Abstract
It has long been recognized that cardiac autonomic neuropathy increases morbidity and mortality in diabetes and may have greater predictive power than traditional risk factors for cardiovascular events. Significant morbidity and mortality can now be attributable to autonomic imbalance between the sympathetic and parasympathetic nervous system regulation of cardiovascular function. New and emerging syndromes include orthostatic tachycardia, orthostatic bradycardia and an inability to use heart rate as a guide to exercise intensity because of the resting tachycardia. Recent studies have shown that autonomic imbalance may be a predictor of risk of sudden death with intensification of glycaemic control. This review examines an association of autonomic dysregulation and the role of inflammatory cytokines and adipocytokines that promote cardiovascular risk. In addition, conditions of autonomic imbalance associated with cardiovascular risk are discussed. Potential treatment for restoration of autonomic balance is outlined.
Highlights
Physiological activities of the cardiovascular system are under the control of the autonomic nervous system
The beneficial effect of glycaemic control on heart rate variability shown in the Epidemiology of Diabetes Interventions and Complications (EDIC) study [12] waned after several years [13]
Further support for a role of leptin in autonomic dysfunction derives from the report by Murialdo et al that bulimia nervosa patients have altered heart rate variability associated with low leptin levels and apparent sympathetic insufficiency [31]
Summary
Physiological activities of the cardiovascular system are under the control of the autonomic nervous system. Analysis of heart rate variability, with analysis of respiratory activity, independently and simultaneously measures parasympathetic and sympathetic activity [1] and thereby provides information with regard to autonomic balance of the cardiovascular system. Reduced heart rate variability as a marker of autonomic dysfunction has been shown to have dire consequences in terms of morbidity (e.g. progression of coronary atherosclerosis) and mortality [8], independent of cardiovascular risk factors in various populations, including those with pre-diabetes and diabetes [9] [10].
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