Heart Rate Variability as a Risk Indicator for Cardiovascular Disease in Asymptomatic Adults with Risk Factors
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Background: Cardiovascular disease often develops silently in adults who already have established cardiometabolic risk factors, and conventional risk assessment may not fully capture early physiological vulnerability in asymptomatic individuals. Heart rate variability (HRV) is a non-invasive measure of autonomic function and may identify early cardiovascular stress before overt clinical disease becomes apparent. Objective: To determine whether baseline HRV predicts future cardiovascular events in asymptomatic adults with established cardiovascular risk factors in a tertiary care hospital setting in Pakistan. Methods: This prospective cohort study included 300 asymptomatic adults aged 30 to 65 years with at least one cardiovascular risk factor. Baseline assessment included demographic and clinical profiling, anthropometry, blood pressure measurement, laboratory investigations, and standardized 5-minute resting electrocardiographic HRV recording. Time-domain and frequency-domain HRV parameters were analyzed, and participants were followed for 12 months for acute coronary syndrome, ischemic stroke, hospitalization for heart failure, coronary artery disease requiring intervention, and cardiovascular death. Associations were assessed using descriptive statistics and multivariable Cox regression. Results: The mean age of participants was 49.8 ± 8.7 years, and 55.3% were male. Hypertension was present in 66.0%, obesity in 54.0%, dyslipidemia in 47.0%, and diabetes mellitus in 32.0%. During follow-up, 43 participants (14.3%) developed cardiovascular events. Event rates were 23.5% in the low HRV group, 13.3% in the intermediate HRV group, and 6.0% in the high HRV group. Participants with events had lower baseline SDNN and RMSSD and a higher LF/HF ratio. After adjustment for age, hypertension, obesity, diabetes mellitus, and smoking, low HRV remained an independent predictor of cardiovascular events (adjusted HR 3.12; 95% CI: 1.31-7.42; p = 0.010). Conclusion: Reduced HRV was significantly associated with higher future cardiovascular risk in asymptomatic adults with established risk factors and may serve as a practical adjunct marker for early cardiovascular risk stratification in tertiary care settings.
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