Risk Factors for the Presence and Progression of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: ADDITION-Denmark

Introduction. Diabetes is strongly associated with macrovascular complications, among which ischemic heart disease is the major cause of mortality. Autonomic neuropathy increases the risk of complications, which calls for an early diagnosis. The aim of this study was to determine both presence and extent of cardiac autonomic neuropathy, in regard to the type of diabetes mellitus, as well as its correlation with coronary disease and major cardiovascular risk factors. Material and methods. We have examined 90 subjects, classified into three groups, with 30 patients each: those with type 1 diabetes, type 2 diabetes and control group of healthy subjects. All patients underwent cardiovascular tests (Valsalva maneuver, deep breathing test, response to standing, blood pressure response to standing sustained, handgrip test), electrocardiogram, treadmill exercise test and filled out a questionnaire referring to major cardiovascular risk factors: smoking, obesity, hypertension, and dyslipidemia. Results. Our results showed that cardiovascular autonomic neuropathy was more frequent in type 2 diabetes, manifesting as autonomic neuropathy. In patients with autonomic neuropathy, regardless of the type of diabetes, the treadmill test was positive, i.e. strongly correlating with coronary disease. In regard to coronary disease risk factors, the most frequent correlation was found for obesity and hypertension. Discussion Cardiovascular autonomic neuropathy is considered to be the principal cause of arteriosclerosis and coronary disease. Our results showed that the occurrence of cardiovascular autonomic neuropathy increases the risk of coronary disease due to dysfunction of autonomic nervous system. Conclusions. Cardiovascular autonomic neuropathy is a common complication of diabetes that significantly correlates with coronary disease. Early diagnosis of cardiovascular autonomic neuropathy points to increased cardiovascular risk, providing a basis for preventive and therapeutic measures. .

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Cardiovascular autonomic neuropathy in people with type 2 diabetes mellitus; investigation of its association with classical cardiovascular risk factors using cardiovascular autonomic reflex tests: a cross-sectional study

The Egyptian Heart Journal ◽

10.1186/s43044-021-00168-3 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Ahmad Osailan

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Autonomic Neuropathy ◽

Cardiovascular Autonomic Neuropathy ◽

Factors Associated ◽

Increased Risk ◽

Autonomic Reflex

Abstract Background People with type 2 diabetes mellitus (DM) are at increased risk of cardiovascular disease (CVD). Cardiovascular autonomic neuropathy (CAN) is an underdiagnosed risk factor for CVD, which is prevalent among people with 2DM and can lead to CVD and CVD-related mortality. Little is known about the risk factors associated with CAN in type 2DM. Thus, the study was aimed to assess CAN using five cardiovascular autonomic reflex tests (represented by Ewing’s score) and explore the factors associated with CAN in people with type 2DM. The studied factors include traditional and serological CVD risk factors obtained from a fasting blood sample and cardiorespiratory fitness (CRF) obtained via attainment of the highest peak of volumes of O2 (VO2Peak). Results Univariate analysis revealed a significant positive correlation between resting systolic blood pressure (SBP) and Ewing’s score (r=0.47, p=.02) and an inverse correlation between VO2Peak and Ewing’s score (r=−0.64, p=.001). Multivariate linear regression revealed that a significant model that included resting SBP and VO2Peak explained 93.8% of Ewing’s score variance. Conclusion CAN was associated with two CVD parameters, including resting SBP and CRF, which may indicate the importance of controlling these two factors to prevent or reduce CAN in people with type 2DM.

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321-OR: A Genetic Locus on Chromosome 1p36 Associated with Cardiovascular Autonomic Neuropathy in Type 2 Diabetes

Diabetes ◽

10.2337/db19-321-or ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 321-OR

Author(s):

YALING TANG ◽

HETAL SHAH ◽

XIUQIN SUN ◽

BRUCE A. PERKINS ◽

MICHAEL J. WAGNER ◽

...

Keyword(s):

Type 2 Diabetes ◽

Autonomic Neuropathy ◽

Genetic Locus ◽

Cardiovascular Autonomic Neuropathy ◽

Chromosome 1P36

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A study of cardiological autonomic neuropathy in Type 2 Diabetes Mellitus with reference to QT interval for its diagnosis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192880 ◽

2019 ◽

Vol 7 (7) ◽

pp. 2574

Author(s):

Lakshmi Priya Inapakolla ◽

Ramgopal Teja Kotla

Keyword(s):

Type 2 Diabetes ◽

Autonomic Neuropathy ◽

Autonomic Dysfunction ◽

Cardiovascular Autonomic Neuropathy ◽

Cardiac Autonomic Neuropathy ◽

P Value ◽

Qtc Interval ◽

Duration Of Diabetes ◽

Cardiac Autonomic Dysfunction

Background: Presence of cardiac autonomic neuropathy (CAN) is responsible for silent myocardial infarction and sudden death in diabetics. Hence recognizing cardiac dysautonomia early, which is asymptomatic will help to delay or arrest its progression.Methods: A cross-sectional study to evaluate the Prevalence of Cardiovascular Autonomic Neuropathy in Type 2 diabetes and correlate it with duration of Diabetes and to investigate the relationship between cardiac autonomic dysfunction and corrected QT interval.Results: In the study population, the prevalence of definite CAN was 8%, 24% and 58% in group A, B and C respectively. The prevalence of definite CAN increases with increase in duration of diabetes. P value <0.001 significant.Conclusions: A significant correlation is present between Cardiovascular autonomic dysfunction and QTc prolongation. QTc interval in the ECG can be used to diagnose Cardiovascular autonomic neuropathy with a reasonable sensitivity and specificity.

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The Association Between Continuous Glucose Monitoring-derived Metrics, Including Time in Range, and Cardiovascular Autonomic Neuropathy in Outpatients With Type 2 Diabetes

10.21203/rs.3.rs-101449/v1 ◽

2020 ◽

Author(s):

Min Young Kim ◽

Gyuri Kim ◽

Ji Yun Park ◽

Min Sun Choi ◽

Ji Eun Jun ◽

...

Keyword(s):

Type 2 Diabetes ◽

Autonomic Neuropathy ◽

Autonomic Function ◽

Glucose Monitoring ◽

Glycemic Variability ◽

Cardiovascular Autonomic Neuropathy ◽

Inverse Association ◽

International Consensus ◽

Time In Range

Abstract BackgroundContinuous glucose monitoring (CGM)-derived metrics including time in range (TIR) are attracting attention as new indicators of glycemic control and diabetes complications beyond hemoglobin A1c. This study investigated the association between CGM-derived TIR, hyperglycemia, hypoglycemia metrics, and cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes.MethodsA total of 284 patients with type 2 diabetes who underwent CGM for three days and autonomic function tests within three months based on outpatient data were recruited. The definition of CGM-derived metrics was subject to the most recent international consensus. CAN was defined as an abnormal case in two or more parasympathetic and the severity of CAN was estimated as the sum of the scores of the five cardiovascular autonomic function tests.ResultsMultiple logistic regression analysis revealed that the odds ratio of definite CAN was 0.876 [95% confidence interval (CI): 0.79–0.98] per 10% increase in the TIR of 70 to 180 mg/dL, after adjusting for age, sex, diabetes duration, any medications, and glycemic variability. A 10% increase in TIR was significantly inversely associated with the presence of advanced CAN (OR: 0.89, 95% CI: 0.81–0.98). In addition, there was a strong inverse association between a 10% increase in the TIR and the total CAN score (p for trend = 0.001). Among the metrics of hyperglycemia, a time above range (TAR) of greater than 180 mg/dL was also independently correlated with the presence of definite CAN (OR: 1.013, 95% CI: 1.00–1.02) and advanced CAN (OR: 1.01, 95% CI: 1.00–1.02).ConclusionsA TIR value of 70 to 180 mg/dL and a TAR value of greater than 180 mg/dL were significantly associated with cardiovascular autonomic neuropathy in outpatients with type 2 diabetes.

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Intensive risk factor management and cardiovascular autonomic neuropathy in type 2 diabetes: the ACCORD Trial

10.2337/figshare.13020338.v1 ◽

2020 ◽

Author(s):

Yaling Tang ◽

Hetal Shah ◽

Carlos Roberto Bueno Junior ◽

Xiuqin Sun ◽

Joanna Mitri ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Autonomic Neuropathy ◽

Pressure Control ◽

Cardiovascular Autonomic Neuropathy ◽

Risk Factor Management ◽

Traditional Risk Factors ◽

Intensive Blood Pressure

Objectives: The effects of preventive interventions on cardiovascular autonomic neuropathy (CAN) remain unclear. We examined the effect of intensively treating traditional risk factors for CAN, including hyperglycemia, hypertension, and dyslipidemia, in persons with type 2 diabetes (T2D) and high cardiovascular risk participating in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Research Design and Methods: CAN was defined as heart rate variability indices below the 5th percentile of the normal distribution. Of 10,250 ACCORD participants, 71% (n=7,275) had a CAN evaluation at study entry and at least once after randomization. The effects of intensive interventions on CAN were analyzed among these subjects through generalized linear mixed models. Results: As compared to standard intervention, intensive glucose treatment reduced CAN risk by 16% (OR=0.84, 95%CI 0.75–0.94, p=0.003) – an effect driven by individuals without cardiovascular disease (CVD) at baseline (OR= 0.73, 95%CI 0.63–0.85, p<0.0001) rather than those with CVD (OR=1.10, 95%CI 0.91–1.34, p=0.34) (p for interaction=0.001). Intensive blood pressure intervention decreased CAN risk by 25% (OR=0.75, 95% CI 0.63–0.89, p=0.001), especially in patients ≥65 years old (OR=0.66, 95% CI 0.49–0.88, p=0.005) (p for interaction =0.05). Fenofibrate did not have a significant effect on CAN (OR=0.91, 95%CI 0.78–1.07, p=0.26). Conclusions: These data confirm a beneficial effect of intensive glycemic therapy and demonstrate, for the first time, a similar benefit of intensive blood pressure control on CAN in T2D. A negative CVD history identifies T2D patients who especially benefit from intensive glycemic control for CAN prevention.

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