Progression of Cardiovascular Autonomic Dysfunction in Patients With Type 2 Diabetes

A 7-year follow-up study

  1. Seung-Hyun Ko, MD, PHD1,
  2. Shin-Ae Park, MD1,
  3. Jae-Hyoung Cho, MD, PHD1,
  4. Ki-Ho Song, MD, PHD1,
  5. Kun-Ho Yoon, MD, PHD1,
  6. Bong-Yun Cha, MD, PHD1,
  7. Ho-Young Son, MD, PHD1,
  8. Ki-Dong Yoo, MD, PHD2,
  9. Keon-Woong Moon, MD, PHD2,
  10. Yong-Moon Park, MD, PHD3 and
  11. Yu-Bai Ahn, MD, PHD1
  1. 1Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
  2. 2Department of Cardiology, The Catholic University of Korea, Seoul, Korea
  3. 3Department of Preventive Medicine, The Catholic University of Korea, Seoul, Korea
  1. Corresponding author: Yu-Bai Ahn, ybahn{at}catholic.ac.kr

Abstract

OBJECTIVE—We investigated whether cardiovascular autonomic dysfunction was associated with glycemic control status over time in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS—From 1999 to 2000, cardiovascular autonomic nerve function testing (AFT) was performed on patients with type 2 diabetes (n = 1,021) and was followed-up in 2006 and February 2008. Tests for cardiovascular autonomic functions measured heart rate variability parameters (expiration-to-inspiration [E/I] ratio, responses to the Valsalva maneuver, and standing). AFT scores were determined from the results of the each test as follows: 0 for normal and 1 for abnormal. We began with those who had a score of 0 and assessed the changes in total score along with biannual A1C levels.

RESULTS—At follow-up, the development of cardiovascular autonomic dysfunction was 34.5% (E/I ratio 21.9%, Valsalva maneuver 77.8%, and posture 58.9%; n = 783). The development of cardiovascular autonomic dysfunction was higher in older patients (P < 0.001); in those with longer duration of diabetes (P < 0.001); of hypertension (P = 0.005), and of diabetic retinopathy (P < 0.001); and in those who had higher levels of microalbuminuria (P = 0.002). Logistic regression analysis revealed that the development of cardiovascular autonomic dysfunction was strongly associated with the mean A1C level during the follow-up period (mean A1C >9.0% vs. ≤7.0%, odds ratio 2.984, 95% CI 1.177–7.561; P = 0.021).

CONCLUSIONS—The development of cardiovascular autonomic dysfunction was independently associated with microvascular complications and glycemic control status during this 7.5-year follow-up in patients with type 2 diabetes.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 28 May 2008.

    Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted May 19, 2008.
    • Received April 8, 2008.
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  1. Published online before print May 28, 2008, doi: 10.2337/dc08-0682 Diabetes Care September 2008 vol. 31 no. 9 1832-1836
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