Article Says Autonomic Dysfunction Heart Disease Indicator

[MomtoGiuliana]

This study points to four indicators that are normally linked to heart disease. One of these is autonomic dysfunction. Are they over-simplifying for the purpose of a short article, or is now autonomic dysfunction in general considered a risk factor for heart disease? Are they just referring to elevated blood pressure possibly?

Bad air raises heart risks in young adults: study - Yahoo! News

http://news.yahoo.com/s/nm/20070815/hl_nm/...ealth_taiwan_dc

Don't know what the source article is, which would be helpful. Just wondering if anyone has any insight.

Thanks,

Katherine

[mom4cem]

I read the same article this morning. Possibly could it be that the actual problem itself that causes the dysfunction (ie: polluted air, smoking etc.) that is what causes the heart disease because it can trigger inflammation, dysfunction etc. So for those with autonomic dysfunction not caused by something like those known to cause heart disease and others listed it is not the same.

It's confusing what I wrote I know Hope you get my jist of it.

[DancingLight]

Katherine,

I don't know, I'm confused too!

Emily

[yogini]

It is a bit confusing - maybe because the original source was not in english. I think it says that bad air triggers changes in some people's bodies which lead to heart disease. It does not seem that autonomic dysfunction was the main point of the study, so hopefully it's not applicable to us.

[Sunfish]

i would guess that something was lost in translation/ interpretation. i think that in some individuals with heart disease/ failure, they can have some signs/ symptoms of autonomic dysfunction. but this would be the result of the heart disease/ failure process, not the cause or a risk factor. thus while perhaps autonomic dysfunction could be one sign of heart disease for someone who already has it this obviously isn't the same as someone with autonomic dysfunction in & of itself being at higher risk for heart disease (other factors aside). i'm not 100% of this but am rather trying to correlate a few things i am aware of to make sense out of an article that isn't the clearest. at one point i worked with neonates with heart problems who, as a result would have some autonomic dysfunction as well. when/ if the heart problems were treated the autonomic problems resolved or improved. they were an effect rather than a cause.

so while i would also be very curious to see the source article, i don't think this "info" is anything for people to be particularly concerned about. i'm not minimizing the main point of the article....bad air can't be good for anyone...but in regard to the implication of ANS dysfunction in relation to heart disease risk i wouldn't be concerned unless i saw an actual research study.

melissa

[flop]

Thanks Melissa,

I think that you are right - this was probably translated from an original report and got rather garbled in the process (after all you can't expect the translator to fully understand all of the scientific factors).

I have never heard any suggestion that autonomic dysfunction causes heart disease, in fact my cardiologist was very clear that my heart itself was perfectly healthy and the only way that POTS could kill you would be if you were to black-out right in front of a bus (or other dangerous situation).

I wonder if doctorguest has had a chance to read this thread or has come across the theory elsewhere?

Flop

[Sunfish]

flop -

just an anecdotal side-story of sorts in regard to a healthy heart despite lots of autonomic craziness (that somehow your post brought to my mind). during one of my hospital stays this year when my vitals were in pretty scary places in the midst of septic shock, a cardiologist that was called in and had some knowledge/ awareness of autonomic issues made an interesting comment in regard to my heart & my body in general. he said that my heart/ body may have actually been better able to withstand such extreme variations than a "normal" person because it has had to adapt to variations in BP/ HR so much already over the years. he mentioned that the BP/ HR readings i was fighting through could have easily killed him or my parents (his example of "normal" folks ) but that my body, as sick as i was (aka in ICU) in some ways was probably stronger in regard to its adaptive capacity for survival. i was too out of it at the time to be a part of the conversation but found it interesting when it was mentioned to me later & asked dr. grubb about it as well. obviously there isn't any quantified research as such but he agreed that he wouldn't disagree with the plausibility of the theory. just thought you (and others) might find this of interest as well...

melissa

[flop]

Ooooh that is interesting! I can see where the theory comes from - after all our swings in vitals on a "normal day" would probably freak out your average doctor / nurse if they didn't know what was wrong with us! I guess we are pretty well used to sky-rocketing and plummeting BPs as well as HRs that just shouldn't be allowed.

I wonder if some time in the distant future having dysautonomia will be a survival benefit and the reason for all this crazyness will be revealed?? (Don't worry I'm thinking way into the future sci-fi type thoughts, extinction of the dinosaurs type situation).

And people think I'm mad, I wonder why when I come up with things as off-the-wall as that last paragraph?????

Flop

[MomtoGiuliana]

Thanks everyone for your replies. That does make sense that something was lost in the translation -- not to mention over-simplication in a short news article. Aren't some symptoms of autonomic dysfunction considered dangerous if you DO have heart disease? And certainly high bp is a risk factor for heart disease.

Melissa/flop that is very interesting, regarding the concept that our condition may actually make us better able to withstand extreme BP/HR variations under life-threatening cicrcumstances.

Katherine

[doctorguest]

Katherine and others,

I had to read the original article to answer your questions. There is no problem with translation of the article - it's actually written pretty nicely by its authors. Rather, the writer for Yahoo news didn't do such a great job in describing their study.

In brief, Heart Rate Variability (HRV) is one of the many measures of the autonomic nervous system function. Decreased HRV is an indicator of the autonomic dysfunction. It has been found that in patients with diabetic autonomic neuropathy and patients with coronary heart disease, decreased HRV "seem" to be associated with poor prognosis.

What the researchers of that particular study on air pollution found is that in young college students, breathing in the bad air is associated with increased markers of inflammation (one risk factor for heart disease) and decreased HRV (a measure of the autonomic nervous system that "seems" to be associated with heart disease). I want to emphasize that the study was not designed to actually access how many of these young college students will go on to develop heart disease in the future - this would require many years of followup - but was designed to measure certain markers of heart disease as a function of breathing in bad air.

Now, how does that research relate to patients with POTS? The honest answer is that we just don't know enough yet. Heart disease is the number one killer in the country, and whether patients with autonomic dysfunction, such as POTS, have a higher risk of developing heart disease in their older years would require a special type of study which haven't been done yet. Thus, as of today, this question remains unanswered.

Should you worry about heart disease in the future because you have POTS today? The simple answer is that there are a few "modifiable" risk factors - i.e. factors that we can change or do something about - that everyone should be aware of, regardless of the current autonomic function status. These include keeping blood pressure below 130/85, keeping cholersterol and lipids in the normal range (discuss with your doctor what "normal" means in your case), avoiding obesity and keeping normal body mass index, doing exercise and stopping smoking if you do smoke.

We cannot change what we don't know or what we do have; we also cannot change our genetic makeup or our family history. I don't want to scare anyone, but if you think about it logically, having a disorder of the autonomic nervous system doesn't exactly contribute to being "healthy", to put it lightly. The best we can do is try to do everything we can to minimize the risks that are known to us thus far.

[Mrs. Burschman]

Doctorguest,

Thanks for hanging out on this site. I know I speak for others when I say that it's nice to have some professional analysis of our conditions and concerns!

Amy

[michiganjan]

I have POTS. I am 60 years old. I am also a patient of Dr. Grubb. He recently ordered a CT angiogram of heart heart for me. I had this done on a 128 slice CT machine. My calcium score is zero. The report written by the cardiologist who read the scans states that all the coronary arteries are normal. The scans were also read by a radiologist who looked at the chest views. He wrote my pictures are unremarkable and stated No significant atherosclerotic changes are seen within the visualized thoracic aorta.

I suppose I could wonder why the radiologist used the word "significant?" Were there changes that were there but they weren't significant?

Anyway the point of my sharing this on this thread is that I am 60 and I just had the best test one can have short of an actual catherization and my heart is normal.

I think having a normal heart is certainly a help with POTS because I have been told by the cardiologist that a normal heart more easily withstands palpitations. By the by I have lots of those, too. I also had a 30 day event monitor. And caught several incidents but the cardiologists were not concerned about anything that showed up.

I alos have been diagnosed with Ehlers Danlos hypermobility syndrome. So I also had an ultrasound of the entire aorta and it was normal, also.

This has helped me to have this concrete knowledge.

Michigan Jan, who is back on the forum after a long hiatus.

[corina]

it is great to have you back michiganjan!!!

i have been thinking about you a lot, hope you are doing okay!

(sorry katherine, this was just to say hi to michiganjan. i am too wiped out to read the article, will try and keep it in mind though!)

corina

[MomtoGiuliana]

doctorquest--Thanks so much for taking the time to read the source article and to respond--I was hoping you would!

Was HRV the only autonomic dysfunction indicator they looked at in this study? Also, don't POTS patients have increased HRV rather than decreased?

Are there any long-term studies of POTS patients underway or planned that you know of?

Again, thanks for clarifying this study for us!

Katherine

[doctorguest]

Yes, HRV was the only measure that they looked at. HRV does not refer to the changes in HR in POTS, but rather changes in time and frequency between each heart beat. This parameter is used in autonomic studies. In some patients with autonomic dysfunction, HRV may be reduced. This can happen in POTS patients, as well as healthy people, and this is why HRV is not a diagnostic marker by any means, unlike the tilt table test. You are correct in questioning the value of HRV in accessing autonomic dysfunction and further predicting the risk of heart disease as a result of it. This is why in my previous post I used the word "seem". My personal take on it is that we only scratched the tip of the iceberg. We don't have the answers that we need. The authors did find reduced HRV as a result of breathing in bad air, but ultimately, we don't know how many of these students will go on to develop heart disease in the future and how the numbers would compare to those in general population.

I am not aware that any longitudinal studies are being conducted because these are the most expensive studies to do - they require many years of followup of many patients with POTS who are mostly young now. As I always say, I welcome any funding, whether from the pharmaceutical companies or private sources, to get those research projects going .

[MomtoGiuliana]

doctorquest--thanks again for explaining and giving your opinion--it is so helpful.