Determinants and Prognostic Value of Cardiovascular Autonomic Function in Coronary Artery Disease Patients With and Without Type 2 Diabetes

Abstract

OBJECTIVE Cardiovascular autonomic dysfunction is a common finding among patients with coronary artery disease (CAD) and type 2 diabetes (T2D). The reasons and prognostic value of autonomic dysfunction in CAD patients with T2D are not well known. RESEARCH DESIGN AND METHODS We examined the association between heart rate recovery (HRR), 24-h heart rate (HR) variability (SD of normal R-R interval [SDNN]), and HR turbulence (HRT), and echocardiographic parameters, metabolic, inflammatory, and coronary risk variables, exercise capacity, and the presence of T2D among 1,060 patients with CAD (mean age 67 ± 8 years; 69% males; 50% patients with T2D). Second, we investigated how autonomic function predicts a composite end point of cardiovascular death, acute coronary event, stroke, and hospitalization for heart failure during a 2-year follow-up. RESULTS In multiple linear regression model, exercise capacity was a strong predictor of HRR (R = 0.34, P < 0.001), SDNN (R = 0.33, P < 0.001), and HRT (R = 0.13, P = 0.001). In univariate analyses, a composite end point was predicted by reduced HRR (hazard ratio 1.7 [95% CI 1.1-2.6]; P = 0.020), reduced SDNN (2.0 [95% CI 1.2-3.1]; P = 0.005), and blunted HRT (2.1 [1.3-3.4]; P = 0.003) only in patients with T2D. After multivariate adjustment, none of the autonomic markers predicted the end point, but high-sensitivity C-reactive protein (hs-CRP) remained an independent predictor. CONCLUSIONS Cardiovascular autonomic function in CAD patients is associated with several variables, including exercise capacity. Autonomic dysfunction predicts short-term cardiovascular events among CAD patients with T2D, but it is not as strong an independent predictor as hs-CRP.

Nitrated apolipoprotein AI/apolipoprotein AI ratio is increased in diabetic patients with coronary artery disease

“…We found that CRP levels were also independent predictors of higher NT-apoAI/apoAI ratio. Elevated CRP was found in patients with DM and those with cardiovascular disease 39 , and it carries prognostic value for cardiovascular events in CAD patients with DM 40 . Further investigations are needed to evaluate whether NT-apoAI/apoAI ratio can be an inflammatory biomarker in cardiovascular disease or inflammation contributes to higher NT-apoAI/apoAI ratio.…”

Exercise Capacity and Heart Rate Responses to Exercise as Predictors of Short-Term Outcome Among Patients With Stable Coronary Artery Disease

“…Detailed exclusion criteria are described elsewhere in details. 12 For the present substudy, the patients with contraindicated exercise test (n ¼ 62) or incomplete follow-up data (n ¼ 118), without b-blocker medication (n ¼ 227), or those who had died because of noncardiovascular reasons (n ¼ 5) were excluded. The study was performed according to the Declaration of Helsinki, and the local committee of research ethics of the Northern Ostrobothnia Hospital District approved the protocol; all the subjects gave written informed consent.…”

Additive Value of Heart Rate Variability in Predicting Obstructive Coronary Artery Disease Beyond Framingham Risk

“…The findings are in line with those of Karjalainen et al, who found that the prognostic impact of autonomic function in CAD was very small in non-diabetic subjects. 30 Moreover, reduced HF power as well as LF power independently correlated with angiographic CAD, after controlling for age in patients with high Framingham risk or diabetes rather than in those without (Figures S1-S3). There was a significant improvement in risk reclassifications by modeling HRV in the prediction model of angiographic CAD in high Framingham risk patients.…”