Impacto cardiovascular da neuropatia autonômica do diabetes mellitus

Abstract

The neuropathic complications related to Diabetes may affect the somatic, sympathetic and parasympathetic nervous system. As a result, there are several clinical manifestations of diabetic neuropathy. They can be related to nervous system lesions of the genital, urinary, gastro-intestinal, skin and cardiovascular tissues. The results of these alterations are loss in the quality of life as well as increase of mortality indexes related to sudden death with cardiac arrhythmias and other causes. The cardiovascular autonomic neuropathy probably contributes to the bad prognosis of the coronary heart disease and of the heart failure in type 1 and type 2 diabetic patients. For diabetologists, the nervous complications of diabetes are the result of an increase influx of glucose to the neuronal and endothelial cells. Evidences show that, with the aim of preventing these complications, the diabetic patients should receive a precocious diagnosis and be instructed for having a good metabolic and blood pressure control. Use of angiotensin converting enzyme inhibitors and beta adrenergic blockers are probably of impact in the prevention of the cardiac autonomic complications of diabetes.

Application of Heart Rate Variability in Diagnosis and Prognosis of Individuals with Diabetes Mellitus: Systematic Review

“…In patient with diabetes, it has been used to recognize incipient CAN and to determine the severity of the disease . This decrease is the first sign of CAN and is suggested as one of the diagnostic tests in a statement by the American Diabetes Association, possibly contributing to the initial diagnosis and thus enabling preventive actions contributing to improvement in health levels, avoiding significant long‐term complications of DM, and minimizing negative effects on quality of life, cardiovascular events, and sudden death …”

Comprometimento sensório-motor dos membros inferiores em diabéticos do tipo 2

“…Embora esta possa afetar qualquer sistema orgânico, geralmente se inicia pelos sistemas neurovascular cutâneo (microcirculação dos pés) e cardiovascular (32). A neuropatia autonômica contribui para um mau prognóstico da doença cardíaca, ocorrendo geralmente manifestações relacionadas a lesões do sistema cardiovascular, diminuição da qualidade de vida, e mesmo morte súbita por arritmia cardíaca (33). Observou-se no grupo estudado incidência de neuropatia diabética, sendo que 97% dos avaliados tinham algum sinal ou sintoma da patologia.…”

Impact of Diabetes on Cardiovascular Disease: An Update

“…CAN represents a strong indicator of cardiovascular risk in both T1D and T2D [119]. In the Detection of Silent Myocardial Ischemia in Asymptomatic Diabetic Subjects (DIAD) study, the strongest predictors for abnormal perfusion tests were abnormal Valsalva maneuver, male sex, and diabetes duration, demonstrating that CAN may have an important role in the screening of CVD [120].…”

“…In the Detection of Silent Myocardial Ischemia in Asymptomatic Diabetic Subjects (DIAD) study, the strongest predictors for abnormal perfusion tests were abnormal Valsalva maneuver, male sex, and diabetes duration, demonstrating that CAN may have an important role in the screening of CVD [120]. Patients with diabetes and CAN have 5-year mortality rates ranging from 16 to 53%, depending on its severity [119]. The mortality rates from CVD in T1D and T2D are 4.2 and 10 times higher, respectively, than in healthy individuals without diabetes [120, 121].…”