Key result
Lower HRV correlates with ~3% greater aortic and reduced carotid stiffness in prediabetes and T2D.
Why the study?
The study was conducted to determine the cross-sectional association between cardiovascular autonomic dysfunction and arterial stiffness across glucose metabolism status.
Is cardiovascular autonomic dysfunction associated with increased arterial stiffness across different glucose metabolism statuses?
Cross-Sectional (n=3,673)
Is cardiovascular autonomic dysfunction associated with increased arterial stiffness across different glucose metabolism statuses?
Effect estimate: 2.8% higher PWV per SD lower time-domain HRV (95% CI 2.1% to 3.4%)
Cardiovascular autonomic dysfunction is associated with increased arterial stiffness, with a more pronounced effect in individuals with prediabetes and type 2 diabetes.
May support vascular surveillance in prediabetes and T2D with low HRV; extends evidence but leaves causality open.
Objective To ascertain the cross-sectional association between cardiovascular autonomic dysfunction and arterial stiffness across glucose metabolism status. Research design and methods We performed a cross-sectional analysis of participants of the Maastricht study. Cardiovascular autonomic function was based on heart rate variability (HRV) indices from 24-hour ECG recordings and summarized in z-scores for time and frequency domains. Aortic and carotid stiffness were assessed by carotid-femoral pulse wave velocity (PWV) and carotid artery distensibility (CD), respectively. We used multiple linear regression to study the associations and adjusted for demographic and lifestyle factors and a range of cardiovascular risk factors. We tested for effect modification of the associations by glucose metabolism status. Results PWV and CD measures were available in 3673 and 1802 participants, respectively (median (25th; 75th percentile) age: 60 years (53; 66), 51% women, 20% type 2 diabetes by design. Participants with lower HRV had higher aortic stiffness. Per SD lower time-domain and frequency-domain HRV z-scores were associated with 2.8% (95% CI 2.1% to 3.4%) and 2.8% (95% CI 2.1% to 3.5%) higher PWV, respectively. Similar trends were observed for carotid stiffness, with 3.2% (95% CI 1.4% to 5.0%) and 3.1% (95% CI 1.2% to 5.0%) lower CD per SD lower time-domain and frequency-domain HRV, respectively. The magnitude of these associations was higher in groups with prediabetes and type 2 diabetes compared with those with normal glucose metabolism, with evidence of effect modification by glucose metabolism status (p value for interaction: <0.01 for prediabetes and <0.05 to <0.10 for type 2 diabetes, both compared with normal glucose metabolism). Conclusion Cardiovascular autonomic dysfunction is associated with higher aortic and carotid stiffness, especially in people with dysglycemia.
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Schaarup et al. (2026) conducted a cross-sectional in Dysglycemia / Type 2 Diabetes (n=3,673). Lower heart rate variability (HRV) vs. Higher HRV was evaluated on Aortic stiffness (carotid-femoral pulse wave velocity) (2.8% higher PWV per SD lower time-domain HRV, 95% CI 2.1% to 3.4%). Lower heart rate variability was associated with higher aortic stiffness (2.8% higher PWV per SD lower time-domain HRV; 95% CI 2.1% to 3.4%), especially in people with dysglycemia.
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