BACKGROUND
Dysfunction of the autonomic nervous system increases cardiovascular risk, but its contribution to cancer outcomes is less well-characterized.
OBJECTIVES
The aim of this study was to evaluate associations between physiological measures reflective of autonomic function and all-site and site-specific cancer mortality in healthy adults.
METHODS
The study included 75,308 participants (26.8% women) in the Cooper Center Longitudinal Study who completed a preventive medicine examination with a treadmill test between 1971 and 2018. Gompertz mortality models estimated associations between autonomic markers-resting heart rate, heart rate reserve, systolic blood pressure response to exercise, and heart rate recovery-and cancer mortality through 2019. Analyses were sex-stratified when significant interactions were present. Models adjusted for age, clinical and lifestyle factors, and cardiorespiratory fitness.
RESULTS
Over a median follow-up of 21.9 years, 3,855 cancer deaths occurred. Lower heart rate reserve (HR per 10% lower: 1.05; 95% CI: 1.02-1.07) and heart rate recovery at 5 minutes (HR per 10 beats/min lower: 1.06; 95% CI: 1.03-1.09) were associated with higher all-site cancer mortality. Sex-specific associations were observed for certain markers: A higher resting heart rate was related to higher cancer mortality in men (HR per 10 beats/min: 1.04; 95% CI: 1.01-1.08), but not in women, whereas systolic blood pressure response associations were stronger in women. Associations with site-specific cancer mortality were particularly pronounced for lung cancer.
CONCLUSIONS
In apparently healthy adults, multiple noninvasive markers of autonomic function were associated with cancer mortality, independent of cardiorespiratory fitness.
Clare Meernik, David Leonard, Kerem Shuval et al.· JACC: Advances· 0 citations
Heart rate variability (HRV) is a widely utilized approach for investigating cardiovascular health and human performance. Methodological approaches, analyses, and interpretations of HRV can vary extensively, and scientific debates on HRV reliability and utility remain. These debates have been amplified in recent years by the rapid growth and ubiquity of wearable devices, and their incorporation into scientific research studies. The present guidelines paper takes an evidence-based approach to propose more consistent and rigorous measurement and interpretation of HRV within human cardiovascular research and application. First, HRV has some utility as a cardiovascular risk stratification tool, but is not appropriate to employ as a specific marker of cardiac sympathetic outflow or sympathovagal balance. While time-domain and spectral analysis can more accurately reflect respiratory modulation of cardiac vagal (parasympathetic) activity, caution is necessary to avoid overinterpretation, particularly with respect to the concept of “vagal tone”. Numerous experimental, demographic, and environmental factors influence HRV assessment, interpretation, and reliability. Specifically, it is critical to account for non-modifiable (age, sex, race/ethnicity, etc.) and modifiable (i.e., exercise, physical fitness, etc.) factors within participant samples. Furthermore, technical approaches such as the HRV input signal (e.g., electrocardiography vs. photoplethysmography), length of recording, location of recordings (i.e., laboratory vs. field), respiratory rate and depth, and analytical approaches (i.e., time vs. frequency domain) can all impact rigor, reliability, and study interpretations. Finally, with respect to the rapid advancements of HRV assessment using wearable technology, investigators should interpret and contextualize findings within the limitations outlined in this guideline review.
Jason R. Carter, Nathaniel D. M. Jenkins, Jeremy A. Bigalke et al.· American Journal of Physiolo...· 1 citation
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