Depressed autonomic nervous system function in African Americans and individuals of lower social class: A potential mechanism of race- and class-related disparities in health outcomes
Depressed autonomic nervous system function in African Americans and individuals of lower social class: A potential mechanism of race- and class-related disparities in health outcomes
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DOI：
10.1016/j.ahj.2004.08.008
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发表时间：
2005-07-01
影响因子：
4.8
通讯作者：
Lee, F
中科院分区：
文献类型：
--
作者：
Lampert, R;Ickovics, J;Lee, F
背景
种族和社会阶层都会影响心血管疾病的预后，但其作用机制尚未完全明确。少数族裔以及较低的社会阶层是慢性压力的来源，这可能会改变自主神经系统的功能。心率变异性（HRV）是衡量自主神经功能的指标，也是心血管疾病预后的重要预测因子。
方法
为了确定少数族裔/种族以及较低的社会阶层是否与心率变异性降低有关，我们对360名接受动态心电图监测的门诊患者进行了调查，前瞻性地收集了社会人口统计学、临床、心理和行为因素方面的数据。通过频域分析测量24小时心率变异性。
结果
在未校正的分析中，非裔美国人的心率变异性低于白人，以教育程度、职业和收入衡量的社会阶层较低的个体，其心率变异性低于社会阶层较高的个体。在多变量分析中，在控制了临床和心理因素后，种族和社会阶层都是极低频功率的独立预测因子。非裔美国人出现心率变异性降低（极低频功率处于最低三分位数）的可能性是白人的3.45倍（95%置信区间为1.74 - 6.98，P = 0.0004），未接受过大学教育的人出现心率变异性降低的可能性是大学毕业生的2.94倍（95%置信区间为1.71 - 5.14，P = 0.0001）。
结论
非裔美国人和社会阶层较低的个体心率变异性较低，且与所测量的临床、心理或行为因素的影响无关。这表明少数族裔和较低社会阶层对心血管疾病预后的不良影响可能是由自主神经功能失调所介导的。
Background Both race and social class influence cardiovascular outcomes, through mechanisms not yet fully understood. Minority race and lower social class are sources of chronic stress, which can alter autonomic nervous system function. Heart rate variability (HRV), a measure of autonomic function,,is also an important predictor of cardiovascular outcomes.Methods To determine whether minority race/ethnicity and lower social class are associatecl with depressed HRV, we prospectively collected data on sociodemographic, clinical, psychological, and,behavioral factors by survey in 360 outpatients undergoing ambulatory electrocardiographic monitoring. Heart rate variability (24-hour) was measured by frequency domain analysis.Results In unadjusted analysis, African Americans had lower HRV than whites, and individuals of lower social class as measured by education, occupation, and income had lower HRV than those of higher class. In multivariable analysis, both race and social class were independent predictors of ultralow frequency power after controlling for clinical and psychological factors. African Americans were 3.45 (95% Cl 1.74-6.98, P =0004) times as likely as whites to have depressed HRV (ultralow frequency power, lowest tertile), and non-college graduates 2.94 (95% Cl, 1.71-5.14, P=.0001) times as likely as college graduates to have depressed HRV.Conclusions Heart rate variability is lower in African Americans and individuals of lower social Class, independent of the effects of measured clinical, psychological, or behavioral factors. This suggests that the adverse effects of minority race and lower social class on cardiovascular outcomes may be mediated by dysregulation of autonomic function.