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Comparison of heart rate variability in different ABO blood groups of young adults.

ABSTRACT

Background: ABO blood groups have been associated with various disease phenotypes, particularly cardiovascular diseases. The analysis of the heart rate variability (HRV) signal is an important tool for studying the autonomic nervous system.

Aims & Objectives: The present study was designed to find out the association between different A, B, O blood groups and HRV in normal individuals.

Materials and Methods: This cross sectional study included 120 volunteered healthy medical students. The subjects were grouped into four groups A, B, AB and O. HRV was analyzed by using time domain and frequency domain method during normal breathing at rest for five minutes. HRV was also analyzed during deep breathing for one minute using time domain method.

Results: The analysis of HRV showed that during normal breathing, there was no statistically significant difference (P>0.05) in HRV among the ABO blood groups. HRV during deep breathing showed that there was a statistically significant increase in SDNN value (P<0.05) (standard deviation of NN interval) in O blood group subjects compared to A, B and AB blood groups. Frequency domain method did not show any statistically significant difference in (LF nu) and (HF nu) among the ABO blood groups.

Conclusion: This study showed a better HRV during deep breathing in O blood group individuals. The blood type O may offer some protection from cardiovascular diseases. High risk blood group individuals can adopt a healthier lifestyle as a preventive measure for the development of cardiovascular diseases in their future.

Key Words: Blood Groups; Heart Rate Variability; Time Domain Analysis; Frequency Domain Analysis; Standard Deviation of NN Intervals (SDNN)

Introduction

Many diseases, especially digestive disorders, cardiovascular diseases, cancer, and infection--express preferences choosing between the ABO blood types. [1-5] Cardiovascular disease is one of the major causes of sudden death. The known risk factors for cardiovascular diseases are tobacco use, decreased physical inactivity, dietary factors, alcohol abuse and genetics. But a recent study published in the United States' journal, Arteriosclerosis, Thrombosis and Vascular Biology, [6] found that a person's blood group also can determine his or her risk of heart disease. It was shown that individuals with blood group O benefit from some natural protection against cardiovascular disease and individuals with blood groups A and B are more at risk whereas individuals with blood group AB are the most vulnerable for cardiovascular diseases.

Heart rate variability (HRV) has become a common non-invasive research tool in cardiology, as it reflects the effects of autonomic system on the sinus node of the heart. [7] Time and frequency domain measures of HRV have provided prognostic information on the significance of changes in the regulation of heart rate changes. Previous studies have shown that reduced HRV implicates an increased risk of cardiovascular disease and mortality. [8,9]

The literature lacks data on the association of blood groups and HRV. As HRV is a non-invasive test to assess the cardiovascular autonomic regulation, the present study was designed to find out association between different A, B, O blood groups and HRV in normal individuals, if any, as decreased HRV is a dependable predictor of future cardiovascular disease.

Materials and Methods

This cross sectional study included 120 volunteered healthy medical students, in the age group of 18-22 years, of both sexes, from Kasturba Medical College, Mangalore. The study was approved, and the procedures were followed in accordance with the institutional ethical standards. At orientation, each subject was explained the purpose, procedures and confidentiality of this study prior to their written informed consent. A detailed history was taken. They were subjected to preliminary medical check-up. A general physical examination was done for all the subjects and the height (in meters), weight (in kilograms), blood pressure (mmHg) and pulse rate (per minute) were noted. Body Mass Index (BMI) was calculated as the weight in kilograms divided by the square of the height in meters. Pulse rate and blood pressure were measured in sitting position after five minutes of rest. The basal recording of blood pressure was done using sphygmomanometer by standard Riva Rocci method. A systemic examination was also carried out for each subject. The following exclusion criteria were accepted for the investigation: presence of any serious cardiovascular disease, including arterial hypertension, metabolic, neurological, respiratory disorders, and history of smoking and alcohol intake that could influence heart rate variability.

Determination of ABO blood groups was by antigen-antibody reaction ABO Slide Agglutination Test. Then subjects were grouped into four groups A, B, AB and O.

Assessment of HRV

All the subjects were asked to abstain from consuming caffeinated beverages and undertaking excessive physical activity, including gymnastics, for 12 hrs preceding the data collection. They were also requested not to eat and drink on the morning of the experiment and not to take a shower. The students were fully habituated to the equipment, the protocols and the experimenters. Our investigation was performed in a semi-darkened, temperature-controlled, quiet laboratory which was at room temperature (210C). Before the experiment, the participants rested in a laboratory room in a sitting posture for about 20 min. The records were taken between 09.00AM-10.00AM. The Autonomic activity was assessed by recording the electrocardiogram (ECG) from the limb lead II from all the subjects by using a BPL ECG machine. The analogue output from the machine was digitized by using an A/D converter from National Instruments, Bangalore. The HRV was analyzed by measuring the R-R intervals using a software "HRV soft 1.1 Version" software package (built by using the LabView software from Texas Instruments, USA) which was provided by the All India Institute of Medical Sciences (AIIMS), New Delhi. The ECG was recorded from all the subjects while they were in a supine position, fully relaxed and breathing normally for a period of five minutes, which gave the "Short term HRV". After this, a break of 2 minutes was given. HRV is also analyzed by deep breathing HR test [10] recorded during deep breathing for one minute. Before beginning the deep breathing test, the subject were taught to breath at a rate of 6 respiratory cycles per min, 5 seconds for each inhalation and 5 seconds for each exhalation. Lead II was then recorded continuously at a speed of 25 mm/seconds for 60 seconds while the subjects were deep breathing as instructed. The HRV was analyzed both by the time domain method and frequency domain analysis both during normal and deep breathing. In the time domain method, root of the mean of the squared successive R-R interval differences (RMSSD) and standard deviation of normal RR intervals in milliseconds (SDNN) were analyzed. The two main frequency components, i.e. the low frequency (LFnu) components (0.04 to 0.15Hz), and the high frequency (HFnu) components (0.15 to 0.4 Hz) in normalized units, was measured.

Statistical Analysis

Statistical analysis of the data was done by SPSS (Statistical Package for Social Sciences) version 11.5. Statistical tests included in this study were ANOVA (analysis of variance), Kluskal Wallis test and Mann Whitney U test. P-value was taken as statistically significant at 5 percent confidence level (P<0.05).

Results

In the present study, the demographic characteristics (Table 1) of the subjects with different blood groups was well balanced and they did not differ significantly in factors like age, weight, body mass index, waist/hip ratio and blood pressure.

HRV of 120 subjects' during normal and deep breathing was studied (Table -2). The analysis of HRV showed, that during normal breathing, there was no statistical significant difference (P>0.05) in HRV among the ABO blood groups. But the values of RMSSD and SDNN were slightly higher among subjects with O blood group, compared to the other ABO blood groups, but it was statistically not significant. HRV during deep breathing showed, that there was a statistical significant increase in SDNN value (P<0.05) in O blood group subjects, compared to A, B and AB blood groups--but there was no statistical significant change in RMSSD.

Analysis of the data (Table 3) showed that when HRV was compared between different ABO blood groups during normal breathing using frequency domain method, the low frequency component in normalized units (LF nu) and high frequency component in normalized units (HF nu) did not show any statistically significant difference among the ABO blood groups.

Discussion

Among the blood group systems, the ABO system is the most important in humans. The relevance of the present study was to find out, if blood groups can be implicated as one of the risk factors in the causation of cardiovascular diseases, by assessing the HRV in normal individuals.

In the present study, the demographic characteristics (Table 1) of the subjects with different blood groups was well balanced, and they did not differ significantly in factors like age, weight, body mass index, waist/hip ratio and blood pressure values, which are well known to affect HRV. [11-14]

HRV was compared among different ABO blood groups, during normal and deep breathing, using time domain method. Analysis of HRV using time domain method and frequency domain method, during normal breathing in A, B, AB and O blood groups, showed that there was no statistical significant difference in the RMSSD, SDNN, LFnu and HF nu--among the ABO blood groups. But the values of RMSSD and SDNN were slightly higher among subjects with O blood group, compared to the other ABO blood groups. Previous studies have shown that RMSSD primarily reflect the parasympathetic tone [15,16] and SDNN is considered to reflect both the sympathetic and the parasympathetic influence on heart rate variability. [17] Hence, the results of the present study probably suggest that there might be a better parasympathetic activity in O blood group subjects, but it did not attain a statistically significant level.

During deep breathing, the heart rate can increase and decrease with each respiratory cycle by as much as 30%. [18] Heart rate variability during deep breathing (DB-HRV) is approximately double than during quiet breathing. During deep breathing, the vagal activity is increased due to respiratory manoeuvre which spills over the cardiac tissue and the HRV under deep breathing condition is a better indicator of parasympathetic role in heart. [18] So in the present study, we tried to analyze, if there is any difference in the heart rate variability in different blood group individuals during deep breathing, as heart rate variability doubles during deep breathing. Time domain analysis of HRV in A, B, AB and O blood groups during deep breathing showed (Table.2) a statistically significant increase in SDNN value (p<0.05) among O blood group subjects compared to A, B, AB blood groups, but there was no statistically significant change in RMSSD value between the different ABO blood groups. Numerous previous studies have demonstrated the association between ABO blood groups, particularly non-O blood groups and cardiovascular major risk factors. This association is attributed to lower activated partial thromboplastin time (APTT) ratio, and levels of VWF factor in non-O blood group subjects. [19-22] The probability of parasympathetic activity being better in O blood group individuals, as per the results of the present study, may be one of the reasons for a lesser incidence of cardiovascular diseases in O blood group individuals, but it needs further study in a larger sample size.

Reduced HRV has been shown to be a risk factor for the development of cardiovascular diseases. [8,9] This study showed a better HRV (increased SDNN value) during deep breathing in O blood group individuals, compared to A, B and AB blood group subjects, which was statistically significant. The blood type O may offer some protection from cardiovascular diseases, but blood type alone will not compensate for other factors that are linked to the cardiovascular diseases. Blood group is a non-modifiable risk factor, but the high risk blood group individuals can adopt a healthier lifestyle as a preventive measure, for the development of cardiovascular diseases in their future.

Conclusion

This study showed a better HRV during deep breathing in O blood group individuals. The blood type O may offer some protection from cardiovascular diseases. High risk blood group individuals can adopt a healthier lifestyle as a preventive measure for the development of cardiovascular diseases in their future.

References

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Chaitra Uppangala (1), Bhagyalakshmi Kodavanji (2), Vinodini Na (2), Anupama Noojibail (2), Rekha D Kini (2), Nayanatara Arunkumar (2), Shreedhara Avabratha (3), Sheila R Pai (2), Prashanth Kumar C (4)

(1) Department of Physiology, Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore, Karnataka, India

(2) Department of Physiology, Kasturba Medical College, Mangalore, Unit of Manipal University, Karnataka, India

(3) Department of Pediatrics, Father Muller Medical College, Mangalore, Karnataka, India

(4) Department of Anaesthesia, Srinivas Institute of Medical Sciences and research Centre, Mukka, Mangalore, Karnataka, India

Correspondence to: Bhagyalakshmi Kodavanji (bhagyaavabratha@yahoo.com)

DOI: 10.5455/ijmsph.2014.120920142

Received Date: 21.08.2014

Accepted Date: 12.09.2014

Cite this article as: Uppangala C, Kodavanji B, Vinodini NA, Noojibail A, Kini RD, Arunkumar N, et al. Comparison of heart rate variability in different ABO blood groups of young adults. Int J Med Sci Public Health 2014;3:1466-1469.

Source of Support: Nil

Conflict of interest: None declared
Table-1: Demographic characteristics of A, B, AB and O blood group
subjects

Parameters                 Blood groups
                   A (n=32)           B (n=29)
   Age               19.62               19.48
 (years)          [+ or -] 1.3       [+ or -] 1.5
 Weight              57.03               54.41
  (kg)            [+ or -] 8         [+ or -] 8
 Height               1.62                1.60
  (m)             [+ or -] 0.07      [+ or -] 0.10
Body Mass            21.57               20.86
  Index           [+ or -] 1.7       [+ or -] 1.6
Waist-Hip             0.79                0.76
  Ratio           [+ or -] 0.06      [+ or -] 0.05
Systolic BP          114.8               115.7
 (mm Hg)          [+ or -] 4.4       [+ or -] 4.4
Diastolic BP         77.43               75.93
 (mm Hg)          [+ or -] 3.9       [+ or -] 3.9

Parameters                 Blood groups               P Value
                AB (n=12)             O (n=47)

   Age             19.75               19.59          0.954
 (years)       [+ or -} 1.7      [+ or -] 1.3          NS
 Weight            54.58             54.02            0.395
  (kg)         [+ or -] 8        [+ or -] 7.4          NS
 Height             1.58                 1.57         0.169
  (m)          [+ or -] 0.06     [+ or -] 0.09         NS
Body Mass          21.69               21.29          0.343
  Index        [+ or -] 1.8      [+ or -] 1.6          NS
Waist-Hip           0.76                 0.77         0.238
  Ratio        [+ or -] 0.07     [+ or -] 0.05         NS
Systolic BP        116.33               115.14        0.712
 (mm Hg)       [+ or -] 4.07     [+ or -] 4.4          NS
Diastolic BP       78.16               76.38          0.234
 (mm Hg)       [+ or -] 3.1      [+ or -] 3.9          NS


Values are as Mean [+ or -] Standard deviation. n = number of subjects;
BP = Blood pressure; NS = not significant

Table-2: Comparison of HRV between different ABO blood groups during
normal breathing (NB) and deep breathing (DB) using time domain method

Parameters                    Blood groups
               A (n=32)        B (n=29)        AB (n=12)

NB-RMSSD         51.30           51.97           59.36
(ms)          [+ or -] 20     [+ or -] 17     [+ or -] 20
NB-SDNN          58.07           65.54           66.24
(ms)          [+ or -] 15     [+ or -] 21     [+ or -] 19
DB-RMSSD         57.07           60.04           59.72
(ms)          [+ or -] 21     [+ or -] 20     [+ or -] 19
DBSDNN           72.03           73.21           72.49
(ms)          [+ or -] 13     [+ or -] 12     [+ or -] 14

Parameters   Blood groups      P value
              O (n=47)

NB-RMSSD        59.79          0.738
(ms)         [+ or -] 16         NS
NB-SDNN         70.95          0.44
(ms)         [+ or -] 15         NS
DB-RMSSD        63.07          0.616
(ms)         [+ or -] 15         NS
DBSDNN          75.67          0.04
(ms)         [+ or -] 12         S

Values are as Mean [+ or -] Standard deviation. n = number of subjects;
NS = not significant; S = significant

Table-3: Comparison of HRV between different ABO blood groups during
normal breathing using frequency domain method

Parameters            Blood groups
               A (n=32)            B (n=29)

LF nu   53.65 [+ or -] 17    52.97 [+ or -] 23
HF nu   46.35 [+ or -] 17    47.03 [+ or -] 23

Parameters            Blood groups                      P value
               AB (n=12)           O (n=47)

LF nu         59.93 [+ or -] 23    51.69 [+ or -] 19    0.633 NS
HF nu         40.07 [+ or -] 23    48.31 [+ or -] 19    0.633 NS

Values are as Mean [+ or -]  Standard deviation. n = number of
subjects; NS = not significant
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Title Annotation:RESEARCH ARTICLE
Author:Uppangala, Chaitra; Kodavanji, Bhagyalakshmi; Na, Vinodini; Noojibail, Anupama; Kini, Rekha D; Arunk
Publication:International Journal of Medical Science and Public Health
Article Type:Report
Geographic Code:9INDI
Date:Dec 1, 2014
Words:3317
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