Abnormal cardiovascular reflex tests are predictors of mortality in Type 2 diabetes mellitus

Chen, H. S.; Hwu, Chii Min; Kuo, Benjamin Ing Tiau; Chiang, Shu Chiung; Kwok, Ching Fai; Lee, S. H.; Lee, Y. S.; Weih, Mei-Jy; Hsiao, Liang‐Tsai; Lin, Sheng-Di; Ho, Low Tone

doi:10.1046/j.1464-5491.2001.00442.x

Cited by 55 publications

(39 citation statements)

References 25 publications

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“…The discrepancy appears to be due to our inclusion of several studies (e.g., [17][18][19][20] with relatively high mortality rates for those without CAN. These additional studies may have included more individuals with severe comorbidities at baseline, emphasizing the difficulty ascertaining the independent effects of CAN on mortality in the presence of other comorbid conditions.…”

Section: Continued On Following Pagementioning

confidence: 92%

The Association Between Cardiovascular Autonomic Neuropathy and Mortality in Individuals With Diabetes

et al. 2003

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OBJECTIVE -To examine by meta-analysis the relationship between cardiovascular autonomic neuropathy (CAN) and risk of mortality in individuals with diabetes.RESEARCH DESIGN AND METHODS -We searched Medline for English-language articles published from 1966 to 2001. Fifteen studies having a baseline assessment of cardiovascular autonomic function and mortality follow-up were identified. The analyses were stratified according to whether a single abnormality or two or more measures of cardiovascular autonomic function were used to define CAN. A global measure of association (i.e., relative risk) was generated for each group by pooling estimates across the studies using the Mantel-Haenszel procedure.RESULTS -CAN was significantly associated with subsequent mortality in both groups, although the magnitude of the association was stronger for those studies for which two or more measures were used to define CAN. The pooled relative risk for studies that defined CAN with the presence of two or more abnormalities was 3.45 (95% CI 2.66 -4.47; P Ͻ 0.001) compared with 1.20 (1.02-1.41; P ϭ 0.03) for studies that used one measure.CONCLUSIONS -These results support an association between CAN and increased risk of mortality. The stronger association observed in studies defining CAN by the presence of two or more abnormalities may be due to more severe autonomic dysfunction in these subjects or a higher frequency of other comorbid complications that contributed to their higher mortality risk. Future studies should evaluate whether early identification of subjects with CAN can lead to a reduction in mortality.

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Section: Continued On Following Pagementioning

confidence: 92%

The Association Between Cardiovascular Autonomic Neuropathy and Mortality in Individuals With Diabetes

et al. 2003

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“…Since CAN is associated with a higher incidence of cardiovascular disease [6][7][8]. and patients with diabetic CAN are suggested to have carotid atherosclerosis more frequently [23], it may be that CAN, which is a complication of the microvascular system, promotes the development of coronary atherosclerosis.…”

Section: Autonomic Function Testmentioning

confidence: 99%

Relationship between cardiovascular autonomic neuropathy and coronary artery calcification in patients with type 2 diabetes

et al. 2010

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“…A utonomic neuropathy is a common and serious complication of diabetes and is known to be an independent risk factor for increased mortality in diabetic patients (1)(2)(3)(4)(5)(6). Currently, approaches to treatment are limited by a lack of any clear understanding of the etiopathogenesis of this condition.…”

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confidence: 99%

Autoantibodies to Autonomic Nerves Associated With Cardiac and Peripheral Autonomic Neuropathy

et al. 2005

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OBJECTIVE -This study examines whether autonomic nerve autoantibodies (ANabs) are associated with development of autonomic neuropathy using a prospective study design. RESEARCH DESIGN AND METHODS-A group of type 1 diabetic patients were followed prospectively with regard to autonomic nerve function on four occasions. At the third examination, 41 patients were tested for ANabs (complement-fixing autoantibodies to the sympathetic ganglion, vagus nerve, and adrenal medulla), and the results were related to cardiac autonomic nerve function (heart rate variation during deep breathing [expiration/inspiration ratio] and heart-rate reaction to tilt [acceleration and brake index]) and to peripheral sympathetic nerve function (vasoconstriction after indirect cooling [vasoconstriction index]). CONCLUSIONS -ANabs were associated with future development of cardiac and peripheral autonomic neuropathy in diabetic patients, implying an etiological relationship between nervous tissue autoimmunity and these diabetes complications. RESULTS Diabetes Care 28:1959 -1964, 2005A utonomic neuropathy is a common and serious complication of diabetes and is known to be an independent risk factor for increased mortality in diabetic patients (1-6). Currently, approaches to treatment are limited by a lack of any clear understanding of the etiopathogenesis of this condition. To develop novel and evidence-based strategies for the prevention and treatment of diabetic autonomic neuropathy, it is therefore essential to establish the disease mechanisms involved in its pathogenesis.It is often assumed that autonomic and peripheral neuropathy are similar in this context and thus that metabolic and vascular events are of major importance (7,8). However, the possibility of an autoimmune basis to autonomic neuropathy has been frequently highlighted. Lymphocytic infiltrations and small nerve fiber damage within autonomic nerve structures in diabetic patients with severe symptomatic autonomic neuropathy have been reported (9). Furthermore, diabetic autonomic neuropathy has been associated with increased levels of circulating immune complexes and activated T-cells (10). Moreover, autoantibodies to autonomic nerve structures (ANabs) have been reported independently from several different laboratories (11-14). Although some of these studies have implied a correlation between ANabs and autonomic dysfunction (15,16), this has been difficult to establish. The question would be addressed most powerfully using a prospective study design, in which patients with and without ANabs were followed with regard to development of diabetic autonomic neuropathy.In light of this, we determined ANabs in a prospectively followed group of type 1 diabetic patients (17-19) and related the findings to autonomic nerve function at the time of blood sampling, as well as 3 and 6 years previously and 7 years after. The aim of our study was to clarify whether ANabs are associated with disturbed autonomic nerve function. -In 1984-In -1985, a total of 58 diabetic patients, all diagnosed...

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Abnormal cardiovascular reflex tests are predictors of mortality in Type 2 diabetes mellitus

Abstract: Type 2 diabetic patients with abnormal CVR tests may have increased mortality, and those combined with postural hypotension have higher mortality than those without. Abnormal CVR tests may be important predictors of mortality in Type 2 diabetes mellitus.

Cited by 55 publications

References 25 publications

The Association Between Cardiovascular Autonomic Neuropathy and Mortality in Individuals With Diabetes

The Association Between Cardiovascular Autonomic Neuropathy and Mortality in Individuals With Diabetes

Relationship between cardiovascular autonomic neuropathy and coronary artery calcification in patients with type 2 diabetes

Autoantibodies to Autonomic Nerves Associated With Cardiac and Peripheral Autonomic Neuropathy

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