Diabetic Cardiovascular Neuropathy

Abstract

Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus, that is strongly associated with increased risk of cardiovascular mortality. Although it is common complication, the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today. In this review we have analyzed the existing data about the known risk factors, screening and diagnostic algorithm, staging of CAN and possible treatment, including effectiveness of lifestyle modification, intensive glycemic control; treatment of diabetic dyslipidemia; antioxidants; vitamins; correction of vascular endothelial dysfunction; prevention and treatment of thrombosis; treatment of orthostatic hypotension. Conclusion 88References 89 Abbreviations list 108Victoria Serhiyenko, Alexandr Serhiyenko 7 ABOUT THE AUTHORSVictoria A Serhiyenko, MD, PhD in Medicine Sciences, DMSc, Associate Professor of the Department of Endocrinology, Lviv National Medical University named by Danylo Halitsky, Lviv, Ukraine. At the moment she is working on the problems concerted with the revelation of the correlating connections between activities of some metabolic, hormonal and other parameter, and state of the proand anti-inflammatory factors in blood in patients with diabetes mellitus which depends on the character of diabetic complications. The second part of his scientific work is the research of the effectively of the benfotiamine in treatment and prevention of diabetic complications in clinical practice.Victoria Serhiyenko has published 238 scientific papers. These works are devoted to the problems of pathogenesis, diagnosis and treatment, prevention of the diabetic cardiovascular autonomic neuropathy.Alexandr A Serhiyenko, MD, PhD in Medicine Sciences, DMSc, Professor of the Department of Endocrinology, Lviv National Medical University named by Danylo Halitsky, Lviv, Ukraine. At the moment he is working on the problems concerted with the revelation of the correlating connections between activities of some metabolic parameters in patients with diabetes mellitus which depends on the character of diabetic complications. The second part of her scientific work is the research of the effectively of the benfotiamine in treatment and prevention of diabetic complications in clinical practice.Alexandr Serhiyenko has published 613 scientific papers. These works are devoted to the problems of pathogenesis, diagnosis and treatment, prevention of the diabetic complications.

Потенциальная Роль Бенфотиамина В Лечении Диабетической Автономной Нейропатии Сердца

“…In our previous investigations we have found that in patients with T2DM and definite stage of CAN, QRS-T (78.30 ± 1.95°; p < 0.001), QTc (431.40 ± 2.94 ms; p < 0.001) and QTd (53.70 ± 1.49 ms; p < 0.01) were prolonged compared to patients without CAN [9]. An association between CAN and QT interval prolongation was demonstrated in many studies and it may predispose to sudden death in DM.…”

“…Based on the CAN Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy [1] CAN is defined as the impairment of cardiovascular autonomic control among patients with established DM following the exclusion of other causes. Cardiac autonomic neuropathy among type 2 DM (T2DM) patients that is characterized by lesion of nerve fibers in the sympathetic and parasympathetic divisions of the ANS is diagnosed unsatisfactorily [5][6][7][8][9]. The reduced heart rate variability (HRV) observed in patients with diabetic CAN might indicate lower parasympathetic activity since time-domain measures of HRV and most frequency-domain indices of HRV are an expression of vagal activity [3,10].…”

“…A wider QRS-T angle reflects an abnormal arrangement of ventricular repolarization and has been considered as a strong and independent risk factor for cardiac morbidity and mortality compared to other traditional cardiovascular risk factors and electrocardiographic (ECG) risk indicators such as the length of the QT interval [13][14][15]. The spatial QRS-T angle has recently been shown to be a strong and independent predictor of cardiac mortality in various groups of patients such as those with coronary artery disease (CAD), heart failure, T2DM, and elderly subjects [9,[15][16][17].…”

Diabetic Cardiac Autonomic Neuropathy: Effect of Benfotiamine on the Corrected Qt Interval, Qt Dispersion and Spatial QRS-T Angle

“…CAN manifests in a spectrum of things, ranging from resting tachycardia and fixed heart rate (HR) to development of "silent" myocardial infarction [1][2][3]. The development of CAN is associated with the lesion of the autonomic nervous system, and may be accompanied by coronary vessels ischemia, arrhythmias, "silent" myocardial infarction (MI), severe orthostatic hypotension (OH) and sudden death syndrome [1,[4][5].…”

Diabetic cardiac autonomic neuropathy: Effects of statins and omega-3 polyunsaturated fatty acids on lipid profile and insulin resistance parameters

“…Therefore, the problem of effective CAN treatment is particularly relevant. Pathogenetic treatment of CAN includes diet and physical activity; reducing of insulin resistance (IR); optimal glycemic control; treatment of dyslipoproteinemia (DLP); prevention and treatment of thrombosis; symptomatic treatment [2,[7][8][9][10].…”