Clinical implication of assessment of heart rate variability in patients with psoriatic arthritis


Aim. To evaluate clinical significance of heart rate variability (HRV) in patients with psoriatic arthritis (PsA).
Material and methods. HRV was investigated by means of time-domain analysis of 24 h ECG ambulatory recording in 113 PsA (70 female) patients < 55 years old and 65 age-matched healthy subjects. We assessed the presence of standard cardiovascular risk factors, performed carotid and femoral ultrasound with measurement of intima-medial thickness (IMT) in PsA patients. Inflammatory markers (CRP, fibrinogen) were detected in all the patients.
Results. Significantly lower values of HRV parameters adjusted by Mean NN (SDNNn%, SDNNIN%) were detected in PsA men and women when compared to the control group. There was a significant negative correlation between HRV and disease duration, PsA activity (DAS4, Ritchi index), swollen and tender joint counts, femoral IMT, CRP in PsA males (p < 0.05). SDNNin% was lower in PsA male smokers than in non-smokers (p = 0.03). There was a significant negative correlation between HRV and age, systolic blood pressure, dyslipidemia, body mass index, carotid IMT, CRP, fibrinogen in PsA women.
Conclusion. Reduced HRV reflects sympatho-vagal imbalance in PsA patients associated with the disease duration and activity, smoking, femoral IMT, markers of inflammation (CRP) in males; with standard cardiovascular risk factors, fibrinogen, CRP, carotid IMT in women, and may be identified as a risk factor for cardiovascular morbidity and mortality in further studies.


  1. Насонов Е. Л., Насонова В. А. (ред.). Ревматология: национальное руководство. М.: Гэотар-Медиа; 2008.
  2. Han C., Robinson D. W., Hackett M. V. et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondilitis. J. Rheumatol. 2006; 33: 2167-2172.
  3. Kimball A. B., Robinson D. Jr., Wu Y. Cardiovascular disease and risk factors among psoriasis patients in two US healthcare databases, 2001-2002. Dermatology 2008; 217 (1): 27-37.
  4. Christophers E. Comorbidities in psoriasis. Clin. Dermatol. 2007; 25 (6): 529-534.
  5. Tam L.-S., Tomlinson B., Chu T. T.-W. et al. Cardiovascular risk profile of patients with psoriatic arthritis compared to controls - the role of inflammation. Rheumatology 2008; 47: 718-723.
  6. Kimhi O., Caspi D., Bornstein N. M. et al. Prevalence and risk factors of atherosclerosis in patients with psoriatic arthritis. Semin. Arthr. Rheum. 2007; 36: 203-209.
  7. Gonzalez-Juanatey C., Llorca J., Amigo-Diaz E. et al. High prevalence of subclinical atherosclerosis in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthr. and Rheum. 2007; 57: 1074-1080.
  8. Gonzalez-Juanatey C., Llorca J., Miranda-Filloy J. A. et al. Endothelial dysfunction in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthr. and Rheum. 2007; 57: 287-293.
  9. Cook S., Togni M., Schaub M. et al. High heart rate: a cardiovascular risk factor? Eur. Heart J. 2006; 27: 2387-2393.
  10. Соколов С. Ф., Малкина Т. А. Клиническое значение оценки вариабельности ритма сердца. Сердце 2002; 2: 72-75.
  11. Диабетическая нейропатия (патогенез, диагностика, лечение) / Чернышева Т. Е., Гурьева И. В., Алтунбаев Н. А. и др. М.: Медпрактика. М.; 2005.
  12. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996; 93: 1043-1065.
  13. Sajadieh A., Nielsen O., Rusmussen V. et al. Increased heart rate and reduced heart rate variability are associated with subclinical inflammation in middle-age and elderly subjects with no apparent heart diseases. Eur. Heart J. 2004; 25: 363-370.
  14. Dietrich D., Schindler C., Schwartz J. et al. Heart rate variability in an ageing population and its association with lifestyle and cardiovascular risk factors: results of the SAPALDIA study. Europace 2006; 8: 521-529.
  15. Shebab A. M., MacFadyen R. J., McLaren M. et al. Sudden unexpected death in heart failure may be preceded by short term, intraindividual increases in inflammation and in autonomic dysfunction: a pilot study. Heart 2004; 90: 1263-1268.
  16. Anan F., Takahashi N., Nakagava M. et al. High-sensitive C-reactive protein is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients. Metabolism 2005; 54 (4): 552-558.
  17. Aronson D., Mittleman M. A., Burger A. J. Interleukin-6 levels are inversely correlated with heart rate variability in patients with decompensated heart failure. J. Cardiovasc. Electrophysiol. 2001; 12: 294-300.
  18. Парнес Е. Я., Красносельский М. Я., Цурко В. В. и др. Долгосрочный прогноз у больных ревматоидным артритом в зависимости от исходной вариабельности сердечного ритма. Тер. арх. 2005; 9: 77-80.
  19. Moll J. M., Wright V. Psoriatic arthritis. Semin. Arthr. Rheum. 1973; 3: 55-78.
  20. Gladman D., Helliwell P., Mease P. et al. Assessment of patients with psoriatic arthritis. Arthr. and Rheum. 2004; 50: 24-35.
  21. Grundy M., Scott G. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equatious. Circulation 1999; 100: 1481-1492.
  22. Haward G., Sharrett A. R., Heiss G. et al. Carotid artery intima-media thickness distribution in general populations as evaluated by B-mode ultrasound. Stroke 1993; 24: 1297-1304.
  23. Lagana B., Gentile R., Vella C. et al. Heart and autonomic nervous system in connective tissue disorders. Recenti Progr. Med. 1997; 88: 579-584.
  24. Gladman D. D., Farewell V. T., Wong K., Husted J. Mortality studies in psoriatic arthritis: results from a single outpatient center. II. Prognostic indicators for death. Arthr. and Rheum. 1998; 41: 1103-1110.
  25. Sloan R. P., Huang M. H., McCreath H. Cardiac autonomic control and the effects of age, race, and sex: the CARDIA study. Auton. Neurosci. 2008; 30: 78-85.
  26. Escalante A., Haas R. W., del Rincon I. Paradoxical effect of body mass index on survival in rheumatoid arthritis: role for comorbidity and systemic inflammation. Arch. Intern. Med. 2005; 167: 1624-1629.
  27. von Kдnel R., Nelesen R. A., Mills P. J. et al. Relationship between heart rate variability, interleukin-6, and soluble tissue factor in healthy subjects. Brain Behav. Immun. 2008; 22: 461-468.
  28. Sloan R. P., McCreath H., Tracey K. J. RR interval variability is inversely related to inflammatory markers: the CARDIA study. Mol. Med. 2007; 13: 178-184.
  29. Escarcega R. O., Garcia-Carrasco M., Fuentes-Alexandro S. et al. Insulin resistance, chronic inflammatory state and the link with systemic lupus erythematosus-related coronary disease. Autoimmun. Rev. 2006; 6: 48-53.
  30. Shinohara T., Tacahashi N., Yufu K. et al. Role of interleukine-6 levels in cardiovascular autonomic dysfunction in type 2 diabetic patients. Eur. J. Nucl. Med. Mol. Imag. 2008; 35 (9): 1616-1623.
  31. Забелина В. Д., Земсков В. М., Мкртумян А. М. и др. Особенности состояния иммунной системы у больных с метаболическим синдромом. Тер. арх. 2004; 5: 66-72.
  32. Yudkin J. S., Kumari M., Humphries S. E. Inflammation, obesity, stressand coronary heart disease: is interleukin-6 the link? Atherosclerosis 2000; 148: 209-214.
  33. Stein P. K., Barzilay J. I., Chaves P. H. Higher levels of inflammation factors and greater insulin resistance are independently associated with higher heart rate and lower heart rate variability in normoglycemic older individuals: the Cardiovascular Health Study. J. Am. Geriatr. Soc. 2008; 2: 315-321.
  34. Neimann A. L., Shin D. B., Wang X. at al. Prevalence of cardiovascular risk factors in patients with psoriasis. J. Am. Acad. Dermatol. 2006; 55: 829-835.
  35. Holman A. J., Ng E. Heart rate variability predicts anti-tumor necrosis factor therapy response for inflammatory arthritis. Auton. Neurosci. 2008; 5; 143 (1-2): 58-67.

Copyright (c) 2009 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail:


© 2018-2021 "Consilium Medicum" Publishing house

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies