What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Healthy (n=628). Intervention: Female gender vs. Male gender. Primary outcome: Moderating effect of gender on the association between unadjusted HRV variables and both HR and IBI (p=<0.05).

November 24, 2021Applied Psychophysiology and Biofeedback40 citationsOpen Access

Gender Differences in Cardiac Chronotropic Control: Implications for Heart Rate Variability Research

Q: What are the key findings of this study?

Female gender significantly moderated the association between all unadjusted heart rate variability variables and both heart rate and inter-beat-intervals (each p < 0.05), showing stronger associations compared to men.

DWDeWayne P. WilliamsUniversity of California, Irvine NJNicholas JosephUniversity at Buffalo, State University of New York GGGina M. GerardoCleveland Clinic

Key Result

Female gender significantly moderated the association between all unadjusted heart rate variability variables and both heart rate and inter-beat-intervals (each p < 0.05), showing stronger associations compared to men.

Study Design

Type

Cross-Sectional (n=628)

Multicenter

Structured PICO

Does gender moderate the association between heart rate variability and indices of cardiac chronotropy?

Population

628 healthy young adults aged 18 to 30 underwent a 5-minute baseline resting period to assess the moderating effect of gender on the association between heart rate variability and cardiac chronotropy.

Outcome

Moderating effect of gender on the association between heart rate variability (HRV) and indices of cardiac chronotropy (heart rate and inter-beat-intervals)surrogate

Main Result

p-value: p=<0.05

Limitations

The sample reflects only young and healthy individuals, limiting generalizability to older age groups where estrogen levels differ.
Only baseline cardiovascular data was available, lacking alternative conditions like orthostatic challenge or psychological tasks.

Abstract

There is a continuing debate concerning "adjustments" to heart period variability i.e., heart rate variability (HRV) for the heart period i.e., increases inter-beat-intervals (IBI). To date, such arguments have not seriously considered the impact a demographic variable, such as gender, can have on the association between HRV and the heart period. A prior meta-analysis showed women to have greater HRV compared to men despite having shorter IBI and higher heart rate (HR). Thus, it is plausible that men and women differ in the association between HRV and HR/IBI. Thus, the present study investigates the potential moderating effect of gender on the association between HRV and indices of cardiac chronotropy, including both HR and IBI. Data from 633 participants (339 women) were available for analysis. Cardiac measures were assessed during a 5-min baseline-resting period. HRV measures included the standard deviation of inter-beat-intervals, root mean square of successive differences, and autoregressive high frequency power. Moderation analyses showed gender significantly moderated the association between all HRV variables and both HR and IBI (each p < 0.05). However, results were not consistent when using recently recommended HRV variables "adjusted" for IBI. Overall, the current investigation provides data illustrating a differential association between HRV and the heart period based on gender. Substantial neurophysiological evidence support the current findings; women show greater sensitivity to acetylcholine compared to men. If women show greater sensitivity to acetylcholine, and acetylcholine increases HRV and the heart period, then the association between HRV and the heart period indeed should be stronger in women compared to men. Taken together, these data suggest that routine "adjustments" to HRV for the heart period are unjustified and problematic at best. As it relates to the application of future HRV research, it is imperative that researchers continue to consider the potential impact of gender.

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