Cardiovascular autonomic dysfunction is linked with arterial stiffness across glucose metabolism: The Maastricht Study

Objective To ascertain the cross-sectional association between cardiovascular autonomic function and arterial stiffness across glucose metabolism status. Methods We performed a cross-sectional analysis of participants of The Maastricht Study without prior CVD. Cardiovascular autonomic function was based on heart rate variability (HRV) indices from 24-hour electrocardiogram 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 the modification of the associations by glucose metabolism status. Results PWV and CD measures were available in 3671 and 1806 participants, respectively (median (25 th ; 75 th percentile) age: 60 years (53; 66), 51% women, 20 % type 2 diabetes by design. Participants with lower HRV had higher aortic stiffness, as reflected by 2.8% (CI: 2.1; 3.4) and 2.8% (2.1; 3.5) higher PWV per standard deviation (SD) lower composite HRV time-domain and frequency domain Z-score, respectively. Similar trends were observed for carotid stiffness, reflected by 3.2% (1.4; 5.0) and 3.1% (1.2; 5.0) lower CD per SD lower composite HRV time-domain and frequency domain Z-score, respectively. Associations were stronger among people with prediabetes and type 2 diabetes compared to normal glucose metabolism (p-value for interaction for prediabetes: <0.05; and for type 2 diabetes ranging between: <0.05 - <0.10). Conclusion Cardiovascular autonomic dysfunction is associated with higher aortic and carotid stiffness, especially in people with dysglycemia. Thus, autonomic dysfunction may contribute to cardiovascular risk by affecting vascular stiffness. Short abstract This study investigates the association between cardiovascular autonomic function and arterial stiffness in 3,671 participants of The Maastricht Study without prior CVD. Cardiovascular autonomic function was assessed using 24-hour heart rate variability (HRV). Aortic stiffness was measured by pulse wave velocity (PWV), and carotid stiffness by carotid artery distensibility (CD). Lower HRV was associated with 2.8–3.2% higher PWV and 3.1–3.2% lower CD per SD decrease in HRV Z-scores, with stronger associations observed in individuals with dysglycemia. These findings suggest that autonomic dysfunction may increase cardiovascular risk through effects on vascular stiffness, particularly in prediabetes and diabetes.