Association Between Systemic Inflammation, Carotid Arteriosclerosis, and Autonomic Dysfunction


Systemic inflammation is associated with arteriosclerotic disease progression and worse stroke outcome in patients with carotid arteriosclerotic disease. We hypothesize that systemic inflammation is mediated by impaired carotid baroreceptor and chemoreceptor function induced by carotid arteriosclerosis rather than by the generalized inflammatory arteriosclerotic process.

Heart rate variability (HRV), serum levels of inflammatory markers, demographic and life style factors, and concomitant diseases with potential impact on systemic inflammation were determined in 105 patients with asymptomatic carotid stenosis of varying degree. Multivariate linear regression analyses were performed to ascertain independent determinants of carotid stenosis severity, autonomic function, and inflammation.

Systemic inflammation (C-reactive protein, beta = .255; P = .014), age (beta = .232; P < .008), and arterial hypertension (beta = .206; P = .032) were associated with carotid stenosis severity. Only carotid stenosis severity and not generalized arteriosclerotic disease, concomitant diseases (arterial hypertension, diabetes mellitus, dyslipidemia, hypothyroidism), life style factors (smoking, obesity), or age was associated with a reduction in vagal tone (HRV HF band power beta = − .193; P < 0.049). Systemic inflammation was related to a reduction in vagal tone (HRV HF band power, beta = − .214; P = .031), and not to generalized arteriosclerotic disease, concomitant diseases (arterial hypertension, diabetes mellitus, dyslipidemia), life style factors (smoking, obesity), and age.

In conclusion, systemic inflammation is associated with carotid rather than with generalized arteriosclerotic disease. The association between systemic inflammation and carotid arteriosclerosis is mediated by a reduction in vagal tone which indicates a major role of carotid arteriosclerosis-mediated autonomic dysfunction in the pathogenesis of systemic inflammation in arteriosclerotic disease.

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We thank all patients who participated at the study. We are grateful to J. Ehrhardt for help in data analysis and manuscript preparation. We further thank Nasim Kroegel for language editing and J Geiling for the anatomical drawings.


The study was supported by the Reinhard-Loewenstein-Foundation and the Else Kröner-Fresenius-Foundation.

Author information

S. Rupprecht was principal investigator and takes full responsibility for data integrity and accuracy of data analysis. He conceived the study, supervised data analysis, and drafted the manuscript. S. Finn recruited patients, performed the autonomic measurements, and analyzed the autonomic data. A. Guenther recruited patients, interpreted the data, and revised the manuscript. D. Hoyer analyzed autonomic data, interpreted the data, and revised the manuscript. O.W. Witte and M. Schwab interpreted the data and revised the manuscript.

Correspondence to Sven Rupprecht.

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Rupprecht, S., Finn, S., Hoyer, D. et al. Association Between Systemic Inflammation, Carotid Arteriosclerosis, and Autonomic Dysfunction. Transl. Stroke Res. 11, 50–59 (2020) doi:10.1007/s12975-019-00706-x

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  • Inflammation
  • Autonomic nervous system
  • Atherosclerosis
  • Carotid stenosis