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Review
. 2018 Oct-Dec;14(4):251-256.
doi: 10.14797/mdcj-14-4-251.

Cardiac Autonomic Neuropathy in Diabetes Mellitus

Shruti Agashe  1 , Steven Petak  1
Affiliations
Review

Cardiac Autonomic Neuropathy in Diabetes Mellitus

Shruti Agashe et al. Methodist Debakey Cardiovasc J. 2018 Oct-Dec.

Abstract

Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed condition in patients with diabetes. The prevalence can range from 2.5% (based on the primary prevention cohort in the Diabetes Control and Complications Trial) to as high as 90% of patients with type 1 diabetes. Clinical manifestations range from orthostasis to myocardial infarction. The diagnosis is made using multiple autonomic function tests to assess both sympathetic and parasympathetic function. The pathophysiology of CAN is complex, likely multifactorial, and not completely understood. Treatment is limited to symptomatic control of orthostatic hypotension, which is a late complication, and current strategies to reverse CAN are limited. This review explores the epidemiology, pathophysiology, clinical manifestations, diagnosis, and complications of CAN as well as current treatment options.

Keywords: CARTs; DCCT study; EDIC study; EURODIAB study; Toronto Consensus Panel; Valsalva; cardiac autonomic neuropathy; cardiac autonomic reflex tests; cardiovagal; diabetes; diabetic neuropathy; exercise intolerance; glycosylation; heart rate variability; hyperglycemia; microvascular complications; orthostatic hypotension; parasympathetic; perioperative mortality; reactive oxygen species; resting tachycardia; silent ischemia; sympathetic.

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Conflict of interest statement

Conflict of Interest Disclosure: The authors have completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported.

Figures

Figure 1.
Figure 1.
Summary of the mechanisms that relate hyperglycemia to microvascular complications such as neuropathy in patients with diabetes. PKC: protein kinase C; AGE: advanced glycation end-products; PARP: poly ADP-ribose polymerase; GAPDH: glyceraldehyde-3 phosphate dehydrogenase; GSH: glutathione; NADH: nicotinamide adenine dinucleotide; TGF-β: transforming growth factor beta; VEGF: vascular endothelial growth factor; PAI-1: plasminogen activator inhibitor-1; eNOS: endothelial nitric oxide synthase; IL-1: interleukin 1; TNF-α: tumor necrosis factor alpha; VCAM-1: vascular cell adhesion molecule 1
See this image and copyright information in PMC

Comment in

References

    1. Dimitropoulos G, Tahrani AA, Stevens MJ. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes. 2014 Feb 15;5(1):17–39. - PMC - PubMed
    1. Vinik AI, Erbas T, Casellini CM. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig. 2013 Jan;4(1):4–18. - PMC - PubMed
    1. Maser R, Lenhard M, DeCherney G. Cardiovascular autonomic neuropathy: the clinical significance of its determination. Endocrinologist. 2000 Jan;10:27–33.
    1. Spallone V, Ziegler D, Freeman R et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011 Oct;27(7):639–53. Toronto Consensus Panel on Diabetic Neuropathy. - PubMed
    1. Balcıoğlu AS, Müderrisoğlu H. Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment. Diabetes Care. 2010 Feb;33(2):434–41. - PMC - PubMed

MeSH terms