Cardiovascular autonomic dysfunction predicts acute ischaemic stroke in patients with Type 2 diabetes mellitus: a 7‐year follow‐up study

Ko, Seung‐Hyun; Song, Ki‐Ho; Park, S. A.; Kim, S. R.; Y., B.; Son, Ho Young; Moon, Keon-Woong; Yoo, Ki‐Dong; Park, Y. M.; Cho, J. H.; Yoon, Kun Ho; Ahn, Yu‐Bae

doi:10.1111/j.1464-5491.2008.02567.x

Cited by 64 publications

(37 citation statements)

References 35 publications

(46 reference statements)

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“…The described imbalance in the autonomic nervous system develops early in diabetes 20 and progresses over time. Furthermore, low HRV is associated with hypertension, 21 ischemic stroke, 22 sleep apnoea, 6 and glycemic variability 23,24 and may be important in the detection and prevention of hypoglycemia. 25,26 Spectral analysis of passive HRV testing is used extensively for research purposes and generally believed to supply information about both sympathetic and parasympathetic modulation earlier than other tests.…”

Section: Discussionmentioning

confidence: 99%

The Degree of Autonomic Modulation Is Associated With the Severity of Microvascular Complications in Patients With Type 1 Diabetes

Fleischer

Cichosz

Jakobsen

et al. 2015

J Diabetes Sci Technol

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Neurological and Microvascular FunctionHeart rate variability (HRV) is a widely accepted noninvasive measure of balance/imbalance in the autonomic nervous system, HRV is defined as the variation in heart rate from beat to beat (RR interval) caused by changes in breathing, blood pressure, sympathoadrenal hormones, as well as mental, physical, and certain pathological conditions. In the general population, low HRV has been associated with compromised health and independently predicts all-cause mortality. [1][2][3] Moreover, in diabetes patients, the presence of autonomic dysfunction has been suggested as a prognostic marker of complications 4,5 and the presence of autonomic dysfunction may occur before other late complications. 5Detailed HRV analysis, including both cardiovascular reflex tests and frequency domain analysis, are an important tool to estimate cardiac autonomic nervous activity. 6,7 Several studies indicate that spectral analysis in particular, describing frequency-specific fluctuations in heart rate, may be a more sensitive tool to detect autonomic imbalance compared to active tests. 8,9 However, it is unknown if the cardiovascular reflex tests and frequency domain analysis decrease according to the severity of microvascular complications or are limited to diagnose cardiovascular autonomic neuropathy (CAN).The objective of this study was therefore to elucidate the association between the degree of autonomic modulation, The objective of this study was to elucidate whether the degree of autonomic modulation is associated with the degree of microvascular complications in patients with type 1 diabetes. Methods: A total of 290 type 1 individuals with diabetes were randomly recruited during normal visits to outpatient clinics at 4 Danish hospitals. The degree of autonomic modulations was quantified by measuring heart rate variability (HRV) during passive spectral analysis and active tests (valsalva ratio [VT], response to standing [RT], and deep breathing [E:I]). To describe possible associations between severity of microvascular complications and measures of autonomic modulation, multivariate analysis was performed. Results: After adjusting for diabetes duration, sex, age, pulse pressure, heart rate, and smoking, autonomic dysfunction remained significantly correlated with severity of retinopathy, nephropathy, and peripheral neuropathy in individuals with type 1 diabetes patients. Conclusions: Autonomic dysfunction is present in early stages of retinopathy, nephropathy, and peripheral neuropathy in patients with type 1 diabetes.

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Section: Discussionmentioning

confidence: 99%

The Degree of Autonomic Modulation Is Associated With the Severity of Microvascular Complications in Patients With Type 1 Diabetes

Fleischer

Cichosz

Jakobsen

et al. 2015

J Diabetes Sci Technol

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“…Rather, an association of diabetic cardiovascular autonomic neuropathy with an increased incidence of stroke has been reported. 21, 22 The American Diabetes Association recommends low-dose aspirin as a primary prevention strategy for diabetic patients at high risk for cardiovascular events on the basis of following risk factors, including family history of cardiovascular disease, cigarette smoking, obesity, macro-and microalbuminuria, and dyslipidemia. 23 Based on our observations, we suggest that patients with cardiovascular autonomic neuropathy should be recognized as at high risk for cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

Baroreflex Sensitivity Predicts Cardiovascular Events in Patients With Type 2 Diabetes Mellitus Without Structural Heart Disease

Okada

Takahashi

Yufu

et al. 2010

Circ J

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Background: Cardiovascular autonomic neuropathy is a major complication in patients with diabetes mellitus (DM). However, the relationship between cardiovascular autonomic neuropathy and the incidence of cardiovascular events has been poorly investigated in type 2 DM. The present study aimed to assess the long-term cardiovascular predictive value of baroreflex sensitivity (BRS) in Japanese patients with type 2 DM without structural heart disease. Methods and Results:BRS was evaluated using the phenylephrine method in 210 patients with type 2 DM who did not have structural heart disease or other severe complications. BRS was considered depressed if <6 ms/mmHg. Accurate follow-up information for 3-10 years (mean 4.7 years) was obtained in 184 patients (90 females, 94 males; mean age 58±12 years). The initial onset of a major adverse cardiovascular event (MACE) was investigated. During follow-up, 19 patients presented with a MACE (4 cardiovascular deaths, 3 nonfatal myocardial infarctions, 4 coronary revascularizations, 5 strokes, 2 congestive heart failures). Cox proportional hazards regression analysis revealed that depressed BRS was independently associated with the incidence of MACE (hazard ratio 1.93, 95% confidence interval 1.09-3.82, P=0.0236). Conclusions:Depressed BRS at baseline has long-term cardiovascular predictive value in Japanese patients with type 2 DM without structural heart disease. (Circ J 2010; 74: 1379 - 1383

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“…17 In addition, cardiovascular autonomic dysfunction mediated by the vagus nerve in GERD patients may lead to a change in the sympathetic and parasympathetic balance in the cerebral vasculature and defective autoregulation of the cerebral blood flow in diabetes patients, increasing the risk of stroke. 18,19 Risk factors regarding the link is risk factors shared by both GERD and stroke patients, such as diet, smoking, obesity, and metabolic syndrome, are a possible explanation for this. 20 -22 One of this study's strengths is the use of a populationbased dataset, which enables us to trace all cases of RE and stroke during the study period.…”

Section: Sheu Et Al Reflux Esophagitis and Stroke 2035mentioning

confidence: 99%

Reflux Esophagitis and the Risk of Stroke in Young Adults

Sheu

Kang

Lou

et al. 2010

Stroke

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Background and Purpose-Reflux esophagitis (RE) is the most common manifestation of gastro-esophageal reflux disease with esophageal injury. To the best of our knowledge, there has been no specific study to evaluate the risk of stroke after diagnosis of RE in young adults. This study aims to evaluate the risk of stroke among RE patients aged 18 to 50 years during a 1-year period after diagnosis of RE compared to a cohort of non-RE patients during the same period. Methods-This study used the Taiwan Longitudinal Health Insurance Database 2005. A total of 2340 RE patients were included as the study cohort and 11 700 non-RE patients were included as the comparison cohort. Each patient was individually tracked for 1 year from the index ambulatory visit to identify those in whom stroke developed. Results-Out of the sample of 14 040 patients, 78 patients (0.56%) had strokes develop during the 1-year follow-up period:22 from the study cohort (0.94% of the RE patients) and 56 from the comparison cohort (0.48% of patients without RE).Patients with RE were 1.68-times more likely to have strokes develop (95% confidence interval, 1.03-2.76) than patients in the comparison cohort during the follow-up period after adjusting for patients' medical comorbidities, such as hypertension, diabetes, coronary heart disease, renal disease, heart failure, and hyperlipidemia, as well as their demographic differences, such as the level of urbanization of their communities, monthly income, and geographical location. Conclusions-We conclude that RE is associated with an increased risk of subsequent stroke in young adults. (Stroke.

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Cardiovascular autonomic dysfunction predicts acute ischaemic stroke in patients with Type 2 diabetes mellitus: a 7‐year follow‐up study

Abstract: Cardiovascular autonomic dysfunction was significantly associated with the development of ischaemic stroke in patients with Type 2 diabetes.

Cited by 64 publications

References 35 publications

The Degree of Autonomic Modulation Is Associated With the Severity of Microvascular Complications in Patients With Type 1 Diabetes

The Degree of Autonomic Modulation Is Associated With the Severity of Microvascular Complications in Patients With Type 1 Diabetes

Baroreflex Sensitivity Predicts Cardiovascular Events in Patients With Type 2 Diabetes Mellitus Without Structural Heart Disease

Reflux Esophagitis and the Risk of Stroke in Young Adults

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