일차진료 클리닉을 방문한 한국인 성인 남녀에서 심박동수변이도와 Triglyceride-Glucose 지수의 연관성 = Relationship of Heart Rate Variability with Triglyceride-Glucose Index among Korean Men and Women in a Primary Care Clinic

다국어 초록 (Multilingual Abstract)

Background: Reduced heart rate variability (HRV) can be a predictor of all causes of death. Few studies have analyzed the association between HRV and the triglyceride-glucose (TyG) index in a primary care setting rather than in specific high-risk patients. This study aimed to investigate the relationship between HRV and the TyG index among Koreans at a primary care clinic.
Methods: This cross-sectional study included 1,991 participants who underwent HRV assessments and blood tests after fasting for more than 8 hours. Common HRV indices such as the standard deviation of normal-to-normal intervals (SDNN), the root mean square of successive difference (RMSSD), total power (TP), low frequency (LF), high frequency (HF), and the LF/HF ratio were measured. Individuals with a TyG index greater than 9.1 (≥75th percentile) were subclassified into a “high TyG index” group. Associations between the TyG index and HRV were investigated using multiple logistic regression analysis.
Results: The individuals’ mean age was 46.6 years, and the high TyG index group included 244 of all 1,991 participants. Among the assessed HRV indices, the SDNN, RMSSD, and HF showed associations with the high TyG index group, with odd ratios of 0.98 (0.97–0.99), 0.98 (0.96–0.99), and 0.99 (0.99–1.00), respectively, after adjusting for age, sex, white blood cell count, total cholesterol, high density lipoprotein cholesterol, alanine aminotransferase, γ-glutamyltransferase, uric acid, creatinine, hypertension, and diabetes.
Conclusion: Among the common HRV indices, the SDNN, RMSSD, and HF were decreased in a subgroup of individuals with a high TyG index.

국문 초록 (Abstract)

연구배경: 심박동수변이도 저하는 모든 사망 원인의 예측인자로서 의 관련성으로 주목 받은 바 있으나, 특정 고위험군 환자가 아닌 지 역사회 일차진료 현장에서 심박동수변이도와 인슐린 저항성 지표인 TyG 지수(triglyceride-glucose index)와의 연관성을 살펴본 연구는 미미 하다. 본 연구에서는 지역사회 일차진료소를 방문한 한국인 성인 남 녀에서 심박동수변이도와 TyG 지수의 관련성을 알아보고자 하였다. 방법: 일차진료 클리닉에 통상 건강관리를 위해 방문한 내원객 중 8 시간 이상 금식 후 혈액검사와 심박동수변이도 검사를 시행한 20세 이상의 성인 남녀 1,991명을 대상으로 하였다. 다중로지스틱 회귀분 석을 통해 개별 심박동수변이도 지표가 high TyG index (TyG 지수≥9.1; 75 퍼센타일)와 연관성이 있는지를 평가하였다.
결과: 연구 대상자 평균 연령은 46.6±12.4세이고, 총 1,991명 가운데 244명이 high TyG index군에 해당되었다. 심박동수변이도는 혼란변 수 보정 후 지표 중에서 total power (TP), low frequency (LF), LF/high frequency (HF)는 TyG 지수와 연관성을 보이지 않았으나, the stan­ dard deviation of normal to normal intervals (SDNN), the root meansquare of successive difference (RMSSD), HF는 TyG 지수와 각각 교차 비 및 95% 신뢰구간 0.98 (0.97–0.99), 0.98 (0.96–0.99), 0.99 (0.99– 1.00)로 유의한 음의 연관성을 보였다(P=0.013, P=0.008, P=0.022).
결론: 통상 건강관리를 위해 지역사회 일차진료소를 방문한 한국 인 성인 남녀에서 심박동수변이도 지표 중 SDNN, RMSSD, HF가 인 슐린 저항성 지표인 TyG 지수와 유의한 음의 연관성을 보였다.

참고문헌 (Reference)

• 1 김원 ; 우종민 ; 채정호, "정신과에서 심박 변이도(Heart Rate Variability)의 이용" 대한신경정신의학회 44 (44): 176-184, 2005
• 2 김범택 ; 이용제 ; 심재용 ; 이혜리 ; 김문성 ; 곽태환, "대사증후군과 심박동수 변이와의 관계" 대한가정의학회 23 (23): 4-1439, 2002
• 3 Vasques AC, "TyG index performs better than HOMA in a Brazilian population : a hyperglycemic clamp validated study" 93 : e98-e100, 2011
• 4 Navarro-González D, "Triglyceride-glucose index(TyG index)in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose : The vascular-metabolic CUN cohort" 86 : 99-105, 2016
• 5 Park B, "Triglyceride glucose(TyG)index as a predictor of incident type 2 diabetes among nonobese adults : a 12-year longitudinal study of the Korean genome and epidemiology study cohort" 228 : 42-51, 2021
• 6 Mohd Nor NS, "Triglyceride glucose index as a surrogate measure of insulin sensitivity in obese adolescents with normoglycemia, prediabetes, and type 2 diabetes mellitus : comparison with the hyperinsulinemic-euglycemic clamp" 17 : 458-465, 2016
• 7 신경아, "Triglyceride and Glucose (TyG) Index is a Clinical Surrogate Marker for the Diagnosis of Metabolic Syndrome" 대한의생명과학회 23 (23): 348-354, 2017
• 8 Li C, "Trends in hyperinsulinemia among nondiabetic adults in the U.S" 29 : 2396-2402, 2006
• 9 Guerrero-Romero F, "The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp" 95 : 3347-3351, 2010
• 10 Kim KR, "The effect of relaxation training program on autonomic nervous system" 5 (5): S359-S365, 2015
• 11 Moullé VS, "The autonomic nervous system regulates pancreatic β-cell proliferation in adult male rats" 317 : E234-E243, 2019
• 12 Singh B, "Surrogate markers of insulin resistance : a review" 1 : 36-47, 2010
• 13 Ito H, "Shift work modifies the circadian patterns of heart rate variability in nurses" 79 : 231-236, 2001
• 14 Abbasi F, "Relationship between obesity, insulin resistance, and coronary heart disease risk" 40 : 937-943, 2002
• 15 Singh JP, "Reduced heart rate variability and new-onset hypertension : insights into pathogenesis of hypertension : the Framingham heart study" 32 : 293-297, 1998
• 16 Tsuji H, "Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham heart study" 90 : 878-883, 1994
• 17 Carnethon MR, "Prospective investigation of autonomic nervous system function and the development of type 2 diabetes : the atherosclerosis risk in communities study, 1987-1998" 107 : 2190-2195, 2003
• 18 McLaughlin T, "Prevalence of insulin resistance and associated cardiovascular disease risk factors among normal weight, overweight, and obese individuals" 53 : 495-499, 2004
• 19 Dekker JM, "Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC study. Atherosclerosis risk in communities" 102 : 1239-1244, 2000
• 20 Ribeiro RT, "Insulin resistance induced by sucrose feeding in rats is due to an impairment of the hepatic parasympathetic nerves" 48 : 976-983, 2005
• 21 Poon AK, "Insulin resistance and reduced cardiac autonomic function in older adults : the atherosclerosis risk in communities study" 20 : 217-, 2020
• 22 Saito I, "Heart rate variability, insulin resistance, and insulin sensitivity in Japanese adults : the toon health study" 25 : 583-591, 2015
• 23 Stuckey MI, "Heart rate variability and the metabolic syndrome : a systematic review of the literature" 30 : 784-793, 2014
• 24 Malik M, "Heart rate variability : standards of measurement, physiological interpretation, and clinical use : Task force of the European society of cardiology and the North American society for pacing and electrophysiology" 1 : 151-181, 1996
• 25 Magkos F, "Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity" 23 : 591-601, 2016
• 26 Lindmark S, "Does the autonomic nervous system play a role in the development of insulin resistance? A study on heart rate variability in first-degree relatives of Type 2 diabetes patients and control subjects" 20 : 399-405, 2003
• 27 Son DH, "Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome" 32 : 596-604, 2022
• 28 Meyer ML, "Association of glucose homeostasis measures with heart rate variability among Hispanic/Latino adults without diabetes : the Hispanic community health study/study of Latinos(HCHS/SOL)" 15 : 45-, 2016
• 29 Lee SB, "Association between triglyceride glucose index and arterial stiffness in Korean adults" 17 : 41-, 2018