The influence of cardiovascular autonomic neuropathy on mortality in type 1 diabetic patients; 10-year follow-up

Abstract

Aim. The aim of our retrospective study was to answer the question if the presence of cardiovascular autonomic neuropathy (CAN) affects mortality in type 1 diabetic patients during a 10-year follow-up. Methods. Patients with type 1 diabetes mellitus examined for CAN in 2003 were enrolled in this retrospective study. A total of 278 patients were included and divided into two groups according to the presence or absence of CAN (111 CAN+, 167 CAN-). The group characteristics and outcomes were compared at baseline and after ten years (in 2013). Results. In the follow-up period, a total of 18 patients died; CAN+ (14/111; 12.6%) and CAN-(4/167; 2.4%) (P < 0.001). At baseline, the CAN+ patients were older (47 vs. 33 years; P < 0.001), had longer duration of diabetes (20 vs. 12 years; P < 0.05), had worse glycemic control assessed by HbA1c (73 vs. 68 mmol/mol; P < 0.05), higher systolic (130 vs. 120 mmHg; P < 0.001) and diastolic (80 vs. 70 mmHg; P < 0.01) blood pressure and had more diabetic complications. In our analysis we found the strongest predictor of mortality to be the presence of CAN (P < 0.01) and the blood pressure value at baseline (P < 0.05). Other baseline characteristics, including the duration of diabetes, age and the presence of micro-and macrovascular complications were not significant. The statistical analysis was performed using logistic regression step-wise analysis. Conclusions. During the 10-year follow-up, CAN+ patients had a 5-fold higher mortality rate than CAN-patients. The strongest predictor of mortality was the presence of CAN.

Analysis of the association between glucose profiles and β‐cell function for diabetic cardiovascular autonomic neuropathy in China

“…Additionally, the lipid profile and its severity associated with DCAN was also reported. Other studies have shown that diabetes mellitus, duration of diabetes mellitus and poor blood glucose control are associated with the progression of DCAN in diabetes patients.…”

“…Other studies have shown that diabetes mellitus, duration of diabetes mellitus and poor blood glucose control are associated with the progression of DCAN in diabetes patients [11][12][13] .…”

Nocturnal ventricular arrhythmias are associated with the severity of cardiovascular autonomic neuropathy in type 2 diabetes

“…It has been demonstrated that CAN is associated with several cardiovascular risk factors, such as hypertension, smoking, and obesity, cardiovascular disease and the use of antihypertensive drugs . Cardiovascular autonomic neuropathy is also an independent risk factor for silent ischemia, myocardial dysfunction, and major cardiovascular events . In addition, definite CAN is not only a predictor for recurrent cardiovascular disease, but has been also associated with increased all‐cause mortality in diabetic patients …”

“…2 Cardiovascular autonomic neuropathy is also an independent risk factor for silent ischemia, myocardial dysfunction, and major cardiovascular events. [3][4][5][6] In addition, definite CAN is not only a predictor for recurrent cardiovascular disease, 7 but has been also associated with increased all-cause mortality in diabetic patients. 8 There have been several studies of nocturnal arrhythmias associated with sudden death or dead-in-bed syndrome.…”

Diabetic autonomic polyneuropathy

“…Авторы обнаружили, что наиболее сильным предиктором смертности были наличие КАН (р<0,01) и исходный уровень артериального давления (р<0,05). Другие характеристики, включая продолжительность диабета, возраст и наличие микро-и макрососудистых осложнений, не были статистически значимыми [15].…”