Association of cardiovascular autonomic dysfunction with peripheral arterial stiffness in patients with type 1 diabetes
Open accessAbstract
CONTEXT: Cardiovascular autonomic neuropathy (CAN) appears to contribute to peripheral arterial stiffness (AS) in type 1 diabetes. Whether CAN in patients with AS is associated with concomitant asymptomatic peripheral arterial disease (aPAD) remains unclear. OBJECTIVE: To assess the risk of CAN in patients with type 1 diabetes and AS and its potential association with atherosclerosis. DESIGN: Cross-sectional study. SETTING: Type 1 diabetes clinic in an academic hospital. PATIENTS: Two hundred sixty-four patients with type 1 diabetes. INTERVENTION: AS was defined as an ankle-brachial index (ABI) >1.2, aPAD by the toe-brachial index and Doppler sonography, and CAN by blood pressure and heart rate responses to active standing and Ewing and Clarke tests. MAIN OUTCOME MEASURES: Odds of having CAN among patients with AS. Odds for CAN were also calculated as a function of the presence of AS and concomitant aPAD. RESULTS: The study population's mean age was 35 ± 11 years, with a duration of disease of 19 ± 10 years and mean hemoglobin A1c of 7.5% ± 1.3%. Seventy-three patients (28%) had peripheral AS, of whom 28 showed aPAD. The prevalence of CAN among patients with AS was 48% but it was only 23% in subjects with normal ABI (OR: 3.1 [1.7; 5.4]). Concomitant aPAD increased the OR for CAN (OR: 4.5 [2.0; 10.1]). After adjustments for aPAD and relevant cardiovascular risk factors, AS remained associated with parasympathetic dysfunction. CONCLUSIONS: In type 1 diabetes, both peripheral AS and atherosclerosis were associated with CAN. A simple method, such as the ABI, may identify a subset of patients with undiagnosed dysautonomia.
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Early detection of CAN may enable tailored interventions that prevent progression and reduce risks of CVD, arrhythmias, myocardial dysfunction leading to CHF, CKD, and all-cause mortality.
“Timely detection of CAN may help implementation of tailored interventions to prevent its progression and mitigate the risk of associated complications, including CVD, cardiac arrhythmias, myocardial dysfunction leading to congestive heart failure (CHF), CKD, and all-cause mortality.547,614,617–625”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [619]
The Abstract says CAN can be detected at a subclinical stage and may cause severe morbidity and mortality, while Discussion and Conclusions suggests that patients with undiagnosed CAN could benefit from early, aggressive management of cardiovascular risk factors. The paper does not show that detection or tailored interventions prevent CAN progression or reduce the listed risks. It mentions cardiomyopathy and cardiovascular events, but does not substantiate the specific claims about arrhythmias, CHF, or CKD. Page numbers were not available in our copy. (LLM, conf=0.86)
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- Authors
- Nattero-Chávez, L., Redondo López, S., Alonso Díaz, S., Garnica Ureña, M., Fernández-Durán, E., Escobar-Morreale, H. F., & Luque-Ramírez, M.
- Affiliations
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Vascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria, CIBER Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain
- Universidad de Alcalá (ES)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2019-02-20
- Volume
- 104
- Issue
- 7
- Pages
- 2675-2684
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2916199430
- Cited by
- 18
- References
- 42
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 5 · 2021: 1 · 2020: 1 · 2019: 1
- FWCI
- 1.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Instituto de Salud Carlos III (PI1400649, PI151686, PIE1600050)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- cardiac autonomic neuropathy, peripheral arterial stiffness, type 1 diabetes, asymptomatic peripheral arterial disease, atherosclerosis, parasympathetic dysfunction, ankle-brachial index, toe-brachial index, autonomic dysfunction, autonomic function testing
- MeSH terms
- Adult, Autonomic Nervous System, Autonomic Nervous System Diseases, Blood Pressure, Cardiovascular System, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetic Neuropathies, Female, Humans, Male, Middle Aged, Risk Factors, Prevalence, Ankle Brachial Index, Young Adult, Asymptomatic Diseases, Peripheral Arterial Disease, Vascular Stiffness
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