Indexed in SCIE, Scopus, PubMed & PMC
pISSN 1226-4512 eISSN 2093-3827


home Article View

Original Article

Korean J Physiol Pharmacol 2023; 27(1): 49-59

Published online January 1, 2023

Copyright © Korean J Physiol Pharmacol.

Association between metabolic syndrome components and cardiac autonomic modulation in southern Indian adults with pre-metabolic syndrome: hyperglycemia is the major contributing factor

Endukuru Chiranjeevi Kumar1, Girwar Singh Gaur2,*, Dhanalakshmi Yerrabelli2, Jayaprakash Sahoo3, Balasubramaniyan Vairappan4, and Alladi Charanraj Goud5

1Department of Physiology, Sri Siddhartha Institute of Medical Sciences & Research Centre, Bangalore 562123, 2Department of Physiology, 3Department of Endocrinology, 4Department of Biochemistry, 5Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605008, India

Correspondence to:Girwar Singh Gaur

Author contributions: E.C.K. prepared concept, methodology and perfomed investigation, validation, acquisition of data, writing original draft, reviewing, editing & funding. G.S.G., D.Y., J.S., B.V., and A.C.G. performed formal analysis, validation and supervised the final manuscript.

Received: July 7, 2022; Revised: September 28, 2022; Accepted: October 13, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Metabolic syndrome (MetS) involves multi-factorial conditions linked to an elevated risk of type 2 diabetes mellitus and cardiovascular disease. Pre-metabolic syndrome (pre-MetS) possesses two MetS components but does not meet the MetS diagnostic criteria. Although cardiac autonomic derangements are evident in MetS, there is little information on their status in pre-MetS subjects. In this study, we sought to examine cardiac autonomic functions in pre-MetS and to determine which MetS component is more responsible for impaired cardiac autonomic functions. A total of 182 subjects were recruited and divided into healthy controls (n=89) and pre-MetS subjects (n=93) based on inclusion and exclusion criteria. We performed biochemical profiles on fasting blood samples to detect pre-MetS. Using standardized protocols, we evaluated anthropometric data, body composition, baroreflex sensitivity (BRS), heart rate variability (HRV), and autonomic function tests (AFTs). We further examined these parameters in pre-MetS subjects for each MetS component. Compared to healthy controls, we observed a significant cardiac autonomic dysfunction (CAD) through reduced BRS, lower overall HRV, and altered AFT parameters in pre-MetS subjects, accompanied by markedly varied anthropometric, clinical and biochemical parameters. Furthermore, all examined BRS, HRV, and AFT parameters exhibited an abnormal trend and significant correlation toward hyperglycemia. This study demonstrates CAD in pre-MetS subjects with reduced BRS, lower overall HRV, and altered AFT parameters. Hyperglycemia was considered an independent determinant of alterations in all the examined BRS, HRV, and AFT parameters. Thus, hyperglycemia may contribute to CAD in pre-MetS subjects before progressing to MetS.

Keywords: Autonomic nervous system, Cardiovascular diseases, Heart rate physiology, Hyperglycemia, Metabolic diseases, Metabolic syndrome