02844nas a2200337 4500008004100000022001400041245017600055210006900231260001500300300001400315490000700329520178800336653000902124653002902133653001802162653002202180653001202202653001502214653001102229653002902240653002302269100002402292700002102316700001902337700002202356700002002378700002302398700002502421700002402446856003602470 2022 eng d a1935-554800aThe Association of Measures of Cardiovascular Autonomic Function, Heart Rate, and Orthostatic Hypotension With Incident Glucose Disorders: The Cardiovascular Health Study.0 aAssociation of Measures of Cardiovascular Autonomic Function Hea c2022 10 01 a2376-23820 v453 a

OBJECTIVE: The autonomic nervous system (ANS) innervates pancreatic endocrine cells, muscle, and liver, all of which participate in glucose metabolism. We tested whether measures of cardiovascular ANS function are independently associated with incident diabetes and annual change in fasting glucose (FG) levels as well as with insulin secretion and insulin sensitivity in older adults without diabetes.

RESEARCH DESIGN AND METHODS: Heart rate (HR) and measures of HR variability (HRV) were derived from 24-h electrocardiographic monitoring. Blood pressure, seated and standing, was measured. Cox proportional hazards models and linear mixed models were used to analyze the associations between HRV, HR, and orthostatic hypotension (SBP >20 mmHg decline) and incident diabetes or longitudinal FG change.

RESULTS: The mean annual unadjusted FG change was 1 mg/dL. Higher detrended fluctuation analyses (DFA) values, averaged over 4-11 (DFA1) or 12-20 beats (DFA2)-reflecting greater versus less organization of beat-to-beat intervals-were associated with less FG increase over time (per 1-SD increment: DFA1: -0.49 mg/dL/year [-0.96, -0.03]; DFA2: -0.55 mg/dL/year [-1.02, -0.09]). In mutually adjusted analyses, higher SD of the N-N interval (SDNN) was associated with less FG increase over time (per 1-SD increment: SDNN: -0.62 mg/dL/year [-1.22, -0.03]). Higher values of DFA1, DFA2, and SDNN were each associated with greater insulin secretion and insulin sensitivity but not with incident diabetes. We observed no association of HR or orthostatic hypotension with diabetes or FG change.

CONCLUSIONS: Specific measures of cardiac autonomic function are prospectively related to FG level changes and insulin secretion and action.

10aAged10aAutonomic Nervous System10aBlood Glucose10aDiabetes Mellitus10aGlucose10aHeart Rate10aHumans10aHypotension, Orthostatic10aInsulin Resistance1 aBarzilay, Joshua, I1 aTressel, William1 aBiggs, Mary, L1 aStein, Phyllis, K1 aKizer, Jorge, R1 aShitole, Sanyog, G1 aBene-Alhasan, Yakubu1 aMukamal, Kenneth, J uhttps://chs-nhlbi.org/node/915503024nas a2200373 4500008004100000022001400041245012200055210006900177260001300246300001200259490000700271520193900278653000902217653001402226653002802240653002402268653001402292653001802306653001102324653000902335653003302344653001702377100002202394700002102416700001902437700002402456700002302480700002102503700002202524700002402546700002402570700002002594856003602614 2022 eng d a2047-998000aCirculating Androgen Concentrations and Risk of Incident Heart Failure in Older Men: The Cardiovascular Health Study.0 aCirculating Androgen Concentrations and Risk of Incident Heart F c2022 Nov ae0269530 v113 a

Background Circulating androgen concentrations in men decline with age and have been linked to diabetes and atherosclerotic cardiovascular disease (ASCVD). A similar relationship has been reported for low total testosterone and incident heart failure (HF) but remains unstudied for free testosterone or the more potent androgen dihydrotestosterone (DHT). We hypothesized that total/free testosterone are inversely related, sex hormone-binding globulin is positively related, and total/free DHT bear a U-shaped relationship with incident HF. Methods and Results In a sample of men from the CHS (Cardiovascular Health Study) without atherosclerotic cardiovascular disease or HF, serum testosterone and DHT concentrations were measured by liquid chromatography-tandem mass spectrometry, and sex hormone-binding globulin by immunoassay. Free testosterone or DHT was calculated from total testosterone or total DHT, sex hormone-binding globulin, and albumin. We used Cox regression to estimate relative risks of HF after adjustment for potential confounders. In 1061 men (aged 76±5 years) followed for a median of 9.6 years, there were 368 HF events. After adjustment, lower calculated free testosterone was significantly associated with higher risk of HF (hazard ratio [HR], 1.14 [95% CI, 1.01-1.28]). Risk estimates for total testosterone (HR, 1.12 [95% CI, 0.99-1.26]), total DHT (HR, 1.10 [95% CI, 0.97-1.24]), calculated free dihydrotestosterone (HR, 1.09 [95% CI, 0.97-1.23]), and sex hormone-binding globulin (HR, 1.07 [95% CI, 0.95-1.21]) were directionally similar but not statistically significant. Conclusions Calculated free testosterone was inversely associated with incident HF, suggesting a contribution of testosterone deficiency to HF incidence among older men. Additional research is necessary to determine whether testosterone replacement therapy might be an effective strategy to lower HF risk in older men.

10aAged10aAndrogens10aCardiovascular Diseases10aDihydrotestosterone10aEstradiol10aHeart Failure10aHumans10aMale10aSex Hormone-Binding Globulin10aTestosterone1 aNjoroge, Joyce, N1 aTressel, William1 aBiggs, Mary, L1 aMatsumoto, Alvin, M1 aSmith, Nicholas, L1 aRosenberg, Emily1 aHirsch, Calvin, H1 aGottdiener, John, S1 aMukamal, Kenneth, J1 aKizer, Jorge, R uhttps://chs-nhlbi.org/node/9256