Biomedical Science Letters (대한의생명과학회지)

The Korean Society for Biomedical Laboratory Sciences (대한의생명과학회)
권호 표지
DOI QR코드

DOI QR Code

Heart Rate Recovery in Metabolically Healthy Obesity and Metabolically Unhealthy Obesity Korean Adults

  • Shin, Kyung-A (Department of Clinical Laboratory Science, Shinsung University)
  • Received : 2018.06.07
  • Accepted : 2018.09.07
  • Published : 2018.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Heart rate recovery (HRR) is simply an indicator of autonomic balance and is a useful physiological indicator to predict cardiovascular morbidity and mortality. The purpose of this study was to compare the differences in HRR between metabolically healthy obesity group and metabolically unhealthy obesity and to ascertain whether heart rate recovery is a predictor of metabolic syndrome. Metabolic syndrome was defined according to the standards of the National Cholesterol Education Program Adult Care Panel III. Obesity was assessed according to WHO Asian criteria. It was classified into three groups of metabolically healthy non-obesity group (MHNO, n=113), metabolically healthy obesity group (MHO, n=66), metabolically unhealthy obesity (MUO, n=18). Exercise test was performed with Bruce protocol using a treadmill instrument. There was no difference in HRR between MHO and MUO ($32.71{\pm}12.25$ vs $25.53{\pm}8.13$), but there was late HRR in MUO than MHNO ($25.53{\pm}8.13$ vs $34.51{\pm}11.80$). HRR in obese was significantly correlated with BMI (r=-0.342, P=0.004), waist circumference (r=-0.246, P=0.043), triglyceride (r=-0.350, P=0.003), HbA1c (r=-0.315, P=0.009), insulin (r=-0.290, P=0.017) and uric acid (r=-0.303, P=0.012). HRR showed a lower prevalence of abdominal obesity, hypertriglyceridemia, and low HDL-cholesterol in the third tertile than in the first tertile. In conclusion, MHO had no difference in vagal activity compared with MHNO, but MUO had low vagal activity. HRR is associated with metabolic parameters and is a useful predictor of abdominal obesity, hypertriglyceridemia, and low HDL-cholesterolemia.

Keywords

References

  1. Appleton SL, Seaborn CJ, Visvanathan R, Hill CL, Gill TK, Taylor AW, Adams RJ; North West Adelaide Health Study Team. Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype: a cohort study. Diabetes Care. 2013. 36: 2388-2394. https://doi.org/10.2337/dc12-1971
  2. Berntson GG, Norman GJ, Hawkley LC, Cacioppo JT. Cardiac autonomic balance versus cardiac regulatory capacity. Psychophysiology. 2008. 45: 643-652. https://doi.org/10.1111/j.1469-8986.2008.00652.x
  3. Bjelakovic L, Vukovic V, Jovic M, Bankovic S, Kostic T, Radovanovic D, Pantelic S, Zivkovic M, Stojanovic S, Bjelakovic B. Heart rate recovery time in metabolically healthy and metabolically unhealthy obese children. Phys Sportsmed. 2017. 45: 438-442. https://doi.org/10.1080/00913847.2017.1376571
  4. Bluher M. Are metabolically healthy obese individuals really healthy? Eur J Endocrinol. 2014. 171: R209-219. https://doi.org/10.1530/EJE-14-0540
  5. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999. 341: 1351-1357. https://doi.org/10.1056/NEJM199910283411804
  6. Curtis BM, O'Keefe JH Jr. Autonomic tone as a cardiovascular risk factor: the dangers of chronic fight or flight. Mayo Clin Proc. 2002. 77: 45-54. https://doi.org/10.4065/77.1.45
  7. Deurenberg P, Yap M, van Staveren WA. Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord. 1998. 22: 1164-1171. https://doi.org/10.1038/sj.ijo.0800741
  8. Dorresteijn JA, Visseren FL, Spiering W. Mechanisms linking obesity to hypertension. Obes Rev. 2012. 13: 17-26. https://doi.org/10.1111/j.1467-789X.2011.00914.x
  9. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001. 285: 2486-2497. https://doi.org/10.1001/jama.285.19.2486
  10. Grundy SM. Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab. 2004. 89: 2595-2600. https://doi.org/10.1210/jc.2004-0372
  11. Guilkey JP, Dykstra B, Erichsen J, Mahon AD. Heart Rate Response and Variability Following Maximal Exercise in Overweight Children. Pediatr Exerc Sci. 2017. 29: 341-349. https://doi.org/10.1123/pes.2016-0132
  12. Hong SB, Shin KA, Choi WS. Comparison of Echocardiogram and Clinical Profile between Metabolically Healthy Obese (MHO) and Non Metabolically Healthy Obese (Non-MHO) Subjects. Biomedical Science Letters. 2012. 18: 260-267.
  13. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, Takeda H, Inoue M, Kamada T. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol. 1994. 24: 1529-1535. https://doi.org/10.1016/0735-1097(94)90150-3
  14. Jais A, Bruning JC. Hypothalamic inflammation in obesity and metabolic disease. J Clin Invest. 2017. 127: 24-32. https://doi.org/10.1172/JCI88878
  15. Kim J, Byun W, Sui X, Lee DC, Cheng YJ, Blair SN. Heart rate recovery after treadmill exercise testing is an independent predictor of stroke incidence in men with metabolic syndrome. Obes Res Clin Pract. 2011. 5: e267-360. https://doi.org/10.1016/j.orcp.2011.04.007
  16. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002. 105: 1135-1143. https://doi.org/10.1161/hc0902.104353
  17. Licht CM, de Geus EJ, Penninx BW. Dysregulation of the autonomic nervous system predicts the development of the metabolic syndrome. J Clin Endocrinol Metab. 2013. 98: 2484-2493. https://doi.org/10.1210/jc.2012-3104
  18. Lim S, Shin H, Song JH, Kwak SH, Kang SM, Won Yoon J, Choi SH, Cho SI, Park KS, Lee HK, Jang HC, Koh KK. Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998-2007. Diabetes Care. 2011. 34: 1323-1328. https://doi.org/10.2337/dc10-2109
  19. Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA. 2000. 284: 1392-1398. https://doi.org/10.1001/jama.284.11.1392
  20. Oh SW, Im JW, Lee JW, Kim KW, Choi JK, Park MS, Yoo TW. What are the Characteristics of Obese Adults without Metabolic Complications?. J Korean Acad Fam Med. 2006. 27: 733-740.
  21. Pecanha T, Silva-Junior ND, Forjaz CL. Heart rate recovery: autonomic determinants, methods of assessment and association with mortality and cardiovascular diseases. Clin Physiol Funct Imaging. 2014. 34: 327-339. https://doi.org/10.1111/cpf.12102
  22. Phillips CM. Metabolically healthy obesity: definitions, determinants and clinical implications. Rev Endocr Metab Disord. 2013. 14: 219-227. https://doi.org/10.1007/s11154-013-9252-x
  23. Primeau V, Coderre L, Karelis AD, Brochu M, Lavoie ME, Messier V, Sladek R, Rabasa-Lhoret R. Characterizing the profile of obese patients who are metabolically healthy. Int J Obes (Lond). 2011. 35: 971-981. https://doi.org/10.1038/ijo.2010.216
  24. Rodriguez-Colon SM, Bixler EO, Li X, Vgontzas AN, Liao D. Obesity is associated with impaired cardiac autonomic modulation in children. Int J Pediatr Obes. 2011. 6: 128-134. https://doi.org/10.3109/17477166.2010.490265
  25. Samocha-Bonet D, Dixit VD, Kahn CR, Leibel RL, Lin X, Nieuwdorp M, Pietilainen KH, Rabasa-Lhoret R, Roden M, Scherer PE, Klein S, Ravussin E. Metabolically healthy and unhealthy obese--the 2013 Stock Conference report. Obes Rev. 2014. 15: 697-708. https://doi.org/10.1111/obr.12199
  26. Shetler K, Marcus R, Froelicher VF, Vora S, Kalisetti D, Prakash M, Do D, Myers J. Heart rate recovery: validation and methodologic issues. J Am Coll Cardiol. 2001. 38: 1980-1987. https://doi.org/10.1016/S0735-1097(01)01652-7
  27. Shin KA. Association of metabolic syndrome with exercise capacity and heart rate recovery after treadmill exercise test. Biomedical Science Letters. 2011. 17: 305-311.
  28. Shin S, Kim JM, Sung S, Kim HS. Prevalence and associated characteristics of metabolically healthy obese phenotypes in a community dwelling population. J Obes Metab Syndr. 2017. 26: 130-137. https://doi.org/10.7570/jomes.2017.26.2.130
  29. Singh K, Shen BJ. Abdominal obesity and chronic stress interact to predict blunted cardiovascular reactivity. Int J Psychophysiol. 2013. 90: 73-79. https://doi.org/10.1016/j.ijpsycho.2013.03.010
  30. Soriguer F, Gutierrez-Repiso C, Rubio-Martin E, Garcia-Fuentes E, Almaraz MC, Colomo N, Esteva de Antonio I, de Adana MS, Chaves FJ, Morcillo S, Valdes S, Rojo-Martinez G. Metabolically healthy but obese, a matter of time? Findings from the prospective Pizarra study. J Clin Endocrinol Metab. 2013. 98: 2318-2325. https://doi.org/10.1210/jc.2012-4253
  31. Stefan N, Haring HU, Hu FB, Schulze MB. Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol. 2013. 1: 152-162. https://doi.org/10.1016/S2213-8587(13)70062-7
  32. Yu TY, Jee JH, Bae JC, Hong WJ, Jin SM, Kim JH, Lee MK. Delayed heart rate recovery after exercise as a risk factor of incident type 2 diabetes mellitus after adjusting for glycometabolic parameters in men. Int J Cardiol. 2016. 221: 17-22. https://doi.org/10.1016/j.ijcard.2016.06.149
  33. World Health Organization. The Asia-Pacific Perspective: Redefining obesity and its treatment. Sydney, Australia: Health Communications Australia. 2000.
  34. Zhu L, Zhao X, Zeng P, Zhu J, Yang S, Liu A, Song Y. Study on autonomic dysfunction and metabolic syndrome in Chinese patients. J Diabetes Investig. 2016. 7: 901-907. https://doi.org/10.1111/jdi.12524