Abstract
BackgroundTo examine whether the progression rate of cardiovascular autonomic neuropathy (CAN) stage is an independent predictive factor for cardiovascular disease (CVD) in type 2 diabetes.MethodsStandardized cardiovascular autonomic reflex tests (CARTs) using traditional Ewing method were performed at baseline. The follow-up CARTs was recommended once every two years. We estimated the primary CVD endpoint, defined as coronary artery disease and ischemic stroke. The association between the progression rate of CAN stage and CVD was examined using time-dependent Cox proportional hazard models.ResultsAt baseline, 578 patients completed follow-up CARTs; the cohort comprised 329 women (56.9%) with a mean age of 58.3 ± 10.3 years and a mean diabetes duration of 10.1 ± 6.2 years. One hundred and seventy-six patients (30.4%) developed CAN progression between baseline and follow-up CARTs. In the multivariable Cox proportional hazards regression analysis, patients with CAN progression demonstrated a 3.32 times higher risk (95% confidence interval, CI 1.81–6.14, P < 0.001) of CVD than those without CAN progression. Patients who experienced CAN progression from the normal to definite stage had the greatest risk of CVD compared to other patients (hazard ratio 4.91, 95% CI 2.05–11.77, P for trend = 0.001).ConclusionsCAN stage progression was associated with an increased risk of CVD in this type 2 diabetes cohort. Patients with rapid CAN progression had the greatest risk of CVD. Thus, regular screening and risk management of CAN progression is necessary to prevent CVD.
Highlights
To examine whether the progression rate of cardiovascular autonomic neuropathy (CAN) stage is an independent predictive factor for cardiovascular disease (CVD) in type 2 diabetes
This study aimed to evaluate the association between the progression of CAN and CVD using standardized Cardiovascular autonomic reflex tests (CARTs) in patients with type 2 diabetes
There were no differences in age, duration of diabetes, presence of hypertension, body mass index (BMI), smoking, alcohol consumption, use of medications, estimated GFR, and albumin excretion rate between the subgroups (Table 2)
Summary
To examine whether the progression rate of cardiovascular autonomic neuropathy (CAN) stage is an independent predictive factor for cardiovascular disease (CVD) in type 2 diabetes. Cardiovascular autonomic neuropathy (CAN) is one of the most common and serious complications associated with diabetes and is defined as the impairment of the autonomic control of the cardiovascular system [1]. Clinical manifestations of CAN are resting tachycardia, CAN is a progressive disease entity [3, 5] that is considered to progress from a subclinical stage, characterized by abnormalities of heart rate variability, to a clinically apparent stage with diverse and disabling symptoms [5]. Yun et al Cardiovasc Diabetol (2018) 17:109 methods for the diagnosis of CAN and can assess cardiovascular autonomic function based on heart rate response to deep breathing, Valsalva maneuver, and postural change [7, 8]. The presence of CAN is associated with poor outcomes among diabetes complications [1, 9,10,11,12]
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