Relationship between cardiovascular autonomic neuropathy and coronary artery calcification in patients with type 2 diabetes

Moon, Su Ho; Choi, Young Yeon; Seo, Hyun-Ae; Jeon, Jae‐Han; Lee, Jung-Eun; Lee, Jeong Eon; Lee, Juyoung; Lee, Duk-Hee; Park, Wanju; Kim, Jung‐Guk; Kim, Bo-Wan; Lee, Inkyu

doi:10.1507/endocrj.k09e-299

Cited by 14 publications

(21 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of these, 53.5% were diagnosed as having early CAN. This result is consistent with other studies [32,33]. In the study of Vinik et al, the prevalence of CAN was approximately 34% among individuals with type 2 diabetes, when diagnostic criteria are based upon at least two abnormalities in the autonomic function tests [27].…”

Section: Discussionsupporting

confidence: 90%

“…In accordance with the results of study by Moon et al, out of the five tests used to determine the CAN score, abnormal responses were most frequently found for the heart rate response to the deep breathing test [33]. In contrast, Ko et al, reported that the abnormal response to valsalva maneuver was the most frequent [37].…”

Section: Discussionsupporting

confidence: 74%

“…In the study of Vinik et al, the prevalence of CAN was approximately 34% among individuals with type 2 diabetes, when diagnostic criteria are based upon at least two abnormalities in the autonomic function tests [27]. This is comparable with another Korean data by Moon et al, who reported that the prevalence of CAN in diabetics is 26.3% and 65.3% had early CAN [33]. Among the 21 patients with newly diagnosed diabetes at baseline, three (14.3%) showed CAN in our study.…”

Section: Discussionmentioning

confidence: 63%

See 2 more Smart Citations

Association of serum adipocytokine levels with cardiac autonomic neuropathy in type 2 diabetic patients

Jung

Kim

et al. 2012

Cardiovasc Diabetol

View full text Add to dashboard Cite

BackgroundCardiac autonomic neuropathy (CAN) is a common complication of diabetes associated with poor prognosis. In addition, the autonomic imbalance is associated with cardiovascular disease (CVD) in diabetes. It is thought that adipocytokines contribute to the increased risk of vascular complications in patients with type 2 diabetes mellitus (T2DM). However, literature data on the association between CAN with adipocytokines such as leptin, tumor necrosis factor-alpha (TNF-alpha), adiponectin in subjects with T2DM is limited.Therefore, in the present study, we examined the relationship between fasting serum leptin, TNF- alpha and adiponectin and CAN in Korean T2DM patients.MethodsA total of 142 T2DM patients (94 males, 48 females) were recruited. CAN was assessed by the five tests according to the Ewing's protocol and the time and frequency domain of the heart rate variability (HRV) was evaluated. Serum TNF-alpha and adiponectin levels were measured using enzyme-linked immunosorbent assay and serum leptin levels were measured using radioimmunoassay.ResultsAlthough, the mean levels of leptin, TNF-alpha and adiponectin were not significantly different between the groups with and without CAN, the levels of leptin and adiponectin had a tendency to increase as the score of CAN increased (p = 0.05, p = 0.036). Serum leptin levels demonstrated a negative correlation with low frequency (LF) in the upright position (p = 0.037). Regarding TNF-alpha, a significant negative correlation was observed with SDNN and RMSSD in the upright position (p = 0.023, p = 0.019). Adiponectin levels were not related to any HRV parameters. Multivariate logistic regression analysis demonstrated that the odds of CAN increased with a longer duration of diabetes (1.25, [1.07-1.47]) and higher homeostatic model of assessment-insulin resistance (HOMA-IR) (5.47, [1.8-16.5]). The relative risks for the presence of CAN were 14.1 and 51.6 for the adiponectin 2nd, 3rd tertiles when compared with first tertile (p-value for trend = 0.022).ConclusionsIn the present study, the higher serum adiponectin levels and HOMA-IR were associated with an increased risk for the presence of CAN. Also, the CAN score correlated with the serum adiponectin. Serum adipocytokines such as leptin and TNF-alpha were significantly correlated with parameters of HRV, representative markers of CAN. Future prospective studies with larger number of patients are required to establish a direct relationship between plasma adipocytokine concentrations and the development or severity of CAN.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 63%

See 1 more Smart Citation

Association of serum adipocytokine levels with cardiac autonomic neuropathy in type 2 diabetic patients

Jung

Kim

et al. 2012

Cardiovasc Diabetol

View full text Add to dashboard Cite

show abstract

“…An association between CACS and reduced cardiac autonomic function has recently been reported in both type 1 (40–42) and type 2 (43) diabetes. Colhoun et al (40) observed an association between CACS and CAN independent of age and triglycerides but not independent of BMI and SBP.…”

Section: Discussionmentioning

confidence: 92%

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

et al. 2012

View full text Add to dashboard Cite

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.

show abstract

“…Numerous clinical studies that have examined the association between CAN and mortality or CAN and silent myocardial ischemia used the CAN definition of an abnormal result on at least two of the five tests [3,4]. Additionally, a study that examined the relationship between CAN and coronary artery calcification in Korean patients with T2DM used the same CAN definition as we used in the present study [5]. However, as mentioned in the letter from the reviewer, we also think that a CAN score ≥2 can be too high to detect early atherosclerotic condition.…”

mentioning

confidence: 99%

Response: Association between Cardiac Autonomic Neuropathy, Diabetic Retinopathy and Carotid Atherosclerosis in Patients with Type 2 Diabetes (Endocrinol Metab 2013;28:309-19, Chan-Hee Jung et al.)

Jung

Mok

2014

Endocrinol Metab

View full text Add to dashboard Cite

Relationship between cardiovascular autonomic neuropathy and coronary artery calcification in patients with type 2 diabetes

Cited by 14 publications

References 40 publications

Association of serum adipocytokine levels with cardiac autonomic neuropathy in type 2 diabetic patients

Association of serum adipocytokine levels with cardiac autonomic neuropathy in type 2 diabetic patients

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

Response: Association between Cardiac Autonomic Neuropathy, Diabetic Retinopathy and Carotid Atherosclerosis in Patients with Type 2 Diabetes (Endocrinol Metab 2013;28:309-19, Chan-Hee Jung et al.)

Contact Info

Product

Resources

About