Cardiovascular autonomic dysfunction may contribute to vascular abnormalities, but its relationship with arterial stiffness across different glucose metabolism states remains incompletely understood. A cross-sectional analysis from the Maastricht Study, published in BMJ Open Diabetes Research & Care, evaluated the association between heart rate variability (HRV) and arterial stiffness among adults with varying glucose metabolism status.

Cardiovascular autonomic function was assessed using HRV indices derived from 24-hour electrocardiogram recordings. Time-domain and frequency-domain HRV metrics were summarized as standardized z-scores. Aortic stiffness was evaluated using carotid-femoral pulse wave velocity (PWV), while carotid stiffness was assessed by carotid artery distensibility (CD). Multiple linear regression models examined these associations with adjustment for demographic characteristics, lifestyle factors, and cardiovascular risk factors.

PWV data were available for 3,673 participants and CD data for 1,802 participants. The median age was 60 years (25th–75th percentile 53-66), 51% were women, and 20% had type 2 diabetes. Lower HRV was associated with greater aortic stiffness. Per SD lower time-domain and frequency-domain HRV z-scores were each associated with 2.8% higher PWV (95% CI 2.1%-3.4% and 2.1%-3.5%).

Similar patterns were observed for carotid stiffness. Per SD lower HRV was associated with 3.2% and 3.1% lower CD for time-domain and frequency-domain measures, respectively. The magnitude of these associations was greater among individuals with prediabetes and type 2 diabetes than among those with normal glucose metabolism. Statistical interaction by glucose metabolism status was observed (p <0.01 for prediabetes and <0.05 to <0.10 for type 2 diabetes). These findings indicate that cardiovascular autonomic dysfunction corresponds with greater arterial stiffness, particularly in individuals with dysglycemia.