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Meta-Analysis
. 2023 Feb;11(1):e003140.
doi: 10.1136/bmjdrc-2022-003140.

Association of arterial stiffness and neuropathy in diabetes: a systematic review and meta-analysis

Angela Beros  1 , John Sluyter  1 , Robert Keith Rhodes Scragg  2
Affiliations
Meta-Analysis

Association of arterial stiffness and neuropathy in diabetes: a systematic review and meta-analysis

Angela Beros et al. BMJ Open Diabetes Res Care. 2023 Feb.

Abstract

Evidence is still emerging on the relationships of arterial stiffness with cardiac autonomic neuropathy (CAN) and peripheral neuropathy (PN). To our knowledge no systematic reviews or meta-analyses of these associations have been published. The purpose of our review was to assess the association of arterial stiffness with each type of neuropathy. Medline and Embase were systematically searched for observational studies of arterial stiffness and neuropathy.The systematic review of 60 studies (25 for CAN and 37 for PN), 59 including people with diabetes, showed arterial stiffness overall was higher in people with neuropathy than people without neuropathy. Forty-three studies were included in the meta-analysis. For CAN (19 studies), arterial stiffness was increased in people with neuropathy compared with without, as measured by pulse wave velocity (PWV) (mean difference: 1.32 m/s, 95% CI 0.82 to 1.81, p<0.00001), pulse pressure (PP) (mean difference: 6.25 mmHg, 95% CI 4.51 to 7.99, p<0.00001) or augmentation index (mean difference: 5.52%, 95% CI 3.46 to 7.58, p<0.0001). For PN (26 studies), arterial stiffness was increased in people with neuropathy compared with those without, as measured by PWV (mean difference: 1.22 m/s, 95% CI 0.87 to 1.58, p<0.00001) or PP (mean difference: 4.59 mmHg, 95% CI 2.96 to 6.22, p<0.00001). Only two cohort studies were located so the temporality of the association between arterial stiffness and neuropathy remains unclear. Increased arterial stiffness is associated with CAN and PN.PROSPERO registration number: CRD42019129563.

Keywords: compliance; diabetic neuropathies; epidemiology; meta-analysis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart diagram for study selection of systematic review and meta-analysis (based on PRISMA guideline). CAN, cardiac autonomic neuropathy; PN, peripheral neuropathy.
Figure 2
Figure 2
Forest plot of the association of cardiac autonomic neuropathy (CAN) with arterial stiffness. AIx, augmentation index; PP, pulse pressure (mmHg); PWV, pulse wave velocity (m/s); T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus.
Figure 3
Figure 3
Forest plot of association of peripheral neuropathy (PN) with arterial stiffness. Forest plot A is stratified by type of PWV. DM, diabetes mellitus; PP, pulse pressure (mmHg); PWV, pulse wave velocity (m/s).
See this image and copyright information in PMC

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