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Background  Heart rate variability ( HRV ) characterizes cardiac autonomic functioning. The association of  HRV  with stroke is uncertain. We examined whether 24‐hour  HRV  added predictive value to the Cardiovascular Health Study clinical stroke risk score ( CHS ‐ SCORE ), previously developed at the baseline examination.    Methods and Results  N=884 stroke‐free  CHS  participants (age 75.3±4.6), with 24‐hour Holters adequate for  HRV  analysis at the 1994–1995 examination, had 68 strokes over ≤8 year follow‐up (median 7.3 [interquartile range 7.1–7.6] years). The value of adding  HRV  to the  CHS ‐ SCORE  was assessed with stepwise Cox regression analysis. The  CHS ‐ SCORE  predicted incident stroke ( HR =1.06 per unit increment,  P =0.005). Two  HRV  parameters, decreased coefficient of variance of  NN  intervals ( CV %,  P =0.031) and decreased power law slope ( SLOPE ,  P =0.033) also entered the model, but these did not significantly improve the c‐statistic ( P =0.47). In a secondary analysis, dichotomization of  CV % ( LOWCV % ≤12.8%) was found to maximally stratify higher‐risk participants after adjustment for  CHS ‐ SCORE . Similarly, dichotomizing  SLOPE  ( LOWSLOPE  <−1.4) maximally stratified higher‐risk participants. When these  HRV  categories were combined (eg,  HIGHCV % with  HIGHSLOPE ), the c‐statistic for the model with the  CHS ‐ SCORE  and combined  HRV  categories was 0.68, significantly higher than 0.61 for the  CHS ‐ SCORE  alone ( P =0.02).    Conclusions  In this sample of older adults, 2  HRV  parameters,  CV % and power law slope, emerged as significantly associated with incident stroke when added to a validated clinical risk score. After each parameter was dichotomized based on its optimal cut point in this sample, their composite significantly improved prediction of incident stroke during ≤8‐year follow‐up. These findings will require validation in separate, larger cohorts.

journal of the american heart association

Addition of 24‐Hour Heart Rate Variability Parameters to the Cardiovascular Health Study Stroke Risk Score and Prediction of Incident Stroke: The Cardiovascular Health Study