Cardiovascular Autonomic Neuropathy and Cardiovascular Outcomes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study

Abstract

OBJECTIVETo examine whether cardiovascular autonomic neuropathy (CAN) is an independent risk factor of cardiovascular disease (CVD) events during DCCT/EDIC.RESEARCH DESIGN AND METHODSStandardized cardiovascular autonomic reflex tests (R-R response to paced breathing, Valsalva maneuver, postural changes in blood pressure) were performed at DCCT baseline, every 2 years throughout DCCT, and at two time points in EDIC. CVD events were ascertained throughout the study and adjudicated by a review committee. Cox proportional hazards models were used to estimate the effect of CAN at DCCT closeout on subsequent CVD risk.RESULTSThere were 299 adjudicated CVD events in 165 participants following the DCCT closeout assessment: 132 of 1,262 subjects (10%) without CAN at DCCT closeout who experienced 244 CVD events versus 33 of 131 subjects (25%) with CAN at DCCT closeout who experienced 55 events (hazard ratio 2.79, 95% CI 1.91–4.09 for time to first CVD event). The cumulative incidence of the first occurrence of any CVD event during EDIC was significantly higher in participants with CAN at DCCT closeout compared with those without CAN. The association remained marginally significant after adjustment for multiple risk factors, including the EDIC updated mean HbA1c. When analyzed as a continuous variable, R-R variation was significantly lower at DCCT closeout in participants who experienced a CVD event compared with those who did not (P = 0.0012).CONCLUSIONSIn the DCCT/EDIC cohort, individuals diagnosed with CAN at DCCT closeout experienced a higher long-term risk of CVD events during follow-up in EDIC. This association was not independent of historic glycemic exposure and its metabolic memory effect, the principal determinant of both long-term CVD risk and CAN in type 1 diabetes.

Diabetic Neuropathy: A Position Statement by the American Diabetes Association

“…Spectrum of AEs, drug interactions, and comorbidities need be considered if selecting these agents. ischemia, any major cardiovascular event, and myocardial dysfunction (152)(153)(154)(155)(156)(157). Data from two large cardiovascular outcomes trials that included 31,531 patients with stable heart disease and/or diabetes followed for a median of 5 years reported that heart rate, an indirect measure of CAN, analyzed as either categorical (baseline heart rate .70 vs. #70 bpm) or across heart rate quintile, was independently associated with significant increases in cardiovascular disease (CVD) events and all-cause death (158).…”

Predictors and diagnosis of cardiac autonomic nervous dysfunction in patients with type 1 and type 2 diabetes mellitus

“…МРТС позволяет оценить все параметры и индексы, доступные методу ЭхоКГ, но в то же время делает их более зримыми, измерения -повторяе мыми и гораздо более доступными восприятию. МРТС пре-доставляет возможность визуализировать фиброзные и рубцовые изменения, определить объем сохранного и фиброзированного миокарда, оценить миокардиаль-ную перфузию с выявлением участков микрососудистой обструкции [54,55].…”

“…В исследовании DCCT/EDIC [55] при выполнении МРТ значимого различия индексов функ-ций ЛЖ (конечный диастолический объем ЛЖ, конеч-ный систолический объем ЛЖ, ударный объем, фракция выброса) у пациентов с ДКАН+ или ДКАН-не выяв-лено. Однако наличие ДКАН ассоциируется с увеличе-нием массы ЛЖ, изменениями структур, характерными для концентрического ремоделирования, а также увели-ченным сердечным выбросом.…”

HbA1c measurement in diabetes diagnosis and management of diabetes in latin: proceedings of the San Pablo Symposium

“…The resultant glycated hemoglobin remains in red blood cells for the rest of its lifespan (3 months), and therefore its measurement gives a good parameter of glucose exposure to the body during this time-period. This method is now routinely used to assess glycemic control in the large majority of health care settings 38 . All major clinical trials including diabetes control and complications trials (DCCT) in T1D and the UKPDS in T2D have used it as a tool to monitor glycemic control 39,40 .…”