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. 2022 Oct 25;17(10):e0276585.
doi: 10.1371/journal.pone.0276585. eCollection 2022.

Heart rate variability and the risk of heart failure and its subtypes in post-menopausal women: The Women's Health Initiative study

Muhammad Baig  1   2   3 , Miremad Moafi-Madani  3 , Reema Qureshi  4 , Mary B Roberts  5 , Matthew Allison  6 , JoAnn E Manson  7   8 , Michael J LaMonte  9 , Simin Liu  3 , Charles B Eaton  3   5   10
Affiliations

Heart rate variability and the risk of heart failure and its subtypes in post-menopausal women: The Women's Health Initiative study

Muhammad Baig et al. PLoS One. .

Abstract

Background: Low heart rate variability (HRV), a measure of autonomic imbalance, is associated with increased risk of coronary heart disease (CHD) and heart failure (HF). However, its relationship with HF subtypes; heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) has not been studied prior.

Methods and findings: We conducted a longitudinal study in Women's Health Initiative study cohort to investigate the association of baseline quartiles of resting heart rate (rHR) and HRV measures; SDNN (SD of normal-to-normal RR interval) and RMSSD (root mean square of successive difference of RR interval) measured by twelve-lead electrocardiogram (ECG) on enrollment, with the risk of hospitalized HF and its subtypes. Total of 28,603 post-menopausal women, predominantly non-Hispanic whites (69%), with a mean (SD) age of 62.6 (7.1) years, free of baseline CHD and HF were included. In a fully adjusted cox-proportional hazards regression model which adjusted for age, race, BMI, alcohol intake, education, physical activity, hyperlipidemia, hypertension, left ventricular hypertrophy, use of beta-blocker, calcium-channel blocker, hormone therapy, and time-varying incident CHD, the hazard ratios of lowest quartile of HRV (Q1) with HF risk were significant (Q1 SDNN compared to Q4 SDNN: 1.22, 95% CI 1.07, 1.39; Q1 RMSSD compared to Q4 RMSSD: 1.17, 95% CI 1.02, 1.33). On subgroup analysis of HF subtypes, low HRV was associated with elevated HFpEF risk (Q1 vs Q4 SDNN: 1.22, 95% CI 1.02, 1.47) but not with HFrEF (Q1 vs Q4 SDNN: 1.19, 95% CI 0.95, 1.50; Q1 RMSSD: 1.13, 95% CI 0.90, 1.43).

Conclusion: Low HRV is associated with elevated overall hospitalized HF risk and HFpEF risk in post-menopausal women. Whether interventions to increase HRV through healthy lifestyle changes will decrease HF risk warrants further investigation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of WHI participants in the analysis.
CHD: coronary heart disease; HF: heart failure; SDNN: standard deviation of normal-to-normal RR interval; RMSSD: root mean square of successive difference of RR intervals; WHI: Women Health Initiative.
Fig 2
Fig 2. Kaplan-Meier survival curve of incident HF by quartiles of SDNN.
HF: heart failure; SDNN: standard deviation of normal-to-normal RR interval.
Fig 3
Fig 3. Kaplan-Meier survival curve of incident HF by quartiles of RMSSD.
HF: heart failure; RMSSD: root mean square of successive difference of RR intervals.
See this image and copyright information in PMC

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