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Impaired Autonomic Function Is Associated With Increased Mortality, Especially in Subjects With Diabetes, Hypertension, or a History of Cardiovascular Disease
Open accessAbstract
OBJECTIVE: Measures of baroreflex sensitivity, heart rate variability (HRV), and the classical Ewing test parameters are currently used for the diagnosis of diabetic autonomic neuropathy and for mortality risk stratification after myocardial infarction. However, the strengths of the associations of these measures of autonomic function with risk of mortality have never been compared in one study population. Furthermore, no evidence is available on the possible effect of glucose tolerance on these associations. RESEARCH DESIGN AND METHODS: The study population (n = 605) consisted of a glucose tolerance-stratified sample from a general population (50-75 years of age). Cardiac cycle duration and continuous finger arterial pressure were measured under two conditions: at rest and on metronome breathing. From these readings, seven parameters of autonomic function were assessed (one Ewing, five HRV, and one baroreflex sensitivity). RESULTS: During 9 years of follow-up, 101 individuals died, 43 from cardiovascular causes. Subjects with diabetes and low levels of the autonomic function parameters, indicating impaired autonomic function, had an approximately doubled risk of mortality. This association was consistent, though not statistically significant, for all parameters. The elevated risk was not observed in subjects without diabetes, hypertension, or prevalent cardiovascular disease. CONCLUSIONS: Impaired autonomic function is associated with all-cause and cardiovascular mortality. Moreover, the results of the present study suggest that cardiac autonomic dysfunction in patients already at risk (diabetes, hypertension, or history of cardiovascular disease) may be especially hazardous.
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“Furthermore, despite HRV being linked with the severity of T2DM [23], no studies have comprehensively assessed the role of the most common variables, such as age [24], gender [25], blood glucose control [26], or medications treating for T2DM, on HRV parameters [27,28].”
From Heart rate variability in type 2 diabetes mellitus: A systematic review and meta–analysis (2018) · cites this paper as [23]
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“In many studies it has been proved that there is an increase in mortality in those patients with a low HRV, but there is no evidence of a relation between low HRV and SCD (Gerritsen et al., 2001).”
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“Therefore it represents a valuable predictor of future cardiovascular morbidity and mortality in a variety of disease states that are associated with autonomic failure, (Gerritsen et al. 2001, La Rovere et al. 1998, Ditto 1990).”
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“Reduced HRV is a predictor of decreased cardiovascular prognosis in patients with hypertension.(59) Decreased HRV is also associated with a higher risk of developing hypertension and being a non-dipper.”
Background
Metadata
- Authors
- Gerritsen, J., Dekker, J. M., TenVoorde, B. J., Kostense, P. J., Heine, R. J., Bouter, L. M., Heethaar, R. M., & Stehouwer, C. D. A.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- Department of Epidemiology and Biostatistics, Vrije Universiteit, Amsterdam, the Netherlands
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2001-10-01
- Volume
- 24
- Issue
- 10
- Pages
- 1793-1798
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2141929799
- Cited by
- 456
- References
- 27
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 14 · 2023: 15 · 2022: 14 · 2021: 20 · 2020: 17 · 2019: 17 · 2018: 17 · 2017: 17 · 2016: 22 · 2015: 24 · 2014: 21 · 2013: 32 · 2012: 29
- FWCI
- 10.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Diabetes Fonds
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- cardiovascular mortality, all-cause mortality, diabetic autonomic neuropathy, heart rate variability, baroreflex sensitivity, Ewing test, cardiac autonomic dysfunction, diabetes mellitus, hypertension, cardiovascular disease, glucose tolerance, risk stratification
- MeSH terms
- Aged, Autonomic Nervous System Diseases, Cardiovascular Diseases, Female, Heart Rate, Humans, Hypertension, Male, Middle Aged, Respiration, Risk Factors, Supination, Baroreflex, Diabetes Complications
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