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The Autonomic Control of Heart Rate and Insulin Resistance in Young Adults¹

MRC Metabolic Programming Group (D.E.F., D.I.P.), University of Southampton, Southampton General Hospital, Southampton SO16 6YD, United Kingdom; Department of Cardiovascular Medicine (J.C.V.), Queen Elizabeth Medical Centre, University of Birmingham B15 2TH, United Kingdom; Department of Medical Physics (G.W.P.), University of Southampton, Southampton General Hospital, Southampton S01 66YD, United Kingdom; Department of Obstetrics and Gynaecology (V.M.M., J.S.R.), University of Adelaide, South Australia 5005; Wynn Department of Metabolic Medicine (I.F.G.), Imperial College School of Medicine, London NW8 95Q, United Kingdom; and Child Development Unit (R.A.C.), Women’s and Children’s Hospital, Adelaide, South Australia 5006

Address all correspondence and requests for reprints to: Dr. David Phillips, Medical Research Council Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom. E-mail: diwp{at}mrc.soton.ac.uk

The pathophysiology of insulin resistance is unclear. A link between increased heart rate (HR) and insulin resistance suggests an association with sympathetic nervous system activity. To further evaluate this, we examined autonomic activity using spectral analysis of HR variability (HRV), which provides a measure of cardiac sympathovagal modulation, and related this to insulin sensitivity (Si) in 137 men and women (20 yr old). The HRV spectrum displays 2 major peaks: a high-frequency peak, reflecting vagal activity, and a low-frequency peak caused by vagal and sympathetic activity. The high-to-low ratio (HLratio) reflects sympathovagal balance. Si was measured, using the iv glucose tolerance test with minimal modeling, and HR data was derived from a 15-min supine electrocardiogram. Women were more insulin resistant than men (Si, 3.94 vs. 5.09 10⁴ min^-1/per pmol·L; P = 0.002), had higher HR (59 vs. 56 beats/min, P = 0.019), but had a higher HLratio (2.04 vs. 1.31, P = 0.001). In men (but not women), Si correlated with HR (r = -0.410, P = 0.001) and measures of HRV: HLratio (r = 0.291, P = 0.002) independently of body mass index. In conclusion, Si correlates with cardiac sympathovagal balance in men, but not women, suggesting gender differences in the autonomic modulation of insulin resistance.

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