Progression of Cardiovascular Autonomic Dysfunction in Patients With Type 2 Diabetes

Ko, Seung‐Hyun; Park, Shin-Ae; Cho, Jae‐Hyoung; Song, Ki‐Ho; Yoon, Kun‐Ho; Cha, Bong-Yun; Son, Ho‐Young; Yoo, Ki‐Dong; Moon, Keon-Woong; Park, Young Jun; Ahn, Yu-Bai

doi:10.2337/dc08-0682

Cited by 36 publications

(25 citation statements)

References 26 publications

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“…These include hyperglycemia induced autonomic neuropathy and resultant cardiac autonomic dysfunction 21, 22 and direct effects upon myocardial structure and function. 23 The autonomic dysfunction associated with hyperglycemia is characterized by sympathetic over-activity, cardiac denervation, increased resting heart rate, and reduced heart rate variability, 21 all markers of elevated SCD risk.…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin A1c levels and risk of sudden cardiac death: A nested case-control study

et al. 2017

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Background Sudden cardiac death (SCD) is often the first manifestation of cardiovascular disease (CVD) and preventive strategies within this broad population are lacking. Patients with diabetes represent a high risk subgroup, but few data exist regarding whether measures of glycemia mediate risk and/or add to SCD risk stratification. Objective Examine the association between hemoglobin A1c (HbA1c) and SCD. Methods We performed a case-control analysis among individuals enrolled in 6 prospective cohort studies. HbA1c levels were determined for 482 cases of SCD and 914 matched controls. Conditional logistic regression with fixed effects meta-analysis was used for analysis. Results In multivariable models, HbA1c levels were linearly associated with SCD risk over a follow-up of 11.3 years (P<0.001). Each 1% increment in HbA1c was associated with a hazard ratio (HR) of 1.32 (95% CI 1.16–1.50). The magnitude of the association was greater in subjects without versus with known CVD [HR per 1% increment 1.64 (95% CI 1.31–2.06) versus 1.15 (95% CI 0.99–1.33); P interaction = 0.009]. In models simultaneously controlling for diabetes status and HbA1c, the association between HbA1c and SCD remained significant (HR 1.29; 95% CI 1.07–1.55, P=0.01); whereas the association between diabetes and SCD was attenuated (RR 1.21, 95% CI 0.64–2.27, P=0.56). Conclusions In these prospective cohorts, HbA1c levels associated with SCD risk, particularly among those without known CVD, even after controlling for diabetes status. These data support the hypothesis that hyperglycemia mediates SCD risk among patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Hemoglobin A1c levels and risk of sudden cardiac death: A nested case-control study

et al. 2017

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“…For example, the EURODIAB study showed that the presence of retinopathy and albuminuria was associated with CAN 13. A large cohort study of 1,021 T2DM patients with CAN demonstrated that over a 7.5-year follow-up diabetic retinopathy (OR 1.513, 95% CI 1.028–2.226; P =0.036) and higher levels of micro-albuminuria (OR 1.515, 95% CI 1.031–2.228; P =0.035) predicted CAN progression 35. Similar results were found in a more recent study 36…”

Section: Can Risk Factorsmentioning

confidence: 99%

Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives

Fisher

Tahrani

2017

DMSO

114

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Cardiac autonomic neuropathy (CAN) is a common and often-underdiagnosed complication of diabetes mellitus (DM). CAN is associated with increased mortality, cardiovascular disease, chronic kidney disease, and morbidity in patients with DM, but despite these significant consequences CAN often remains undiagnosed for a prolonged period. This is commonly due to the disease being asymptomatic until the later stages, as well as a lack of easily available screening strategies. In this article, we review the latest developments in the epidemiology, pathogenesis, diagnosis, consequences, and treatments of CAN in patients with DM.

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“…Several studies have indicated that the prevalence of CAN ranges from 20 to 80% in patients with type 2 diabetes (3)(4)(5). Various factors, such as increased age, diabetes duration, the presence of microvascular complications, and glycemic control status, correlate with the development of CAN (3,6).…”

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confidence: 99%

Cardiovascular Autonomic Dysfunction Predicts Severe Hypoglycemia in Patients With Type 2 Diabetes: A 10-Year Follow-up Study

et al. 2013

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OBJECTIVEThe aim of this study was to investigate the development of severe hypoglycemia (SH) in the presence of cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes. RESEARCH DESIGN AND METHODSFrom January 2001 to December 2002, a total of 894 patients with type 2 diabetes were enrolled. A cardiovascular autonomic function test (AFT) was performed using the following heart rate variability parameters: expiration-to-inspiration ratio, response to Valsalva maneuver, and standing. From the results for each of the three tests (0 for normal, 1 for abnormal), a total AFT score of 1 was defined as early CAN, and an AFT score of ‡2 was defined as definite CAN. RESULTSThe median follow-up time was 9.5 years. The mean age was 54.5 6 10.1 years, and the mean duration of diabetes was 8.9 6 6.3 years. One hundred ninety-six patients (31.4%) showed an abnormal cardiovascular AFT score at baseline. Sixtytwo patients (9.9%) experienced 77 episodes of SH (1.33 per 100 patient-years). The number of SH events increased as the CAN score increased (23 CONCLUSIONSDefinite CAN was an independent prognostic factor for the development of SH in patients with type 2 diabetes.

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Progression of Cardiovascular Autonomic Dysfunction in Patients With Type 2 Diabetes

Cited by 36 publications

References 26 publications

Hemoglobin A1c levels and risk of sudden cardiac death: A nested case-control study

Hemoglobin A1c levels and risk of sudden cardiac death: A nested case-control study

Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives

Cardiovascular Autonomic Dysfunction Predicts Severe Hypoglycemia in Patients With Type 2 Diabetes: A 10-Year Follow-up Study

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