Open Access Highly Accessed Research article

Association of health behaviour with heart rate variability: a population-based study

Alexander Kluttig1*, Barbara Schumann12, Cees A Swenne3, Jan A Kors4, Oliver Kuss1, Hendrik Schmidt5, Karl Werdan6, Johannes Haerting1 and Karin H Greiser17

Author Affiliations

1 Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany

2 Department of Public Health and Clinical Medicine, Centre for Global Health Research, Umeå University, Umeå, Sweden

3 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

4 Department of Medical Informatics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

5 Department of Cardiology, Hospital Magdeburg, Germany

6 Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany

7 Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany

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BMC Cardiovascular Disorders 2010, 10:58  doi:10.1186/1471-2261-10-58

Published: 25 November 2010



Reduced heart rate variability (HRV), a non-invasive marker of autonomic dysfunction, and an unhealthy lifestyle are associated with an increased morbidity and mortality of cardiovascular diseases (CVD). The autonomic dysfunction is a potential mediator of the association of behavioural risk factors with adverse health outcomes. We studied the association of HRV with behavioural risk factors in an elderly population.


This analysis was based on the cross-sectional data of 1671 participants (age range, 45-83 years) of the prospective, population-based Cardiovascular Disease, Living and Ageing in Halle (CARLA) Study. Physical activity, smoking habits, alcohol consumption and dietary patterns were assessed in standardized interviews. Time and frequency domain measures of HRV were computed from 5-min segments of highly standardized 20-min electrocardiograms. Their association with behavioural risk factors was determined by linear and non-parametric regression modelling.


There were only weak and inconsistent associations of higher physical activity, moderate consumption of alcohol, and non-smoking with higher time and frequency domain HRV in both sexes, and no association with dietary pattern. Results changed only marginally by excluding subjects with CVD, diabetes mellitus and use of cardioactive medication.


We hypothesized that HRV is associated with behavioural factors and therefore might be a mediator of the effect of behavioural risk factors on CVD, but this hypothesis was not confirmed by our results. These findings support the interpretation that there may be no true causal association of behavioural factors with HRV.