Abstract
BackgroundIncreased carotid-femoral pulse wave velocity (PWV) has been associated with incident cardiovascular disease, independently of traditional risk factors. Cardiac autonomic dysfunction is a common complication of diabetes and has been associated with reduced aortic distensibility. However, the association of cardiac autonomic dysfunction with PWV is not known. In this study we examined the association between cardiac autonomic function and PWV in subjects with type 2 diabetes mellitus.MethodsA total of 290 patients with type 2 diabetes were examined. PWV was measured at the carotid-femoral segment with applanation tonometry. Central mean arterial blood pressure (MBP) was determined by the same apparatus. Participants were classified as having normal (n = 193) or abnormal (n = 97) PWV values using age-corrected values. Cardiac autonomic nervous system activity was determined by measurement of parameters of heart rate variability (HRV).ResultsSubjects with abnormal PWV were older, had higher arterial blood pressure and higher heart rate than those with normal PWV. Most of the values of HRV were significantly lower in subjects with abnormal than in those with normal PWV. Multivariate analysis, after controlling for various confounding factors, demonstrated that abnormal PWV was associated independently only with peripheral MBP [odds ratio (OR) 1.049, 95% confidence intervals (CI) 1.015–1.085, P = 0.005], central MBP (OR 1.052, 95% CI 1.016–1.088, P = 0.004), log total power (OR 0.490, 95% CI 0.258–0.932, P = 0.030) and log high frequency power (OR 0.546, 95% CI 0.301–0.991, P = 0.047).ConclusionsIn subjects with type 2 diabetes, arterial blood pressure and impaired cardiac autonomic function is associated independently with abnormal PWV.
Highlights
Increased carotid-femoral pulse wave velocity (PWV) has been associated with incident cardiovascular disease, independently of traditional risk factors
Based on the above literature data, the research hypothesis we examined in this study is that impaired cardiac autonomic function is associated with abnormal PWV in people with Type 2 diabetes (T2DM), when diabetes-related and classical risk factors for atherosclerosis are taken into consideration
Participants with normal and abnormal PWV did not differ in terms of gender, Body mass index (BMI), duration of diabetes, waist circumference, HbA1c, smoking status, lipid profile, treatment for dyslipidemia or hypertension, use of antiplatelets, prevalence of macrovascular complications and prevalence of retinopathy or nephropathy, except for peripheral neuropathy which was more common in participants with abnormal PWV (P = 0.030)
Summary
Increased carotid-femoral pulse wave velocity (PWV) has been associated with incident cardiovascular disease, independently of traditional risk factors. In this study we examined the association between cardiac autonomic function and PWV in subjects with type 2 diabetes mellitus. Several studies have reported that early in the course of type 1 diabetes impaired cardiac autonomic function and arterial stiffness are strongly associated [8, 9]. Patients without diabetes but with primary autonomic failure have stiffer aortas when compared with healthy age- and sex-matched control individuals [10]. These findings imply that there is a pathophysiological link between cardiac autonomic dysfunction and arterial stiffness and that the preservation of the elastic
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