Introduction:
Heart rate variability (HRV) is a non-invasive method for assessing autonomic nervous system function that plays an important role in physiological regulation and may provide complementary information on autonomic alterations associated with cardiometabolic disorders.

Aim:
To summarize current scientific evidence on the role of HRV alterations in major metabolic disorders and also to identify common autonomic patterns across different stages of cardiometabolic disease progression and evaluate the potential role of HRV as an early marker of cardiometabolic risk.

Material and methods:
A narrative review of clinical studies on HRV in patients with cardiometabolic disorders (obesity, dyslipidemia, hypertension, type 2 diabetes mellitus (T2DM)) was performed. Literature was searched in PubMed, Scopus, Web of Science, and Google Scholar using relevant keywords, mainly covering the last five years.

Results and discussion:
Metabolic disorders are characterized by autonomic imbalance with predominance of sympathetic activity and reduced parasympathetic tone. This is reflected by decreased SDNN, RMSSD, pNN50, and HF, along with increased LF and LF/HF ratio. These changes have been reported at early subclinical stages and are associated with blood pressure, glycemia, insulin resistance, lipid profile, and anthropometric parameters. Comorbid conditions are associated with more pronounced HRV reduction and progressive autonomic dysregulation.

Conclusions:
The findings of this review suggest that HRV alterations may represent a potential marker of metabolic disorders and a promising adjunctive tool for cardiometabolic risk stratification, early diagnosis, and monitoring of metabolically associated diseases.