Introduction. Obesity has reached the scale of a global noncommunicable pandemic: according to the World Health Organization, more than one billion people worldwide are affected by this disease. Of particular concern is the increasing prevalence of obesity among the working-age population and its association with cardiovascular complications. A key pathophysiological mechanism underlying these complications is autonomic nervous system imbalance, which is objectively reflected by heart rate variability parameters. The aim of this review is to analyze current evidence on the pathophysiological mechanisms of heart rate variability disturbances in patients with obesity, their clinical significance, and potential approaches to their correction.
Materials and methods. Materials from Russian and international publications addressing heart rate variability in patients with metabolic syndrome and obesity published between 2009 and 2025 were reviewed. The literature search was conducted using open-access electronic databases, including PubMed, CyberLeninka, and eLibrary. A unified search strategy was applied throughout the review process. The following combinations of keywords and phrases were used: “heart rate variability and obesity”, “heart rate variability and metabolic syndrome”, and “heart rate variability and obstructive sleep apnea syndrome”. Conference abstracts, studies with limited representativeness of the reported results, and animal studies were excluded. Data retrieval was performed between January 10, 2026, and February 20, 2026.
Results. Current evidence on the mechanisms underlying impaired heart rate variability in obesity, methods for its quantitative assessment, and the clinical application of heart rate variability monitoring has been systematized. The review examines the pathophysiological pathways of autonomic imbalance, the role of visceral adipose tissue and adipokines, as well as the impact of comorbid conditions such as metabolic syndrome and obstructive sleep apnea syndrome. Algorithms for the interpretation of heart rate variability parameters, their prognostic value, and potential corrective strategies are presented. Particular emphasis is placed on heart rate variability as an integrative marker of cardiovascular risk and a tool for the personalization of therapy.
ะกonclusion. Obesity, particularly visceral obesity, has been shown to cause autonomic imbalance characterized by reduced overall heart rate variability, suppression of parasympathetic activity, and hyperactivation of the sympathetic nervous system. The key mechanisms involved in the pathogenesis include the endocrine activity of visceral adipose tissue, systemic inflammation, insulin resistance and hyperinsulinemia, oxidative stress and endothelial dysfunction, as well as associated comorbid conditions. These mechanisms mutually reinforce one another. The clinical significance of heart rate variability lies in cardiovascular risk stratification, as reduced heart rate variability is an independent predictor of adverse outcomes, and in monitoring treatment efficacy, since improvements in heart rate variability correlate with weight reduction and the amelioration of metabolic disturbances.
DOI: 10.15507/3034-6231.26022.150-164
Publication Date: 2026-06-18