Cardiovascular Autonomic Neuropathy and Subclinical Cardiovascular Disease in Normoalbuminuric Type 1 Diabetic Patients

Abstract

Cardiovascular autonomic neuropathy (CAN) is associated with increased mortality in diabetes. Since CAN often develops in parallel with diabetic nephropathy as a confounder, we aimed to investigate the isolated impact of CAN on cardiovascular disease in normoalbuminuric patients. Fifty-six normoalbuminuric, type 1 diabetic patients were divided into 26 with (+) and 30 without (−) CAN according to tests of their autonomic nerve function. Coronary artery plaque burden and coronary artery calcium score (CACS) were evaluated using computed tomography. Left ventricular function was evaluated using echocardiography. Blood pressure and electrocardiography were recorded through 24 h to evaluate nocturnal drop in blood pressure (dipping) and pulse pressure. In patients +CAN compared with −CAN, the CACS was higher, and only patients +CAN had a CACS >400. A trend toward a higher prevalence of coronary plaques and flow-limiting stenosis in patients +CAN was nonsignificant. In patients +CAN, left ventricular function was decreased in both diastole and systole, nondipping was more prevalent, and pulse pressure was increased compared with −CAN. In multivariable analysis, CAN was independently associated with increased CACS, subclinical left ventricular dysfunction, and increased pulse pressure. In conclusion, CAN in normoalbuminuric type 1 diabetic patients is associated with distinct signs of subclinical cardiovascular disease.

Low Prevalence of Subclinical Atherosclerosis in Asymptomatic Patients With Type 1 Diabetes in a European Mediterranean Population

“…Other studies by Colhoun et al (16) and Dabelea et al (23) displayed a smaller proportion of patients with CACS of 0 than our study despite that mean age and duration of type 1 diabetes were similar. Long duration of disease and the presence of autonomic cardiovascular neuropathy are also associated with high CACS (26). None of our patients presented clinical signs of dysautonomia, although no specific procedures were performed to rule it out.…”

Cardiovascular Autonomic Neuropathy Is Associated With Macrovascular Risk Factors in Type 2 Diabetes

“…7,8 A recent publication suggests that CAN in normoalbuminuric type 1 patients is associated with distinct signs of subclinical cardiovascular disease. 9 In this context early testing of CAN is an important risk marker and predictive for future stroke and (cardiovascular) death, both in the general population and in patients with diabetes. 10,11 Adding to this, there is a link between hypoglycemia and CAN.…”

Glycemic Variability Is Associated With Reduced Cardiac Autonomic Modulation in Women With Type 2 Diabetes

“…Cardiac autonomic modulation was measured noninvasively with HRV in the resting state and during active tests, which is a well-established diagnostic method to assess cardiac autonomic neuropathy in patients with diabetes (16). Cardiac autonomic neuropathy is a severe complication of diabetes and is associated with impaired left ventricular function, impaired dilations of coronary resistance vessels, unawareness of hypoglycemia, exercise intolerance, increased intraoperative cardiovascular risk, increased arterial pulse pressure, and a higher prevalence of reduced circadian variation in blood pressure (31). Furthermore, cardiac autonomic neuropathy has been associated with an increased risk of compromised cerebral blood flow (32,33), hypertension (34), silent myocardial ischemia (35), and higher cardiovascular mortality (10).…”