Sex-related differences in autonomic modulation of heart rate in middle-aged subjects
Sex-related differences in autonomic modulation of heart rate in middle-aged subjects
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DOI：
10.1161/01.cir.94.2.122
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发表时间：
1996-07-15
期刊：
影响因子：
37.8
通讯作者：
Kesaniemi, YA
中科院分区：
文献类型：
--
作者：
Huikuri, HV;Pikkujamsa, SM;Kesaniemi, YA
背景 女性在经历急性心肌梗死 (MI) 时的预后较差，但这种性别相关差异的原因尚不清楚。由于心血管神经调节在心脏死亡率中起着重要作用，我们研究了没有已知心脏病的中年受试者心率（HR）自主调节可能与性别相关的差异。方法和结果在随机选择的年龄匹配的无高血压的中年女性（n = 186；平均年龄，50 +/- 6岁）和男性（n = 188；平均年龄，50 +/- 6岁）人群中研究了压力反射敏感性（BRS）和HR变异性，糖尿病，或心脏病的临床或超声心动图证据。从 Valsalva 动作过冲阶段测得的 BRS，女性 (8.0 +/- 4.6 ms/mm Hg，n = 152) 显着低于男性 (10.5 +/- 4.6 ms/mm Hg，n = 151) (P < .001)，并且根据 ECG 记录测量的 HR 变异性的低频分量在女性中也较低 (P < .001)，而高频分量则为女性高于男性 (P < .001)。女性的低频和高频振荡之间的比率也较低 (P < .001)。女性因直立姿势而导致的心率增加和心率变异性高频成分的减少幅度小于男性（两者 P < .01）。在调整血压、HR、吸烟、饮酒和心理社会评分等基线变量的差异后，BRS 和 HR 变异性的性别相关差异仍然显着（所有 P < .001）。接受雌激素替代治疗的女性 (n = 46) 的 BRS 和总 HR 方差显着高于未接受激素治疗的年龄匹配女性 (两者 P < 0.1)，并且接受雌激素治疗的女性的 BRA 和 HR 变异性与年龄匹配的男性没有差异。 结论 与男性相比，中年女性压力感受反射反应性减弱，但 HR 的强直迷走神经调节增强。激素替代疗法似乎对绝经后妇女的心血管自主调节具有良好的作用。
Background Women have worse outcomes when they experience acute myocardial infarction (MI), but the reasons for this sex-related difference are not well understood. Because cardiovascular neural regulation plays an important role in cardiac mortality, we studied possible sex-related differences in the autonomic modulation of heart rate (HR) in middle-aged subjects without known heart disease.Methods and Results Baroreflex sensitivity (BRS) and HR variability were studied in randomly selected, age-matched population of middle-aged women (n = 186; mean age, 50 +/- 6 years) and men (n = 188; mean age, 50 +/- 6 years) without hypertension, diabetes, or clinical or echocardiographic evidence of heart disease. BRS measured from the overshoot phase of the Valsalva maneuver was significantly lower in women (8.0 +/- 4.6 ms/mm Hg, n = 152) than in men (10.5 +/- 4.6 ms/mm Hg, n = 151) (P < .001), and the low-frequency component of HR variability measured from ECG recordings also was lower in women (P < .001), whereas the high-frequency component was higher in women than in men (P < .001). The ratio between the low- and high-frequency oscillations also was lower in the women (P < .001). The increase of HR and decrease of high-frequency component of HR variability in response to an upright posture were smaller in magnitude in women than in men (P < .01 for both). After adjustment for differences in the baseline variables, such as blood pressure, HR, smoking, alcohol consumption, and psychosocial score, the sex-related differences in BRS and HR variability still remained significant (P < .001 for all). Women with estrogen replacement therapy (n = 46) had significantly higher BRS and total HR variance than the age-matched women without hormone treatment (P < 0.1 for both), and the BRA and HR variability of the women with estrogen therapy did not differ from those of the age-matched men.Conclusions Baroreflex responsiveness is attenuated in middle-aged women compared with men, but the tonic vagal modulation of HR is augmented. Hormone replacement therapy appears to have favorable effects on the cardiovascular autonomic regulation in postmenopausal women.