Vitor E. Valenti
Luiz C. M. Vanderlei- 1Autonomic Nervous System Center, São Paulo State University (UNESP), Marilia, SP, Brazil
- 2Department of Physical Therapy, Faculty of Sciences and Technologies, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil
Editorial on the Research Topic
Autonomic nervous system and cardiovascular risk
The autonomic nervous system is related to involuntary body functions, including gastrointestinal mechanisms, blood pressure, skin muscle activity and heart rate (Hall, 2015). The literature provided strong evidence that autonomic dysfunction may lead to cardiovascular risk factors (Gezer et al., 2022; Samora et al., 2023). Accordingly, this Research Topic explores recent studies that investigated the relationship between the autonomic nervous system and cardiovascular risk.
The first article published in this Research Topic was the study conducted by Abdalbari et al., which applied Granger Causality to capture brain-heart mechanisms during wakefulness and sleep. Granger Causality is a statistical test that can also be used as a measure for bidirectional connectivity in EEG (Coben and Mohammad-Rezazadeh, 2015). In the Abdalbari et al. study, EEG and ECG were recorded during the different sleep stages and wakefulness. As the main data, the authors demonstrated the relevance of fronto-posterior connectivity during wakefulness and sleep stages via Granger Causality. The study also showed differences in ipsilateral and contralateral mechanisms and identified bidirectional brain-heart connections which are stronger from brain to heart.
Brain-heart interaction was also evaluated by Liu Y. et al.. These authors analyzed alterations in spontaneous function of the brain, which are related to autonomic function, during changes in the cardiovascular system induced by dobutamine, a sympathomimetic drug usually used for heart failure treatment (alpha-1, beta-1, and beta-2 agonist drug) (Drugs Lactation Database., 2006; Mahoney et al., 2016). In healthy young subjects cognitive function was unaffected when blood pressure and heart rate increased following dobutamine administration. However, spontaneous neural activity was changed after dobutamine infusion. In addition, the level of spontaneous brain activity was associated with systolic and diastolic arterial pressure changes.
In this context, the vasovagal syncope (VVS), also known as neurocardiogenic syncope or reflex syncope, is an impairment investigated worldwide (Ali et al., 2021). Li et al., provided interesting data regarding the Calcitonin gene-related peptide (CGRP) and its association with VVS. The CGRP is a peptide localized to C and Aδ sensory fibers with important role in sensory and efferent function, which presents a broad innervation throughout the body with large perivascular location (Russell et al., 2014). Li et al. compared the CGRP plasma levels between healthy children and children with VVS. Their data indicated that plasma CGRP concentration was significantly increased in VVS children. Furthermore, correlation analysis evidenced positive association between CGRP and clinical symptoms severity, indicating that CGRP levels estimated treatment efficacy.
Regarding the vagus nerve, Cai et al. performed an overview related to symptomatic vagal-induced sinus node dysfunction. The study described many factors in order to identify the best candidate for cardioneuroablation, a therapeutic option in sinus dysfunction, neurocardiogenic syncope and functional atrio-ventricular block (Aksu et al., 2019). The researchers highlighted cardiac autonomic nervous system mechanisms, sinus node dysfunction with vagal overactivity and cardioneuroablation considered for a new treatment for refractory symptomatic sinus node dysfunction. On the other hand, the review reinforced that most of the studies presented low quality of evidence.
A systematic review was conducted by Aftyka et al. to discuss the estimative power of heart rate variability for stroke course, functional outcome, and medical complications. In this context, heart rate variability is a non-invasive method that estimates heart rhythm autonomic regulation. Increased heart rate variability is related to good adaptation, i.e., healthy individuals with efficient autonomic mechanisms whereas reduced heart rate variability is an indicator of impaired adaptation of the autonomic nervous system (Task Force., 1996). The initial search found 1,305 potential references. After rigorous exclusion criteria based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method, 36 studies that investigated linear and non-linear heart rate variability were included. Following a careful quality assessment and risk of bias evaluation, the systematic review concluded that heart rate variability may be considered an optimal predictor of stroke outcomes and complications. Nevertheless, the authors pointed to individual methodological features to adequately measure and interpret the heart rate variability indices.
Another study related to heart rate variability was published by Liu J. et al. in this Research Topic. The study examined the effect of taxane combined with carboplatin, antineoplasic and cardiotoxic drugs (Griesinger et al., 2019; Guijosa et al., 2022) on heart rate variability in patients with cervical cancer. The patients were divided into one group treated with docetaxel + carboplatin whereas another group received paclitaxel + carboplatin. Short heart rate variability was analyzed via standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), low-frequency power (LF), high-frequency power (HF), and LF/HF. As the main data, heart rate variability was increased by taxane and carboplatin treatment.
Finally, Takotsubo cardiomyopathy is another pathology involved with the relationship between autonomic injury and cardiovascular risk increase (Amin et al., 2020). With this in mind, Arai et al. tried to establish a new animal model related to stress cardiomyopathy. The study investigated epilepsy-induced stress cardiomyopathy and the involvement of neuropeptide Y in cardiac dysfunction. The report evidenced that activation of the sympathetic nervous system leads to upregulation of neuropeptide Y in cardiac sympathetic nerves and stellate ganglion.
Briefly, the articles published in this Research Topic provide additional information regarding brain-heart interaction, vagus nerve activity, heart rate variability and stress cardiomyopathy. Therefore, the results obtained in this Research Topic supply compelling evidence that adds valid data to better comprehend the association between cardiovascular risk and autonomic nervous system.
Author contributions
VV and LV drafted the editorial and gave final approval.
Funding
The authors receive grants from CNPq.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
Aksu, T., Guler, T. E., Bozyel, S., and Yalin, K. (2019). Potential usage of cardioneuroablation in vagally mediated functional atrioventricular block. SAGE Open Med. 7, 2050312119836308. doi: 10.1177/2050312119836308
Ali, M., Pachon Maetos, J. C., Kichloo, A., Masudi, S., Grubb, B. P., and Kanjwal, K. (2021). Management strategies for vasovagal syncope. Pacing Clin. Electrophysiol. 44, 2100–2108. doi: 10.1111/pace.14402
Amin, H. Z., Amin, L. Z., and Pradipta, A. (2020). Takotsubo cardiomyopathy: a brief review. J. Med. Life. 13, 3–7. doi: 10.25122/jml-2018-0067
Coben, R., and Mohammad-Rezazadeh, I. (2015). Neural connectivity in epilepsy as measured by granger causality. Front. Hum. Neurosci. 9, 194. doi: 10.3389/fnhum.2015.00194
Drugs and Lactation Database. (2006). Drugs and Lactation Database (LactMed®). Bethesda, MD: National Institute of Child Health and Human Development.
Gezer, H. H., Acer Kasman, S., and Duruöz, M. T. (2022). Autonomic dysfunction and cardiovascular risk in psoriatic arthritis. Clin. Rheumatol. doi: 10.1007/s10067-022-06484-6. [Epub ahead of print].
Griesinger, F., Korol, E. E., Kayaniyil, S., Varol, N., Ebner, T., and Goring, S. M. (2019). Efficacy and safety of first-line carboplatin-versus cisplatin-based chemotherapy for non-small cell lung cancer: a meta-analysis. Lung Cancer 135, 196–204. doi: 10.1016/j.lungcan.2019.07.010
Guijosa, A., Freyria, A., Espinosa-Fernandez, J. R., Estrada-Mena, F. J., Armenta-Quiroga, A. S., Ortega-Treviño, M. F., et al. (2022). Pharmacogenetics of taxane-induced neurotoxicity in breast cancer: systematic review and meta-analysis. Clin. Transl. Sci. 15, 2403–2436. doi: 10.1111/cts.13370
Mahoney, L., Shah, G., Crook, D., Rojas-Anaya, H., and Rabe, H. (2016). A literature review of the pharmacokinetics and pharmacodynamics of dobutamine in neonates. Pediatr. Cardiol. 37, 14–23. doi: 10.1007/s00246-015-1263-9
Russell, F. A., King, R., Smillie, S. J., Kodji, X., and Brain, S. D. (2014). Calcitonin gene-related peptide: physiology and pathophysiology. Physiol. Rev. 94, 1099–1142. doi: 10.1152/physrev.00034.2013
Keywords: autonomic nervous system, cardiovascular, neuroscience, cardiovascular risk, sympathetic, vagus, parasympathetic tone
Citation: Valenti VE and Vanderlei LCM (2023) Editorial: Autonomic nervous system and cardiovascular risk. Front. Neurosci. 17:1185320. doi: 10.3389/fnins.2023.1185320
Received: 13 March 2023; Accepted: 27 March 2023;
Published: 04 April 2023.
Edited and reviewed by: Joel C. Bornstein, The University of Melbourne, Australia
Copyright © 2023 Valenti and Vanderlei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Vitor E. Valenti, vitor.valenti@unesp.br