Association between Arterial Stiffness and Cardiovascular Autonomic Neuropathy in Youth with Type 2 Diabetes—SEARCH for Diabetes in Youth Study

Abstract

Accelerated vascular aging in youth with type 2 diabetes (T2D) makes them vulnerable for a cardiovascular event in early adulthood. We explored the relationship between increased arterial stiffness (AS) and reduced heart rate variability (HRV) in youth with T2D. 193 youth with T2D (age 22 ± 4 years, duration 8 ± 2 years, HbA1c 8.9 ± 4.4%, 40% non-Hispanic black) enrolled in the SEARCH study had PWV (pulse wave velocity carotid-femoral segment) and HRV [standard deviation (SDNN) and root mean square successive difference(RMSSD) of normal RR interval] assessed. AS+ was defined as the PWV > 90th percentile for age and gender-matched healthy controls. Youth with increased AS were older, had higher blood pressure (BP), BMI, triglycerides and lower HDL-c (P ≤ 0.05) (Table). In linear regression analysis, increased PWV was associated with lower SDNN independent of age, gender, race/ethnicity, BP and BMI (β= -0.03, SE=0.02, P=0.04). However, the association was attenuated and non-significant when controlled for triglyceride suggesting that the relationship between AS and HRV is mediated partly by dyslipidemia. TABLE 1. Characteristics of the youth with type 2 diabetes stratified by their arterial stiffness (AS) statusVariableAS –AS +P-valueAge, years22 ± 423 ± 40.008Systolic Blood Pressure, mm Hg115 ± 10121 ± 11<0.001BMI z-score1.9 ± 0.42.4 ± 0.37<0.001HDL-cholesterol, mg/dL43 ± 939 ± 90.002Triglycerides, mg/dL104 (73,175)139 (87,248)0.02HbA1c, %8.7 ± 4.49.5 ± 4.10.28SDNN, msec52(36,79)42(29,62)0.003 Early subclinical atherosclerosis was associated with cardiovascular autonomic neuropathy in young people with T2D which could potentially increase the risk of early cardiovascular events. Interventions targeting the risk factors for AS and CAN are needed. Disclosure M. Jaiswal: None. J. Divers: None. D. Dabelea: None. J.M. Lawrence: None. G. Kim: None. A.D. Liese: None. E.M. Urbina: None.