Differences in Long-Term Heart Rate Variability between Subjects with and without Metabolic Syndrome: A Systematic Review and Meta-Analysis

Abstract

Background: Our aim was to determine the impact that metabolic syndrome (MS) produces in long-term heart rate variability (HRV), quantitatively synthesizing the results of published studies to characterize the cardiac autonomic dysfunction in MS.

Methods: We searched electronic databases for original research works with long-term HRV recordings (24 h) that compared people with MS (MS+) versus healthy people as a control group (MS-). This systematic review and meta-analysis (MA) was performed according to PRISMA guidelines and registered at PROSPERO (CRD42022358975).

Results: A total of 13 articles were included in the qualitative synthesis, and 7 of them met the required criteria to be included in the MA. SDNN (-0.33 [-0.57, 0.09], p = 0.008), LF (-0.32 [-0.41, -0.23], p < 0.00001), VLF (-0.21 [-0.31, -0.10], p = 0.0001) and TP (-0.20 [-0.33, -0.07], p = 0.002) decreased in patients with MS. The rMSSD (p = 0.41), HF (p = 0.06) and LF/HF ratio (p = 0.64) were not modified.

Conclusions: In long-term recordings (24 h), SDNN, LF, VLF and TP were consistently decreased in patients with MS. Other parameters that could be included in the quantitative analysis were not modified in MS+ patients (rMSSD, HF, ratio LF/HF). Regarding non-linear analyses, the results are not conclusive due to the low number of datasets found, which prevented us from conducting an MA.

Keywords: long-term heart rate variability; meta-analysis; metabolic syndrome.

Figure 1

Preferred reporting items for systematic reviews and meta-analyses flow diagram illustrating selection of studies.

Figure 2

Comparison of the effects of metabolic syndrome (MS+) versus control (MS−) group on SDNN using forest plot. Each study is represented by a green dot at the point estimate of intervention effect with a horizontal line extending either side of the dot. The area of the dot indicates the weight assigned to that study in the meta-analysis while the horizontal line depicts the confidence interval (95% level of confidence). Balcioglu et al., 2016 [29]; Rasic-Milutionovic et al., 2010 [27]; Ma et al., 2017 [11]; Slušnienė et al., 2019 [30]; Stein et al., 2007 [21].

Figure 3

Comparison of the effects of metabolic syndrome (MS+) versus control (MS−) group on rMSSD using forest plot. Each study is represented by a green dot at the point estimate of intervention effect with a horizontal line extending either side of the dot. The area of the dot indicates the weight assigned to that study in the meta-analysis while the horizontal line depicts the confidence interval (95% level of confidence). Ma et al., 2017 [11]; Rasic-Milutinovic et al., 2010 [27]; Slušnienė et al., 2019 [30].

Figure 4

Comparison of the effects of metabolic syndrome (MS+) versus control (MS−) group on HF using forest plot. Each study is represented by a green dot at the point estimate of intervention effect with a horizontal line extending either side of the dot. The area of the dot indicates the weight assigned to that study in the meta-analysis while the horizontal line depicts the confidence interval (95% level of confidence). Aso et al., 2006 [31]; Assoumou et al., 2010 [26]; Ma et al., 2017 [11]; Rasic-Milutinovic et al., 2010 [27]; Slušnienė et al., 2019 [30].

Figure 5

Comparison of the effects of metabolic syndrome (MS+) versus control (MS−) group on LF using forest plot. Each study is represented by a green dot at the point estimate of intervention effect with a horizontal line extending either side of the dot. The area of the dot indicates the weight assigned to that study in the meta-analysis while the horizontal line depicts the confidence interval (95% level of confidence). Aso et al., 2006 [31]; Assoumou et al., 2010 [26]; Ma et al., 2017 [11]; Rasic-Milutinovic et al., 2010 [27]; Slušnienė et al., 2019 [30].

Figure 6

Comparison of the effects of metabolic syndrome (MS+) versus control (MS−) group on LF/HF using forest plot. Each study is represented by a green dot at the point estimate of intervention effect with a horizontal line extending either side of the dot. The area of the dot indicates the weight assigned to that study in the meta-analysis while the horizontal line depicts the confidence interval (95% level of confidence). Ma et al., 2017 [11]; Rasic-Milutinovic et al., 2010 [27]; Slušnienė et al., 2019 [30].

Figure 7

Comparison of the effects of metabolic syndrome (MS+) versus control (MS−) group on VLF using forest plot. Each study is represented by a green dot at the point estimate of intervention effect with a horizontal line extending either side of the dot. The area of the dot indicates the weight assigned to that study in the meta-analysis while the horizontal line depicts the confidence interval (95% level of confidence). Assoumou et al., 2010 [26]; Ma et al., 2017 [11]; Rasic-Milutinovic et al., 2010 [27]; Slušnienė et al., 2019 [30]; Stein et al., 2007 [21].

Figure 8

Comparison of the effects of metabolic syndrome (MS+) versus control (MS−) group on TP using forest plot. Each study is represented by a green dot at the point estimate of intervention effect with a horizontal line extending either side of the dot. The area of the dot indicates the weight assigned to that study in the meta-analysis while the horizontal line depicts the confidence interval (95% level of confidence). Assoumou et al., 2010 [26]; Ma et al., 2017 [11]; Rasic-Milutinovic et al., 2010 [27]; Stein et al., 2007 [21].