coronary heart disease and cause-specific death in tertiles of heart rate variability were computed with Poisson regression for the case-cohort design. Subjects with low heart rate variability had an adverse cardiovascular risk profile and an elevated risk of incident coronary heart disease and death. The increased risk of death could not be attributed to a specific cause and could not be explained by other risk factors.

Conclusions—Low heart rate variability was associated with increased risk of coronary heart disease and death from several causes. It is hypothesized that low heart rate variability is a marker of less favorable health.

Key Words: heart rate • nervous system, autonomic • coronary disease • mortality • heart diseases

Depressed Heart Rate Variability and Inflammatory Process in Sarcoidosis Patients.

Elias Gialafos; Gerasimos Siasos; Dimitris Tousoulis; Evangelos Oikonomou; Marina Zaromitidou; Konstantinos Zisimos; Stamatios Kioufis; Elias Peros; Aggeliki Rapti; Athanasios G Papavassiliou; Christodoulos Stefanadis Athens University Medical School, 1st Cardiology Dept, Hippokration Hosp, Greece, Athens, Greece

Introduction: Sarcoidoisis (Sar) is a multisystemic disease characterized by extensive inflammation and disturbance of autonomic nervous system function. However, the effect of inflammatory process, in heart rate variability (heart rate variability), which is a marker of autonomic nervous system function, remains unknown.

Hypothesis: In the present study we investigated the hypothesis that inflammation status is associated with depressed heart rate variability in Sar patients.

Methods: Ninety five patients with Sar and fifty matched healthy subjects (Cl) were included in the study. Twenty minutes recording of heart rate was used in order to calculate the Standard Deviation of RR (SDNN) as an index of heart rate variability. Serum levels of s-ICAM-1 were measured by ELISA.

Results: Patients with Sar had significantly lower values of SDNN compared to the Cl (38.52±13.37 vs 58.44±22.81, p< 0.05). Bivariate correlation showed that SDNN was significantly associated with the age of the patients (p < 0.005, r= 0.344) and with sICAM-1 values (p < 0.005, r=–0.355). Disease duration and cortisone use were not correlated with heart rate variability indices.

Conclusions: These findings indicate that Sarcoidosis is associated with reduced heart rate variability and with increased inflammatory process. This autonomic nervous system imbalance can be used as a surrogate marker of disease activity and for the long term prognosis of Sarcoidosis patients.

Author Disclosures: E. Gialafos: None. G. Siasos: None. D. Tousoulis: None. E. Oikonomou: None. M. Zaromitidou: None. K. Zisimos: None. S. Kioufis: None. E. Peros: None. A. Rapti: None. A.G. Papavassiliou: None. C. Stefanadis: None.

Key Words: Heart rate/Heart rate variability • Inflammation • Pulmonary

Medicine Impact of a Workplace Stress Reduction Program on Blood Pressure and Emotional Health in Hypertensive Employees

By Rollin McCraty, PhD HeartMath Research Center, Institute of HeartMath, Boulder Creek, CA Mike Atkinson, Dana Tomasino, BA

This study examined the impact of a workplace-based stress management program on blood pressure, emotional health, and workplace-related measures in hypertensive employees of a global information technology company.

Thirty-eight (38) employees with hypertension were randomly assigned to a treatment group that received the stress-reduction intervention or a waiting control group that received no intervention during the study period. The treatment group participated in a 16-hour program, which included instruction in positive emotion refocusing and emotional restructuring techniques intended to reduce sympathetic nervous system arousal, stress, and negative affect, increase positive affect, and improve performance. Learning and practice of the techniques was enhanced by heart rate variability feedback, which helped participants learn to self-generate physiological coherence, a beneficial physiologic mode associated with increased heart rhythm coherence, physiologic entrainment, parasympathetic activity, and vascular resonance. blood pressure, emotional health, and workplace-related measures were assessed before and 3 months after the program.

Three months post-intervention, the treatment group exhibited a mean adjusted reduction of 10.6 mm Hg in systolic blood pressure and of 6.3 mm Hg in diastolic blood pressure. The reduction in systolic blood pressure was significant in relation to the control group. The treatment group also demonstrated improvements in emotional health, including significant reductions in stress symptoms, depression, and global psychological distress and significant increases in peacefulness and positive outlook. Reduced systolic blood pressure was correlated with reduced stress symptoms. Furthermore, the trained employees demonstrated significant increases in the work-related scales of workplace satisfaction and value of contribution.

Results suggest that a brief workplace stress management intervention can produce clinically significant reductions in blood pressure and improve emotional health among hypertensive employees. Implications are that such interventions may produce a healthier and more productive workforce, enhancing performance and reducing losses to the organization resulting from cognitive decline, illness, and premature mortality.

Depression, Heart Rate Variability, and Acute Myocardial Infarction

Robert M. Carney, PhD; James A. Blumenthal, PhD; Phyllis K. Stein, PhD; Lana Watkins, PhD; Diane Catellier, PhD; Lisa F. Berkman, PhD; Susan M. Czajkowski, PhD; Christopher O’Connor, MD; Peter H. Stone, MD; Kenneth E. Freedland, PhD

From the Departments of Psychiatry (R.M.C., K.E.F.) and Medicine (P.K.S.), Washington University School of Medicine, St Louis, Mo; Departments of Psychiatry (J.A.B., L.W.) and Medicine (C.O.C.), Duke University, Durham, NC; Department of Biostatistics (D.C.), University of North Carolina, Raleigh, NC; Departments of Epidemiology (L.F.B.) and Medicine (P.H.S.), Harvard University, Boston Mass; and National Heart, Lung, and Blood Institute (S.M.C.), Bethesda, Md.

Background— Clinical depression is associated with an increased risk for mortality in patients with a recent myocardial infarction (MI). Reduced heart rate variability (heart rate variability) has been suggested as a possible explanation for this association. The purpose of this study was to determine if depression is associated with reduced heart rate variability in patients with a recent MI.

Methods and Results— Three hundred eighty acute MI patients with depression and 424 acute MI patients without depression were recruited. All underwent 24-hour ambulatory electrocardiographic monitoring after hospital discharge. In univariate analyses, 4 indices of heart rate variability were significantly lower in patients with depression than in patients without depression. Variables associated with heart rate variability were then compared between patients with and without depression, and potential confounds were identified. These variables (age, male/female, diabetes, and present cigarette smoking) were entered into an analysis of covariance model, followed by depression status. In the final model, all but one heart rate variability index (high-frequency power) remained significantly lower in patients with depression than in patients without depression.

Conclusions— We conclude that greater autonomic dysfunction, as reflected by decreased heart rate variability, is a plausible mechanism linking depression to increased cardiac mortality in post-MI patients.

Emotion Self-Regulation, Psychophysiological Coherence, and Test Anxiety: Results from an Experiment Using Electrophysiological Measures

Raymond Trevor Bradley, Rollin McCraty, Mike Atkinson, Dana Tomasino, Alane Daugherty, Lourdes Arguelles Applied Psychophysiology and Biofeedback. Dec 2010, Vol. 35, No. 4: 261-283

Resonances in the cardiovascular system caused by rhythmical muscle tension

Evgeny G. Vaschillo, Bronya Vaschillo, Robert J. Pandina, Marsha E. Bates Psychophysiology. Dec 2010: no-no

Biofeedback for hypertension: a systematic review

Janette Greenhalgh, Rumona Dickson, Yenal Dundar Journal of Hypertension. Apr 2010, Vol. 28, No. 4: 644-652

New Hope for Correctional Officers: An Innovative Program for Reducing Stress and Health Risks

Rollin McCraty, Mike Atkinson, Lee Lipsenthal, Lourdes Arguelles Applied Psychophysiology and Biofeedback. Dec 2009, Vol. 34, No. 4: 251-272

Types of Prayer, Heart rate variablity

Ruth Stanley Zygon(r). Dec 2009, Vol. 44, No. 4: 825-846

Chronic medical problems and distressful thoughts of suicide in primary care patients: mitigating role of happiness

Jameson K. Hirsch, Paul R. Duberstein, Jürgen Unützer International Journal of Geriatric Psychiatry. Jul 2009, Vol. 24, No. 7: 671-679

Nonpharmacological approaches in the management of hypertension

M. Elayne DeSimone, Amanda Crowe Journal of the American Academy of Nurse Practitioners. Apr 2009, Vol. 21, No. 4: 189-196

A Pilot Study of the Efficacy of Heart Rate Variability (heart rate variability) Biofeedback in Patients with Fibromyalgia

Afton L. Hassett, Diane C. Radvanski, Evgeny G. Vaschillo, Bronya Vaschillo, Leonard H. Sigal, Maria Katsamanis Karavidas, Steven Buyske, Paul M. Lehrer Applied Psychophysiology and Biofeedback. Mar 2007, Vol. 32, No. 1: 1-10

Electrophysiological Evidence of Intuition: Part 1. The Surprising Role of the Heart

Rollin McCraty, Mike Atkinson, Raymond Trevor Bradley The Journal of Alternative and Complementary Medicine. February 2004: 133-143.

Elderly with CHF, and exercise

14 patients with CHF, after 8 sessions USING freeze frame, (increasing heart rate variability) Significant improvements were noted in perceived stress, emotional distress, 6-minute walk, and depression. PMID:

Improved exercise capacity in people with congestive heart failure (Luskin F, et al. Prev Cardiology. 2002; 5(4): 168–172.).

Low HRV, increases risk for coronary heart disease

Low HRV was associated with increased risk of CHD and death from several causes. It is hypothesized that low HRV is a marker of less favorable health. http://circ.ahajournals.org/cgi/content/abstract/102/11/1239

Decreased HRV in Sarcoidosis patients:

"These findings indicate that Sarcoidosis is associated with reduced heart rate variability and with increased inflammatory process. This autonomic nervous system imbalance can be used as a surrogate marker of disease activity and for the long term prognosis of Sarcoidosis patients" http://circ.ahajournals.org/cgi/content/meeting_abstract/122/21_MeetingAbstracts/A17172

Controlled Pilot Study of Stress Management Training of Elderly Patients with Congestive Heart Failure

Frederic Luskin, PhD, Megan Reitz, BA, Kathryn Newell, MA, Thomas Gregory Quinn, MD, and William Haskell, PhD. Preventive Cardiology. 2002; 5 (4): 168-172, 176.


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