Cardiac vagal activity is associated with insulin metabolism in heart failure: Results from the Myovasc study
Authors' conclusion
This study demonstrates the relevance of insulin status for vagal activity of cardiac autonomic function, particularly in heart failure. The pathophysiological implications underlying the relationship between insulin status and parasympathetic activity merit further mechanistic exploration.
Study context
- Population
- Individuals of the MyoVasc heart failure cohort in a fasting state; median age 64.0 years, 33% women; symptomatic HF in 43.7%
- Participants
- 1,588 individuals
- Exposure
- HbA1c, HOMA-IR and C-peptide vs parasympathetic reactivation
- Outcome
- Heart rate recovery 60 s (HRR60) after cardiopulmonary exercise testing
Methodological detailscross-sectional and longitudinal analyses, multivariable linear regression
- Cross-sectional and longitudinal analyses
- Multivariable linear regression
Main finding
As reported in the abstract
Association with HRR60 (adjusted for age, sex, clinical profile, medication)
- Median HRR60, beats per minute (IQR 14.0;28.0)
- 21.0
- HbA1c, β per SD (95% CI −0.122;−0.026), P = 0.003
- −0.074
- HOMA-IR, β per SD (−0.165;−0.062), P < 0.0001
- −0.113
- HOMA-IR additionally adjusted for glucose status, β per SD (−0.155;−0.040), P < 0.0001
- −0.097
- HbA1c additionally adjusted for insulin status, β per SD (−0.084;0.025), P = 0.28
- −0.030
- C-peptide, independent of HbA1c, β per SD (−0.225;−0.117), P < 0.0001
- −0.171
Observational data: associations, not effects.
Further findings
Subgroups with HF and T2D
- HOMA-IR, but not HbA1c, independently related to HRR60 confirmed in subgroups with HF and T2D
Association with lower HRR60 at follow-up · two years
- Higher HbA1c, β per SD (−0.171;−0.017), P = 0.017
- −0.094
- Higher C-peptide, β per SD (−0.159;0.007), P = 0.075
- −0.076
Original publication
Cardiac vagal activity is associated with insulin metabolism in heart failure: Results from the Myovasc study. Cardiovasc Diabetol. Published 8 January 2026. doi:10.
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