Which is responsible for cardiac autonomic dysfunction in non-diabetic patients with metabolic syndrome: Prediabetes or the syndrome itself?

Balcıoğlu, Akif Serhat; Akıncı, Si̇nan; Çiçek, Davran; Eldem, Halil Olcay; Çoner, Ali; Bal, Uğur Abbas; Müderrisoğlu, Haldun

doi:10.1016/j.dsx.2015.09.001

Cited by 12 publications

(15 citation statements)

References 34 publications

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“…Dysglycaemia in prediabetes is a common route to multiple pathophysiological pathways that lead to autonomic neuropathy. Similarly, the findings of Rasic-Milutinovic et al [46] support the notion that continuously elevated glucose level, as a component of the metabolic syndrome, correlates with spectral HRV indices [46]; other supporting data have been published [29]. Interestingly, Rasic-Milutinovic et al [46] also reported disturbed sympathovagal balance with dominant parasympathetic dysfunction in individuals with the metabolic syndrome and type 2 diabetes in keeping with the natural history of CAN.…”

Section: Pathophysiology Of Can In Prediabetessupporting

confidence: 56%

“…Risk factors for CAN include prediabetic and diabetic range dysglycaemia, dyslipidaemia, hypertension, elevated BMI and increased waist circumference [24][25][26]. A number of studies have considered the association between autonomic dysfunction in prediabetes and the metabolic syndrome and have reported an increased prevalence of CAN compared with healthy people [25][26][27][28][29], although this has been contradicted in other published data [30].…”

Section: Introductionmentioning

confidence: 99%

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The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

et al. 2020

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Aims/hypothesis Cardiac autonomic neuropathy (CAN) is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Several studies have highlighted the increased prevalence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose). Considering the exponential rise of prediabetes, we aimed to determine the prevalence of CAN through a systematic literature review. Methods This systematic review was registered with PROSPERO (CRD42019125447). An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, Scopus and Cochrane databases. Published full text, English language articles that provide CAN prevalence data of studies in individuals with prediabetes and aged over 18 years were included. Prevalence data for normal glucose tolerance and diabetes were also extracted from the selected articles, if present. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using a critical appraisal tool. Results Database searches found 4500 articles; subsequently, 199 full text articles were screened, 11 of which fulfilled the inclusion criteria (4431 total participants, 1730 people with prediabetes, 1999 people with normal glucose tolerance [NGT] and 702 people with predominantly type 2 diabetes). Six of the selected studies reported definite CAN prevalence data (9–39%). Only a single large population-based study by Ziegler et al (KORA S4 study, 1332 participants) determined definite CAN based on two or more positive autonomic function tests (AFTs), with a mean prevalence of 9% in all prediabetes groups (isolated impaired glucose tolerance 5.9%; isolated impaired fasting glucose 8.1%; impaired fasting glucose plus impaired glucose tolerance 11.4%), which was higher than NGT (4.5%). This study is most likely to provide a reliable population-specific estimate of CAN in prediabetes. There was a higher than expected prevalence of CAN in prediabetes (9–38%) when compared with normal glucose tolerance (0–18%) within the same studies (n = 8). There was a wide prevalence of possible CAN based on one positive AFT (n = 5). There was heterogeneity between the studies with variations in the definition of CAN, methodology and characteristics of the populations, which likely contributed to the diversity of prevalence estimates. The overall risk of bias was low. Conclusions/interpretation There is a higher than expected prevalence of CAN in prediabetes. Early detection of CAN in prediabetes through population screening needs careful consideration in view of the excess morbidity and mortality risk associated with this condition.

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Section: Pathophysiology Of Can In Prediabetessupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

et al. 2020

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“…The HF parameter ( p < 0.001) and baroreflex sensitivity ( p < 0.05) were diminished in both hypertensive groups [ 28 ]. A prospective study by Balcioğlu et al [ 29 ] ( n = 240) showed significantly decreased HRV parameters (SDNN, SDNN index, SDANN, rMSSD, pNN50) in 24-hour Holter recordings in comparison with those in the control group. Unlike in the studies mentioned above, the lowering of HRV parameters correlated only with fasting glucose levels, with no differences between the groups in terms of the remaining 4 diagnostic criteria of MetS (notably, both study groups included patients with HTN).…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Variability in Patients with Hypertension: the Effect of Metabolic Syndrome and Antihypertensive Treatment

Maciorowska

Krzesiński

Wierzbowski

et al. 2020

Cardiovascular Therapeutics

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Metabolic syndrome (MetS) is a combination of factors which, collectively, increase cardiovascular risk to a greater extent than each of them separately. Previous studies showed high cardiovascular risk to be associated with autonomic nervous system dysfunction. The purpose of this study was to assess the effects of antihypertensive treatment on heart rate variability (HRV) in patients with hypertension (HTN), depending on cooccurrence of MetS. 118 patients with uncontrolled HTN were enrolled to the study. HRV was compared among patients with and without MetS (MetS [+], n = 70 ) at baseline and following 12 months antihypertensive treatment. The HRV indices measured from RR intervals recorded form using 24-hour ambulatory electrocardiography. The measured HRV domains were the standard deviation of the average of NN intervals [SDNN], square root of the mean of the sum of the squares of differences between adjacent NN intervals [rMSSD], percentage of NN50 [pNN50], low frequency [LF], high frequency [HF], total power of variance of all NN intervals [TP], and LF/HF ratio. Baseline parameters: SDNN, rMSSD, pNN50, and HF were significantly lower in the MetS[+] compared to the MetS[-] subgroup ( p < 0.05 ). After a 12-month antihypertensive treatment, MetS[+] patients achieved a significant improvement in parameters: SDNN, rMSSD, pNN50, and TP ( p < 0.05 ), while the changes in HRV observed in the MetS[-] subgroup were not statistically significant. The cooccurrence of HTN and other components of MetS is associated with disturbances of the autonomic balance. HTN control has a beneficial effect on HRV, with the effect being more evident in patients with MetS.

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“…White coat hypertension is significantly associated with a higher prevalence of glucose dysregulation that can be detected by glucose challenge but not a threshold value for fasting blood glucose (56,57). Similarly, in the absence of diabetes, a prediabetic level of fasting blood glucose (Ͼ100 mg/dl) is a better predictor of impaired HR variability and HR turbulence than any other attribute of metabolic syndrome (5). Furthermore, in patients with type 2 diabetes the variability of blood glucose has a highly significant inverse relationship with baroreflex sensitivity (58).…”

Section: Perspectives and Significancementioning

confidence: 99%

Improved glucose homeostasis in male obese Zucker rats coincides with enhanced baroreflexes and activation of the nucleus tractus solitarius

Chaudhary

Schreihofer

2018

American Journal of Physiology-Regulatory, Integrative and Comp

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Chaudhary P, Schreihofer AM. Improved glucose homeostasis in male obese Zucker rats coincides with enhanced baroreflexes and activation of the nucleus tractus solitarius. Young adult male obese Zucker rats (OZR) develop insulin resistance and hypertension with impaired baroreflex-mediated bradycardia and activation of nucleus tractus solitarius (NTS). Because type 1 diabetic rats also develop impaired baroreflex-mediated NTS activation, we hypothesized that improving glycemic control in OZR would enhance compromised baroreflexes and NTS activation. Fasting blood glucose measured by telemetry was comparable in OZR and lean Zucker rats (LZR) at 12-17 wk. However, with access to food, OZR were chronically hyperglycemic throughout this age range. By 15-17 wk of age, tail samples yielded higher glucose values than those measured by telemetry in OZR but not LZR, consistent with reports of exaggerated stress responses in OZR. Injection of glucose (1g/kg ip) produced larger rises in glucose and areas under the curve in OZR than LZR. Treatment with metformin (300 mg·kg Ϫ1 ·day Ϫ1 ) or pioglitazone (5 mg·kg Ϫ1 ·day Ϫ1 ) in drinking water for 2-3 wk normalized fed glucose levels in OZR with no effect in LZR. After metformin treatment, area under the curve for blood glucose after glucose injection was reduced in OZR and comparable to LZR. Hyperinsulinemia was slightly reduced by each treatment in OZR, but insulin was still greatly elevated compared with LZR. Neither treatment reduced hypertension in OZR, but both treatments significantly improved the blunted phenylephrine-induced bradycardia and NTS c-Fos expression in OZR with no effect in LZR. These data suggest that restoring glycemic control in OZR enhances baroreflex control of heart rate by improving the response of the NTS to raising arterial pressure, even in the presence of hyperinsulinemia and hypertension. baroreceptor reflex; hyperglycemia; metabolic syndrome; metformin; pioglitazone Address for reprint requests and other correspondence: A. M. Schreihofer,

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Which is responsible for cardiac autonomic dysfunction in non-diabetic patients with metabolic syndrome: Prediabetes or the syndrome itself?

Cited by 12 publications

References 34 publications

The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

Heart Rate Variability in Patients with Hypertension: the Effect of Metabolic Syndrome and Antihypertensive Treatment

Improved glucose homeostasis in male obese Zucker rats coincides with enhanced baroreflexes and activation of the nucleus tractus solitarius

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