Circulation. 2007;115:387-397
doi: 10.1161/CIRCULATIONAHA.106.634949
doi: 10.1161/CIRCULATIONAHA.106.634949
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2007;115:387-397.)
© 2007 American Heart Association, Inc.
Contemporary Reviews in Cardiovascular Medicine |
Diabetic Cardiovascular Autonomic Neuropathy
From the Strelitz Diabetes Research Institute, Norfolk, Va (A.I.V.), and the German Diabetes Clinic, German Diabetes Center, Leibniz Center at the Heinrich Heine University Dusseldorf, Dusseldorf, Germany (D.Z.).
Correspondence to Aaron I. Vinik, MD, PhD, FCP, MACP, Director, Strelitz Diabetes Research Institute, 855 W Brambleton Avenue, Norfolk, VA 23510. E-mail vinikai@evms.edu
Key Words: diabetes mellitus • cardiovascular diseases • diabetic neuropathies
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
 |
Introduction |
|---|
One of the most overlooked of all serious complications of diabetes is cardiovascular autonomic neuropathy (CAN),1–3 which encompasses damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in heart rate control and vascular dynamics.4
The present report discusses the clinical manifestations (eg, resting tachycardia, orthostasis, exercise intolerance, intraoperative cardiovascular liability, silent myocardial infarction [MI], and increased risk of mortality) in the presence of CAN. It also demonstrates that autonomic dysfunction can affect daily activities of individuals with diabetes and may invoke potentially life-threatening outcomes. Advances in technology, built on decades of research and clinical testing, now make it possible to objectively identify early stages of CAN with the use of careful measurement of autonomic function and to provide therapeutic choices that are based on symptom control and that might abrogate the underlying disorder.
|
Epidemiology of CAN |
|---|
Little information exists as to frequency of CAN in representative diabetic populations. This is further complicated by the differences in the methodology used and the lack of standardization. Fifteen studies using different end points report prevalence rates of 1% to 90%.1 The heterogenous methodology makes it difficult to compare epidemiology across different studies. CAN may be present at diagnosis, and prevalence increases with age, duration of diabetes, and poor glycemic control. CAN also cosegregates with distal symmetric polyneuropathy, microangiopathy, and macroangiopathy. Age, diabetes, obesity, and smoking are risk factors for reduced heart rate variability (HRV)5 in type 2 diabetes. Thus, there may be selectivity and sex-related differences among the various
This article has been cited by other articles:
 |
|
 |
|
  R. P. Nolan, S. M. Barry-Bianchi, A. E. Mechetiuc, and M. H. Chen Sex-based differences in the association between duration of type 2 diabetes and heart rate variability Diabetes and Vascular Disease Research, October 1, 2009; 6(4): 276 - 282. [Abstract] [PDF]
|
|
|
|
 |
|
 A. I. Vinik and R. E. Maser Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes JAMA, August 19, 2009; 302(7): 735 - 736. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Nagaya, H. Yoshida, H. Takahashi, and M. Kawai Resting heart rate and blood pressure, independent of each other, proportionally raise the risk for type-2 diabetes mellitus Int. J. Epidemiol., June 29, 2009; (2009) dyp229v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Pop-Busui, P. A. Low, B. H. Waberski, C. L. Martin, J. W. Albers, E. L. Feldman, C. Sommer, P. A. Cleary, J. M. Lachin, W. H. Herman, et al. Effects of Prior Intensive Insulin Therapy on Cardiac Autonomic Nervous System Function in Type 1 Diabetes Mellitus: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) Circulation, June 9, 2009; 119(22): 2886 - 2893. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. H. Young, F. J. Th. Wackers, D. A. Chyun, J. A. Davey, E. J. Barrett, R. Taillefer, G. V. Heller, A. E. Iskandrian, S. D. Wittlin, N. Filipchuk, et al. Cardiac Outcomes After Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes: The DIAD Study: A Randomized Controlled Trial JAMA, April 15, 2009; 301(15): 1547 - 1555. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Kahn Glucose Control in Type 2 Diabetes: Still Worthwhile and Worth Pursuing JAMA, April 15, 2009; 301(15): 1590 - 1592. [Full Text] [PDF]
|
|
|
|
 |
|
 G. K. Adler, I. Bonyhay, H. Failing, E. Waring, S. Dotson, and R. Freeman Antecedent Hypoglycemia Impairs Autonomic Cardiovascular Function: Implications for Rigorous Glycemic Control Diabetes, February 1, 2009; 58(2): 360 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Chow, C. C. Szeto, B. C.-H. Kwan, K. Y. Chung, C. B. Leung, and P. K.-T. Li FACTORS ASSOCIATED WITH SUDDEN DEATH IN PERITONEAL DIALYSIS PATIENTS Perit. Dial. Int., January 1, 2009; 29(1): 58 - 63. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W T. Cade Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting Physical Therapy, November 1, 2008; 88(11): 1322 - 1335. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. T. Bloomgarden American College of Endocrinology Pre-Diabetes Consensus Conference: Part One Diabetes Care, October 1, 2008; 31(10): 2062 - 2069. [Full Text] [PDF]
|
|
|
|
|
|
S.-H. Ko, S.-A. Park, J.-H. Cho, K.-H. Song, K.-H. Yoon, B.-Y. Cha, H.-Y. Son, K.-D. Yoo, K.-W. Moon, Y.-M. Park, et al. Progression of Cardiovascular Autonomic Dysfunction in Patients With Type 2 Diabetes: A 7-year follow-up study Diabetes Care, September 1, 2008; 31(9): 1832 - 1836. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kindermann and M. Bohm Sweet hearts die earlier--lessons from CHARM Eur. Heart J., June 1, 2008; 29(11): 1342 - 1343. [Full Text] [PDF]
|
|
|
|
 |
|
 J.-S. Wu, F.-H. Lu, Y.-C. Yang, T.-S. Lin, J.-J. Chen, C.-H. Wu, Y.-H. Huang, and C.-J. Chang Epidemiological Study on the Effect of Pre-Hypertension and Family History of Hypertension on Cardiac Autonomic Function J. Am. Coll. Cardiol., May 13, 2008; 51(19): 1896 - 1901. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Ziegler, C. P. Zentai, S. Perz, W. Rathmann, B. Haastert, A. Doring, C. Meisinger, and for the KORA Study Group Prediction of Mortality Using Measures of Cardiac Autonomic Dysfunction in the Diabetic and Nondiabetic Population: The MONICA/KORA Augsburg Cohort Study Diabetes Care, March 1, 2008; 31(3): 556 - 561. [Abstract] [Full Text] [PDF]
|
|