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Table 1.

Clinical, Metabolic, and Hemodynamic Characteristics

Basal arterialized plasma NE concentrations were similar in the 2 groups. Basal epinephrine levels were lower in women than men (21 [interquartile range, 16] versus 44 [46] pg/mL; P =0.01) and inversely related to BMI (age- and sex-adjusted r =0.44, P =0.01). Urine flow did not differ between the nocturnal and diurnal collection in either group (Table 2 ). In the lean subjects, urinary output of epinephrine and NE both dropped by ≈70% during the night compared with day. In the obese group, 24-hour catecholamine output (epinephrine, 8.2 [11.7] μg; NE, 41.0 [47.4] μg) was not different from that of lean control subjects (epinephrine, 12.7 [18.0] μg; NE, 42.2 [27.3] μg; P =NS for both). However, the nocturnal decline in urinary NE excretion was blunted in the obese as both total output and excretion rate. In the whole data set, the difference in NE output between day and night was inversely related to BMI (age- and sex-adjusted r =0.53, P =0.01).

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Table 2.

Urinary Catecholamine Excretion

Clinical ANS Tests

The Valsalva ratio was 1.46±0.07 in obese subjects and 1.50±0.05 in control subjects (=NS). The ratio of maximum to minimum RR calculated during deep breathing was 1.32±0.03 in the obese and 1.39±0.04 in control subjects (=NS). The HR ratio in response to standing averaged 1.26±0.03 in the obese and 1.31±0.05 in control subjects (=NS).

To assess the influence of sex, age, and HR on HRV, a preliminary analysis was performed on the 24-hour spectral parameters for the whole data set (Table 3 ). There were strong associations of all 3 physiological factors with most spectral parameters; in particular, spectral indexes were reciprocally related to age and HR (data not shown). Therefore, in comparisons of spectral variables between obese and control subjects, simultaneous statistical adjustment for sex, age, and HR was used in every case.

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Table 3.

Spectral Analysis by Time of Day

In the whole data set, clock time was associated with marked changes in the autonomic control of HR. Thus, HR was higher during the day than at night (by 16 bpm on average, P <0.001). This physiological tachycardia was accompanied by a reduction in spectral powers, particularly marked within the VLF and HF bands, a left shift of the central VLF frequency, and a right shift of the central LF frequency. The proportion of total power in the LF band rose, and that in the HF band decreased, so the LF/HF ratio increased from a mean of 2.6 at night to a mean of 6.2 during the day ( P <0.0001).

In the obese, the mean day/night HR excursion was significantly smaller than in control subjects (12 [10] versus 18 [9] bpm, P =0.05 after adjustment by age and sex). During both daytime and nighttime, LF power was significantly lower in the obese than in the lean group, the difference accounting for most of the observed decrease in total power.

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Editors' profiles

Professor Enrique Fisman graduated with a medical degree from Buenos Aires University, Argentina. Subsequently, he obtained the degree of Academic Cardiologist at the same university and worked several years at Carlos G. Durand Hospital in Buenos Aires. His research interests initially encompassed numerous fields of cardiology, with emphasis on Doppler and exercise echocardiography, estrogens and the heart, diagnostic expediency of dynamic and isometric stress testing, sports cardiology, epidemiology, hypertension, coronary calcification, computed tomography angiography, diagnostic and prognostic value of biomarkers, aortic blood flow velocity, and clinical pharmacology of antilipidemic agents. Since 1998, he focused mainly on the research of several experimental and clinical topics linked to the diabetes/cardiovascular interrelationship at Sheba Medical Center, Tel Hashomer, Israel. Professor Fisman is author or coauthor of more than 200 scientific publications, most of them original research articles. He is currently Professor Emeritus of Cardiology at Sackler Faculty of Medicine, Tel Aviv University, and Professor of Cardiology at the Specialization Career in Cardiology, del Salvador University (USAL), Buenos Aires.

Professor Alexander Tenenbaum graduated with a medical degree and a PhD in the former Soviet Union. He then became a cardiologist at the Sheba Medical Center, Tel Hashomer, Israel. Currently, he is the Scientific Director of the Cardiac Rehabilitation Institute, Sheba Medical Center, the Founder and Director of "Cardioline" Heart Institute and Professor of Cardiology at Tel Aviv University. His research interests and areas of expertise include clinical cardiology, echocardiography, hypertension, heart failure, cardiac rehabilitation, cardiovascular pharmacotherapy and computed tomography. During recent years he has become especially involved in the research of various aspects of dyslipidemia, metabolic syndrome, obesity and the diabetes/cardiovascular interrelationship. Prof. Tenenbaum is author or coauthor of hundreds scientific publications. He served as Governor of The International Society of Cardiovascular Pharmacotherapy and co-founder and Chairman of the Israel Heart Society Working Group on Cardiovascular Pharmacotherapy.

"Since the American Heart Association stated in 1999 that "diabetes is a cardiovascular disease", many revolutionary events took place in the rapidly evolving field of cardiovascular diabetology. The initial 'bridal' between heart diseases and diabetes is at present a vast and complex interdisciplinary texture which includes innovative biotechnological approaches, such as genomics, proteomics, metabolomics, molecular biometrics, bioinformatics, customized therapies and various additional sophisticated practices. Our journal endeavors to be a harbinger of these fascinating advances."

"A strong correlation between cardiovascular disease and diabetes is now well established. The American Heart Association considers that individuals with insulin resistance or diabetes are more likely to fall victim to heart disease or stroke. Cardiovascular Diabetology is the world's foremost journal specifically devoted to this issue. Submitted manuscripts may report any aspect of laboratory, animal, or human research related to diabetes and its cardiovascular complications"

Professor Enrique Fisman

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