A comparative study of autonomic nervous system dysfunction in post menopausal women with diabetes and without diabetes as a predictor of cardiovascular events

Abstract

Cardiovascular diseases (CVDs) are one of the leading caus­es of death in women across the globe. CVD is more prevalent in women after menopause due to the lack of estrogens which have a cardioprotective effect Menopause and diabetes mellitus are individually high risk for cardiovascular autonomic neuropathy which in turn results in CV accidents and deaths. The aim of this study was to evaluate the Autonomic Nervous System dysfunctions in post menopausal women with diabetes mellitus, to grade the severity of dysfunctions and to compare the severity of the ANS dysfunction with age matched healthy controls.This observational study was conducted in the department of Obstetrics and Gynecology, Akash Institute of Medical Sciences & Research Centre, Devanahalli, Bengaluru, Karnataka, India. A total of 120 postmenopausal women were examined for the study. They were divided into two equal groups (60 women in each group) as menopausal women with diabetes and without diabetes. The ANS dysfunctions were evaluated based on symptoms and also specific tests like heart rate response to Valsalva maneuver, heart rate response to standing up from supine position, blood pressure response to sustained handgrip, blood pressure response to standing up from supine position. The ANS dysfunctions were categorized into mild, moderate and severe dysfunctions.Of the 60 postmenopausal women without diabetes, 20 women had symptoms of autonomic dysfunction in the form of hot flushes, giddiness and palpitations, (33%) and they also tested positive for ANS dysfunction. Though the remaining 40 women did not have any symptoms, they tested positive for ANS dysfunction. 40 women had mild ANS dysfunctions, 12 had moderate dysfunctions and 8 had severe dysfunctions. In the other group of postmenopausal women with diabetes, 30 women had symptoms of ANS dysfunction (50%) and also tested positive for ANS dysfunction. The remaining 30 women, though did not have any symptoms, they also tested positive for ANS dysfunctions. 30 of them had mild dysfunctions, 18 had moderate dysfunctions and 12 had severe dysfunctions.Our study has broadly shown that postmenopausal women suffer from autonomic derangements, and degree and severity of such derangements are much higher in post menopausal women with diabetes mellitus and are possibly at an increased risk of developing heart disease. Hence early detection, good control of diabetes and early detection of autonomic dysfunction and management is important in these women.