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Autonomic dysfunction independently predicts poor cardiovascular outcomes in asymptomatic individuals with type 2 diabetes in the DIAD study
- Source :
- SAGE Open Medicine, Vol 3 (2015), SAGE Open Medicine
- Publication Year :
- 2015
- Publisher :
- SAGE Publications, 2015.
-
Abstract
- Objective: The primary aim of this secondary analysis was to determine whether cardiac autonomic neuropathy independently predicted adverse cardiac outcomes in asymptomatic individuals with type 2 diabetes. Additional aims include the determination of the correlation of standard autonomic testing measures and power spectral analysis of heart rate variability, and the association of diabetes-related and cardiac risk factors with cardiac autonomic neuropathy measures. Methods: Cardiac autonomic neuropathy was assessed at the study entry into the Detection of Ischemia in Asymptomatic Diabetics study, using autonomic heart rate and blood pressure testing, and power spectral analysis of heart rate variability. All participants were prospectively followed for the composite clinical outcome of cardiac death, acute coronary syndromes, heart failure, or coronary revascularization. Results: Over 5 years of follow-up, 94 of 1119 (8.4%) subjects developed symptomatic cardiac disease. In unadjusted bivariate analyses, abnormalities in several cardiac autonomic neuropathy tests, including lower Valsalva and Standing Heart Rate Ratios, higher resting Heart Rate, greater systolic blood pressure decrease on standing, and lower low-frequency power, were predictive of symptomatic disease. Independent predictors of poor cardiac outcome were a lower Valsalva Heart Rate Ratio, non-Black ethnicity, longer diabetes duration, higher glycated hemoglobin (HbA1c), insulin use, reported numbness in the extremities, higher pulse pressure, family history of coronary artery disease, and higher waist-to-hip ratio. Clinical factors independently associated with a lower Valsalva Heart Rate Ratio were insulin use, clinical proteinuria, higher pulse pressure, use of angiotensin-converting enzyme inhibitor and non-Black ethnicity. Conclusion: Cardiac autonomic neuropathy predicted adverse cardiac outcomes in asymptomatic type 2 diabetes without known cardiac disease. Clinical variables may help to identify patients who might have cardiac autonomic neuropathy and warrant consideration for autonomic testing.
- Subjects :
- medicine.medical_specialty
Diad
030209 endocrinology & metabolism
Type 2 diabetes
030204 cardiovascular system & hematology
Asymptomatic
03 medical and health sciences
0302 clinical medicine
Secondary analysis
Internal medicine
Medicine
asymptomatic myocardial ischemia
lcsh:R5-920
business.industry
Cardiac autonomic neuropathy
pulse pressure
General Medicine
medicine.disease
cardiac autonomic neuropathy
3. Good health
Pulse pressure
cardiovascular system
Cardiology
Original Article
medicine.symptom
lcsh:Medicine (General)
business
Cardiovascular outcomes
Subjects
Details
- ISSN :
- 20503121
- Volume :
- 3
- Database :
- OpenAIRE
- Journal :
- SAGE Open Medicine
- Accession number :
- edsair.doi.dedup.....02c3971d2347505b168c1aec7c174fb4