Pharmacologic modulation of autonomic tone: implications for the diabetic patient

Aronson, Doron

doi:10.1007/s001250050704

Cited by 32 publications

(21 citation statements)

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“…Also several drugs prescribed for cardiovascular disease, including beta-blocking agents, have been found to influence the autonomic nervous system [21]. In our study the strongest associations were observed for SDNN, LF power, LF/(LF + HF), EI difference, and RRmax/min.…”

Section: Discussionsupporting

confidence: 51%

“…Besides diabetes, many other factors possibly influence the outcome of cardiovascular autonomic function tests, including age [13±15], sex [16], anthropometric factors [17], cardiovascular disease [18,19], use of anti-hypertensive drugs [20,21], metabolic factors [22±24], and lifestyle [25,26]. Since most of these associations have been described in persons without diabetes, it is not known to what extent such factors contribute to the severity of autonomic dysfunction in diabetic subjects.…”

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confidence: 99%

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Glucose tolerance and other determinants of cardiovascular autonomic function: the Hoorn Study

et al. 2000

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Aims/hypothesis. Currently, three categories of measures are used to assess cardiovascular autonomic dysfunction: measures of the Ewing-test, measures of heart-rate variability, and measures of baroreflex sensitivity. We studied the determinants of these measures obtained from cardiovascular autonomic function tests in the Hoorn Study. Methods. The study group (n = 631) consisted of a glucose-tolerance-stratified sample from a 50-to 75-year-old group of people. Cardiac cycle duration (RR interval) and continuous finger arterial pressure were measured under three conditions: during (a) spontaneous breathing, (b) six deep breaths over one minute, and (c) an active change in position from lying to standing. From these readings, ten measures of autonomic function were assessed (three Ewing, six heart-rate variability and one baroreflex sensitivity). As possible determinants we considered age, sex, glucose tolerance, cardiovascular disease, use of anti-hypertensive drugs, anthropometric factors, metabolic factors and lifestyle factors.Results. Multivariate analysis showed that eight of ten cardiovascular autonomic function measures were most strongly associated with glucose tolerance. Furthermore, measures were moderately associated with age, sex, waist-to-hip ratio, use of anti-hypertensive drugs, and insulin. The measures were weakly associated with coronary artery disease but not with lipids. The strongest determinants seemed to differ between subjects with and without diabetes: in the non-diabetic subjects the most strongly associated were age and use of anti-hypertensive drugs and in subjects with diabetes, insulin. No consistent differences in association between the three categories of measures were observed. Conclusion/interpretation. The strongest determinants of autonomic function were age, presence of diabetes and use of anti-hypertensive drugs. [Diabetologia (2000) 43: 561±570]Keywords Aging, baroreflex, Type II diabetes mellitus, cardiovascular disease, glucose intolerance, heart-rate variability, hypertension, lifestyle, autonomic nervous system, obesity. Abbreviations: BRS, Baroreflex sensitivity (ms/mmHg); DM, diabetes mellitus; EI difference, expiration-inspiration difference in RR intervals during breathing at 6/min (ms); HRV, heart-rate variability; HF power, high frequency power in the RR-interval spectrum between 0.12±0.40 Hz (ms 2 ); KDM, known diabetes mellitus; LF power, low frequency power in the RR-interval spectrum between 0.04±0.12 Hz (ms 2 ); LF/ (LF + HF), ratio of low frequency power to the sum of low and high frequency power in the RR-interval spectrum; Mean NN, mean of all sinus rhythm (normal-to-normal) RR intervals (ms); NDM, newly-diagnosed diabetes mellitus; RRmax, maximal change in RR interval after standing up (ms); RRmax/min, maximal RR interval between 15 s and 30 s after standing up divided by the minimal RR interval within 15 s after standing up; SBP difference, systolic blood pressure 1.5±2 min after standing up minus systolic blood pressure in supine position (mm...

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Section: Discussionsupporting

confidence: 51%

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confidence: 99%

Glucose tolerance and other determinants of cardiovascular autonomic function: the Hoorn Study

et al. 2000

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“…Experiences from cardiology indicate that long-term increases in HRV and reduction in sudden cardiac death have only been shown with lipophilic agents that readily penetrate the blood nerve/blood brain barrier. In accordance with these observations experimental data indicate a preventive effect of BFT on the development of CAN [195].…”

Section: Strategies Targeted Against Individual Oxidative Stress Pathsupporting

confidence: 86%

Diabetic Cardiovascular Neuropathy

Serhiyenko¹,

Publisher²,

Serhiyenko³

2018

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Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus, that is strongly associated with increased risk of cardiovascular mortality. Although it is common complication, the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today. In this review we have analyzed the existing data about the known risk factors, screening and diagnostic algorithm, staging of CAN and possible treatment, including effectiveness of lifestyle modification, intensive glycemic control; treatment of diabetic dyslipidemia; antioxidants; vitamins; correction of vascular endothelial dysfunction; prevention and treatment of thrombosis; treatment of orthostatic hypotension. Conclusion 88References 89 Abbreviations list 108Victoria Serhiyenko, Alexandr Serhiyenko 7 ABOUT THE AUTHORSVictoria A Serhiyenko, MD, PhD in Medicine Sciences, DMSc, Associate Professor of the Department of Endocrinology, Lviv National Medical University named by Danylo Halitsky, Lviv, Ukraine. At the moment she is working on the problems concerted with the revelation of the correlating connections between activities of some metabolic, hormonal and other parameter, and state of the proand anti-inflammatory factors in blood in patients with diabetes mellitus which depends on the character of diabetic complications. The second part of his scientific work is the research of the effectively of the benfotiamine in treatment and prevention of diabetic complications in clinical practice.Victoria Serhiyenko has published 238 scientific papers. These works are devoted to the problems of pathogenesis, diagnosis and treatment, prevention of the diabetic cardiovascular autonomic neuropathy.Alexandr A Serhiyenko, MD, PhD in Medicine Sciences, DMSc, Professor of the Department of Endocrinology, Lviv National Medical University named by Danylo Halitsky, Lviv, Ukraine. At the moment he is working on the problems concerted with the revelation of the correlating connections between activities of some metabolic parameters in patients with diabetes mellitus which depends on the character of diabetic complications. The second part of her scientific work is the research of the effectively of the benfotiamine in treatment and prevention of diabetic complications in clinical practice.Alexandr Serhiyenko has published 613 scientific papers. These works are devoted to the problems of pathogenesis, diagnosis and treatment, prevention of the diabetic complications.

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“…Patients with diabetes for 10 yr have an impaired response of the heart to parasympathetic stimulation characterized by a reduction in the HF component of HRV. The increase in the incidence of sudden death in diabetics has been associated, at least in part, with a decrease in parasympathetic responsiveness of the heart (1,5). Finally, a study (32) of type 1 diabetics who died suddenly in their sleep ("dead in bed syndrome") suggested that HRV analysis of diabetic patients who lacked clinical evidence of autonomic neuropathy often demonstrated decreased parasympathetic tone.…”

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confidence: 99%

Increased inducibility of ventricular tachycardia and decreased heart rate variability in a mouse model for type 1 diabetes: effect of pravastatin

Rajab

Jin

Welzig

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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Park HJ, Link MS, Noujaim SF, Galper JB. Increased inducibility of ventricular tachycardia and decreased heart rate variability in a mouse model for type 1 diabetes: effect of pravastatin. Am J Physiol Heart Circ Physiol 305: H1807-H1816, 2013. First published October 25, 2013; doi:10.1152/ajpheart.00979.2012.-Although a reduction in the high-frequency (HF) component of heart rate variability (HRV) is a major complication of diabetes and a risk factor for sudden death, its relationship to ventricular tachycardia (VT) is unknown. We developed a mouse model for the study of VT and its relationship to changes in HRV in the Akita type 1 diabetic mouse. Programmed ventricular stimulation of anesthetized mice demonstrated that Akita mice were more inducible for VT compared with wild-type mice: 78.6% versus 28.6% (P ϭ 0.007). Optical mapping of perfused hearts demonstrated multifocal breakthroughs that occasionally gave rise to short-lived rotors consistent with focal initiation and maintenance of VT. Treatment of Akita mice with pravastatin, which had been previously shown clinically to decrease ventricular ectopy and to increase HRV, decreased the inducibility of VT: 36.8% compared with 75.0% with placebo treatment (P ϭ 0.022). The HF fraction of HRV was reduced in Akita mice (48.6 Ϯ 5.2% vs. 70.9 Ϯ 4.8% in wild-type mice, P ϭ 0.005) and was increased compared with placebo treatment in pravastatin-treated mice. Pretreatment of Akita mice with the muscarinic agonist carbamylcholine or the ␤-adrenergic receptor blocker propranolol decreased the inducibility of VT (P ϭ 0.001). In conclusion, the increased inducibility of focally initiated VT and reduced HF fraction in Akita mice were partially reversed by both pravastatin treatment and pharmacologic reversal of parasympathetic dysfunction. In this new animal model for the study of the pathogenesis of VT in type 1 diabetes, pravastatin may play a role in the prevention of VT by attenuating parasympathetic dysfunction. type 1 diabetes; ventricular tachycardia; statins; secondary effects of diabetes ALTHOUGH DIABETES MELLITUS is associated with an increase in cardiovascular mortality and sudden death (11), its relationship to ventricular tachycardia (VT) is not known. Risk factors for sudden death include clinical manifestations of parasympathetic dysfunction, such as a decreased high-frequency (HF), predominantly parasympathetic, component of heart rate (HR) variability (HRV) and increased dispersion of QT intervals (25,27). Furthermore, analysis of HRV in a group of patients with a history of nonsustained VT demonstrated a reduction in parasympathetic activity in conjunction with an increase in sympathetic activity before the onset of nonsustained VT, further supporting the relationship between decreased parasympathetic tone and the development of arrhythmia (21). Patients with diabetes for 10 yr have an impaired response of the heart to parasympathetic stimulation characterized by a reduction in the HF component of HRV. The increase in the incidence of sudden death in d...

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Pharmacologic modulation of autonomic tone: implications for the diabetic patient

Cited by 32 publications

References 53 publications

Glucose tolerance and other determinants of cardiovascular autonomic function: the Hoorn Study

Glucose tolerance and other determinants of cardiovascular autonomic function: the Hoorn Study

Diabetic Cardiovascular Neuropathy

Increased inducibility of ventricular tachycardia and decreased heart rate variability in a mouse model for type 1 diabetes: effect of pravastatin

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