Table 4.
Factors associated with the lowest quartile of Valsalva ratio.
| Highest three quartiles (n = 911) | Lowest quartilea (n = 208) | p | |
|---|---|---|---|
| Age (years) (mean ± SD) | 60.6 ± 6.6 | 61.6 ± 6.4 | .04 |
| Sex (M/F) —no. (%) | |||
| Male | 491 (54%) | 109 (52%) | .70 |
| Female | 420 (46%) | 99 (48%) | |
| Race—no. (%) | |||
| White | 697 (77%) | 174 (84%) | .06 |
| Black | 166 (18%) | 24 (12%) | |
| Other | 48 (5%) | 10 (5%) | |
| Diabetes-related factors | |||
| Diabetes duration—years (mean ± SD) | 8.1 ± 6.9 | 9.9 ± 7.4 | .001 |
| Age at diagnosis—years (mean ± SD) | 52.4 ± 8.8 | 51.6 ± 8.8 | .29 |
| HbA1C—% (mean ± SD) (mmol/mol) | 7.1 ± 1.5 (54) | 7.2 ± 1.4 (55) | .25 |
| Insulin—no. (%) | 197 (22%) | 63 (30%) | .008 |
| Microalbumin:creatinine no. (%) | |||
| <30 µg/mg | 704 (79%) | 130 (64%) | <.0001 |
| 30–299 µg/mg | 164 (18%) | 51 (25%) | |
| >299 µg/mg | 24 (3%) | 22 (11%) | |
| Serum creatinine—mg/dl (mean ± SD) | .95 ± .27 | 1.02 ± .45 | .05 |
| Retinopathy—no. (%) | 128 (14%) | 45 (22%) | .006 |
| Extremity numbness—no. (%) | 307 (34%) | 84 (40%) | .07 |
| Extremity pain—no. (%) | 102 (11%) | 27 (13%) | .47 |
| Extremity tingling—no. (%) | 251 (28%) | 62 (30%) | .51 |
| Abnormal monofilament—no. (%) | 104 (11%) | 32 (15%) | .11 |
| Absent ankle reflex—no. (%) | 284 (31%) | 74 (36%) | .22 |
| Decreased vibratory sensation—no. (%) | 253 (28%) | 71 (34%) | .07 |
| Dizziness—no. (%) | 125 (14%) | 39 (19%) | .06 |
| Bloating after meals—no. (%) | 125 (14%) | 39 (19%) | .06 |
| Erectile dysfunction (men)—no. (%) | 226 (46%) | 63 (58%) | .03 |
| ⩾2 signs/symptoms of peripheral neuropathyb—no. (%) | 355 (39%) | 95 (46%) | .08 |
| ⩾ 1 symptom of autonomic neuropathyc—no. (%) | 372 (41%) | 104 (50%) | .02 |
| Cardiac risk factors | |||
| Waist-to-hip ratio (mean ± SD) | .94 ± .09 | .94 ± .08 | .58 |
| LDL—mg/dl (mean ± SD) | 114 ± 33 | 114 ± 32 | .96 |
| HDL—mg/dl (mean ± SD) | 50 ± 15 | 48 ± 13 | .04 |
| TG—mg/dl (mean ± SD) | 167 ± 108 | 182 ± 117 | .08 |
| Lipid treatment—no. (%) | 412 (45%) | 115 (55%) | .009 |
| SBP—mmHg (mean ± SD) | 131 ± 16 | 134 ± 16 | .004 |
| DBP—mmHg (mean ± SD) | 79 ± 8 | 79 ± 9 | .78 |
| PP—mmHg (mean ± SD) | 51.7 ± 13.3 | 55.5 ± 13.6 | .0002 |
| Hypertension treatment—no. (%) | 495 (54%) | 139 (67%) | .001 |
| Family history CAD—no. (%) | 167 (18%) | 47 (23%) | .16 |
| PVD—no. (%) | 77 (8%) | 26 (13%) | .07 |
| ACE—no. (%) | 335 (37%) | 99 (48%) | .004 |
| Beta—no. (%) | 79 (9%) | 30 (14%) | .01 |
| Statin—no. (%) | 333 (37%) | 104 (50%) | .0003 |
| Current smoking—no. (%) | 89 (10%) | 18 (9%) | .62 |
| Aspirin—no. (%) | 404 (44%) | 97 (47%) | .55 |
| CAN testing | |||
| HR-DB (beats) (mean ± SD) | 8.39 ± 4.84 | 5.60 ± 4.14 | <.0001 |
| HR-DB (ratio) during deep breathing (mean ± SD) | 1.14 ± .09 | 1.09 ± .08 | <.0001 |
| Standing heart rate ratio (mean ± SD) | 1.25 ± .15 | 1.15 ± .13 | <.0001 |
| Lowest quartile standing heart rate ratio—no. (%) | 148 (16%) | 96 (46%) | <.0001 |
| Resting heart rate (mean ± SD) | 69 ± 10 | 73 ± 11 | .0007 |
| BP-StandSBP change on standing (mean ± SD) | 1.25 ± .15.0 | 3.05 ± 14.5 | .12 |
| DBP increase with handgrip (mmHg) (mean ± SD) | 18.5 ± 9.6 | 17.9 ± 8.8 | .45 |
| LF power (mean ± SD) | 438 ± 572 | 196 ± 237 | <.0001 |
| HF power (mean ± SD) | 213 ± 186 | 98 ± 80 | <.0001 |
| LF:HF (mean ± SD) | 3.4 ± 3.0 | 2.9 ± 2.7 | .05 |
SD: standard deviation; HbA1C: glycated hemoglobin; DBP: diastolic blood pressure; HDL: high-density lipoprotein cholesterol; HF: high-frequency power; LDL: low-density lipoprotein cholesterol; LF: lower frequency power; PP: pulse pressure; PVD: peripheral vascular disease; SBP: systolic blood pressure; TG: triglycerides; CAD: coronary artery disease; ACE: angiotensin-converting enzyme; CAN: cardiac autonomic neuropathy; HR-DB: heart rate changes during deep breathing; BP-Stand: SBP change on standing.
Lowest quartile of Valsalva is ⩽1.37 with Anscore or 1.17 with Holter.
Numbness, tingling, or pain in extremities; diminished sensation, vibration, or reflex.
Gastric bloating, postural dizziness, or erectile dysfunction.