Decreased baroreflex sensitivity is associated with cardiometabolic risks and prehypertension status in early-postmenopausal women.

OBJECTIVE: We studied the link of decreased baroreflex sensitivity (BRS) to cardiometabolic risks and prehypertension status in postmenopausal women during their early menopausal phase. METHODS: Premenopausal women (n = 55) and early-postmenopausal women (n = 50) of age group between 40 and 55 years were recruited for the study, and their anthropometric parameters, complete battery of autonomic function tests (AFT), BRS, hormone levels, and cardiometabolic risk parameters were measured and compared between two groups. Correlation analysis of BRS with various physiological and biochemical parameters in these two groups were performed. Multiple regression analysis of BRS with various other associated factors in postmenopausal subjects and bivariate logistic regression analysis for assessing prediction of prehypertension status by BRS in postmenopausal group were performed. RESULTS: There was a significant difference in AFT and metabolic parameters between premenopausal and postmenopausal women. Sympathovagal imbalance (increased sympathetic and decreased parasympathetic) was prominent in early-postmenopausal women. Decreased BRS, the marker of cardiovascular (CV) risk was found to be significant (P < .001) and correlated with various cardiometabolic parameters in early-postmenopausal subjects. Multiple regression analysis demonstrated that decreased BRS is independently linked to parameters of decreased vagal activity, inflammation, and oxidative stress in early-postmenopausal group. Decreased BRS could predict prehypertension status in early-postmenopausal subjects as confirmed by bivariate logistic regression analysis. CONCLUSION: Sympathovagal imbalance, decreased BRS and considerable metabolic derangements were observed in women in their early phase of menopause. Decreased BRS appears to be associated with the cardiometabolic risks in these women. Prehypertension status in early-postmenopausal subjects could be predicted by decreased BRS.

Attenuation of baroreflex sensitivity and heart rate variability is linked to reduced levels of nitric oxide in pregnant women having risks of developing gestational hypertension.

Purpose: Decreased baroreflex sensitivity (BRS) and sympathovagal imbalance (SVI) have been reported as a cardiovascular (CV) risk in gestational hypertension (GH). Nitric oxide (NO) has been implicated in pathophysiology of GH. In the present study, we assessed the link of CV risks (decreased BRS and SVI) to the plasma levels of NO in women having risk of developing GH. Materials and Methods: A total of 96 pregnant women having risk factors for GH were recruited for the study. The blood pressure variability (BPV), heart rate variability (HRV), plasma NO, marker of insulin resistance (HOMA-IR), lipid risk factors, inflammatory markers (hsCRP, interleukin-6), and malondialdehyde (MDA), the marker of oxidative stress (OS) were measured at 16th and 36th week. Link of various parameters to NO was assessed by correlation and multiple regression analysis. Results: Of HRV indices, parasympathetic components were decreased and sympathetic components were increased, BRS was decreased, NO was decreased, HOMA-IR, lipid risk factors, hsCRP, interleukin-6, and MDA were increased significantly at 36th week compared to 16th week of pregnancy. Most of the markers of cardiometabolic risk were correlated with NO. However, only the markers of CV risk (SVI and reduced BRS) were independently associated with decreased level of NO, but not the metabolic markers except interleukin-6. The independent contribution of BRS (ß = 0.334, P < .001) to NO was found to be most significant. Conclusion: It was concluded that decreased BRS, SVI, and increased interleukin-6 are associated with reduction in NO in GH, which may possibly be linked to the development of CV risks in GH.

Effects of Three Months of Honey Supplementation on Quality of Life and Neuropathy in Type 2 Diabetic Patients.

CONTEXT: Diabetic neuropathy, a common debilitating complication of type 2 diabetes, can occur despite adequate treatment. To date, no studies have occurred on the use alternative medicine as an adjunct therapy for treating diabetic neuropathy. OBJECTIVE: The study assessed the effects of three months of honey supplementation on insulin resistance, lipid profiles, oxidant status, nerve conduction, and QOL in patients with diabetic neuropathy. METHODS/DESIGN: The research team designed a single-arm, open-label pilot study. SETTING: The study took place at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) in Puducherry, India. PARTICIPANTS: The study included 48 patients with diabetic neuropathy at the institute, with a mean age of 58.91 ± 7.976 years. INTERVENTION: Participants took honey for three months at a dose of 0.5 gm/Kg of body weight per day. OUTCOME MEASURES: Participants completed the Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire and the Norfolk QOL Diabetic Neuropathy (Norfolk QOL-DN) questionnaire at baseline and postintervention. Also, participants' glucose levels, lipid profiles, and biochemical markers were obtained and a nerve conduction study was completed at baseline and postintervention. RESULTS: A significant reduction occurred in the NTSS-6 score (P < .0001) and the Norfolk QOL-DN total score (P < .0001) from baseline to postintervention. Participants' fasting blood glucose (FBG), triglycerides (TG), and total cholesterol (TC) decreased significantly, at P = .0192, P = .0371, and P = .0049, respectively. Their malondialdehyde (MDA), and inflammatory markers interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) also decreased significantly, and MDA showed a significant correlation with neuron specific enolase (NSE). CONCLUSIONS: Three months honey supplementation reduced participants' subjective pain scores and symptoms from diabetic neuropathy and improved their QOL. However, the nerve conduction study showed that no significant change had occurred in motor velocity.

Contribution of insulin resistance to decreased baroreceptor sensitivity & cardiometabolic risks in pre-obesity & obesity.

BACKGROUND & OBJECTIVES: Although insulin resistance (IR) is a known complication in obesity, the physiological mechanisms linking IR with cardiometabolic risks in obesity have not been well studied. This study was conducted to assess the difference in cardiovascular (CV) risk profile in IR and non-IR (NIR) conditions, and contribution of IR to cardiometabolic risks in pre-obese and obese individuals. METHODS: Basal CV, blood pressure variability, autonomic function test and cardiometabolic parameters were recorded in pre-obese (n=86) and obese (n=77) individuals during 2012 and 2015. The association of altered cardiometabolic parameters with homeostatic model for IR (HOMA-IR) in pre-obese and obese groups and with baroreceptor sensitivity (BRS) in IR and NIR groups was calculated by appropriate statistical analysis. RESULTS: Decreased BRS, a known CV risk and cardiometabolic parameters were significant in IR (pre-obese and obese) group compared to the NIR group. Sympathovagal imbalance in the form of increased sympathetic and decreased parasympathetic activities was observed in individuals with IR. There was no significant difference in the level of independent contribution of HOMA-IR to cardiometabolic parameters in pre-obese and obese groups. Adiponectin and inflammatory markers had an independent contribution to BRS in IR group. INTERPRETATION & CONCLUSIONS: Findings of the present study demonstrated that the intensity of cardiometabolic derangements and CV risk were comparable between IR, pre-obese and obese individuals. Pro-inflammatory state, dyslipidaemia and hypoadiponectinaemia might contribute to CV risk in these individuals with IR. IR could possibly be the link between altered metabolic profile and increased CV risks in these individuals independent of the adiposity status.

Decreased baroreflex sensitivity is linked to the atherogenic index, retrograde inflammation, and oxidative stress in subclinical hypothyroidism.

Purpose/aim of the study: The present study investigated the link of hyperlipidemia, inflammation and oxidative stress (OS) to cardiovascular (CV) risks in subclinical hypothyroidism (SCH). MATERIALS AND METHODS: We enrolled 81 subclinical hypothyroid patients and 80 healthy subjects as control. Their CV and autonomic functions were assessed by spectral analysis of heart rate variability (HRV), continuous blood pressure variability (BPV) measurement and conventional autonomic function testing. Thyroid profile, lipid profile, immunological, inflammatory and OS markers were estimated and correlated with the baro-reflex sensitivity (BRS), the marker of sympathovagal imbalance (SVI) & CV risk. RESULTS: Mean arterial pressure (MAP, P<0.0001), total peripheral resistance (TPR, P<0.0001), ratio of low-frequency to high-frequency power of HRV (LF-HF ratio) (P<0.0001) were significantly higher and BRS (P<0.0001) was significantly lower in SCH group than the control group. BRS significantly correlated with heart rate, MAP, LF-HF ratio, lipid risk factors, anti-thyroperoxidase antibody, thyroid-stimulating hormone, high-sensitive C-reactive protein (hsCRP), malondialdehyde (MDA) and SCH. CONCLUSIONS: It was concluded that SVI is associated with SCH. Though dyslipidemia, inflammation and OS contributed to decreased BRS, SCH per se contributed maximally to it. Decreased BRS could be a physiological basis of increased CV risks in patients with SCH.

Body Fat Analysis in Predialysis Chronic Kidney Disease: Multifrequency Bioimpedance Assay and Anthropometry Compared With Dual-Energy X-Ray Absorptiometry.

OBJECTIVES: Body composition analysis is required for accurate assessment of nutritional status in patients with predialysis chronic kidney disease (CKD). The reference method for assessing body fat is dual-energy X-ray absorptiometry (DXA), but it is relatively expensive and often not available for widespread clinical use. There is only limited data on the utility of less expensive and easily available alternatives such as multifrequency bioimpedance assay (BIA) and skinfold thickness (SFT) measurements for assessing body fat in predialysis CKD. The study intends to assess the utility of BIA and SFT in measuring body fat compared to the reference method DXA in subjects with predialysis CKD. METHODS: Body composition analysis was done in 50 subjects with predialysis CKD using multifrequency BIA, SFT, and DXA. The agreement between the body fat percentages measured by reference method DXA and BIA/SFT was assessed by paired t-test, intraclass correlation coefficients (ICCs), regression, and Bland-Altman plots. RESULTS: Percentage of body fat measured by BIA was higher compared to the measurements by DXA, but the difference was not significant (30.44 ± 9.34 vs. 28.62 ± 9.00; P = .071). The ICC between DXA and BIA was 0.822 (confidence interval: 0.688, 0.899; P = .000). The mean values of body fat percentages measured by anthropometry (SFT) was considerably lower when compared to DXA (23.62 ± 8.18 vs. 28.62 ± 9.00; P = .000). The ICC between DXA and SFT was .851 (confidence interval: 0.739, 0.915; P = .000). Bland-Altman plots showed that BIA overestimated body fat by a mean of 1.8% (standard deviation, 6.98), whereas SFT underestimated body fat by 5% (standard deviation, 4.01). Regression plots showed a better agreement between SFT and DXA (R(2) = .79) than BIA (R(2) = .50). Overall, SFT showed better agreement with the DXA. Body mass index (BMI) showed a moderate positive correlation with body fat measured by DXA whereas serum albumin failed to show good correlation. CONCLUSIONS: SFT showed relatively better agreement with the reference method DXA, compared to BIA. SFT can be used as a tool for assessing nutritional status in predialysis patients with CKD.

Attenuated baroreflex sensitivity in normotensive prediabetes and diabetes in Indian adults.

PURPOSE/AIM OF THE STUDY: Though attenuated baroreflex sensitivity (BRS) is known to promote cardiovascular disease (CVD) risk in diabetics, its status in prediabetes has not been reported. Also, the link of BRS to CVD risk in normotensive diabetics has not been reported. This study aimed to evaluate the association of BRS to CVD risk in normotensive prediabetics and diabetics. MATERIALS AND METHODS: Participants (n = 154) of 18-45 years were divided into normoglycemics (n = 52), prediabetics (n = 64) and diabetics (n = 38) based on American Diabetes Association criteria. Body mass index, waist-hip ratio, waist-height ratio, body fat mass index, basal heart rate, systolic blood pressure, diastolic blood pressure, rate pressure product, BRS, heart rate variability (HRV), fasting plasma glucose, fasting insulin, lipid profile and atherogenic index of plasma (AIP) were measured. Indian Diabetes Risk Score (IDRS) and homeostatic model assessment of insulin resistance were calculated. RESULTS: There was significant increase in all the parameters except BRS, HRV and high-density lipoprotein in prediabetics and diabetics compared to normoglycemics. All these parameters were significantly altered in prediabetics compared to diabetics. Significant negative correlation was found between BRS and other parameters in prediabetics and diabetics. CONCLUSIONS: BRS was attenuated in normotensive prediabetics and diabetics with high IDRS, insulin resistance, AIP, dyslipidemia and reduced HRV that predisposes them to CVD risk. The study demonstrates CVD risk quite early in the prediabetics with reduced HRV, high body fat, hyperinsulinemia, insulin resistance, AIP and rate pressure product.

Prehypertension status, cardiometabolic risks, and decreased baroreflex sensitivity are linked to sympathovagal imbalance in salt-preferring individuals.

Salt preference has been reported to cause sympathovagal imbalance (SVI) and prehypertension. We investigated the role of inflammation, insulin resistance (IR), hyperlipidemia, and oxidative stress (OS) in genesis of SVI and cardiovascular (CV) risks in salt-preferring prehypertensives. The subjects were divided into no-salt-preferring (NSP, n = 87) and salt-preferring (SP, n = 89) group based on their preference for salted food. Body mass index (BMI), blood pressure (BP) variability parameters including baroreflex sensitivity (BRS), heart rate variability (HRV) indices, autonomic function tests, IR, lipid risk factors, inflammatory and OS markers, and renin were measured in both the groups. Based on the contribution of various cardiometabolic risks to low-frequency-high-frequency (LF-HF) ratio of HRV, the marker of SVI was assessed by multiple-regression analysis. Prediction of prehypertension status by the LF-HF ratio was assessed by bivariate logistic regression. BMI, heart rate, BP parameters, cardiac output, total peripheral resistance, LF-HF ratio, IR, atherogenic index, inflammatory, and OS markers were significantly increased, and BRS was significantly decreased in the SP group compared with the NSP group. There was an independent association of IR, atherogenic index, markers of inflammation and OS, and BRS with the LF-HF ratio in SP subjects, and the LF-HF ratio had significant prediction of prehypertension status in these subjects. It was concluded that IR, low-grade inflammation, atherogenic lipid profile, and OS contribute to SVI in SP subjects. Decreased BRS (the marker of CV risk) is linked to SVI, and SVI predicts prehypertension status in SP subjects.

Association of sympathovagal imbalance with cardiovascular risks in patients with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is associated with cardiovascular risks like obesity, insulin resistance, dyslipidemia that can lead to sympathovagal imbalance (SVI). The study was designed to assess the cardiovascular risk in PCOS and link of metabolic derangements to SVI. Thirty-five newly diagnosed PCOS patients and 32 age-matched controls were recruited. Waist-hip ratio, body mass index (BMI), basal cardiovascular parameters such as basal heart rate (BHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and rate pressure product (RPP) were recorded. Autonomic functions were assessed using short-term heart rate variability (HRV) analysis, heart rate and blood pressure response to standing (30:15 ratio), deep breathing (E:I ratio) and isometric handgrip (ΔDBPihg). Fasting plasma glucose, insulin, lipid profile and testosterone were assayed. Insulin resistance (HOMA-IR) and lipid risk factors were calculated. The cases had increased BHR, BMI, SBP, DBP, MAP and RPP. The ratio of low-frequency to high-frequency (LF-HF) of HRV, the marker of SVI was significantly increased in cases. 30:15 ratio and ΔDBPihg were increased and E:I ratio was decreased in the cases. HOMA-IR, lipid risk factors and testosterone were significantly elevated in cases. There was a significant correlation of LF-HF with BMI, BHR, RPP, insulin resistance and lipid risk factors. On regression analysis, insulin resistance and lipid risk factors had independent association with LF-HF. PCOS patients have SVI, decreased HRV and increased RPP and the potential cardiovascular risks. The insulin resistance and dyslipidemia contribute to SVI and cardiovascular risks in PCOS patients.

Assessment of cardiovascular autonomic function in patients with polycystic ovary syndrome.

AIM: The study was conducted to assess the sympathovagal balance in patients with polycystic ovary syndrome (PCOS) using short-term heart rate variability (HRV) analysis and conventional autonomic function tests (CAFT). METHODS: Thirty-one newly diagnosed patients with PCOS and 30 age-matched controls were recruited. Body mass index (BMI), waist : hip ratio (WHR), cardiovascular parameters such as basal heart rate (BHR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and rate-pressure product (RPP), and fasting blood glucose (FBG) were measured in both groups. Cardiovascular autonomic functions assessed were spectral analysis of HRV, heart rate and blood pressure response to standing (30:15 ratio), deep breathing (E:I ratio) and isometric handgrip (ΔDBP(ihg)). RESULTS: The cases had significantly increased BMI, WHR, BHR, SBP, DBP and RPP. Ratio of low-frequency to high-frequency power of HRV (LF-HF ratio), the marker of sympathovagal balance was significantly increased in cases compared to controls. Time-domain indices of HRV and E:I ratio were decreased, and 30:15 ratio, ΔDBP(ihg) and FBG were increased in cases. Though there was a significant correlation of LF-HF ratio with BMI, WHR, BHR, RPP and FBG, only BHR and RPP had independent contribution to LF-HF ratio. CONCLUSION: We conclude that PCOS patients have altered autonomic modulation in the form of increased sympathetic and decreased parasympathetic reactivity and HRV. The sympathovagal imbalance exposes them to cardiovascular morbidities.

Effect of pranayama on sympatho-vagal imbalance and cognitive deficit in premenstrual syndrome.

Context: Premenstrual syndrome (PMS) is a prevalent and often neglected condition that affects around 80% of women of reproductive age. In PMS, abnormal fluctuations in gonadal hormones cause altered homeostasis, resulting in sympatho-vagal imbalance and poor cognition. Aim: To compare autonomic function parameters and cognitive performance between PMS and control groups, and to study the effect of pranayama on the above parameters in PMS women. Settings and Design: It was a randomized control trial. Materials and Methods: We recruited 40 women of reproductive age who fit the inclusion criteria. They were asked to complete the Premenstrual Syndrome Screening Tool (PSST) questionnaire and were categorized as having PMS (n = 20) or not having PMS (n = 20). All study participants had their baseline CAFT, HRV, BRS, P300, and MOCA values recorded. Following that, participants in the PMS group were divided into two groups of ten at random. For 8 weeks, one group received pranayama training. Following that, all baseline data were recorded again in both the pranayama and no-intervention groups. Statistical Analysis Used: SPSS version 20 was used to analyze the data. For parametric data, the unpaired t test was used to compare between the PMS and no PMS groups, whereas the Mann-Whitney U test was employed for non-parametric data. To compare the parameters before and after intervention, the Students paired 't' test for parametric data and the Wilcoxan-signed rank test for non-parametric data were used. Results: According to the findings, autonomic function and cognition were considerably affected in the PMS group and improved significantly in the PMS group following pranayama intervention. Conclusion: Pranayama is an effective and safe non-pharmacological method for treating PMS and improving women's quality of life.

Inflammation and decreased cardiovagal modulation are linked to stress and depression at 36th week of pregnancy in gestational diabetes mellitus.

Stress and depression have been reported in gestational diabetes mellitus (GDM). Though inflammation and oxidative stress are associated with depression, there are no reports of link of cardiometabolic risks (CMR) to stress and depression in GDM. Normal pregnant women (control group, n = 164) and women with GDM (study group, n = 176) at 36th week of gestation were recruited for the study. Blood pressure (BP), body composition, heart rate variability (HRV), glycated hemoglobin (HbA1C), markers of insulin resistance, oxidative stress, inflammation and endothelial dysfunction, were assessed. Perceived stress score (PSS), quality of life (QoL) scale, Indian diabetic risk score (IDRS) and Edinburg postnatal depression score (EPDS) were assessed. Association of potential contributors to PSS and EDPS were assessed by correlation and regression analyses. There was significant increase in PSS, EPDS, IDRS scores, HbA1C, malondialdehyde (MDA) (oxidative stress marker) and high-sensitive C-reactive protein and interleukin-6 (inflammatory markers), and significant decrease in total power (TP) of HRV (marker of cardiovagal modulation), QoL and nitric oxide (endothelial dysfunction marker) in study group compared to control group. Though many cardiometabolic risk parameters were correlated with PSS and EPDS, the significant independent association was observed for TP, HbA1C, MDA and interleukin-6. However, interleukin-6 had maximum contribution to PSS (ß = 0.550, p < 0.001) and EPDS (ß = 0.393, p < 0.001) as demonstrated by multiple regression analysis. Inflammation, oxidative stress, glycation status and decreased cardiovagal modulation are associated with stress and depression at 36th week of gestation in GDM.

Body mass index contributes to sympathovagal imbalance in prehypertensives.

BACKGROUND: The present study was conducted to assess the nature of sympathovagal imbalance (SVI) in prehypertensives by short-term analysis of heart rate variability (HRV) to understand the alteration in autonomic modulation and the contribution of BMI to SVI in the genesis of prehypertension. METHODS: Body mass index (BMI), basal heart rate (BHR), blood pressure (BP), rate pressure product (RPP) and HRV indices such as total power (TP), low-frequency power (LF), normalized LF (LFnu), high-frequency power (HF), normalized HF (HFnu), LF-HF ratio, mean heart rate (mean RR), square root of the mean squared differences of successive normal to normal intervals (RMSSD), standard deviation of normal to normal RR interval (SDNN), the number of interval differences of successive NN intervals greater than 50 ms (NN50) and the proportion derived by dividing NN50 by the total number of NN intervals (pNN50) were assessed in three groups of subjects: normotensives having normal BMI (Group 1), prehypertensives having normal BMI (Group 2) and prehypertensives having higher BMI (Group 3). SVI was assessed from LF-HF ratio and correlated with BMI, BHR, BP and RPP in all the groups by Pearson correlation. The contribution of BMI to SVI was assessed by multiple regression analysis. RESULTS: LF and LFnu were significantly increased and HF and HFnu were significantly decreased in prehypertensive subjects in comparison to normotensive subjects and the magnitude of these changes was more prominent in subjects with higher BMI compared to that of normal BMI. LF-HF ratio, the sensitive indicator of sympathovagal balance had significant correlation with BMI (P=0.000) and diastolic blood pressure (DBP) (P=0.002) in prehypertensives. BMI was found to be an independent contributing factor to SVI (P=0.001) in prehypertensives. CONCLUSIONS: It was concluded that autonomic imbalance in prehypertensives manifested in the form of increased sympathetic activity and vagal inhibition. In prehypertensives with higher BMI, vagal withdrawal was predominant than sympathetic overactivity. Magnitude of SVI (alteration in LF-HF ratio) was linked to changes in BMI and DBP. BMI had an independent influence on LF-HF ratio. It was advised that life-style modifications such as yoga and exercise would enable achieve the sympathovagal balance and blood pressure homeostasis in prehypertensives.

Effect of gender on sympathovagal imbalance in prehypertensives.

Although recently the incidence of prehypertension has increased considerably, the pathophysiological mechanisms and the effects of gender in its causation have not yet been fully elucidated. Therefore, in this study body mass index (BMI), waist-hip ratio (WHR), basal heart rate (BHR), blood pressure (BP), rate pressure product (RPP), and spectral indices of heart rate variability (HRV) were reordered and analyzed in normotensive and prehypertensive males and females. It was observed that low frequency-high frequency (LF-HF) ratio, the sensitive indicator of sympathovagal imbalance (SVI), is significantly more (P < .001) in male prehypertensives compared with female prehypertensives. Although SVI in prehypertensives was found to be due to both sympathetic activation and vagal inhibition, contribution of vagal withdrawal was prominent in males. The LF-HF ratio was significantly correlated with BMI, WHR, BHR, BP, and RPP, which was more prominent in male prehypertensives and the degree of correlation was more for WHR and diastolic pressure. It was concluded that vagal inhibition plays an important role in critical alteration of SVI in the genesis of prehypertension, especially in males, and WHR could be a better indicator of SVI in prehypertensives. It was suggested that prehypertensives should improve their vagal tone to restore the sympathovagal homeostasis.

Effects of yoga on cardiometabolic risks and fetomaternal outcomes are associated with serum nitric oxide in gestational hypertension: a randomized control trial.

Gestational hypertension (GH) is associated with adverse cardiometabolic and pregnancy outcomes. Though yoga is known to be beneficial in pregnancy, the effects of yoga rendered for twenty weeks starting from 16th week of gestation in pregnant women having risk of GH on the incidence of hypertension, cardiometabolic risks and fetomaternal outcomes have not been studied. A randomized control trial was conducted on 234 pregnant women having risk of GH receiving standard antenatal care (Control group, n = 113), and receiving standard care + yoga (Study group, n = 121). Interventions were given for twenty weeks starting at 16th week of gestation. Baroreflex sensitivity (BRS), heart rate variability (HRV), insulin resistance, lipid-risk factors, and markers of inflammation, oxidative stress and vascular endothelial dysfunction (VED) were assessed before and after intervention. Incidence of new-onset hypertension, level of cardiometabolic risks at 36th week, and fetomaternal-neonatal outcomes in the perinatal period, were noted. The link of hypertension, pregnancy outcomes and cardiometabolic risks with nitric oxide (NO), the marker of VED was assessed by analysis of covariance, Pearson's correlations, and multilinear and logistic regressions. In study group, 6.61% women developed hypertension compared to 38.1% in the control group following 20-week intervention and there was significant decrease in risk of developing GH (RR, 2.65; CI 1.42-4.95). There was less-painful delivery, decreased duration of labor, increased neonatal birthweight and Apgar score in study group. Increase in total power of HRV (ß = 0.187, p = 0.024), BRS (ß = 0.305, p < 0.001), and decrease in interleukin-6 (ß = - 0.194, p = 0.022) had significant association with increased NO. Twenty weeks of practice of yoga during pregnancy decreases the incidence of hypertension, improves fetomaternal outcomes, and reduces cardiometabolic risks in pregnant women having risk of GH. Decreased blood pressure, increased HRV, BRS and birth weight and decreased inflammation were associated with improved endothelial function. Trial registration: Clinical Trials Registry of India (CTRI), registration number: CTRI/2017/11/010608, on 23.11.2017.

Link of neurocognitive deficit to impaired cardiovagal modulation in prehypertensives is comparable to newly diagnosed hypertensives in young Indian population.

BACKGROUND: Hypertension has been reported to cause impaired cardiovagal modulation and a wide variety of cognitive loss. However, the link cardiovagal modulation to neurocognitive impairment has not been studied yet. The present study has compared the link cardiovagal modulation to neurocognitive impairment between prehypertension and newly diagnosed hypertension in young adults. METHODS: One hundred forty-seven subjects (42 normotensives, 54 prehypertensives and 51 newly diagnosed hypertensives) aged between 18-44 years were included in this case-control study. The demographic, anthropometric, basal parameters, heart rate variability (HRV), cardiovascular autonomic function tests (CAFTs), event-related potential P300 and biochemical parameters were recorded in all the groups. Association of various parameters with neurocognitive deficit was studied by Pearson correlation analysis and independent contribution of various factors to cognitive deficit was assessed by multiple regression analysis in the study groups. RESULTS: Total power (TP) of HRV, the marker of cardiovagal modulation was reduced in both prehypertensives and hypertensives compared to controls. Among CAFTs, the ΔDBPIHG was increased, and 30:15 ratio and E:I ratio were decreased in both study groups. The latency of P300 (the marker of neurocognition) was significantly prolonged in prehypertensives and hypertensives and P300 latency was significantly associated with reduction in TP in both the groups. HOMA-IR was increased, and total oxidant capacity was decreased in prehypertensives and hypertensives, and both these parameters had independent contribution to P300. CONCLUSION: Prehypertensives had considerable autonomic imbalance, reduced cardiovagal modulation and neurocognitive deficit that were comparable to newly diagnosed hypertensives. Though the causal relationship between cardiovagal modulation and neurocognitive impairment can't be established from the findings of the present study, it appears that neurocognitive deficit might have some possible link to the decreased cardiovagal modulation and metabolic derangements in young prehypertensives and hypertensives.

Effects of 12 Weeks Practice of Yoga on Heart Rate Variability in Males with Type 2 Diabetes Receiving Oral Antidiabetic Drugs: A Randomized Control Trial.

Objective: To investigate the effects of 12 weeks practice of a structured yoga module on heart rate variability (HRV) and cardiometabolic risks in patients with type 2 diabetes (T2D) receiving similar kind of oral antidiabetic drugs (OAD) with yoga therapy and without yoga therapy, matched for all the known confounders. Design: Parallel design interventional (randomized control trial) study. Subjects: Eighty treatment-naive males with T2D were randomized into control group (n = 40) and study group (n = 40). Intervention: Study group participants received a structured yoga therapy that included asana and pranayama practice for 12 weeks in addition to OAD, whereas control group participants received OAD alone. Outcome measures: Before and after intervention, BP parameters, rate pressure product (RPP) as the marker of myocardial stress, total power (TP) of HRV, low-frequency to high-frequency (LF-HF) ratio of HRV, homeostatic model of insulin resistance (HOMA-IR), lipid profile and lipid risk factors, malondialdehyde (MDA), and high-sensitive C-reactive protein (hsCRP) were measured. TP of HRV was defined as the primary outcome. Association of TP (the marker of HRV) and LF-HF ratio (the marker of sympathovagal balance) with cardiometabolic parameters was assessed by correlation and regression analyses. Results: After 12 weeks yoga therapy, there was significant reduction in cardiometabolic risks (TP of HRV, RPP, lipid risks factors, levels of MDA, and hsCRP) in study group subjects compared with control subjects that did not receive yoga therapy. All cardiometabolic risk factors were significantly correlated with TP in study group, having maximum significance with homeostatic model of insulin secretion (r = 0.502, p ≤ 0.001). Multiple regression analysis demonstrated the independent contribution of decrease in RPP, HOMA-IR, hsCRP, and MDA to increased TP and decreased LF-HF ratio in T2D patients after yoga therapy. Conclusion: From the results of this study, the authors conclude that 12 weeks practice of a structured yoga module improves TP of HRV, sympathovagal balance, and metabolic functions, and reduce cardiovascular (CV) risks in patients with diabetes who received routine antidiabetic medicines along with yoga therapy, compared with the patients with diabetes who received antidiabetic medicines alone. The reduction in cardiometabolic risks in these patients is linked to the improvement in TP of HRV. Future studies should also include a control group with rapid walking or a similar exercise program of equal time to the yoga intervention group to discern whether it is in fact yoga that is leading to these results and not simply increased CV activity. Clinical Trial Registry of India (No. CTRI/2021/06/034074).

Effect of honey and insulin treatment on oxidative stress and nerve conduction in an experimental model of diabetic neuropathy Wistar rats.

Diabetic neuropathy is the most common complication affecting more than 50% of patients with longstanding diabetes. Till date, there are no reports to explain the scientific basis of alternative medicine as an adjunct therapy for treating diabetic neuropathy. Hence, we studied the effect of honey and insulin treatment on hyperglycemia, dyslipidemia, oxidant and anti-oxidant status and nerve conduction in experimental diabetic neuropathy Wistar rats. In this experimental study, forty healthy male Wistar albino rats of 10-12 weeks age, weighing between 150 to 200g were obtained from our institute central animal house. After acclimatization, the rats were divided into control (n = 8) and experimental (n = 32) groups randomly. In the experimental group, type 2 diabetic neuropathy was induced with high fat and high sugar diet for 8 weeks followed by streptozotocin at a dose of 35 mg/kg body weight. Three days after streptozotocin injection, blood glucose levels of rats were measured from fasting samples to confirm diabetes. After the development of diabetes, rats were given standard rodent chow and allowed four more weeks to remain diabetic and to develop neuropathy. Every second week, nerve conduction study was done to confirm neuropathy. All the diabetic rats of experimental group developed neuropathy after 4 weeks of developing diabetes, which was confirmed by significant reduction in conduction velocity of sensory and motor nerve when compared to non-diabetic control group. After the development of neuropathy, these rats were randomly divided into diabetic neuropathy with no treatment group (n = 8) and three treatment groups (n = 8, each). The rats of treatment group were administered with either honey or insulin or honey+insulin for six weeks. After six-weeks of intervention, there was significant decrease in blood glucose and lipids in honey, insulin and honey+insulin treated neuropathy rats, when compared with no treatment group. Malondialdehyde was reduced and total anti-oxidant status improved in all the three treatment groups. There was no significant increase in conduction velocity of sciatic tibial motor nerve in treatment groups when compared with no treatment group. However, the sensory nerve conduction velocity improved significantly in honey+insulin treated neuropathy rats. In conclusion, six-week honey treatment helped in reducing dyslipidemia and oxidative stress. Honey given along with insulin for six-weeks improved sensory nerve conduction velocity in experimental diabetic neuropathy Wistar rats.

Effect of Yoga Therapy on Disease Activity, Inflammatory Markers, and Heart Rate Variability in Patients with Rheumatoid Arthritis.

Background: Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease. Antirheumatoid treatment reduces disease activity and inflammation, but not all patients respond to treatment. Autonomic dysfunction is common in RA leading to frequent cardiovascular complications. Yoga therapy may be useful in these patients, but there are little data on the effect of yoga on disease activity, inflammatory markers, and heart rate variability (HRV). Objectives: This study assessed the effect of 12-week yoga therapy on disease activity, inflammatory markers, and HRV in patients with RA. Materials and Methods: This randomized control trial was conducted on newly diagnosed RA patients attending outpatient services at the Department of Clinical Immunology, JIPMER. One hundred and sixty-six participants were randomized into two groups: the control group (CG) (n = 83) and yoga group (YG) (n = 83). Yoga therapy was administered to participants in the YG for 12 weeks, along with standard medical treatment. The CG received only standard medical treatment. Primary outcomes were disease activity score 28, interleukin-1α (IL-1α), IL-6, tumor necrosis factor-α (TNF-α), cortisol, and HRV parameters. All parameters were measured at baseline and after 12 weeks. Results: Disease activity significantly decreased in both groups after 12 weeks, but it was reduced more in YG, which was statistically significant (p < 0.05). In both YG and CG, IL-1α, IL-6, TNF-α, and cortisol decreased after 12 weeks, but IL-1α and cortisol decreased more significantly in YG than in CG. Low-frequency component expressed as normalized unit (LFnu) and the low-frequency/high-frequency (LF-HF) ratio decreased significantly, and total power and HF component expressed as normalized unit (HFnu) increased significantly in the YG compared with CG. Conclusion: Twelve-week yoga therapy, if given along with standard medical treatment, significantly reduces disease activity and improves sympathovagal balance in RA patients.

Assessment of the association of heart rate variability and baroreflex sensitivity with depressive symptoms and stress experienced by women in pregnancy.

BACKGROUND: Pregnancy is a unique physiological state with systemic changes including cardiovascular, autonomic, hemodynamic and psychological. Increase in incidence of stress and depression in antenatal period has been reported. Autonomic changes in pregnancy and its dysfunction in depression are well documented. However, there is lack of evidence associating cardiovascular autonomic dysfunction to stress and depressed mood in pregnant women. METHODS: In this correlation study, we assessed cardiovascular autonomic functions of 172 pregnant women using heart rate variability (HRV) and baroreflex sensitivity (BRS). The Edinburg postnatal depression scale (EPDS) was used to evaluate depressive symptoms and perceived stress scale (PSS) was used to assess stress. The HRV and BRS parameters were correlated with EPDS and PSS. Multiple regression analysis was performed for EPDS and PSS individually to study their association with cardiac autonomic functions(CAF). RESULTS: HRV and BRS were well correlated to EPDS and PSS scores. The depression and stress were found to be significantly associated to autonomic dysfunctions as increased sympathetic and decreased parasympathetic activity. Among various CAF parameters, LF:HF ratio and BRS were found to be significantly associated with depression and stress among these women. CONCLUSION: LF:HF ratio and BRS may be associated with depression during antenatal period. The depression in antenatal period may add on to cardiovascular risk in expecting mothers.